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Overview of the current state of the art in nutritional interventions for polycystic ovary syndrome
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O Síndrome do ovário poliquístico (SOP) é um complexo transtorno endócrino e metabólico frequentemente associado a infertilidade, obesidade e a insulinorresistência. A etiologia da doença permanece mal compreendida, apesar de causas poligenicas e multifatoriais parecerem estar envolvidas, incluindo, em particular, elementos ambientais, onde se destaca a dieta e outros fatores do estilo de vida. Neste contexto, a terapêutica da SOP deve ser ajustada de acordo com a gravidade das manifestações e necessidades da doença e, partindo da modificação do estilo de vida, conjuntamente com potenciais abordagens farmacológicas e/ou cirúrgicas.
A presente revisão tem por objetivo fornecer uma revisão compreensiva do estado atual da investigação no que respeita ao tratamento e gestão de mulheres com SOP, focando-se, em particular, nas intervenções nutricionais, pois são estas consideradas opções de tratamento de primeira linha.
A dieta e proporção relativa de macronutrientes ideal, em situações de SOP, ainda não foi passível de ser identificada e globalmente reconhecida, já que a heterogeneidade dos resultados encontrados é significativa. Não obstante, uma distribuição de macronutrientes similar à descrita na dieta Mediterrânica mostrou impactos positivos e revelou-se adequada para manutenção a longo prazo. A suplementação de certos elementos em défice pode também desempenhar um papel de interesse na abordagem destes doentes sendo que a vitamina D e os ácidos gordos polinsaturados n3 mostraram os resultados mais consistentes. Mais ainda, a disbiose da microbiota intestinal parece não só influenciar a patogénese da doença como também a sua correção, através de agentes prébióticos e probióticos, parece constituir uma intervenção terapêutica promissora.
Apesar da constante publicação de novos dados, esta área de investigação carece ainda de mais estudos de qualidade, visto que devem ser contempladas intervenções com maior duração e com grupos em estudo de maior dimensão e mais diversificados, especialmente no que se refere à etnicidade dos mesmos.
Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic disorder frequently associated with infertility, obesity and insulin resistance. The etiology of the disease remains poorly understood, despite polygenic and multifactorial causes are thought to be involved and from which environmental elements should be emphasised, these including diet and lifestyle factors. In this regard, treatment of PCOS should be adjusted accordingly to the severity of manifestations and necessities of the patient. The approach should be, ideally, based on lifestyle modifications, these eventually in conjunction with a pharmacologic and/or surgical approach. This article aims to provide a comprehensive review of the current state of research in what regards the therapeutic strategies and management of women with PCOS, however, focusing, particularly, in dietary interventions as these are considered first line treatment options. The optimal diet and macronutrient balance, in the PCOS setting, is yet to be identified and globally recognised, as heterogeneity in the available data is still significant. Nevertheless, a macronutrient distribution similar to the one found in a Mediterranean diet showed positive impacts and suitable for long-term maintenance. Supplementation of specific lacking elements may also play an important role in the approach of these patients, expressly vitamin D as well as omega-3 polyunsaturated fatty acids having the most consistent evidence-based results. Furthermore, dysbiosis of the gut microbiota may influence the pathogenesis of the disease and its correction, through prebiotic and probiotic agents, a promising treatment option. Despite the fact that new data is constantly published, this area of research is still in lack of further good quality studies, as broader time of intervention as well as broader and more diverse intervention groups should be contemplated, especially in what refers to ethnicity variety.
Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic disorder frequently associated with infertility, obesity and insulin resistance. The etiology of the disease remains poorly understood, despite polygenic and multifactorial causes are thought to be involved and from which environmental elements should be emphasised, these including diet and lifestyle factors. In this regard, treatment of PCOS should be adjusted accordingly to the severity of manifestations and necessities of the patient. The approach should be, ideally, based on lifestyle modifications, these eventually in conjunction with a pharmacologic and/or surgical approach. This article aims to provide a comprehensive review of the current state of research in what regards the therapeutic strategies and management of women with PCOS, however, focusing, particularly, in dietary interventions as these are considered first line treatment options. The optimal diet and macronutrient balance, in the PCOS setting, is yet to be identified and globally recognised, as heterogeneity in the available data is still significant. Nevertheless, a macronutrient distribution similar to the one found in a Mediterranean diet showed positive impacts and suitable for long-term maintenance. Supplementation of specific lacking elements may also play an important role in the approach of these patients, expressly vitamin D as well as omega-3 polyunsaturated fatty acids having the most consistent evidence-based results. Furthermore, dysbiosis of the gut microbiota may influence the pathogenesis of the disease and its correction, through prebiotic and probiotic agents, a promising treatment option. Despite the fact that new data is constantly published, this area of research is still in lack of further good quality studies, as broader time of intervention as well as broader and more diverse intervention groups should be contemplated, especially in what refers to ethnicity variety.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Síndrome do ovário poliquístico Desarranjo metabólico Intervenção nutricional Microbiota intestinal Disbiose