Efetividade da intervenção nutricional em curto e longo prazo de pacientes com síndrome dos ovários policísticos

Abstract

Introduction: The Polycystic Ovary Syndrome (PCOS) is an endocrinopathy that affects 6% to 10% of all childbearing aged women. Approximately 38% to 88% of the patients are obesity, especially visceral, which can increase the degree of insulin resistance (IR) and interfere with the metabolic alterations that are intrinsic to the syndrome. The reduction of 5% to 10% in the initial body weight can improve the reproductive and metabolic functions. Previous studies have been shown that the use of metformin could improve the IR with subsequent impact on body weight; however, some studies have shown inconclusive results. Aim: To evaluate the effectiveness of short and long-term of nutritional intervention in patient with POCS regarding the nutritional state and food intake considering the use or not of metformin. Methods: six-month of uncontrolled nutritional intervention were carried out on PCOS women patients who received a hypocaloric diet plan (deficit of 500 to 700 kcal/day) and individual nutritional advice. This study evaluated anthropometric and food intake data - intake of energy, nutrients and diet quality index revised, information related to the physical activity, and the use of metformin. Results: 70 women, at an average age of 30.8 ± 5.6 years, were included in the study. 42.9% of the patients presented noncommunicable diseases and injuries other than PCOS. Of all women evaluated 95.5% presented excess of body weight, while 91.3% and 89.9% presented risks of metabolic complications and cardiovascular disease, evaluated by means of waist measurement (WM) and waist/hip relation (WHR), respectively. The excessive consumption of calories could be observed in 35.3% of the sample. Fifteen women completed the nutritional intervention period (180 days). The women who finished the study presented more advanced age than those who abandoned the study (33.9 ± 5.40 vs. 30.0 ± 5.45 years; p=0.017). Other characteristics proved to be similar (p>0.05). The use of metformin, at doses of 1500mg/day, was reported by 40% of the sample. Reduction in the anthropometric parameters during the short (30 days) and long (180 days) periods, after nutritional intervention, could be observed, with a reduction of 6.44 ± 4.59% in body weight, 4.09 ± 4.15% of WM, and 3.57 ± 4.34% of WHR, at the end of the study. Concerning the food intake, an improvement in the total score quality of the diet could be observed (71.82 ± 9.61 vs. 55.15 ± 8.88) after the nutritional intervention period. No change in the level of physical activity was identified. The reduction in body weight was significantly higher in the group treated with metformin (-10.25 ± 2.39% vs. -3.90 ± 3.89%; p=0.004), despite similarities in food intake and physical activity. No differences in other anthropometric parameters were identified. Conclusion: The nutritional intervention at short and long term, based on caloric restriction and individual nutritional advice, proved to be effective in promoting the improvement of anthropometric and food intake parameters. The use of metformin seems to have an additional effect since it improves weight loss without change the food consumption or the level of physical activity.