This document discusses the relationship between diet and PCOS (polycystic ovarian syndrome). It notes that a woman's diet is responsible for PCOS and provides tips on eating a nutrient-dense diet to avoid PCOS and its comorbidities like diabetes and cardiovascular disease. The document also discusses snacking patterns in Indian adolescents which commonly include unhealthy snacks high in fat, salt, and sugar. It emphasizes the importance of prioritizing health, food, and lifestyle by choosing whole, minimally processed foods to support metabolic health and prevent conditions like PCOS.

1. Is our Diet responsible for
PCOS
Dr Sharda Jain
EAT
RIGHT
BABY
Dr Jyoti Agarwal

2. Your Diet is responsible for
PCOS
Dr Sharda Jain
EAT RIGHT
BABY
TO AVOID
PCOD

3. D
I
E
T

4. PCOS Lets Recap
• Leading cause of Female Infertility
• Assoc. with Co-morbidities:
: Type 2 Diabetes, Insulin Resistance
: Psychiatric Disorders, Cardiovascular disorders
: Endometrial Hyperplasia and Cancer
• Globally 15% women suffer from PCOS
India 1/3rd of Adolescent
→ high healthcare burden to a country
→ due to lack of clarity of origin of PCOS.
Ref. Dumesic, D.A. et al.Endocr.Rev. 36, 487–525

5. : CAN IT BE REVERSED ?
PCOS

6. : CAN IT PREVENTED ?
PCOS
TODAY

7. Take Away Message of this Lecture
Prioritize your Food,
Health and Lifestyle …. It's
Worth it !!!
01
Know the Important
Nutrients and Every Day
Foods.
02
Do Not Make ‘Sometime
Foods’ your ‘Every Day
Foods’.
03
Get Nutrient Density in
small portions.
04
Plan your week for nutrient
dense food options and
feel proud about it !!
05
EAT HEALTHY BABY
TO AVOID PCOD
06
Create a window of
activity break throughout
the day every 45 minutes.
07
Find time for 45 minutes of
exercise every day !!!... its
a PRESCRIPTION TODAY…
08
Be positive, Grateful and
smile !! Spend 15 to 20
minutes just with yourself
before you retire to bed.
09

8. Why is Women’s Health Important?
With puberty, women develop
unique nutritional
requirements.Anemia -60%
High risk for Micronutrient
deficiencies due to bad Nutrition
/ Obesity.
As children, boys’ and girls’ dietary needs are largely similar.
1
While women tend to need fewer calories than men, our requirements
for certain vitamins and minerals are much higher.
2
Women’s health influences the health of the next generation.
3

9. Unhealthy Nutrition
• Obesity
• Glucose intolerance
• Insulin Resistance
LEAN PCOS / OBESE PCOS

10. Children of PCOS Mothers at Puberty
• Intrauterine environment has been implicated in the origin of
PCOS in Girls / women.
• Puberty is a phase when there are profound changes in body
composition, Insulin Sensitivity and Sex Steroid production.
• Daughters of PCOS mothers (PCOSd) have been investigated and
found to have reproductive and metabolic disorders when they
reach Puberty.
Ref. Nicolas Crisosto et.al. Research Open Access, 2017, 607-613

11. Low Birth
weight due to
undernutrition
- ↑ risk of developing Metabolic Syndrome
- Obesity /PCOD /DM
- Hypertension
- Insulin Resistance
Ref. Desai 2013 et.al. Current Diabetes Reports 13 27–33.
Contd….
Large Birth weight
due to excessive
maternal nutrition
In Adult life
Due to epigenetic changes
in genes resp. for energy
conservation
Intra uterine Effect in PCOS

12. Ref. Dumesic DA, et.al. Clinical Endocrinology and Metabolism 101 4178–4188, Manneras-Holm L, et.al. Journal of Clinical
Endocrinology and Metabolism 96 E304–E311., Chang R & Dumesic D 2018 Clinical Management,
8th ed. Longo M, et.al. Diabetologia 61 369–380.
Normal glucose /Insulin
homeostasis
Normal weight Over weight
Small SC abdominal
adipocytes
↑ large adipocytes
protect fetus against insulin
resistance in humans
↑ regional Fat Depots
bet. 14-28 wks.
↑ abd. obesity
Hence abd. fat is
developmentally
programmed during early-
to-mid gestation
Effect of Maternal Obesity on baby of PCOS women

13. Metabolic Phenotypes
The phenotypes are usually identified using surrogate markers of insulin resistance, the number of metabolic
syndrome components, the amount of visceral fat, or the composition of cardiovascular risk factors.
Although many different definitions are used for metabolic health, insulin resistance is
regarded as the core pathophysiology
Lower degree of IR , <2
metabolic risk factors or
favourable metabolic
profiles even in patients
with BMI >25kg/m2
Higher degree of IR &
adiposity , >2 metabolic
risk factors even in
patients with BMI
<25kg/m2
Higher degree of IR &
metabolic abnormalities
>2 metabolic risk factors
in patients with BMI
>25kg/m2
BMI <25 kg/m2
and <2 metabolic risk
factor
Lee Et Al. Changes In Metabolic Health Status Over Time And Risk Of Developing Type 2 Diabetes. Medicine.2015, Metabolic Health And Weight: Understanding Metabolically Unhealthy Normal Weight Or Metabolically Healthy Obese
Patients. M E T A B O L I S M C L I N I C A L A N D E X P E R I M E N T A L 6 5 ( 2 0 1 6 ) 7 3 – 8 0. Indulekha Et Al. Metabolic Obesity, Adipocytokines, And Inflammatory Markers In Asian Indians—cures-124
JM 2022
Metabolically
Healthy Non-Obese
(MHNO)
Metabolically
Healthy, Obese
(MHO)
Metabolically
Unhealthy, Non-Obese
(MUHNO)
Metabolically
Unhealthy, Obese
(MUHO)

14. Genetic
Predisposition
 Sedentary Lifestyle
 Mechanised Transport
 Sleep Deprivation
 Increased Screen Time
 Free Radical damage
(Smoking. environmental
pollution, aging)
 Energy dense &
Nutrient poor diets
 Increased availability
of processed & fast
foods
 Endocrine disruptors
 Dietary AGE
Thin-Fat Indian Phenotype & Young Women
JM 2019
Papalou O, Kandaraki EA, Papadakis G and Diamanti-Kandarakis E (2019) Endocrine Disrupting Chemicals: An Occult Mediator of Metabolic Disease. Front. Endocrinol. 10:112.Clarke et al. Dietary Advanced Glycation End Products and Risk Factors for Chronic Disease: A Systematic
Review of Randomised Controlled Trials. Nutrients 2016
Yajnik 2004; Kurpad A, Kiruba V, Aerbeli I 2011, Misra A, Vikram NK, 2009
● Indians have higher body
fat and visceral fat
percentages at similar
BMIs- “Thin-Fat” Indian
diabetes phenotype.
● This leads to - Early onset
of diabetes mellitus and
metabolic derangements
Non-Asian Asian
% Body
Fat for
same
BMI
Metabolic Health: Maladaptation to the Modern World
Genetic
Factors
Lifestyle Factors Dietary Factors

15. Typical Day’s Diet of Indian Adolescents & Young Adults
 Unhealthy snacking patterns, skipping
meals (60%) and snacking in between
meals (70%) was observed among
adolescents and young adults.
 More than three- fourth (90%) of the
adolescents and young adults consumed
HFSS snacks and 35% consumed ultra-
processed snacks.
Jagmeet Madan1, Sharvari Desai2, Panchali Moitra1, Sheryl Salis1, Rekha Battalwar1, Soumik Kalita1, Ajay Phatak2, Shobha Udipi2, Rama Vaidya2, Ashok Vaidya Snacking Pattern and Its Association with Body Composition in Young Adults of Mumbai, India, Sir Vithaldas Thackersey College
of Home Science (Autonomous), SNDT Women’s University, Mumba, 2Kasturba Health Society’s Medical Research Centre, Mumbai, India
HFSS snacks & UPFs
Refined CHOs & Saturated fat
Meat
Dairy
Fruits Veggies Legumes
Cereals
Nuts

16. HFSS Snacks ?
Such foods referred to as Junk Foods are categorized as
HFSS foods i.e. foods that are
'High in Fat, Salt and Sugar’
by the World Health Organization (WHO).
Globally , OLD term Junk Foods  food items with little or no nutritional
value but high in salt, sugar and fat.

17. UPFs  Ultra Processed Food
Foods in the UPF category include
biscuits, mass-produced buns and breads, sweetened
cereals, margarines and spreads, packaged snacks, ice
cream, flavoured yogurts, soft drinks, powdered meals,
ready-made meals, and instant sauces and stocks.

18. Are refined carbohydrates worse than saturated fat?
An uptake in consumption of saturated fat does not
increase saturated fat levels in the blood,
but consuming more carbohydrates is related to
higher levels of fatty acids associated with adverse
health outcomes, according to a new study.

19. Does refined carbs increase cholesterol ?
Highly processed carbohydrates play a role in high cholesterol.
Carbohydrates give your body energy, but getting more than
60% of your daily calories from carbohydrates can increase your
cholesterol levels because your liver thinks it's time to make
more cholesterol.

20. Factors related to increasing waist circumference in Indians.
Potential Factors Related to Waist Circumference in Urban South Indian Children, R Kuriyan et al, Indian Pediatr 2012;49: 124-128
Games
 Sleep
TV
FBMI
MBMI
Fish
Chicken
SD
IFF
FF
Bakery
SBF 
EO
TV
 Sleep
Games
FBMI
MBMI
Fish
Chicken
SD
FJ
C
Egg
Sweets
Bakery
FF
SBF
EO

21. Snacking in India
60% of
Indian
consumers
snack
more than twice a day,
15% of them are
“super snackers”
who snack more than
four times a day.
The COVID  further boosted these figures

22. Results
Snacking
Patterns in
Adolescent
and Young
Adults
(Girls and Boys)
(Girls and Boys)
(Girls > Boys)

23. Metabolic Syndrome Criteria and India
Five Criteria of Metabolic Syndrome
● Waist circumference over 40 inches (men)
or
● 35 inches (women),
● Blood pressure over 130/85 mmHg,
● fasting triglyceride (TG) level
over 150 mg/dl,
● Fasting high-density lipoprotein (HDL < 50
in women)
● FBS >100MG
25%
(approximately
31% in women and
18.5% in men).

24. ● PCOD is one of the many many
● Manifestation on METABOLIC SYNDROME
IS RELATED TO INFLAMATTERY MARKERS
WHICH INTERN CAUSE DISEASE
Like
PCOD
Diabetes
hearth attack
Stroke & others

25. Inflammatory Markers & Metabolic Health
Indulekha et al. Metabolic Obesity, Adipocytokines, and Inflammatory Markers in Asian Indians—CURES-124. DIABETES TECHNOLOGY & THERAPEUTICS Volume 17, Number 2, 2015.
JM 2022
Metabolically
Healthy Non-Obese
(MHNO)
Metabolically
Healthy, Obese
(MHO)
Metabolically
Unhealthy, Non-Obese
(MUHNO)
Metabolically
Unhealthy, Obese
(MUHO)

26. Metabolic Health: d-AGE
P. ANGOORANI ET AL.Dietary consumption of advanced glycation end products and risk of metabolic syndrome. International Journal of Food Sciences and Nutrition. 2016
Dietary Advanced glycation end products (d-AGEs) also known as Glycotoxins are compounds formed
through nonenzymatic reaction between reducing sugars and free amino groups in proteins,lipids, or
nucleic acids
d-AGEs make a substantial contribution to the systemic burden through binding with their receptors
which is present in a wide range of differentiated adult cells including epithelial,
immune, and endothelial cells and therefore predispose individuals to oxidative stress (OS) and
inflammation, which play a major role in the causation of chronic diseases
d-AGE
Plasma levels of AGE
Weight gain
Progression & risk of diabetes
Glucose intolerance
Atherosclerotic lesions
Risk of Renal Failure
Plasma levels of AGE
Low-grade inflammation
Oxidative damage
Adipocyte Hypertropy
Metabolic & Cardiovascular Disease

27. d-AGE : Inflammation & Cardiometabolic Health
Yamagishi et al. Pathologic role of dietary advanced glycation end products in cardiometabolic disorders, and therapeutic intervention. Nutrition 32 (2016) 157–165
P
C
O
D

28. Ultra Processed Food
and Metabolic Health
PCOD

29. High Fructose Corn Syrup Intake  Negative effect on
Metabolic Health
Fructose metabolism pathway is
uncontrolled.
This causes a fall in ATP and increase
in uric acid that leads to oxidative
stress, inhibition of protein
synthesis, and mitochondrial
dysfunction,
This can further induce obesity,
insulin resistance, and fatty liver that
eventually manifest in global
metabolic syndrome.
Mai BH, Yan LJ. The negative and detrimental effects of high fructose on the liver, with special reference to metabolic disorders. Diabetes Metab Syndr Obes. 2019;12:821-826. Published 2019 May 27. doi:10.2147/DMSO.S198968

30. What are synthetic emulsifiers in food?
Synthetic emulsifiers are chemical ingredients that have been created
in a laboratory setting. Semi-synthetic emulsifiers are a combination of
glycerol and natural fatty acids extracted from animal or plant sources
This Hidden Ingredient Could Be Sabotaging Your Gut Health
 Overall Health

31. It is well known that a healthful diet is essential for supporting and maintaining a
diverse and stable gut microbiome. Vegetables, fruits, high-quality proteins, and
healthy fats are the foundation of a gut-healthy diet.
However, the sauces, dressings, condiments, breads, and convenience foods that we use to prepare and add to
our real-foods often contain ingredients that might be sabotaging our gut health / Obesity :
Emulsifiers

32. Effects of Synthetic Emulsifiers on Human Health
Partridge, D., Lloyd, K. A., Rhodes, J. M., Walker, A. W., Johnstone, A. M., & Campbell, B. J. (2019). Food additives: Assessing the impact of exposure to permitted emulsifiers on bowel and
metabolic health - introducing the FADiets study. Nutrition bulletin, 44(4), 329–349.
Leaky
Gut

33. High Trans-Fat Intake  Sterile Inflammation
Oteng, A. B., & Kersten, S. (2020). Mechanismsof Action of trans Fatty Acids. Advances in nutrition(Bethesda, Md.), 11(3), 697–708. https://doi.org/10.1093/advances/nmz125
In a randomized controlled trial in
healthy people a diet containing
8% of daily energy from industrial
trans fatty acids caused a 3.4-fold
increase in plasma concentrations
of C-reactive protein (CRP)
after 5 wk of intake compared to a
control diet with no trans fatty
acids.

34. Diet High in Ultra-Processed Food
All Spectrum is related to PCOD also

35. FSSAI and Ultra Processed Foods
Every packaged food except those exempted
from nutritional information under these
regulations, shall display the prescribed
format (INR) on front of pack calculated on
the basis of contribution of energy (in kilo
calories; kcal), saturated fat (g), total sugar
(g) and sodium (mg) and the positive
nutrients per 100 g of solid food or 100 ml of
liquid food on a “as sold‟ basis
Indian Nutrition Rating (INR)
FSSAI definition of HFSS
“Processed food product which has high levels of saturated fat or total sugar or sodium. The declared values of these
ingredients are such that the product; does not satisfy the value of energy (kcal) from total sugar less than 10 percent of
total energy, or from saturated fat 10 percent of total energy, and sodium less than 1 mg/1 kcal.”

36. Indian Nutrition Rating (INR): 1 to 5 Star Rating
½ % star (least healthy) to
5 stars (healthiest).
More stars indicate the food product is better
positioned to provide for the daily human need of
nutrients.

37. CHO Quality and
Metabolic Health PCOD

38. Blood Sugar PEAKING NOT GOOD  All complications
https://ihealthlabs.com/blogs/education/different-carbohydrates-and-their-effects-on-blood-glucose
Blood
Sugar
PEAKING
Is related
to
glycemic
index

39. Resistant Starch / Fibre for metabolic health
JM 2022
Data presented as mean ± SD
What is a resistant starch?
Resistant starches
are carbohydrates that do
not break down into sugar
and are not absorbed by the
small intestine. Similar to
insoluble fibre, they pass
through most of the
digestive system unchanged

40. Nigudkar, Curr. Res. Nutr Food Sci Jour., Vol. 2(2), 73-83 (2014)
Food Sample RS (g/100g)
Basmati Rice 20.22
Kolam Rice 27.67
Whole Wheat
Flour
0.50
Refined Wheat
Flour
0.65
Whole Moong 4.52
Kabuli Chana 1.93
Chana Flour 1.98
Content of Resistant Starch in Indian Foods

41. Effect of Almond Consumption on Glucose Metabolism,
Hyperinsulinemia and Selected Markers of Inflammation:
A Randomized Controlled Trial in Adolescents and Young
Adults in Mumbai, India
Jagmeet Madan1, Panchali Moitra1, Sharvari Desai2, Sheryl Salis1, Rekha
Battalwar1, Soumik Kalita1, Ajay Phatak2, Shobha Udipi2, Rama Vaidya2,
Ashok Vaidya2

42. Conclusion:
- Almonds → Beneficial effect on HbA1C, hyperinsulinemia, IR, lipid
profile & inflammatory markers at an early stage that even precede
prediabetes
- Inclusion of almonds as a part of a balanced diet has the potential
to be a nutritional food based strategy to prevent progression to
further metabolic dysfunction, prediabetes & further into T2DM

43. Dietary Antioxidants
and Metabolic Health
(Fruits and Vegetables)
50-75
%
Big tip for PCOD patient Plant
Protein

44. Antioxidant Food Table for Berries, Fruits and Vegetables
Carlsen, M.H., Halvorsen, B.L., Holte, K. et al. The total antioxidant content of more than 3100 foods, beverages, spices, herbs and supplements used worldwide. Nutr J 9, 3 (2010). https://doi.org/10.1186/1475-2891-9-3

45. ORAC (Oxygen Radical Absorbance Capacity)of Selected Fruits
Wang, Hong; Cao, Guohua; Prior, Ronald L. (1996). Total Antioxidant Capacity of Fruits. , 44(3), 701–705. doi:10.1021/jf950579y
Antioxidant effects

46. Dietary
Determinants
& Lifestyle
Factors
Metabolic
Health
Components
• Quality CHO (Complex CHO &
dietary fibre) in rationed amounts
• Good quantity & quality of
proteins with emphasis on Plant
Proteins
• Good quality fats through
invisible sources
• Abundance Vitamins & Minerals
& Phytochemicals Low AGE &
Obesogens
• Regular Physical Activity &
Quality Sleep
Inflammatory Biomarkers
Insulin Resistance
Obesity
What Diet You eat -- you become- CHOICE IS YOURS !

47. What does healthy eating look like?
Close to
Natural food
No
processed
food

48. Take Away Messages-To Avoid PCOD
Prioritize your Food,
Health and Lifestyle …. It's
Worth it !!!
01
Know the Important
Nutrients and Every Day
Foods.
02
Do Not Make ‘Sometime
Foods’ your ‘Every Day
Foods’.
03
Get Nutrient Density in
small portions.
04
Plan your week for nutrient
dense food options and
feel proud about it !!
05
Demand Healthy and
Nutrient Dense Food at
Workplace.
06
Create a window of
activity break throughout
the day every 45 minutes.
07
Find time for 45 minutes of
exercise every day !!!... its
a PRESCRIPTION TODAY…
08
Be positive, Grateful and
smile !! Spend 15 to 20
minutes just with yourself
before you retire to bed.
09
Disease of civilization can be prevented / reversed by lifestyle changes

49. CAN BE REVERSED
PCOS

50. YOU GIVE HER HOPE
PLUS
PROMISE OF SAFETY
By Proper Advising
on Diet

51. Please Remember
PCOD can be prevented / reversed