QOL Similar Among Infertile Obese Women With, Without PCOS


Investigators compared physical and mental health outcomes among infertile women with and without polycystic ovary syndrome (PCOS), who were considered obese, by looking at their dietary intake, eating behavior, physical activity levels, and quality of life (QOL).

A post-hoc cross-sectional analysis of data from the large, multicenter, randomized, controlled LIFEstyle study in The Netherlands showed that infertile women who are considered obese and who do or do not have polycystic ovary syndrome (PCOS) are still likely to have similar mental and physical quality-of-life (QOL) outcomes.

Findings were published recently in Nutrients.

“PCOS is the most common endocrinopathy with reproductive, metabolic, and psychological features, affecting 5% to 25% of women of reproductive age worldwide,” the authors wrote. “To personalize lifestyle advice for women with PCOS and obesity, detailed information regarding dietary intake, eating behavior, physical activity levels, and QOL may be useful.”

They added that a popular thought in this space is there may be a bidirectional relationship between obesity and PCOS.

Using the food frequency questionnaire, the Dutch Eating Behavior Questionnaire, the Short QUestionnaire to ASsess Health-enhancing physical activity, and the 36-item Short Form Health Survey, the study investigators evaluated responses from 491 participants (PCOS, n = 170; non-PCOS, n = 321), with a mean body mass index (BMI) of 36 kg/m2, in 4 areas at study entry:

  • Dietary intake: vegetables, fruits, sugary drinks, alcoholic beverages, and savory/sweet snacks
  • Eating behavior: emotional, external, and restricted eating
  • Physical activity
  • QOL

The women in the PCOS group had a slightly younger mean (SD) age vs the non-PCOS group (28.0 [4.2] vs 30.8 [4.4] years) and a slightly higher waist-to-hip circumference: 0.87 (0.07) vs 0.86 (0.06) (P = .02). Education levels were similar between the groups, with the exception of intermediate vocational education, which saw the non-PCOS group ahead of the PCOS group by more than 25 percentage points: 74.8% vs 49.4%.

Also at baseline, weight, BMI, waist circumference, hip circumference, systolic blood pressure, and diastolic blood pressure, as well as the biochemical measures of high-sensitivity C-reactive protein, triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and fasting glucose were similar between the groups. Significant differences were seen in mean (SD) fasting insulin (PCOS, 116.5 [60.5] pmoL/L; non-PCOS, 92.4 [51.1] pmoL/L) and homeostasis model assessment of insulin resistance (HOMAS-IR)scores (4.1 [2.7] vs 3.2 [1.9], respectively).

Because of these results, “age, waist-hip circumference, and HOMA-IR were included in the adjusted regression models to investigate the difference in diet, eating behavior, physical activity, and QOL,” the authors said.

The women in the PCOS group ate far fewer vegetables per day than the non-PCOS group—107 vs 129 g), but this was declared statistically insignificant after adjusting overall for age, waist-hip circumference ratio, and HOMA-IR. No dietary differences were seen in the other items. Emotional eating scores were also similar, at 34.6 (11.2) in the PCOS group and 34.1 (11.3) in the non-PCOS group, and no significant differences were seen in external or restricted eating or physical activity (total moderate-to-vigorous, when comparing leisure time to commuting activity levels).

Overall, the physical component scores were 49.1 (9.5) in the PCOS group and 50.2 (9.1) in the non-PCOS group, and the mental component scores were 50.2 (8.5) and 49.4 (10.4), respectively.

The investigators note that their findings are important because they echo those of previous studies, in regard to dietary intake and physical activity, and add new information on specific eating behaviors due to the large cohort.

They highlight that additional studies are needed regarding mental health QOL among women with PCOS who are obese, specifically because poor mental health may be linked to the obesity and not the PCOS.

“Exploring whether women with PCOS and obesity have different dietary habits, physical activity, and QOL compared with non-PCOS obese controls is important,” the authors concluded, “since it could provide further clinical guidance with respect to what kind of adaptations might be needed in lifestyle intervention programs for these women, with more-or-less emphasis on diet or physical activity.”


Wang Z, Groen H, Cantineau AEP, et al. Dietary intake, eating behavior, physical activity, and quality of life in infertile women with PCOS and obesity compared with non-PCOS obese controls. Nutrients. Published online October 8, 2021. doi:10.3390/nu13103526

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