The role of diet composition in PCOS needs further study. In particular, the utility of the gastrointestinal system in assisting energy restriction in PCOS needs to be assessed, as does the effect of high-protein and low-carbohydrate diets on satiety in this group. More data on the type and intensity of physical activity required to improve reproductive performance is needed. Whether this is modified by a concomitant energy-restricted diet will guide the development of well-defined lifestyleintervention programs. These programs need to be tailored to PCOS patients and evaluated against and in addition to metformin. Understanding the motivation of responders and nonresponders to lifestyle intervention, both behavioral and metabolic, will also assist in tailoring clinical management of PCOS.
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