Background: Polycystic ovary syndrome (PCOS) is an endocrine disorder that can lead to major reproductive and metabolic complications. Management of glycemic parameters is an important step to improve the symptoms of PCOS.

Objective: This study aims to evaluate the effects of the dietary approaches to stop hypertension (DASH) diet and curcumin (Cur) co-administration on glycemic parameters in normal weight and overweight/obese women with PCOS undergoing in vitro fertilization.

Materials and Methods: In this double-blind randomized clinical study, 104 infertile women with PCOS were divided into 4 intervention groups considering treatment conditions and body mass index. They received 500 mg twice daily of Cur or placebo (Pls) along with DASH or a standard diet (St) based on macronutrient composition (52% carbohydrate, 18% protein, and 30% fat) for 12 wk, (DASH + Cur, DASH + Pls, St + Cur, St + Pls). The effect of these interventions on fasting blood sugar and insulin levels, insulin resistance (IR), and insulin sensitivity were determined.

Results: Participants adhered to the intervention protocol (> 80%). Insulin levels in the supplement intervention (Cur + diet) decreased significantly in the crude model. They remained significant even after adjusting for confounding variables in adjusted models (body mass index classification, energy difference, age, and physical activity levels at the baseline) (ß = -45.3, 95% CI [-73.23, -17.46], p = 0.002). Homeostasis model assessment of IR decreased significantly in the supplement intervention even after controlling for confounding factors in adjusted models. Changes in fasting blood sugar and insulin sensitivity were not significant in either the crude or adjusted models.

Conclusion: The study results show that adding Cur to the diet can positively reduce insulin levels, improve IR, and lead to faster recovery of hyperinsulinemia. Cur supplementation with a healthy diet has synergistic beneficial effects on glycemic parameters. Larger clinical trials with longer durations are needed to confirm these results.

Key words: Polycystic ovary syndrome, Dietary approaches to stop hypertension, Curcumin, Insulin resistance, Glycemic control.

[1] Sanchez-Garrido MA, Tena-Sempere M. Metabolic dysfunction in polycystic ovary syndrome: Pathogenic role of androgen excess and potential therapeutic strategies. Mol Metab 2020; 35: 100937.

[2] Manique MES, Ferreira AMAP. Polycystic ovary syndrome in adolescence: Challenges in diagnosis and management. Rev Bras Ginecol Obstet 2022; 44: 425–433.

[3] Zhao H, Zhang J, Cheng X, Nie X, He B. Insulin resistance in polycystic ovary syndrome across various tissues: An updated review of pathogenesis, evaluation, and treatment. J Ovarian Res 2023; 16: 9.

[4] Chadt A, Al-Hasani H. Glucose transporters in adipose tissue, liver, and skeletal muscle in metabolic health and disease. Pflugers Arch 2020; 472: 1273–1298.

[5] Wood AC, Jensen ET, Bertoni AG, Ramesh G, Rich SS, Rotter JI, et al. Defining the relative role of insulin clearance in early dysglycemia in relation to insulin sensitivity and insulin secretion: The microbiome and insulin longitudinal evaluation study (MILES). Metabolites 2021; 11: 420.

[6] Thomas DD, Corkey BE, Istfan NW, Apovian CM. Hyperinsulinemia: An early indicator of metabolic dysfunction. J Endocr Soc 2019; 3: 1727–1747.

[7] Lewgood J, Oliveira B, Korzepa M, Forbes SC, Little JP, Breen L, et al. Efficacy of dietary and supplementation interventions for individuals with type 2 diabetes. Nutrients 2021; 13: 2378.

[8] Wolosowicz M, Prokopiuk S, Kaminski TW. Recent Advances in the treatment of insulin resistance targeting molecular and metabolic pathways: Fighting a losing battle? Medicina 2022; 58: 472.

[9] Esfandyari S, Bahadoran Z, Mirmiran P, Tohidi M, Azizi F. Adherence to the dietary approaches to stop hypertension trial (DASH) diet is inversely associated with incidence of insulin resistance in adults: The Tehran lipid and glucose study. J Clin Biochem Nutr 2017; 61: 123–129.

[10] Campbell AP. DASH eating plan: An eating pattern for diabetes management. Diabetes Spectr 2017; 30: 76–81.

[11] Asemi Z, Esmaillzadeh A. DASH diet, insulin resistance, and serum hs-CRP in polycystic ovary syndrome: A randomized controlled clinical trial. Horm Metab Res 2015; 47: 232–238.

[12] Jakubczyk K, Druzga A, Katarzyna J, Skonieczna-Zydecka K. Antioxidant potential of curcumin-a meta-analysis of randomized clinical trials. Antioxidants (Basel) 2020; 9: 1092.

[13] Sharifi-Rad J, Rayess YE, Rizk AA, Sadaka C, Zgheib R, Zam W, et al. Turmeric and Its major compound curcumin on health: Bioactive effects and safety profiles for food, pharmaceutical, biotechnological and medicinal applications. Front Pharmacol 2020; 11: 01021.

[14] Shen W, Qu Y, Jiang H, Wang H, Pan Y, Zhang Y, et al. Therapeutic effect and safety of curcumin in women with PCOS: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2022; 13: 1051111.

[15] Yasmin A, Roychoudhury S, Paul Choudhury A, Ahmed ABF, Dutta S, Mottola F, et al. Polycystic ovary syndrome: an updated overview foregrounding impacts of ethnicities and geographic variations. Life (Basel) 2022; 12: 1974.

[16] Zohrabi T, Sheikhha MH, Jambarsang S, Nadjarzadeh A, Aflatoonian A, Mozaffari-Khosravi H. Effect of dietary approaches to stop hypertension, and standard diets with and without curcumin on interleukin-1 alpha, 5-alpha reductase gene expressions, and androgenic and glycemic profile in polycystic ovary syndrome women undergoing in vitro fertilization treatment: A study protocol. Int J Reprod BioMed 2023; 21: 433–442.

[17] Steinberg D, Kay M, Burroughs J, Svetkey Lp, Bennett Gg. the effect of a digital behavioral weight loss intervention on adherence to the dietary approaches to stop hypertension (dash) dietary pattern in medically vulnerable primary care patients: Results from a randomized controlled trial. J Acad Nutr Diet 2019; 119: 574–584.

[18] Chien YJ, Chang CY, Wu MY, Chen CH, Horng YS, Wu HC. Effects of curcumin on glycemic control and lipid profile in polycystic ovary syndrome: Systematic review with meta-analysis and trial sequential analysis. Nutrients 2021; 13: 684.

[19] Barber TM, Franks S. Obesity and polycystic ovary syndrome. Clin Endocrinol (Oxf) 2021; 95: 531–541.

[20] Koh H-CE, Cao C, Mittendorfer B. Insulin clearance in obesity and type 2 diabetes. Int J Mol Sci 2022; 23: 596.

[21] Kim Y, Rouse M, González-Mariscal I, Egan JM, O’Connell JF. Dietary curcumin enhances insulin clearance in diet-induced obese mice via regulation of hepatic PI3K-AKT axis and IDE, and preservation of islet integrity. Nutr Metab (Lond) 2019; 16: 48.

[22] Clark CCT, Ghaedi E, Arab A, Pourmasoumi M, Hadi A. The effect of curcumin supplementation on circulating adiponectin: A systematic review and meta-analysis of randomized controlled trials. Diabetes Metab Syndr 2019; 13: 2819–2825.

[23] Okura T, Fujioka Y, Nakamura R, Anno M, Ito Y, Kitao S, et al. Hepatic insulin clearance is increased in patients with high HbA1c type 2 diabetes: A preliminary report. BMJ Open Diabetes Res Care 2020; 8: e001149.

[24] Patil S, Veerabhadra Goud GK, Shivashankar RN, Anusuya SK, Ganesh V. Association of adiponectin levels with polycystic ovary syndrome among Indian women. Bioinformation 2022; 18: 864–869.

[25] Li H, Meng Y, He S, Tan X, Zhang Y, Zhang X, et al. Macrophages, chronic inflammation, and insulin resistance. Cells 2022; 11: 3001.

[26] Ou M-Y, Zhang H, Tan P-C, Zhou S-B, Li Q-F. Adipose tissue aging: Mechanisms and therapeutic implications. Cell Death Dis 2022; 13: 300.

[27] Dewi RC, Rimawati N, Purbodjati P. Body mass index, physical activity, and physical fitness of adolescence. J Public Health Res 2021; 10: 2230.

[28] Moslehi N, Zeraattalab-Motlagh Sh, Rahimi Sakak F, Shab-Bidar S, Ramezani Tehrani F, Mirmiran P. Effects of nutrition on metabolic and endocrine outcomes in women with polycystic ovary syndrome: An umbrella review of meta-analyses of randomized controlled trials. Nutr Rev 2023; 81: 555–577.

[29] Hmedeh C, Ghazeeri G, Tewfik I. Nutritional management in polycystic ovary syndrome: Challenges and opportunities. International Journal of Food Safety, Nutrition and Public Health 2021; 6: 120–130.

[30] Akhavan NS, Pourafshar S, Johnson SA, Foley EM, George KS, Munoz J, et al. The relationship between Protein Intake and Source on Factors Associated with Glycemic Control in Individuals with Prediabetes and Type 2 Diabetes. Nutrients 2020; 12: 2031.

[31] Shirani F, Salehi-Abargouei A, Azadbakht L. Effects of dietary approaches to stop hypertension (DASH) diet on some risk for developing type 2 diabetes: A systematic review and meta-analysis on controlled clinical trials. Nutrition 2013; 29: 939–947.