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Background: Women with polycystic ovary syndrome (PCOS) have higher intestinal mucosal permeability, leading to the lipopolysaccharide (LPS) leakage and endotoxemia. This, in turn, leads to oxidative stress (OS) and neuro-inflammation caused by the gut-brain axis, affecting the neurotrophic factors levels such as brain-derived neurotrophic factor (BDNF) and S100 calcium-binding protein B (S100 B) levels. In this study, it was hypothesized that the thylakoid membranes of spinach supplementation along with a hypocaloric diet may have improved the LPS levels, neurotrophic factors, and OS in PCOS patients., Methods: In this double-blind, randomized, placebo-controlled, and clinical trial, 48 women with obesity and diagnosed with PCOS based on Rotterdam criteria were randomly assigned to thylakoid (N = 21) and placebo groups (N = 23). A personalized hypocaloric diet with 500 calories less than the total energy expenditure was prescribed to all patients. The participants were daily supplemented with either a 5 g/day thylakoid-rich spinach extract or a placebo (5 g cornstarch) for 12 weeks along with a prescribed low-calorie diet. Anthropometric measurements and biochemical parameters were assessed at baseline and after the 12-week intervention., Results: A statistically significant decrease in the LPS levels (P < 0.001) and an increase in the BDNF levels (P < 0.001) were recorded for the participants receiving the oral thylakoid supplements and a low-calorie diet. Furthermore, significant decreases were observed in fasting blood glucose, insulin, homeostatic model of assessment for insulin resistance, free testosterone index, and follicle-stimulating hormone / luteinizing hormone ratio in both groups (P < 0.05). No significant differences were detected between the two groups regarding the changes in malondialdehyde, catalase, total antioxidant capacity, and S100B levels (P > 0.05)., Conclusions: In sum, the thylakoid membranes of spinach supplemented with a hypocaloric diet reduced the LPS levels, increased the BDNF levels, and improved the glycemic profile and sex-hormone levels; however, they had no effects on the OS markers levels after 12 weeks of intervention., (© 2023. The Author(s).)

Background: There is a promising outlook regarding the potential effect of spinach-derived thylakoids in the management of obesity and its associated metabolic disturbances. This research aimed to evaluate the effects of spinach-derived thylakoids supplementation combined with a calorie-restricted diet on anthropometric and metabolic profiles in obese women with the polycystic ovary syndrome (PCOS)., Methods: In a 12-week double-blind placebo-controlled randomized clinical trial, 48 females with obesity and PCOS were randomly allocated into either intervention (5 g/day thylakoid) or placebo (5 g/day cornstarch) groups along with calorie-restricted diets. Anthropometric measures, physical activity levels, dietary intakes, insulin resistance markers, as well as serum levels of insulin, fasting blood glucose (FBG), non-esterified fatty acids (NEFA), and sex hormones including dehydroepiandrosterone sulfate (DHEAS), follicle-stimulating hormone (FSH), luteinizing hormone (LH), sex hormone-binding globulin (SHBG), and free androgen index (FAI) were evaluated pre-and post-intervention., Results: After the 12-week intervention, there were significant decreases in weight (- 6.97 ± 0.52 vs. -3.19 ± 0.72 kg; P < 0.001), waist circumference (- 7.78 ± 2.50 vs. -3.73 ± 1.40 cm; P < 0.001), fat mass (- 5.19 ± 0.53 vs. -1.36 ± 0.39 kg; P < 0.001), and insulin levels (- 5.40 ± 1.86 vs. -1.19 ± 0.85 μU/mL; P < 0.001) in the spinach-derived thylakoid group compared to the placebo group. Furthermore, insulin resistance markers and serum levels of testosterone decreased significantly in the thylakoid group compared to the placebo group (P < 0.05). The changes in other parameters did not show significant differences between the two groups., Conclusions: Spinach-derived thylakoid supplementation resulted in more favorable improvements in anthropometric indices and insulin sensitivity compared to the calorie restriction alone., Trial Registration: The study was approved by the Ethics Committee of Research Vice-chancellor of Tabriz University of Medical Sciences, Tabriz, Iran, and was registered in the Iranian Registry of Clinical Trials (registration ID: IRCT20140907019082N9 ).

Polycystic ovary syndrome (PCOS) is a polygenic endocrine disorder and the most common gynecological endocrinopathy among reproductive-aged women. Current remedies are often used only to control its signs and symptoms, while they are not thoroughly able to prevent complications. Quercetin is an herbal bioactive flavonoid commonly used for the treatment of metabolic and inflammatory disorders. Thus, this systematic review was conducted to evaluate the efficacy of quercetin supplementation in subjects with PCOS. Databases until March 2019 were searched. All human clinical trials and animal models evaluating the effects of quercetin on PCOS women were included. Out of 253 articles identified in our search, 8 eligible articles (5 animal studies and 3 clinical trials) were reviewed. The majority of studies supported the beneficial effects of quercetin on the ovarian histomorphology, folliculogenesis, and luteinisation processes. The effects of quercetin on reducing the levels of testosterone, luteinizing hormone (LH), and insulin resistance were also reported. Although quercetin improved dyslipidemia, no significant effect was reported for weight loss. It is suggested that the benefits of quercetin may be more closely related to antioxidant and anti-inflammatory features of quercetin rather than weight-reducing effects. Therefore, this review article provides evidence that quercetin could be considered as a potential agent to attenuate PCOS complications. However, due to the paucity of high-quality clinical trials, further studies are needed.

Background. Hyperandrogenism is a common disorder in women with polycystic ovary syndrome (PCOS) that can cause changes in body fat distribution and the amount of visceral adipose tissue. Visceral adiposity impairs insulin action, leading to insulin resistance (IR), cardiovascular disease, and renal disorders due to obesity and insulin resistance. Dietary thylakoids reduce visceral fat mass by suppressing appetite and regulating body weight. The present trial aimed to evaluate the fat distribution and renal function after thylakoid membranes of spinach supplementation along with a hypo-caloric diet. Methods. Forty-four obese women with PCOS participated in this randomized, double-blind, placebo-controlled clinical trial for 12 weeks and were allocated to receive 5 gr of thylakoid membranes of spinach extract combined with hypo-caloric diet or 5 gr placebo along with a hypo-caloric diet. Novel atherogenic and anthropometric indices including the atherogenic index of plasma (AIP), Castelli risk index I (CRI-I), Castelli risk index II (CRI-II), TyG-BMI (TyG-BMI), metabolic score for insulin resistance (METS-IR), abdominal volume index (AVI), body adiposity index (BAI), a body shape index (ABSI), and serum urea, creatinine, and total protein were assessed at the baseline and end of the intervention period. Results. Thylakoid membranes of spinach supplementation along with a calorie restriction diet showed a significant decrease in the AIP, CRI-I, II, TyG-BMI, and METS-IR (P < 0.05). AVI, BAI, and ABSI were found to reduce in the thylakoid and placebo groups (P < 0.05). However, the changes in serum urea, creatinine, and total protein did not show significant differences between the intervention and placebo groups. Conclusion. After 12-week supplementation with thylakoid membranes extracted from spinach, improvements in the value of atherogenic indices and insulin resistance surrogate markers were observed, while this intervention did not make a significant difference in the serum levels of renal function factors. This trial is registered with IRCT20140907019082N9. [ABSTRACT FROM AUTHOR]

This trial evaluated the effects of thylakoid‐rich spinach extract supplementation combined with a hypocaloric diet on body composition and serum levels of neopterin, chemerin, and omentin‐1 in obese women with polycystic ovary syndrome (PCOS). In this randomized controlled trial, 48 obese women with PCOS, aged 20–45 years old, were recruited and randomly divided into thylakoid (n = 24) and placebo (n = 24) groups. They received a low‐calorie diet with 5 g/day thylakoid‐rich spinach extract or a low‐calorie diet with 5 g/day placebo for 12 weeks. The mean age of the participants of the thylakoid group was 31.86 years, and the placebo group was 32.04 years. Thylakoid‐rich spinach extract supplementation with a low‐calorie diet increased serum levels of omentin‐1 (10.90 vs. 3.87 ng/L; p <.001) and decreased fat mass (−5.19 vs. −1.35 kg; p <.001) and serum levels of neopterin (−0.66 vs. −0.38 nmol/L; p =.003) and chemerin (−41.24 vs. −11.26 ng/L; p <.001) in the thylakoid group compared to the placebo group. A significant improvement in omentin‐1, chemerin, and neopterin by thylakoid‐rich spinach extract supplementation was under the influence of weight change and insulin resistance status throughout the study. A significant decrease in the other anthropometric indices and insulin resistance was also observed in the thylakoid group, compared to the placebo group (p <.001, for all parameters). Thylakoid‐rich spinach extract combined with a low‐calorie diet increased circulating omentin‐1 and decreased fat mass, abdominal obesity, as well as circulating chemerin, neopterin, and insulin in obese women with PCOS. [ABSTRACT FROM AUTHOR]