Carbohydrate Quantity vs. Quality in Polycystic Ovary Syndrome: Population-Based Meta-Analysis Combined with GBD Data-Driven Assessment

Abstract

Introduction

Polycystic ovary syndrome (PCOS), a common metabolic-endocrine disorder, is linked to low-quality carbohydrate intake, though evidence remains controversial. This research aimed to evaluate carbohydrate quantity/quality impacts on PCOS by combining global trends from the Global Burden of Disease (GBD) 2021 database with pooled study from individual-level data.

Methods

We analyzed GBD 2021 data to assess annual trends in PCOS incidence and low-grain/high-sugar-sweetened beverage consumption. Six databases were searched until February 2025 to identify population-based studies for meta-analysis. Results were expressed as mean differences (MD) with 95 % CIs, and heterogeneity was evaluated using χ² tests and I² statistics.

Results

GBD 2021 data revealed rising PCOS incidence alongside increased low whole-grain intake and high sugar-sweetened beverage consumption. This meta-analysis of 25 studies (n = 20,738) found no significant difference in total carbohydrate intake between PCOS and non-PCOS women. However, women with PCOS had significantly higher refined grain intake (SMD (95 % CI) = 0.66 [0.09, 1.24]) and lower whole grains (SMD (95 % CI) = −0.64 [-1.34, 0.07]) and fiber intake (MD (95 % CI) = −1.83 [-3.80, 0.13]). Subgroup analyses demonstrated significantly reduced fiber intake in overweight (MD = −2.92 [95 % CI: 4.64 to −1.21]) and non-diabetic women with PCOS (MD = −1.40 [95 % CI: 2.42 to −0.38]).

Conclusion

Compared with carbohydrate quantity, lower-quality carbohydrate intake-characterized by higher refined grain consumption and lower intake of fiber and whole grains-appears to be more closely associated with PCOS. Different metabolic phenotypes in PCOS may require personalized dietary strategies.