Meal Patterns and Physical activity among women with Polycystic Ovary Syndrome: A Case-Control Study

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Introduction

PCOS is one of the most prevalent endocrine illnesses in females of reproductive age, exhibiting systemic metabolic symptoms. This syndrome is intimately linked to chronic anovulation and is the primary cause of ovulatory infertility today (Collée et al., 2021; McDonnell et al., 2022) [7, 15]. The prevalent symptoms noted include hirsutism, alopecia, and acne, accompanied by oligomenorrhea and amenorrhea, which are associated with the diagnostic criteria(Hoeger et al., 2021) [8].The current clinically accepted criterion for diagnosing PCOS is the presence of at least two of the following three traits: oligo-ovulation or anovulation, polycystic ovaries, and hyperandrogenism as identified by ultrasound analysis (Chang & Dunaif, 2021) [6]. According to data from the World Health Organization (WHO), approximately 116 million women worldwide (3.4%) are affected by PCOS (Bulsara et al., 2021) [5]. Studies reveal that 3 out of 10 women acquire PCOS before to menopause and experience its associated difficulties (Sadeghi et al., 2022) [19]. Research indicates that the global prevalence of PCOS ranges from 10% to 13%, with marginally higher rates noted in certain populations compared to other (Teede et al., 2023) [25]. Insulin resistance is a critical aetiological factor in PCOS, and it is intrinsically present in slender women (Stepto et al., 2013) in a form that is mechanistically distinct from that associated with obesity. Subsequently, weight gain exacerbates insulin resistance and exacerbates (Lim et al., 2013) [14].

Insulin resistance is believed to be substantially influenced by diet and physical activity. It is crucial to note that the impact of dietary patterns on IR is both remarkable and well-documented(Kazemi et al., 2021; Shang et al., 2020) [11, 20]. PCOS women are advised to engage in physical activity, as it is an essential component of a well-balanced lifestyle. In particular, improvements in insulin sensitivity may be achieved through vigorous aerobic physical exercise (Shele et al., 2020) [21]. The significance of lifestyle interventions in the management of PCOS has been underscored in recent recommendations for its treatment(Teede et al., 2018) [24] (Moran et al., 2020) [16]. Finally, specific dietary patterns, such as consuming smaller, more frequent meals throughout the day (Papakonstantinou et al., 2016) [18]and consuming a larger breakfast and a smaller dinner (Jakubowicz et al., 2013) [9], have also been confirmed to be beneficial for insulin sensitivity (Jakubowicz et al., 2013; Papakonstantinou et al., 2016) [9, 18]and androgen reductions (Jakubowicz et al., 2013) [9]. This is a significant discovery, as women with PCOS are more likely to either forego breakfast or consume their breakfast and lunch at a later time.(Kulshreshtha et al., 2022) [12]. This study aims to evaluate the meal patterns and physical activity among women with PCOS compered to healthy controls.

Methods

Study design and setting A quantitative case-control study, the study was conducted in the city of Tikrit, Iraq. Data were obtained from the gynecology consultant at Tikrit Teaching Hospital and outpatient gynecological clinics.

Sample and Sampling A non-probability (purposive) sample of 200 women, divided into a case group consisting total of 100 women diagnosed with polycystic ovarian syndrome (PCOS) by a gynecologist according to the Rotterdam criteria, along with a control group of 100 age- and BMI-matched healthy women.

Tools of data collection The study instrument was a structured interview questionnaire, divided into sections as follows

1. Participants' demographic data: This section involved

seven items, which include age, marital status, weight, height, BMI.

2. Meal patterns data: This section contained four, items including (eat more than three meals, regularly eat breakfast, late night eating after 9:00 PM, eat snacks between meals). Elements of the questionnaire were measured on the two scales of classification (true and false).

3. Physical activity (Adapted from KomPAN): This

section contained three items including, (engage in physical exercise per week, type of activity, duration of exercise, reason for exercise, effect of regular physical activity on PCOS symptom. were measured on the two scales of classification (true and false).

Data collected Data were collected through face-to-face interviews with women diagnosed with polycystic ovary syndrome and healthy women on an average of six days per week. Each interview lasted approximately 15 minutes.

Statistical analysis The data were analyzed and interpreted using the Statistical Package for Social Sciences (SPSS) Version 26.0. The Kolmogorov-Smirnov and Levana’s test was implemented to verify the normality and homogeneity of the data. To summarize the data, descriptive statistics were employed, which included frequencies, percentages, mean, and standard deviation. Differences and associations between variables were identified by the Mann-Whitney U test.

Result Table 1: Comparison of demographic Variables (SDVs) for Women with PCOS (Case) and Healthy Women (Control) No. Variable Case (n=100) Control (n=100) Variance test F % F %

4 Body Mass Index

Normal 27 27 27 27 Λ= .007 P= .935 Overweight 35 35 35 35 Obesity I 35 35 34 34 Obesity II 3 3 4 4 No: Number, f: Frequency, %: Percentage, Λ= Levene's Test, P: Probability value, *Significant Table (1) presents the comparison between case and control groups in the study; the findings indicates that there is significant differences in marital status (P=.005). Age, body mass index, reported no significant difference between the two groups indicating homogeneity of these variables. The description of variables show close age group with same average age for each group (28±6) years. Married women were seen in case group with 70% while in the control group were distributed between single (49%) and married (49%). The BMI was approximately close both groups; 35% in each group seen with overweight, obesity I were also reported among 35% in the case group and 34% in control group.

Table 2: Mean Scores Assessments of Meal Patterns Items among Women with PCOS (Case) and Healthy Women (Control) Meal Patterns Case (n=100) Control (n=100) P Items Scale % Mean SD Ass. % Mean SD Ass. Do you eat more than three meals a day? No 33 .67 .473 Moderate 31 .69 .465 Good .763 Yes 67 69 Do you regularly eat breakfast? No 53 .47 .502 Moderate 48 .52 .502 Moderate .482 Yes 47 52 Do you eat late at night (after 9:00 PM)? No 65 .35 .479 Moderate 71 .29 .456 Poor .366 Yes 35 29 Do you eat snacks between meals? No 72 .28 .451 Poor 49 .51 .502 Moderate .001* Yes 28 51 SD: Standard Deviation, Ass: Assessment, P: Probability value (≤ 0.05), *Significant Poor= 0.00 – 0.33, Moderate= 0.34 – 0.67, Good= 0.68 – 1.00 Table (2) exhibits comparison regarding various meal patterns between women with PCOS and healthy women that emphasize the behavioral aspects of meal consumption regarding meal frequency, regularity of breakfast, eating at late night, and eating snacks. While several behavioral patterns indicates similar between two groups, a high significant difference has been found in snacking pattern with regard to control group (P=.001).

Table 3: Overall Assessments of Meal Patterns among Women with PCOS (Case) and Healthy Women (Control) Groups Case Control Variable Scores F % M SD Ass. f % M SD Ass. Meal Patterns Poor 48 48 1.33 1.162 Poor meal patterns 31 31 2.01 1.030 Moderate meal pattern Moderate 24 24 35 35 Good 28 28 34 34 Total 100 100 100 100 f: Frequency, %: Percentage M: Mean for total score, SD: Standard Deviation for total score, Ass: Assessment Poor= 0.00 – 1.33, Moderate= 1.34 – 2.67, Good= 2.68 – 4.00 Table (3) exhibits the overall assessment of meal patterns among women with PCOS in the case group and healthy women in the control group; the findings indicates that women in the case group showing poor meal pattern as reported among 48% with mean score 1.33(±1.162), 24% showing moderate meal pattern, and 28% showing good pattern. In the control group, women showing moderate (35%) to- good (34%) meal pattern with mean score 2.01 (±1.030).

Fig 1: Levels of Meal Patterns among Women with PCOS (Case) and Healthy Women (Control)

This figure shows that 48% of women in the case group and 35% in the control group associated with moderate meal patterns.

CaseControl Poor Moderate Good Table 4: Mean Scores Assessments of Physical Activity among Women with PCOS (Case) and Healthy Women (Control) Physical Activity Case (n=100)

Control (n=100) P Items Scale No % No % How often do you engage in physical exercise per week? Never 87 87 89 89 .726 1–2 times 11 11 9 9 3–5 times 2 2 2 2 What type of physical activity do you usually perform? None 76 76 82 82 .451 One 13 13 8 8 Two 11 11 10 10 Three 0 0 0 0 More than one 0 0 0 0 On average, how long is each session of physical activity? Less than 15 minutes 89 89 91 91 .499 15–30 minutes 7 7 7 7 30–60 minutes 4 4 2 2 What is your main reason for exercising? Weight management 87 87 89 89 .676 Improving health 7 7 6 6 Reducing PCOS symptoms 6 6 5 5 Do you feel that regular physical activity improves your PCOS symptoms (e.g., mood, menstrual cycle, weight)? No 92 92 89 89 .722 Not sure 3 3 11 11 Yes 5 5 0 0 No: Number, %: Percentage, P: Probability value (≤ 0.05), *Significant Table (4) Physical activity shows almost no significant difference between the two groups, in which both group showing high level of inactivity.

Table 5: Overall Assessments of Physical Activity among Women with PCOS (Case) and Healthy Women (Control) Groups Case Control Variable Scores F % M SD Ass. f % M SD Ass. Physical Activity Low 87 87 .97 2.294 Low 89 89 .79 2.076 Low Moderate 9 9 10 10 High 4 4 1 1 f: Frequency, %: Percentage M: Mean for total score, SD: Standard Deviation for total score, Ass: Assessment Physical Activity: Low= 0 – 3, Moderate= 4 – 7, High= 8– 11 Table (5) Regarding physical activity, both groups were associated with low physical activity as reported among 87% among women with PCOS (M±SD= .97±2.294) and 89% in the control group (M±SD= .79±2.076).

Discussion

The demographic profile of the participant findings indicated that the majority of women in both categories were between the ages of 20 and 29. This discovery is in accordance with a study conducted in Iran, which discovered that the prevalence of PCOS increased among women aged 20-24 (Motlagh Asghari et al., 2022) [17]. Additionally, the mean age of the participants was 28±6 years, which is nearly identical to a previous study conducted in Saudi Arabia (Alqntash et al., 2024) [2]. According to the body mass index, 35% of the women in this study were overweight, which is consistent with previous research conducted in Jordan (Abutaima et al., 2024) [1]. Furthermore, 34% of the participants were obese, a finding that is consistent with a study conducted in Baghdaad, Iraq (Alsaadi & Mohamad, 2019) [3]. Regarding meal pattern behaviors, the finding of current study indicated that there is no significant differences between women with PCOS and healthy controls in most assessed items, including the number of meals consumed per day, regular breakfast consumption, and late-night eating (p > 0.05). This finding suggests that overall meal timing and frequency were generally comparable between the two groups. However, a statistically significant difference was observed in snacking behavior between meals (p = 0.001), with healthy controls reported a higher frequency of snacking compared to women with PCOS. This finding is disagree with study conducted by Łagowska & Pieczyńska, (2022) [13], which reported higher rates of snacking betweens meals among women with PCOS Compered to control groups. These findings suggest that specific eating behaviors, such as frequent snacking and avoiding meals, may contribute to the dietary patterns associated with PCOS and may have metabolic implication (Łagowska & Pieczyńska, 2022) [13]. The overall assessment of meal patterns indicates that women in the case group showing poor to moderate meal pattern compered to healhy women showing moderate to good meal pattern, the overall assessment indicate the women with PCOS often follow unhealthy eating habits. Regarding the physical activity, the finding of the current study showed that no significant difference between the two groups, was reported that 87% of women in the PCOS did not exercise. Additionally, 89% of the participants indicate that their physical activity sessions less than 15 minutes. This finding are consistent with study conducted by (Shishehgar, Tehrani, et al., 2016) [22], which reported that 59.2% of women with PCOS had a low level of physical activity. However, this result contradicts the study conducted by (Moran et al., 2017), which reported high level of physical activity among both women with PCOS (85.4%) and those without PCOS (82.1%). Previous studies had proven the role of physical activity in the management of insulin resistance in PCOS women (Jurczewska et al., 2023) [10]. Furthermore, (Benham et al., 2018) [4] reported that regular physical activity positively influenced the hormonal profile, ovulation, and menstrual cycle control, which directly impacted reproductive health and pregnancy rates. The low level of physical activity among women in both groups explained by culture and social factors and limited access to women-only sports facilities.

Conclusion

The study concludes that women with PCOS follow poor to moderate dietary patterns compered healthy women, with a clear imbalance in snaking habits. The results also revealed high levels of physical inactivity among the majority of participants. Women with PCOS are advised to follow a healthy diet and engage in regular physical activity to control PCOS symptoms and improve reproductive health.