The purpose of the VLCKD randomized clinical trial is to demonstrate the superiority of very low calorie ketogenic diet with respect to the standard low calorie diet in reducing body weight and insulin resistance in obese and insulin resistant patients with Polycystic Ovary Syndrome
Consecutive patients coming to the Endocrinology and Diabetes Clinic of the S.Orsola hospital in Bologna with the suspicion of PCOS, during the study period, will be eligible to participate. In the screening phase, patients from the clinic conforming to the inclusion criteria will be invited to participate in the anovulation screening phase, lasting up to 8 weeks, during which measurements of LH, FSH, estradiol, progesterone and a gynecologic ultrasound will be done on 7th, 14th, 21st and 28th day of the presumed ovulatory cycle, or at any time if amenorrhea present. Consenting participants will provide written informed consent. Following the anovulation screening, the patients will be randomized in two arms of the study: 1. very low calorie ketogenic diet (VLCKD) and the 2. low calorie standard diet (LCD). The study is open label; thus, patients and investigators will not be blinded to treatment allocation due to the nature of the study intervention. The group assigned to the VLCKD will follow the VLCKD for 8 weeks, after which they will follow the LCD for the next 8 weeks. The group assigned to the LCD will follow the LCD for the entire length of the study (16 weeks.) At the start of the study, after 8 weeks and after 16 weeks, following measurements and tests will be done: 1. clinical examination with the measurement of height, body mass, circumference at the waist and hip level, arterial systolic and diastolic pressure, heart rate, Ferriman-Gallwey and videodermoscopic evaluation of hirsutism and bioimpedance body composition measurement; 2. blood will be taken for: lipid profile, hepatic transaminases, fasting glucose, fasting insulin, HbA1c, potassium, sodium, urea, calcium, phosphorus, total proteins, albumins, total bilirubin, uric acid, complete blood count, sex hormone binding globulin (SHBG), liquid chromatography-mass spectrometry measurement of testosterone, androstenedione, DHEA, 17OH-progesterone, 17OH-pregnenolone; 3. dietary interview; 4. psychological evaluation using the following questionnaires: Symptom Questionnaire, the Psychosocial index and the Psychological Well-Being scales.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
30
Dietary intervention with a very low calorie ketogenic diet, using commercial products of the Pronokal PnK® method
Low calorie standard diet with no specified dietary supplement addition
Unit of Endocrinology and Prevention and Care of Diabetes, S.Orsola Hospital
Bologna, Italy
Change in Body mass index
Weight and height will be combined to report BMI in kg/m\^2
Time frame: 16 weeks after the start of treatment
Change in body composition measured by bioimpedentiometry
Fat mass and lean mass changes will be considered to estimate change in body composition and reported as %
Time frame: 16 weeks after the start of the treatment
Change in Body mass index
Weight and height will be combined to report BMI in kg/m\^2
Time frame: 8 weeks after the start of treatment
Change in body composition measured by bioimpedentiometry
Fat mass and lean mass will be considered to estimate change in body composition and reported as %
Time frame: 8 weeks after the start of the treatment
Change in Homeostasis Model Assessment Index
Fasting glucose in mmol/L and fasting insulin in mcU/mL will be combined to report Homeostasis Model Assessment Index
Time frame: 16 weeks after the start of the treatment
Change in frequency of menstrual cycles
Number of menses in the 16 weeks before will be considered to report the frequency of menstrual cycles
Time frame: 16 weeks after the start of the treatment
Change in hirsutism
Modified Ferriman-Gallwey score will be used to measure changes in hirsutism; the minimum and maximum values are 4 and 36 respectively; higher score means a worse outcome
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Time frame: 16 weeks after the start of the treatment
Change in plasma concentrations of testosterone
testosterone will be reported in ng/mL
Time frame: 16 weeks after the start of the treatment