The effects of ketogenic diet on polycystic ovary syndrome: A systematic review and meta-analysis

IF 7.9 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition Pub Date : 2026-01-01 Epub Date: 2025-12-03 DOI:10.1016/j.clnu.2025.11.019

Elisavet Arsenaki , Dimitra Stathi , Konstantinos Katsikas Triantafyllidis , Yeshey Seldon , Stergios Bobotis , George Lockett , Shaun Haran , Maria Kyrgiou , Srdjan Saso , Konstantinos S. Kechagias

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Abstract

Background and aim

Polycystic ovary syndrome (PCOS) is a common endocrine disorder linked to obesity, insulin resistance, and reproductive dysfunction. While dietary modification is central to management, the optimal approach remains unclear. This systematic review and meta-analysis evaluated the effects of the ketogenic diet on anthropometric, metabolic, and endocrinological outcomes in women with PCOS.

Methods

A systematic search of five databases (inception–February 2025) identified studies reporting outcomes in women with PCOS following a ketogenic diet. Meta-analyses compared pre- and post-ketogenic diet outcomes (primary analysis) and ketogenic diet versus other diets (secondary analysis). Summary mean differences (MDs) with 95 % confidence intervals (CIs) were calculated using a random-effects model. Risk of bias and evidence quality were assessed using validated tools and the GRADE approach.

Results

Fifteen studies were included in the review, of which ten met the criteria for inclusion in the meta-analysis. Most participants in the included studies had a BMI exceeding 25 kg/m². In the primary analysis, ketogenic diet led to significant reductions in BMI (MD: −3.38 kg/m², 95 % CI: 2.53 to 4.23, I² = 0 %), weight (MD: −10.77 kg, 95 % CI: 8.73 to 12.81, I² = 0 %), and waist circumference (MD: −8.93 cm, 95 % CI: 5.66 to 12.19; I² = 44 %). Reductions were also observed in luteinising hormone (LH) levels (MD: 4.07, 95 % CI: 3.36 to 4.79, I² = 0 %), menstrual cycle duration (MD: 26.06, 95 % CI: 2.28 to 49.85, I² = 68 %), and insulin resistance (MD: 2.43; 95 % CI: 1.16 to 3.69, I² = 95 %). In the secondary analysis, ketogenic diet showed superior effects on BMI (MD: −1.65, 95 % CI: −2.76 to −0.55, I² = 0 %) and weight loss (MD: −4.98, 95 % CI: −9.05 to −0.91, I² = 7 %) as well as LH levels (MD 1.68, 95 % CI: −3.18 to −0.19, I² = 30 %) and insulin resistance (MD: −1.71, 95 % CI: −2.98 to −0.43, I² = 90 %) compared to other diets, though results for androgen and lipid parameters were inconsistent. Heterogeneity was high for most of the studied outcomes.

Conclusion

The ketogenic diet appears to be a promising dietary intervention for improving weight, insulin sensitivity, and reproductive hormone profiles in women with PCOS and a BMI exceeding 25 kg/m². Nonetheless, the considerable heterogeneity among included studies and variations in study quality warrant cautious interpretation of these findings. Further high-quality, long-term randomized controlled trials are needed to more definitively establish the efficacy and safety of the ketogenic diet in women with PCOS.

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生酮饮食对多囊卵巢综合征的影响：系统回顾和荟萃分析

背景和目的多囊卵巢综合征（PCOS）是一种常见的内分泌疾病，与肥胖、胰岛素抵抗和生殖功能障碍有关。虽然饮食调整是治疗的核心，但最佳方法尚不清楚。本系统综述和荟萃分析评估了生酮饮食对多囊卵巢综合征女性人体测量学、代谢和内分泌结果的影响。方法系统检索5个数据库（启动至2025年2月），确定了报告生酮饮食后多囊卵巢综合征（PCOS）妇女结果的研究。荟萃分析比较了生酮饮食前后的结果（主要分析）和生酮饮食与其他饮食的对比（次要分析）。采用随机效应模型计算具有95%置信区间（ci）的总平均差（MDs）。使用经过验证的工具和GRADE方法评估偏倚风险和证据质量。结果本综述纳入了15项研究，其中10项符合纳入meta分析的标准。在纳入的研究中，大多数参与者的BMI超过25 kg/m2。在初步分析中，生酮饮食导致BMI （MD: - 3.38 kg/m2, 95% CI: 2.53至4.23,I2 = 0%）、体重（MD: - 10.77 kg, 95% CI: 8.73至12.81,I2 = 0%）和腰围（MD: - 8.93 cm, 95% CI: 5.66至12.19,I2 = 44%）的显著降低。在黄体生成素（LH）水平（MD: 4.07, 95% CI: 3.36至4.79,I2 = 0%）、月经周期持续时间（MD: 26.06, 95% CI: 2.28至49.85,I2 = 68%）和胰岛素抵抗（MD: 2.43, 95% CI: 1.16至3.69,I2 = 95%）方面也观察到降低。在二级分析,生酮饮食显示优越的影响体重指数(MD:−1.65,95%置信区间CI: 2.76−−0.55,I2 = 0%)和减肥(MD:−4.98,95%置信区间CI: 9.05−−0.91,I2 = 7%)以及LH水平(MD 1.68, 95%置信区间CI: 3.18−−0.19,I2 = 30%)和胰岛素抵抗(MD:−1.71,95%置信区间CI: 2.98−−0.43,I2 = 90%)与其他饮食相比,虽然雄激素和脂质参数的结果是不一致的。大多数研究结果的异质性很高。结论生酮饮食是改善PCOS患者体重、胰岛素敏感性和生殖激素谱的一种有前景的饮食干预方法，BMI超过25 kg/m2。尽管如此，纳入研究之间的相当大的异质性和研究质量的差异需要谨慎解释这些发现。需要进一步的高质量、长期的随机对照试验来更明确地确定生酮饮食对多囊卵巢综合征女性的疗效和安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical nutrition 医学-营养学

CiteScore

14.10

自引率

6.30%

发文量

356

审稿时长

28 days

期刊介绍： Clinical Nutrition, the official journal of ESPEN, The European Society for Clinical Nutrition and Metabolism, is an international journal providing essential scientific information on nutritional and metabolic care and the relationship between nutrition and disease both in the setting of basic science and clinical practice. Published bi-monthly, each issue combines original articles and reviews providing an invaluable reference for any specialist concerned with these fields.