Efficacy and safety of dietary polyphenol administration as assessed by hormonal, glycolipid metabolism, inflammation and oxidative stress parameters in patients with PCOS: a meta-analysis and systematic review

The current knowledge about the efficacy and safety of dietary polyphenol administration in patients with polycystic ovarian syndrome (PCOS) is divergent. To evaluate the pooled efficacy and safety of dietary polyphenol administration in the treatment of patients with PCOS. The pubmed, Embase, Scopus, Cochrane Library, and Web of Science databases were searched for randomized controlled trials (RCTs) of dietary polyphenol administration for the treatment of PCOS. English-language RCTs involving adults with PCOS were thoroughly searched in electronic databases from the time of their establishment to May 2024. Random-effects models were used because heterogeneity was derived from differences in intervention materials and study duration, among other confounding factors. The effect sizes of the outcomes in the pooled analysis are expressed as weighted mean differences (WMDs) and 95% confidence intervals (CIs). A total of 15 RCTs involving 934 patients were finally included. Compared with control treatments, dietary polyphenol administration significantly reduced luteinizing hormone (LH) (WMD: −0.85, 95% CI [-1.32 to −0.38], <i>p</i> = 0.00), and prolactin levels (WMD: −3.73, 95% CI [-6.73 to −0.74], <i>p</i> = 0.01). Dietary polyphenol administration significantly reduced insulin levels (WMD: −0.85, 95% CI [-1.32 to −0.38], <i>p</i> = 0.00). Regarding lipid metabolism, dietary polyphenol administration only reduced triglyceride levels (WMD: −8.96, 95% CI [-16.44 to −1.49], <i>p</i> = 0.02). Malondialdehyde (MDA) (WMD: −0.65, 95% CI [-0.68 to −0.62], <i>p</i> = 0.00), tumor necrosis factor (TNF-α) (WMD: −1.39, 95% CI [-2.41 to −0.37], <i>p</i> = 0.01) concentrations were significantly reduced by dietary polyphenol administration. None of the interventions significantly affected weight, body mass index (BMI), waist circumference (WC), homeostatic model–insulin resistance (HOMA-IR), fasting blood sugar (FBS), glycated hemoglobin (HBA1c), follicle-stimulating hormone (FSH), testosterone (T), dehydroepiandrosterone (DHEA), estradiol (E2), anti-Müllerian hormone (AMH), quantitative insulin-sensitivity check index (QUICKI), sex hormone-binding globulin (SHBG), total antioxidant capacity (TAC), C-peptide, C-reactive protein (CRP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), cholesterol, cholesterol/HDL, acne score, thyroid-stimulating hormone (TSH), aspartate aminotransferase (AST), alanine aminotransferase (ALT) or alkaline phosphatase (ALP). Dietary polyphenol administration was efficacious in patients with PCOS in our study. This review might provide new insight into the treatment of patients with PCOS and the potential of daily polyphenol supplementation in patients with PCOS. Nevertheless, these results must be interpreted carefully as a result of the heterogeneity and risk of bias among the studies and we expect that more high-quality RCTs evaluating the efficacy and safety of dietary polyphenol adnimistration in patients with PCOS will be conducted in the future. CRD42024498494

当前关于饮食多酚给药治疗多囊卵巢综合征（polycystic ovarian syndrome, PCOS）患者的疗效与安全性的认知尚存分歧。本研究旨在评估饮食多酚给药治疗多囊卵巢综合征患者的综合疗效与安全性。本研究检索了PubMed、Embase、Scopus、Cochrane图书馆及Web of Science数据库，收集饮食多酚给药治疗多囊卵巢综合征的随机对照试验（randomized controlled trial, RCT）。我们于各数据库建库至2024年5月期间，系统检索了纳入成年多囊卵巢综合征患者的英文随机对照试验。由于异质性源于干预材料、研究时长及其他混杂因素的差异，本研究采用随机效应模型进行分析。合并分析中结局指标的效应量以加权均数差（weighted mean difference, WMD）及95%置信区间（confidence interval, CI）表示。最终共纳入15项随机对照试验，涉及934例患者。与对照组相比，饮食多酚给药可显著降低黄体生成素（luteinizing hormone, LH）水平（WMD=-0.85，95%CI[-1.32, -0.38]，p=0.00）及催乳素（prolactin）水平（WMD=-3.73，95%CI[-6.73, -0.74]，p=0.01）；同时可显著降低胰岛素（insulin）水平（WMD=-0.85，95%CI[-1.32, -0.38]，p=0.00）。在脂质代谢方面，饮食多酚给药仅可显著降低甘油三酯（triglyceride）水平（WMD=-8.96，95%CI[-16.44, -1.49]，p=0.02）。此外，饮食多酚给药可显著降低丙二醛（malondialdehyde, MDA）水平（WMD=-0.65，95%CI[-0.68, -0.62]，p=0.00）及肿瘤坏死因子-α（tumor necrosis factor-α, TNF-α）浓度（WMD=-1.39，95%CI[-2.41, -0.37]，p=0.01）。而该干预对体重、体质量指数（body mass index, BMI）、腰围（waist circumference, WC）、稳态模型胰岛素抵抗指数（homeostatic model assessment-insulin resistance, HOMA-IR）、空腹血糖（fasting blood sugar, FBS）、糖化血红蛋白（glycated hemoglobin, HbA1c）、卵泡刺激素（follicle-stimulating hormone, FSH）、睾酮（testosterone, T）、脱氢表雄酮（dehydroepiandrosterone, DHEA）、雌二醇（estradiol, E2）、抗缪勒管激素（anti-Müllerian hormone, AMH）、定量胰岛素敏感性检测指数（quantitative insulin-sensitivity check index, QUICKI）、性激素结合球蛋白（sex hormone-binding globulin, SHBG）、总抗氧化能力（total antioxidant capacity, TAC）、C肽、C反应蛋白（C-reactive protein, CRP）、高密度脂蛋白（high-density lipoprotein, HDL）、低密度脂蛋白（low-density lipoprotein, LDL）、总胆固醇、胆固醇/高密度脂蛋白比值、痤疮评分、促甲状腺激素（thyroid-stimulating hormone, TSH）、天门冬氨酸氨基转移酶（aspartate aminotransferase, AST）、丙氨酸氨基转移酶（alanine aminotransferase, ALT）及碱性磷酸酶（alkaline phosphatase, ALP）均无显著影响。本研究结果表明，饮食多酚给药对多囊卵巢综合征患者具有治疗效用。本综述可为多囊卵巢综合征患者的治疗及日常多酚补充的潜在价值提供新的研究视角。然而，由于纳入研究存在异质性及偏倚风险，对本研究结果的解读需谨慎。我们期待未来开展更多高质量的随机对照试验，以进一步评估饮食多酚给药在多囊卵巢综合征患者中的疗效与安全性。本研究注册编号为CRD42024498494。