The potential role of the Mediterranean diet for the treatment and management of polycystic ovary syndrome: a review of the pathophysiological mechanisms and clinical evidence

Polycystic ovary syndrome (PCOS) is a common endocrine disorder amongst reproductive-aged women associated with cardiometabolic, reproductive and psychological abnormalities. Lifestyle modification, including a healthy diet, is considered first-line treatment for management of clinical symptoms. However, there is limited high-quality evidence to support one superior therapeutic dietary intervention for PCOS management that is beyond general population-based dietary guidelines. Adherence to a Mediterranean diet (MedDiet) has been shown to decrease cardiometabolic disease risk and attenuate depressive symptoms, particularly in patients with metabolic perturbations. This narrative review summarises the proposed biological mechanisms underpinning the potential therapeutic benefits of a MedDiet for the management of cardiometabolic, reproductive and psychological features related to PCOS. Observational evidence suggests an inverse relationship between MedDiet adherence and PCOS features, particularly insulin resistance and hyperandrogenemia. Although the exact mechanisms are complex and multifaceted, they are likely related to the anti-inflammatory potential of the dietary pattern. These mechanisms are underpinned by anti-inflammatory bioactive constituents present in the MedDiet, including carotenoids, polyphenols and n-3 polyunsaturated fatty acids (PUFAs). Synthesis of the available literature suggests the MedDiet could be a promising therapeutic dietary intervention to attenuate short and long-term symptoms associated with PCOS and may aid in reducing the longer-term risks associated with cardiometabolic diseases and reproductive and psychological dysfunction. Nevertheless, current evidence remains insufficient to inform clinical practice and well-designed clinical trials are needed. As such, we provide recommendations for the design and delivery of future MedDiet interventions in women with PCOS, including exploring the acceptability, and feasibility to enhance adherence.