INCREASED INSULIN SENSITIVITY AND FIBRINOLYTIC CAPACITY AFTER DIETARYINTERVENTION IN OBESE WOMEN WITH POLYCYSTIC-OVARY-SYNDROME

In overweight women with polycystic ovary syndrome (PCOS), increased i nsulin resistance has been observed. Since abdominal obesity is associ ated with impaired fibrinolytic capacity and elevated levels of plasmi nogen activator inhibitor (PAI-1) and since PAI-1 seems to be related to insulin resistance, we investigated the possible effects of dietary intervention on lipids, fibrinolysis, coagulation, and insulin sensit ivity in obese PCOS women. Nine women aged 22 to 39 years (median weig ht, 97 kg) ate a protein-rich very-low-calorie diet (VLCD) (Nutrilett, Nycomed Pharma, Oslo, Norway; 421 kcal/d)for 4 weeks (part 1). After significant reductions of body fat (13%, P < .01), two of nine women a chieved regular menstruation and became pregnant. Six of the remaining women continued on a conventional low-calorie diet (1,000 to 1,500 kc al/d) for the next 20 weeks (part 2), during which time they were gene rally able to preserve the body fat loss obtained in part 1 of the stu dy. During part 1, significant reductions of total serum cholesterol ( 29%, P = .001) and fasting triglyceride ([TG] 31%, P < .05) levels wer e observed, as well as significant reductions of fasting glucose (6%, P < .05) and insulin (20%, P < .05). Insulin sensitivity (glucose disp osal rate [GDR]) was increased by 93% (P < .05). After finishing part 2, insulin sensitivity was still significantly increased (86%, P < .05 ) and PAI-1 activity was significantly reduced (54%, P < .05). Moreove r, overall fibrinolytic activity was significantly improved (serum D-d imer concentration increased by 75%, P < .05). In conclusion, through intensive dietary intervention with adequate loss of weight it is poss ible to change an unfavorable atherothrombogenic risk profile in overw eight (PCOS) women. Most convincingly, significantly increased insulin sensitivity and fibrinolytic capacity were observed. Copyright (C) 19 95 by W.B. Saunders Company