(P18-21-26) Hypocaloric Dietary Intervention is Associated With Androgen Improvements in Women With Polycystic Ovary Syndrome, Independent of Change in Diet Quality or Weight Loss

Objectives: Impact of lifestyle intervention on androgen status and dietary behavior in polycystic ovary syndrome (PCOS) remains limited. This study examined if changes in diet quality or weight loss were associated with improvements in androgens during a hypocaloric dietary intervention in women with and without PCOS.

Methods: Retrospective analysis of a clinical trial of 11 women with PCOS and 17 age- and BMI-matched controls  who underwent a 6-month hypocaloric dietary intervention (1200-1500 kcal/day). Dietary intake was assessed via validated food frequency questionnaire (VioscreenÓ) at baseline and post-intervention. Baseline and post-intervention anthropometric and androgen measures were compared across groups with unpaired t-tests and Wilcoxon rank-sum tests. Linear mixed models assessed longitudinal changes within and between groups. Linear regression assessed associations between changes in Healthy Eating Index (HEI-2020) and weight loss with changes in androgens.

Results: By design, the PCOS group had elevated hirsutism, total testosterone, free androgen index (FAI), and free testosterone (FT) compared to controls at baseline (all p< 0.05). Both groups had significant weight loss, with controls losing more weight (PCOS: 6.5%, controls: 10.2%, p< 0.05). Diet quality did not differ between groups at baseline and post-intervention (p >0.05), with both groups increasing HEI-2020 score (ΔHEI-2020: PCOS=+10.6 [4.3, 16.9], controls=+5.9 [0.8, 11.0], both p< 0.05). Degree of dietary change did not differ by PCOS status (interaction=4.7 [-3.0, 12.5], p >0.05). FAI and FT decreased in women with PCOS, but not controls (ΔFAI: -1.6 [-2.6, -0.3]; ΔFT: -0.18 ng/dL [-0.34,-0.02], both p< 0.05).  These decreases were not associated with improved HEI-2020 score (FAI: -0.03 [-0.21, 0.14]; FT: -0.008 ng/dL [-0.03, 0.01], both p >0.05) or weight loss (FAI: -0.14 [-0.47, 0.19]; FT: -0.02 ng/dL [-0.06, 0.02], both p >0.05).

Conclusions: Women with PCOS showed similar dietary adherence to controls, although they experienced less weight loss. Hypocaloric dietary intervention was associated with PCOS-specific reductions of androgen bioavailability, independent of diet quality improvement and degree of weight loss, warranting further investigation into underlying mechanisms.

Funding Sources: NICHD R01-HD0937848, NIDDK T32 DK007158