Purpose: To clarify the current, evidence-based guidelines for the lifestyle management of PCOS and understand research gaps, specifically as they relate to adolescent support.

Methods: Systematic review and meta-analyses were conducted to evaluate the current evidence for the utility of lifestyle interventions in general, specific diet or physical activity interventions, behavioural interventions and to assess the reasons for higher weight gain and impact of weight stigma for the treatment and management of PCOS. When sufficient data were available to make an evidence-based recommendation, the recommendation was based on the certainty of evidence and strength of the recommendation following review of individual studies. In absence of sufficient data in PCOS, consensus recommendations and practice points were provided.

Results: Evidence-based recommendations (EBR) were made across all domains except for behavior strategies for the treatment or PCOS, although the quality of evidence for the EBRs were low or very-low confidence in the effect estimate. The high frequency of clinical recommendations and practice points underscore the lack of data in individuals with PCOS. Focusing on dietary interventions for the management of PCOS, the EBR advises that no one type of diet favoring macro- or micronutrient composition shows benefit for the management of PCOS across physiological or psychological outcomes, with very low certainty in the effect estimate. While details of the recommendations will be outlined in the presentation, the lack of data among adolescents with PCOS was noted.

Conclusion: The 2023 International Guideline summarizes all of the available evidence using lifestyle management of PCOS; however, these data are largely in adult populations. Whether lifestyle interventions early in the PCOS diagnosis confers additional benefit to mitigate the chronic disease burden of PCOS remains unknown and unaddressed.

Purpose: To characterize goal setting by registered dietitians (RDs) and identify barriers and facilitators to nutrition and lifestyle modifications for adolescents newly diagnosed with polycystic ovary syndrome (PCOS) at a multi-specialty PCOS clinic.

Methods: A retrospective chart review was conducted of RD nutrition notes recorded into the medical record of adolescents newly diagnosed with PCOS at the Children’s Mercy Kansas City Hospital multi-specialty PCOS clinic between 2015-2020. Nutrition notes were extracted, de-identified, and coded using open coding and a priori objectives. Goals, barriers, and facilitators were characterized for emerging themes using qualitative content analysis.

Results: Of the 118 nutrition notes, the majority recorded 3 or more goals set with the adolescent at the end of the session (7 notes recorded 0 goals, 10 recorded 1 goal, 40 recorded 2 goals, and 61 recorded ³3 goals). The goals covered four major themes: incorporation of the MyPlate/plate model, modifying carbohydrate intake, incorporate or increase physical activity, and little focus on weight reduction despite most patients having obesity (70%). Further thematic analysis identified five major themes that highlight both barriers and facilitators to behavior change in adolescents with PCOS: interest and motivation, family involvement, resources and food environment, taste preferences, and perceived behavioral control and competence.

Conclusion: RDs are critical in supporting lifelong dietary and lifestyle management of PCOS. Goal setting is a strategy used to help identify specific behaviors to change and plan associated courses of action. However, the potential burden of too many goals was noted. Adolescents with PCOS report several intrapersonal, interpersonal, and environmental barriers and facilitators that may affect their ability to establish and act upon these goals. Further research will explore the impact of goal-setting strategies and nutritional counseling on long-term behavior change and PCOS outcomes in adolescents with newly diagnosed PCOS.

Purpose: To determine whether dietary intake and social determinants of dietary intake are associated with the development of PCOS symptoms in the early post-menarcheal years.

Methods: Dietary intake was evaluated via two 24-hour diet recalls at 6-10, 12-, 18-, and 24-months post-menarche in n=26 adolescents participating in a prospective cohort study (Clinicaltrials.gov NCT04424576). A fasting blood draw, anthropometry, and hirsutism score were also conducted. Menstrual diaries were maintained by participants during the study. In our pilot analysis, dietary data from 6-10- and 12-months post-menarche were patterned for adherence to a Mediterranean-style Diet, Healthy-Eating Index, and their respective individual dietary components. The degree to which dietary intake at predicted symptoms of PCOS and/or PCOS risk at the end of the study (n=4 at 18 months, n=22 at 24 months) was determined using generalized mixed models, adjusting for race, household income, total caloric intake, and baseline BMI. For continuous variables, random effects of study site were included.

Results: Low-fat/non-fat dairy intake at 12 months post-menarche reduced the likelihood of PCOS risk at the end of the study(p<0.05). Red meat intake (g/1000kcal/day) at 12 months post-menarche tended to predict menstrual irregularity (p<0.1), whereas red meat intake at 6-10 months post-menarche was associated with free androgen index (p=0.05). Higher hirsutism scores were associated with lower intakes of legumes (p=0.02), vegetables (p=0.04), and whole grains (p=0.02) at 6-10 months post-menarche. Overall dietary patterns and other dietary components were not significant predictors of reproductive symptoms or PCOS risk in this analysis.

Conclusion: Dietary intake during the early post-menarcheal years is independently associated with evidence of reproductive dysfunction consistent with a trajectory towards PCOS. Research is underway to model dietary intake over time through 2 years post-menarche and to expand these findings in a larger cross-sectional cohort with inclusion of assessments of food insecurity and food environment.