DASH Diet, Insulin Resistance, and Serum hs-CRP in Polycystic Ovary Syndrome: A Randomized Controlled Clinical Trial

Z. Asemi; A. Esmaillzadeh

doi:10.1055/s-0034-1376990

Hormone and Metabolic Research, Table of Contents

Horm Metab Res 2015; 47(03): 232-238
DOI: 10.1055/s-0034-1376990

Endocrine Care

DASH Diet, Insulin Resistance, and Serum hs-CRP in Polycystic Ovary Syndrome: A Randomized Controlled Clinical Trial

Z. Asemi

¹Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran

,

A. Esmaillzadeh

²Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

³Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran

› Author Affiliations

Abstract

This study was designed to assess the effects of Dietary Approaches to Stop Hypertension (DASH) eating plan on insulin resistance and serum hs-CRP in overweight and obese women with PCOS. This randomized controlled clinical trial was done on 48 women diagnosed with PCOS. Subjects were randomly assigned to consume either the control (n=24) or the DASH eating pattern (n=24) for 8 weeks. The DASH diet consisted of 52% carbohydrates, 18% proteins, and 30% total fats. It was designed to be rich in fruits, vegetables, whole grains, and low-fat dairy products and low in saturated fats, cholesterol, refined grains, and sweets. Sodium content of the DASH diet was designed to be less than 2 400 mg/day. The control diet was also designed to contain 52% carbohydrates, 18% protein, and 30% total fat. Fasting blood samples were taken at baseline and after 8 weeks intervention to measure insulin resistance and serum hs-CRP levels. Adherence to the DASH eating pattern, compared to the control diet, resulted in a significant reduction of serum insulin levels (−1.88 vs. 2.89 μIU/ml, p=0.03), HOMA-IR score (−0.45 vs. 0.80; p=0.01), and serum hs-CRP levels (−763.29 vs. 665.95 ng/ml, p=0.009). Additionally, a significant reduction in waist (−5.2 vs. −2.1 cm; p=0.003) and hip circumference (−5.9 vs. −1 cm; p<0.0001) was also seen in the DASH group compared with the control group. In conclusion, consumption of the DASH eating pattern for 8 weeks in overweight and obese women with PCOS resulted in the improvement of insulin resistance, serum hs-CRP levels, and abdominal fat accumulation.

Clinical trial registration number: www.irct.ir: IRCT201304235623N6

Key words

DASH - PCOS - insulin resistance - inflammation - waist/hip circumference

Full Text

References

References
1 Thomson RL, Spedding S, Buckley JD. Vitamin D in the aetiology and management of polycystic ovary syndrome. Clin Endocrinol (Oxf) 2012; 77: 343-350
2 Salehi M, Bravo-Vera R, Sheikh A, Gouller A, Poretsky L. Pathogenesis of polycystic ovary syndrome: what is the role of obesity?. Metabolism 2004; 53: 358-376
3 Atkin S. Cardiovascular disease in polycystic ovary syndrome. Clin Endocrinol (Oxf) 2013; 78: 823-824
4 Beydoun HA, Beydoun MA, Wiggins N, Stadtmauer L. Relationship of obesity-related disturbances with LH/FSH ratio among post-menopausal women in the United States. Maturitas 2012; 71: 55-61
5 Magnotti M, Futterweit W. Obesity and the polycystic ovary syndrome. Med Clin North Am 2007; 91: 1151-1168 ix–x
6 Garruti G, Depalo R, Vita MG, Lorusso F, Giampetruzzi F, Damato AB, Giorgino F. Adipose tissue, metabolic syndrome and polycystic ovary syndrome: from pathophysiology to treatment. Reprod Biomed Online 2009; 19: 552-563
7 Phelan N, O’Connor A, Kyaw Tun T, Correia N, Boran G, Roche HM, Gibney J. Leucocytosis in women with polycystic ovary syndrome (PCOS) is incompletely explained by obesity and insulin resistance. Clin Endocrinol (Oxf) 2013; 78: 107-113
8 Shang K, Jia X, Qiao J, Kang J, Guan Y. Endometrial abnormality in women with polycystic ovary syndrome. Reprod Sci 2012; 19: 674-683
9 Ehrmann DA, Kasza K, Azziz R, Legro RS, Ghazzi MN. Effects of race and family history of type 2 diabetes on metabolic status of women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005; 90: 66-71
10 Bargiota A, Diamanti-Kandarakis E. The effects of old, new and emerging medicines on metabolic aberrations in PCOS. Ther Adv Endocrinol Metab 2012; 3: 27-47
11 Geller DH, Pacaud D, Gordon CM, Misra M. State of the Art Review: Emerging Therapies: The Use of Insulin Sensitizers in the Treatment of Adolescents with Polycystic Ovary Syndrome (PCOS). Int J Pediatr Endocrinol 2011; 2011: 9
12 Mehrabani HH, Salehpour S, Amiri Z, Farahani SJ, Meyer BJ, Tahbaz F. Beneficial effects of a high-protein, low-glycemic-load hypocaloric diet in overweight and obese women with polycystic ovary syndrome: a randomized controlled intervention study. J Am Coll Nutr 2012; 31: 117-125
13 Barr S, Reeves S, Sharp K, Jeanes YM. An isocaloric low glycemic index diet improves insulin sensitivity in women with polycystic ovary syndrome. J Acad Nutr Diet 2013; 113: 1523-1531
14 Puchau B, Zulet MA, de Echavarri AG, Hermsdorff HH, Martinez JA. Dietary total antioxidant capacity is negatively associated with some metabolic syndrome features in healthy young adults. Nutrition 2010; 26: 534-541
15 Vollmer WM, Sacks FM, Ard J, Appel LJ, Bray GA, Simons-Morton DG, Conlin PR, Svetkey LP, Erlinger TP, Moore TJ, Karanja N. Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-sodium trial. Ann Intern Med 2001; 135: 1019-1028
16 Asemi Z, Samimi M, Tabassi Z, Sabihi SS, Esmaillzadeh A. A randomized controlled clinical trial investigating the effect of DASH diet on insulin resistance, inflammation, and oxidative stress in gestational diabetes. Nutrition 2013; 29: 619-624
17 Azadbakht L, Surkan PJ, Esmaillzadeh A, Willett WC. The Dietary Approaches to Stop Hypertension eating plan affects C-reactive protein, coagulation abnormalities, and hepatic function tests among type 2 diabetic patients. J Nutr 2011; 141: 1083-1088
18 Azadbakht L, Fard NR, Karimi M, Baghaei MH, Surkan PJ, Rahimi M, Esmaillzadeh A, Willett WC. Effects of the Dietary Approaches to Stop Hypertension (DASH) eating plan on cardiovascular risks among type 2 diabetic patients: a randomized crossover clinical trial. Diabetes Care 2011; 34: 55-57
19 Asemi Z, Tabassi Z, Samimi M, Fahiminejad T, Esmaillzadeh A. Favourable effects of the Dietary Approaches to Stop Hypertension diet on glucose tolerance and lipid profiles in gestational diabetes: a randomised clinical trial. Br J Nutr 2012; 1-7
20 Azadbakht L, Mirmiran P, Esmaillzadeh A, Azizi T, Azizi F. Beneficial effects of a Dietary Approaches to Stop Hypertension eating plan on features of the metabolic syndrome. Diabetes Care 2005; 28: 2823-2831
21 Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 81: 19-25
22 Zello GA. Dietary Reference Intakes for the macronutrients and energy: considerations for physical activity. Appl Physiol Nutr Metab 2006; 31: 74-79
23 Esmaillzadeh A, Azadbakht L. Major dietary patterns in relation to general obesity and central adiposity among Iranian women. J Nutr 2008; 138: 358-363
24 Pisprasert V, Ingram KH, Lopez-Davila MF, Munoz AJ, Garvey WT. Limitations in the Use of Indices Using Glucose and Insulin Levels to Predict Insulin Sensitivity: Impact of Race and Gender and Superiority of the Indices Derived From Oral Glucose Tolerance Test in African Americans. Diabetes Care 2013; 36: 845-853
25 Lien LF, Brown AJ, Ard JD, Loria C, Erlinger TP, Feldstein AC, Lin PH, Champagne CM, King AC, McGuire HL, Stevens VJ, Brantley PJ, Harsha DW, McBurnie MA, Appel LJ, Svetkey LP. Effects of PREMIER lifestyle modifications on participants with and without the metabolic syndrome. Hypertension 2007; 50: 609-616
26 Liese AD, Nichols M, Sun X, D’Agostino Jr RB, Haffner SM. Adherence to the DASH Diet is inversely associated with incidence of type 2 diabetes: the insulin resistance atherosclerosis study. Diabetes Care 2009; 32: 1434-1436
27 Yazici M, Kaya A, Kaya Y, Albayrak S, Cinemre H, Ozhan H. Lifestyle modification decreases the mean platelet volume in prehypertensive patients. Platelets 2009; 20: 58-63
28 Azadbakht L, Kimiagar M, Mehrabi Y, Esmaillzadeh A, Hu FB, Willett WC. Dietary soya intake alters plasma antioxidant status and lipid peroxidation in postmenopausal women with the metabolic syndrome. Br J Nutr 2007; 98: 807-813
29 Hodson L, Harnden KE, Roberts R, Dennis AL, Frayn KN. Does the DASH diet lower blood pressure by altering peripheral vascular function?. J Hum Hypertens 2010; 24: 312-319
30 King DE, Egan BM, Woolson RF, Mainous 3rd AG, Al-Solaiman Y, Jesri A. Effect of a high-fiber diet vs. a fiber-supplemented diet on C-reactive protein level. Arch Intern Med 2007; 167: 502-506
31 Ludwig DS, Pereira MA, Kroenke CH, Hilner JE, Van Horn L, Slattery ML, Jacobs Jr DR. Dietary fiber, weight gain, and cardiovascular disease risk factors in young adults. JAMA 1999; 282: 1539-1546
32 Liu S, Manson JE, Buring JE, Stampfer MJ, Willett WC, Ridker PM. Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women. Am J Clin Nutr 2002; 75: 492-498
33 Macan M, Vrkic N, Vrdoljak AL, Radic B, Bradamante V. Effects of high sucrose diet, gemfibrozil, and their combination on plasma paraoxonase 1 activity and lipid levels in rats. Acta Biochim Pol 2010; 57: 321-326
34 Shikany JM, Phadke RP, Redden DT, Gower BA. Effects of low- and high-glycemic index/glycemic load diets on coronary heart disease risk factors in overweight/obese men. Metabolism 2009; 58: 1793-1801
35 Man Q, He L. Effects of high-sugar and high-fat diet on growth and carbohydrate, lipid metabolism in Wistar rats. Wei Sheng Yan Jiu 2009; 38: 722-724
36 Piatti PM, Monti LD, Valsecchi G, Magni F, Setola E, Marchesi F, Galli-Kienle M, Pozza G, Alberti KG. Long-term oral L-arginine administration improves peripheral and hepatic insulin sensitivity in type 2 diabetic patients. Diabetes Care 2001; 24: 875-880
37 Rowe WJ. Correcting magnesium deficiencies may prolong life. Clin Interv Aging 2012; 7: 51-54
38 Lopes Nobre J, Lisboa PC, da Silva Lima N, Franco JG, Firmino Nogueira Neto J, de Moura EG, de Oliveira E. Calcium supplementation prevents obesity, hyperleptinaemia and hyperglycaemia in adult rats programmed by early weaning. Br J Nutr 2011; 1-10
39 Nobre JL, Lisboa PC, Santos-Silva AP, Lima NS, Manhaes AC, Nogueira-Neto JF, Cabanelas A, Pazos-Moura CC, Moura EG, de Oliveira E. Calcium supplementation reverts central adiposity, leptin, and insulin resistance in adult offspring programmed by neonatal nicotine exposure. J Endocrinol 2011; 210: 349-359
40 Pikilidou MI, Lasaridis AN, Sarafidis PA, Befani CD, Koliakos GG, Tziolas IM, Kazakos KA, Yovos JG, Nilsson PM. Insulin sensitivity increase after calcium supplementation and change in intraplatelet calcium and sodium-hydrogen exchange in hypertensive patients with Type 2 diabetes. Diabet Med 2009; 26: 211-219
41 Sargeant HR, Miller HM, Shaw MA. Inflammatory response of porcine epithelial IPEC J2 cells to enterotoxigenic E. coli infection is modulated by zinc supplementation. Mol Immunol 2011; 48: 2113-2121
42 Almoznino-Sarafian D, Berman S, Mor A, Shteinshnaider M, Gorelik O, Tzur I, Alon I, Modai D, Cohen N. Magnesium and C-reactive protein in heart failure: an anti-inflammatory effect of magnesium administration?. Eur J Nutr 2007; 46: 230-237
43 Wongwananuruk T, Rattanachaiyanont M, Indhavivadhana S, Leerasiri P, Techatraisak K, Tanmahasamut P, Angsuwathana S, Dangrat C. Prevalence and clinical predictors of insulin resistance in reproductive-aged thai women with polycystic ovary syndrome. Int J Endocrinol 2012; 2012: 529184
44 Deligeoroglou E, Vrachnis N, Athanasopoulos N, Iliodromiti Z, Sifakis S, Iliodromiti S, Siristatidis C, Creatsas G. Mediators of chronic inflammation in polycystic ovarian syndrome. Gynecol Endocrinol 2012; 28: 974-978