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Objective To investigate the effects of a balanced nutrient diet combined with metformin on glucose and lipid metabolism in patients with polycystic ovary syndrome (PCOS). Methods This was a single-center, non-randomized controlled study. From January 2019 to June 2020, outpatients and inpatients diagnosed with PCOS in the Department of Endocrinology, Jingxi District of Beijing Chaoyang Hospital Affiliated to Capital Medical University were enrolled as the study subjects, and they were given a 6-month standardized balanced nutrient diet combined with metformin intervention. Height, weight, triglyceride (TG), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), fasting insulin (FINS), fasting plasma glucose (FPG), glycated hemoglobin A1c (HbA1c), glutamic pyruvic transaminase (ALT), glutamic oxaloacetic transaminase (AST), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol and testosterone were measured before and after the intervention. Body mass index (BMI), homeostasis model assessment of insulin resistance (HOMA-IR), homeostasis model assessment of β-cell function (HOMA-β), quantitative insulin sensitivity check index (QUICKI) and LH/FSH ratio were calculated. PCOS patients were divided into A group [hypoovulatory and/or anovulatory+clinical and/or biochemical signs of hyperandrogenism+ovarian polycystic], B group [hypoovulatory and/or anovulatory+clinical and/or biochemical signs of hyperandrogenism], C group [clinical and/or biochemical signs of hyperandrogenism+ovarian polycystic], and D group [hypoovulatory and (or) Anovulatory+ovarian polycystic] according to international guidelines. Paired t test or Wilcoxon signed rank test were used to compare the indexes before and after the intervention. Results A total of 92 PCOS patients were enrolled in the study before intervention, and 71 patients completed the standardized treatment of balanced nutrient diet combined with metformin for 6 months, including 17 cases in group A, 29 cases in group B, 1 case in group C, and 24 cases in group D. Compared with before intervention, after 6 months of balanced nutrient diet combined with metformin intervention, the overall body weight, BMI, TG, LDL-C, FPG, HbA1c, HOMA-IR and HOMA-β, testosterone and LH/FSH ratio of 71 PCOS patients were decreased, while estradiol, HDL-C and QUICK index were increased (all P<0.05). The effects of the standardized treatment on different phenotypes were analyzed. The results showed that after 6 months of intervention, HDL-C of PCOS patients in groups A, B and D were all increased compared with before intervention, while LDL-C of group A was decreased. In group B, body weight, BMI, TG, FPG and HOMA-β were all decreased. In addition to reduced body weight and BMI, the liver enzymes ALT and AST were also decreased in type D group (all P<0.05). Conclusions A balanced nutrient diet combined with metformin can improve glucose and lipid metabolism disorders in PCOS patients, and promote the recovery of hormone levels. The therapeutic effect varied in PCOS patients with different phenotypes. [ABSTRACT FROM AUTHOR]