BACKGROUND Lifestyle (dietary and/or physical activity [PA]) modification is recommended as first-line therapy to manage polycystic ovary syndrome (PCOS). Current recommendations are based on healthy lifestyle practices for the general public since evidence for unique lifestyle approaches in PCOS is limited and low quality. OBJECTIVE AND RATIONALE We aimed to synthesize evidence on dietary and PA behaviors between women with PCOS and those without PCOS. Primary outcomes were overall diet quality, total energy intake and total PA, and secondary outcomes included macronutrients, micronutrients, food groups, foods, glycemic indices, sedentary time and sitting levels. We conducted this work to identify any unique lifestyle behaviors in women with PCOS that could underlie the propensity of weight gain and obesity in PCOS and be targeted for precision nutrition and PA interventions. These findings could be used to inform future practice recommendations and research that more effectively address complications (weight gain, obesity, diabetes, infertility, cardiovascular disease and mental health) in this high-risk population. SEARCH METHODS Databases of MEDLINE, Web of Science, Scopus and CINAHL were searched until 15 February 2022 to identify observational studies documenting dietary and PA behaviors between women with PCOS and without PCOS (Controls). Studies on children, adolescents (<18 years), pregnant or menopausal-aged women (>50 years) were excluded. Data were pooled by random-effects models and expressed as (standardized) mean differences (MD) and 95% CIs. The risk of bias was assessed by the Newcastle-Ottawa scale (NOS). OUTCOMES Fifty-four studies (N = 39 471 participants; [n = 8736 PCOS; 30 735 Controls]) were eligible (96%; [52/54] NOS scores ≥ 7). Women with PCOS had higher cholesterol (MD: 12.78, 95% CI: 1.48 to 24.08 mg/day; P = 0.03; I2 = 19%), lower magnesium (MD: -21.46, 95% CI: -41.03 to -1.91 mg/day; P = 0.03; I2 = 76%), and a tendency for lower zinc (MD: -1.08, 95% CI: -2.19 to -0.03 mg/day; P = 0.05; I2 = 96%) intake, despite lower alcohol consumption (MD: -0.95, 95% CI: -1.67 to 0.22 g/day; P = 0.02; I2 = 0%) versus Controls. Also, women with PCOS had lower total PA (standardized mean difference: -0.38, 95% CI: -0.72 to 0.03; P = 0.03; I2 = 98%). Conversely, energy, macronutrients (carbohydrate, fat, protein, fiber), micronutrients (folic acid, iron, calcium, sodium), glycemic index and glycemic load were similar (all: P ≥ 0.06). Most eligible studies reported lower total adherence to healthy eating patterns or poorer consumption of major food groups (grains, fruits, vegetables, proteins, seeds, nuts, dairy) in women with PCOS, as described narratively since variable study methodology did not permit meta-analyses. WIDER IMPLICATIONS Collective evidence supports that women with PCOS have a lower overall diet quality, poorer dietary intakes (higher cholesterol, lower magnesium and zinc) and lower total PA, despite lower alcohol consumption versus those without PCOS. Considerable heterogeneity among studies reinforces the need for research to address any relative contributions of other factors (e.g. genetic, metabolic or sociodemographic) to the observed differences. These clarifications may contribute to future evidence-based guideline recommendations on monitoring and managing PCOS in the era of precision lifestyle medicine.

中文翻译：

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多囊卵巢综合征和非多囊卵巢综合征女性饮食和身体活动行为的比较：对 39 471 名女性的系统回顾和荟萃分析。

背景 生活方式（饮食和/或身体活动 [PA]）的改变被推荐作为治疗多囊卵巢综合征 (PCOS) 的一线疗法。目前的建议是基于普通大众的健康生活方式实践，因为 PCOS 独特生活方式方法的证据有限且质量低下。目的和基本原理 我们的目的是综合 PCOS 女性和非 PCOS 女性之间饮食和 PA 行为的证据。主要结果是总体饮食质量、总能量摄入和总 PA，次要结果包括常量营养素、微量营养素、食物组、食物、血糖指数、久坐时间和坐姿水平。我们进行这项工作是为了确定患有 PCOS 的女性的任何独特的生活方式行为，这些行为可能是 PCOS 体重增加和肥胖倾向的基础，并作为精准营养和 PA 干预的目标。这些发现可用于为未来的实践建议和研究提供信息，以更有效地解决这一高危人群的并发症（体重增加、肥胖、糖尿病、不孕症、心血管疾病和心理健康）。搜索方法 搜索了截至 2022 年 2 月 15 日的 MEDLINE、Web of Science、Scopus 和 CINAHL 数据库，以确定记录患有 PCOS 和未患有 PCOS 的女性（对照组）之间的饮食和 PA 行为的观察性研究。排除了对儿童、青少年（<18 岁）、孕妇或绝经期妇女（>50 岁）的研究。数据通过随机效应模型汇集并表示为（标准化）平均差 (MD) 和 95% CI。通过纽卡斯尔-渥太华量表 (NOS) 评估偏倚风险。结果 54 项研究（N = 39 471 名受试者；[n = 8736 名 PCOS；30 735 名对照]）符合条件（96%；[52/54] NOS 评分≥ 7）。患有 PCOS 的女性胆固醇较高（MD：12.78，95% CI：1.48 至 24.08 mg/天；P = 0.03；I2 = 19%），镁含量较低（MD：-21.46，95% CI：-41.03 至 -1.91 mg /天；P = 0.03；I2 = 76%），以及锌摄入量较低的趋势（MD：-1.08，95% CI：-2.19 至 -0.03 mg/天；P = 0.05；I2 = 96%），尽管与对照组相比，酒精摄入量较低（MD：-0.95，95% CI：-1.67 至 0.22 克/天；P = 0.02；I2 = 0%）。此外，PCOS 女性的总 PA 较低（标准化平均差：-0.38，95% CI：-0.72 至 0.03；P = 0.03；I2 = 98%）。相反，能量，宏量营养素（碳水化合物、脂肪、蛋白质、纤维）、微量营养素（叶酸、铁、钙、钠）、血糖指数和血糖负荷相似（均：P≥0.06）。大多数符合条件的研究报告说，患有 PCOS 的女性对健康饮食模式的总体依从性较低或主要食物类别（谷物、水果、蔬菜、蛋白质、种子、坚果、乳制品）的摄入量较差，正如叙述性描述的那样，因为变量研究方法不允许元-分析。更广泛的意义 集体证据支持，尽管饮酒量低于未患 PCOS 的女性，但患有 PCOS 的女性总体饮食质量较低、饮食摄入量较差（胆固醇较高、镁和锌较低）和总 PA 较低。研究之间相当大的异质性强化了研究解决其他因素（例如遗传，代谢或社会人口学）到观察到的差异。这些澄清可能有助于未来在精准生活方式医学时代监测和管理 PCOS 的循证指南建议。