Ovary Syndrome and Vitamin D
DOI:
https://doi.org/10.33448/rsd-v11i11.31907Keywords:
Polycystic Ovarian Syndrome; Vitamin D; Insulin resistance; Calcitriol.Abstract
The polycystic ovary syndrome (PCOS) is one of the most common endocrine dysfunctions above women in reproductive age. Because it's a disease of undefined and complex etiology, the search for new approaches for the management of the symptoms in PCOS through non-pharmacological methods have grown. The deficiency of vitamin D is associated with the severity of the symptoms of the disease, therefore, there are hipotesis about the potential benefit of the vitamin on the management of PCOS. In addition, vitamin D acts in different tissues, including insulin secretor beta-pancreatic cells. The present review had as its goal to identify and explain the main benefits related to biochemical parameters that verify insulin resistance (IR) with vitamin D supplementation in women with PCOS. An integrative review of the literature was made with sources from the last 10 years that used this vitamin's supplementation as an intervention strategy. In the 10 articles, it can be concluded that the efficiency of vitamin D supplementation remains still hypothetical on insulin response of women diagnosed with the disease, but it is a promising intervention. It was possible to identify metabolic and physiological parameters that justify the relation between the vitamin and the diseases' metabolism, nevertheless, until the present moment, concrete evidence of the supplementation's efficacy against symptoms lacks. Even though keeping adequate levels of vitamin D is essential to all human beings, more studies are needed to determine the action of vitamin D on improvement of clinical parameters of PCOS.
References
Anagnostis, P., Karras, S., & Goulis, D. G. (2013). Vitamin D in human reproduction: A narrative review. International Journal of Clinical Practice, 67(3), 225–235. 10.1111/ijcp.12031.
Assunção, C. M. V., & Carvalho, L. M. F. de. (2021). Condutas nutricionais no cuidado das manifestações da Síndrome dos Ovários Policísticos. Research, Society and Development, 10(17), e24101724260. 10.33448/rsd-v10i17.24260
Balen, A. (2004). The pathophysiology of polycystic ovary syndrome: Trying to understand PCOS and its endocrinology. Best Practice & Research. Clinical Obstetrics & Gynaecology, 18(5), 685–706. 10.1016/j.bpobgyn.2004.05.004.
Barber, T. M., & Franks, S. (2021). Obesity and polycystic ovary syndrome. Clinical Endocrinology, 95(4), 531–541. 10.1111/cen.14421.
Bonakdaran, S., Mazloom Khorasani, Z., Davachi, B., & Mazloom Khorasani, J. (2012). The effects of calcitriol on improvement of insulin resistance, ovulation and comparison with metformin therapy in PCOS patients: A randomized placebo- controlled clinical trial. Iranian Journal of Reproductive Medicine, 10(5), 465–472. 10.1038/nrendo.2010.217.
Botelho, L., Cunha, C., e Macedo, M. (2011). O método da revisão integrativa nos estudos organizacionais. Gestão e Sociedade, 5(11), 121-136. http://www.
gestaoesociedade.org/gestaoesociedade/article/view/1220/906.
Brakta, S., Lizneva, D., Mykhalchenko, K., Imam, A., Walker, W., Diamond, M. P., & Azziz, R. (2017). Perspectives on polycystic ovary syndrome: Is polycystic ovary syndrome research underfunded?. The Journal of Clinical Endocrinology and Metabolism, 102(12), 4421–4427. 10.1210/jc.2017-01415.
Capllonch-Amer, G., Lladó, I., Proenza, A. M., García-Palmer, F. J., & Gianotti, M. (2014). Opposite effects of 17-β estradiol and testosterone on mitochondrial biogenesis and adiponectin synthesis in white adipocytes. Journal of Molecular Endocrinology, 52(2), 203–214. 10.1530/JME-13-0201.
Cavalcante, I. dos S., Mendes, I. P. G., Silva, M. L. L. dos S., Barbosa, G. S. L., Hasegawa, L. E. M., Veiga, A. V. M., Ferraz, I. C., Gomes, F. E. S., & Santos, L. M. de S. A. dos. (2021). Síndrome dos ovários policísticos: Aspectos clínicos e impactos na saúde da mulher. Research, Society and Development, 10(2), e23810212398. 10.33448/rsd-v10i2.12398
Chen, Y.-H., Heneidi, S., Lee, J.-M., Layman, L. C., Stepp, D. W., Gamboa, G. M., Chen, B.-S., Chazenbalk, G., & Azziz, R. (2013). Mirna-93 inhibits glut4 and is overexpressed in adipose tissue of polycystic ovary syndrome patients and women with insulin resistance. Diabetes, 62(7), 2278–2286. 10.2337/db12-0963.
Ciaraldi, T. P., Aroda, V., Mudaliar, S., Chang, R. J., & Henry, R. R. (2009). Polycystic ovary syndrome is associated with tissue-specific differences in insulin resistance. The Journal of Clinical Endocrinology and Metabolism, 94(1), 157–163. 10.1210/jc.2008-1492
Ciaraldi, T. P., Morales, A. J., Hickman, M. G., Odom-Ford, R., Olefsky, J. M., & Yen, S. S. (1997). Cellular insulin resistance in adipocytes from obese polycystic ovary syndrome subjects involves adenosine modulation of insulin sensitivity. The Journal of Clinical Endocrinology and Metabolism, 82(5), 1421–1425. 10.1210/jcem.82.5.3961.
Cozzolino, S. M. F. (2016). Biodisponibilidade de nutrientes (5a ed.). Barueri, SP: Manole Editora. (Trabalho original publicado em [2005]).
Dastorani, M., Aghadavod, E., Mirhosseini, N., Foroozanfard, F., Zadeh Modarres, S., Amiri Siavashani, M., & Asemi, Z. (2018). The effects of vitamin D supplementation on metabolic profiles and gene expression of insulin and lipid metabolism in infertile polycystic ovary syndrome candidates for in vitro fertilization. Reproductive Biology and Endocrinology: RB&E, 16(1), 94. 10.1186/s12958-018-0413-3.
Deswal, R., Narwal, V., Dang, A., & Pundir, C. S. (2020). The prevalence of polycystic ovary syndrome: A brief systematic review. Journal of Human Reproductive Sciences, 13(4), 261–271. 10.4103/jhrs.JHRS_95_18.
Diamanti-Kandarakis, E., Argyrakopoulou, G., Economou, F., Kandaraki, E., & Koutsilieris, M. (2008). Defects in insulin signaling pathways in ovarian steroidogenesis and other tissues in polycystic ovary syndrome (Pcos). The Journal of Steroid Biochemistry and Molecular Biology, 109(3–5), 242–246. 10.1016/j.jsbmb.2008.03.014.
Diamanti-Kandarakis, E., & Dunaif, A. (2012). Insulin resistance and the polycystic ovary syndrome revisited: An update on mechanisms and implications. Endocrine Reviews, 33(6), 981–1030. 10.1016/j.jsbmb.2008.03.014. 10.1210/er.2011-1034.
Dravecká, I., Figurová, J., Javorský, M., Petríková, J., Vaľková, M., & Lazúrová, I. (2016). The effect of alfacalcidiol and metformin on phenotype manifestations in women with polycystic ovary syndrome—A preliminary study. Physiological Research, 65(5), 815–822. 10.33549/physiolres.933266.
Dumesic, D. A., Oberfield, S. E., Stener-Victorin, E., Marshall, J. C., Laven, J. S., & Legro, R. S. (2015). Scientific statement on the diagnostic criteria, epidemiology, pathophysiology, and molecular genetics of polycystic ovary syndrome. Endocrine Reviews, 36(5), 487–525. 10.1210/er.2015-1018.
Ehrmann, D. A., Barnes, R. B., & Rosenfield, R. L. (1995). Polycystic ovary syndrome as a form of functional ovarian hyperandrogenism due to dysregulation of androgen secretion. Endocrine Reviews, 16(3), 322–353. 10.1152/ajpendo.00475.2003.
Ehrmann, D. A., Breda, E., Corcoran, M. C., Cavaghan, M. K., Imperial, J., Toffolo, G., Cobelli, C., & Polonsky, K. S. (2004). Impaired beta-cell compensation to dexamethasone-induced hyperglycemia in women with polycystic ovary syndrome. American Journal of Physiology. Endocrinology and Metabolism, 287(2), E241-246. 10.1210/edrv-16-3-322.
Escobar-Morreale, H. F. (2018). Polycystic ovary syndrome: Definition, aetiology, diagnosis and treatment. Nature Reviews Endocrinology, 14(5), 270–284. 10.1038/nrendo.2018.24.
Fauser, B. C. J. M., Tarlatzis, B. C., Rebar, R. W., Legro, R. S., Balen, A. H., Lobo, R., Carmina, E., Chang, J., Yildiz, B. O., Laven, J. S. E., Boivin, J., Petraglia, F., Wijeyeratne, C. N., Norman, R. J., Dunaif, A., Franks, S., Wild, R. A., Dumesic, D., & Barnhart, K. (2012). Consensus on women’s health aspects of polycystic ovary syndrome (Pcos): The Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertility and Sterility, 97(1), 28-38.e25. 10.1016/j.fertnstert.2011.09.024.
Ferreira, C. E. S., Maeda, S. S., Batista, M. C., Lazaretti-Castro, M., Vasconcellos, L. S., Madeira, M., Soares, L. M., Borba, V. Z. C., & Moreira, C. A. (2017). Posicionamento oficial da Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial (Sbpc/ml) e da Sociedade Brasileira de Endocrinologia e Metabologia (Sbem) sobre intervalos de referência da vitamina D [25(Oh)D]. Jornal Brasileiro de Patologia e Medicina Laboratorial, 53(6), 377–381. 10.5935/1676-2444.20170060.
Franks, S., Gharani, N., e McCarthy, M. (2001). Candidate genes in polycystic ovary syndrome. Human Reproduction Update, 7(4), 405–410. 10.1093/humupd/7.4.405.
Franks, S., Stark, J., & Hardy, K. (2008). Follicle dynamics and anovulation in polycystic ovary syndrome. Human Reproduction Update, 14(4), 367–378. 10.1093/humupd/dmn015.
González, F. (2015). Nutrient-induced inflammation in polycystic ovary syndrome: Role in the development of metabolic aberration and ovarian dysfunction. Seminars in Reproductive Medicine, 33(4), 276–286. 10.1055/s-0035-1554918.
Goodarzi, M. O., Dumesic, D. A., Chazenbalk, G., & Azziz, R. (2011). Polycystic ovary syndrome: Etiology, pathogenesis and diagnosis. Nature Reviews Endocrinology, 7(4), 219–231. 10.1038/nrendo.2010.217.
Hahn, S., Haselhorst, U., Tan, S., Quadbeck, B., Schmidt, M., Roesler, S., Kimmig, R., Mann, K., & Janssen, O. E. (2006). Low serum 25-hydroxyvitamin D concentrations are associated with insulin resistance and obesity in women with polycystic ovary syndrome. Experimental and Clinical Endocrinology & Diabetes: Official Journal, German Society of Endocrinology [and] German Diabetes Association, 114(10), 577–583. 10.1055/s-2006-948308.
He, C., Lin, Z., Robb, S. W., & Ezeamama, A. E. (2015). Serum vitamin d levels and polycystic ovary syndrome: A systematic review and meta-analysis. Nutrients, 7(6), 4555–4577. 10.3390/nu7064555.
Huang, Z. H., Manickam, B., Ryvkin, V., Zhou, X. J., Fantuzzi, G., Mazzone, T., & Sam, S. (2013). PCOS is associated with increased CD11c expression and crown-like structures in adipose tissue and increased central abdominal fat depots independent of obesity. The Journal of Clinical Endocrinology and Metabolism, 98(1), E17-24. 10.1210/jc.2012-2697.
Hughan, K. S., Tfayli, H., Warren-Ulanch, J. G., Barinas-Mitchell, E., & Arslanian, S. A. (2016). Early biomarkers of subclinical atherosclerosis in obese adolescent girls with polycystic ovary syndrome. The Journal of pediatrics, 168, 104-111.e1. 10.1016/j.jpeds.2015.09.082.
Ibáñez, L., Oberfield, S. E., Witchel, S., Auchus, R. J., Chang, R. J., Codner, E., Dabadghao, P., Darendeliler, F., Elbarbary, N. S., Gambineri, A., Garcia Rudaz, C., Hoeger, K. M., López-Bermejo, A., Ong, K., Peña, A. S., Reinehr, T., Santoro, N., Tena-Sempere, M., Tao, R., … Lee, P. A. (2017). An international consortium update: Pathophysiology, diagnosis, and treatment of polycystic ovarian syndrome in adolescence. Hormone Research in Paediatrics, 88(6), 371–395. 10.1159/000479371.
Jamilian, M., Foroozanfard, F., Rahmani, E., Talebi, M., Bahmani, F., & Asemi, Z. (2017). Effect of two different doses of vitamin d supplementation on metabolic profiles of insulin-resistant patients with polycystic ovary syndrome. Nutrients, 9(12), E1280. 10.3390/nu9121280.
Javed, Z., Papageorgiou, M., Deshmukh, H., Kilpatrick, E. S., Mann, V., Corless, L., Abouda, G., Rigby, A. S., Atkin, S. L., & Sathyapalan, T. (2019). A randomized, controlled trial of vitamin d supplementation on cardiovascular risk factors, hormones, and liver markers in women with polycystic ovary syndrome. Nutrients, 11(1), E188. 10.3390/nu11010188
Jorde, R., & Grimnes, G. (2015). Vitamin D and health: The need for more randomized controlled trials. The Journal of Steroid Biochemistry and Molecular Biology, 148, 269–274. 10.1016/j.jsbmb.2015.01.021.
Lambert, E. A., Teede, H., Sari, C. I., Jona, E., Shorakae, S., Woodington, K., Hemmes, R., Eikelis, N., Straznicky, N. E., De Courten, B., Dixon, J. B., Schlaich, M. P., & Lambert, G. W. (2015). Sympathetic activation and endothelial dysfunction in polycystic ovary syndrome are not explained by either obesity or insulin resistance. Clinical Endocrinology, 83(6), 812–819. 10.1111/cen.12803.
Lee, M.-J., Pramyothin, P., Karastergiou, K., & Fried, S. K. (2014). Deconstructing the roles of glucocorticoids in adipose tissue biology and the development of central obesity. Biochimica Et Biophysica Acta, 1842(3), 473–481. 10.1016/j.bbadis.2013.05.029.
Li, S., Huang, X., Zhong, H., Peng, Q., Chen, S., Xie, Y., Qin, X., & Qin, A. (2014). Low circulating adiponectin levels in women with polycystic ovary syndrome: An updated meta-analysis. Tumour Biology: The Journal of the International Society for Oncodevelopmental Biology and Medicine, 35(5), 3961–3973. 10.1007/s13277-013-1595-0.
Lips, P., Eekhoff, M., van Schoor, N., Oosterwerff, M., de Jongh, R., Krul-Poel, Y., & Simsek, S. (2017). Vitamin D and type 2 diabetes. The Journal of Steroid Biochemistry and Molecular Biology, 173, 280–285. 10.1016/j.jsbmb.2016.11.021.
Littlejohn, E. E., Weiss, R. E., Deplewski, D., Edidin, D. V., & Rosenfield, R. (2007). Intractable early childhood obesity as the initial sign of insulin resistant hyperinsulinism and precursor of polycystic ovary syndrome. Journal of Pediatric Endocrinology & Metabolism: JPEM, 20(1), 41–51. 10.1515/jpem.2007.20.1.41.
Lord, J., & Wilkin, T. (2002). Polycystic ovary syndrome and fat distribution: The central issue? Human Fertility (Cambridge, England), 5(2), 67–71. 10.1080/1464727022000198952.
Macut, D., Bjekić-Macut, J., Rahelić, D., & Doknić, M. (2017). Insulin and the polycystic ovary syndrome. Diabetes Research and Clinical Practice, 130, 163–170. 10.1016/j.diabres.2017.06.011.
Maestro, B., Dávila, N., Carranza, M. C., & Calle, C. (2003). Identification of a Vitamin D response element in the human insulin receptor gene promoter. The Journal of Steroid Biochemistry and Molecular Biology, 84(2–3), 223–230. 10.1016/s0960-0760(03)00032-3.
Miao, C.-Y., Fang, X.-J., Chen, Y., & Zhang, Q. (2020). Effect of vitamin D supplementation on polycystic ovary syndrome: A meta-analysis. Experimental and Therapeutic Medicine, 19(4), 2641–2649. 10.3892/etm.2020.8525.
Ministério da Saúde (2019). Relatório de Recomendação: Protocolos Clínicos e Diretrizes Terapêuticas – PCDT (pp. 9-12). Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Brasília, Brasília: Ministério da Saúde.
Moran, L. J., Ko, H., Misso, M., Marsh, K., Noakes, M., Talbot, M., Frearson, M., Thondan, M., Stepto, N., & Teede, H. J. (2013). Dietary composition in the treatment of polycystic ovary syndrome: A systematic review to inform evidence-based guidelines. Journal of the Academy of Nutrition and Dietetics, 113(4), 520–545. 10.1016/j.jand.2012.11.018.
Mu, Y., Cheng, D., Yin, T.-L., & Yang, J. (2021). Vitamin d and polycystic ovary syndrome: A narrative review. Reproductive Sciences (Thousand Oaks, Calif.), 28(8), 2110–2117. 10.1007/s43032-020-00369-2.
O’Connor, A., Phelan, N., Tun, T. K., Boran, G., Gibney, J., & Roche, H. M. (2010). High-molecular-weight adiponectin is selectively reduced in women with polycystic ovary syndrome independent of body mass index and severity of insulin resistance. The Journal of Clinical Endocrinology and Metabolism, 95(3), 1378–1385. 10.1210/jc.2009-1557.
O’Reilly, M., Gathercole, L., Capper, F., Arlt, W., & Tomlinson, J. (2015). Effect of insulin on AKR1C3 expression in female adipose tissue: In-vivo and in-vitro study of adipose androgen generation in polycystic ovary syndrome. Lancet (London, England), 385 Suppl 1, S16. 10.1016/S0140-6736(15)60331-2.
Ostadmohammadi, V., Jamilian, M., Bahmani, F., & Asemi, Z. (2019). Vitamin D and probiotic co-supplementation affects mental health, hormonal, inflammatory and oxidative stress parameters in women with polycystic ovary syndrome. Journal of Ovarian Research, 12(1), 5. 10.1186/s13048-019-0480-x.
Patten, R. K., Boyle, R. A., Moholdt, T., Kiel, I., Hopkins, W. G., Harrison, C. L., & Stepto, N. K. (2020). Exercise interventions in polycystic ovary syndrome: A systematic review and meta-analysis. Frontiers in Physiology, 11, 606. 10.3389/fphys.2020.00606.
Prietl, B., Treiber, G., Pieber, T. R., & Amrein, K. (2013). Vitamin D and immune function. Nutrients, 5(7), 2502–2521. 10.3390/nu5072502.
Raja-Khan, N., Shah, J., Stetter, C. M., Lott, M. E. J., Kunselman, A. R., Dodson, W. C., & Legro, R. S. (2014). High-dose vitamin D supplementation and measures of insulin sensitivity in polycystic ovary syndrome: A randomized, controlled pilot trial. Fertility and Sterility, 101(6), 1740–1746. 10.1016/j.fertnstert.2014.02.021.
Reis, G. V. O. P. D., Gontijo, N. A., Rodrigues, K. F., Alves, M. T., Ferreira, C. N., & Gomes, K. B. (2017). Vitamin D receptor polymorphisms and the polycystic ovary syndrome: A systematic review. The Journal of Obstetrics and Gynaecology Research, 43(3), 436–446. 10.1111/jog.13250.
Rosa-e-Silva, A. C. (2019). Conceito, epidemiologia e fisiopatologia aplicada à prática clínica. Revista Femina: publicação oficial da Federação Brasileira das Associações de Ginecologia e Obstetrícia. São Paulo, SP: Febrasgo. 47(4), 1-15. http://www.febrasgo.org.br/pt/femina/item/866-revista-femina-2019-vol-47-n-9/
Rosen, E. D., & Spiegelman, B. M. (2014). What we talk about when we talk about fat. Cell, 156(1–2), 20–44. 10.1016/j.cell.2013.12.012.
Rosenfield, R. L., & Ehrmann, D. A. (2016). The pathogenesis of polycystic ovary syndrome (Pcos): The hypothesis of pcos as functional ovarian hyperandrogenism revisited. Endocrine Reviews, 37(5), 467–520. 0.1210/er.2015-1104.
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. (2004). Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and Sterility, 81(1), 19–25. 10.1016/j.fertnstert.2003.10.004.
Salehpour, S., Hosseini, S., Nazari, L., Hosseini, M., & Saharkhiz, N. (2019). The effect of vitamin d supplementation on insulin resistance among women with polycystic ovary syndrome. JBRA Assisted Reproduction, 23(3), 235–238. 10.5935/1518-0557.20190032.
Samuel, V. T., Petersen, K. F., & Shulman, G. I. (2010). Lipid-induced insulin resistance: Unravelling the mechanism. Lancet (London, England), 375(9733), 2267–2277. 10.1016/S0140-6736(10)60408-4.
Sociedade Brasileira de Diabetes (2019). Diretrizes da Sociedade Brasileira de Diabetes: biênio 2019-2020. São Paulo, SP: Clannad; 2017
Soldani, R., Cagnacci, A., & Yen, S. S. (1994). Insulin, insulin-like growth factor I (Igf-i) and IGF-II enhance basal and gonadotrophin-releasing hormone-stimulated luteinizing hormone release from rat anterior pituitary cells in vitro. European Journal of Endocrinology, 131(6), 641–645. 10.1530/eje.0.1310641.
Souza, M., Silva, M., e Carvalho, R. (2010). Revisão integrativa: o que é e como fazer. Einstein Journal, 8 (1), 102-106., 2010. 10.1590/s1679-45082010rw1134.
Stein, I. F. & Leventhal, M. L. (1965). Amenorrhea associated with bilateral polycystic ovaries. American Journal of Obstetrics and Gynecology, 29(2),181–191. 10.1016/j.ajog.2015.12.013.
Takiishi, T., Gysemans, C., Bouillon, R., & Mathieu, C. (2010). Vitamin D and diabetes. Endocrinology and Metabolism Clinics of North America, 39(2), 419–446, table of contents. 10.1016/j.ecl.2010.02.013.
Teede, H. J., Misso, M. L., Costello, M. F., Dokras, A., Laven, J., Moran, L., Piltonen, T., Norman, R. J., & International PCOS Network. (2018). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertility and Sterility, 110(3), 364–379. 10.1093/humrep/dey256.
Teixeira, E., Medeiros, H, Nascimento, M, Silva, B., & Rodrigues, C. (2013). Revisão Integrativa da Literatura passo-a-passo & convergências com outros métodos de revisão. Revista de Enfermagem da Universidade Federal do Piauí, 2(5),3-7. 10.26694/reufpi.v2i5.1457.
Trummer, C., Schwetz, V., Kollmann, M., Wölfler, M., Münzker, J., Pieber, T. R., Pilz, S., Heijboer, A. C., Obermayer-Pietsch, B., & Lerchbaum, E. (2019). Effects of vitamin D supplementation on metabolic and endocrine parameters in PCOS: A randomized-controlled trial. European Journal of Nutrition, 58(5), 2019–2028. 10.1007/s00394-018-1760-8.
Webber, L. J., Stubbs, S., Stark, J., Trew, G. H., Margara, R., Hardy, K., & Franks, S. (2003). Formation and early development of follicles in the polycystic ovary. Lancet (London, England), 362(9389), 1017–1021. 10.1016/s0140-6736(03)14410-8.
Wehr, E., Pieber, T. R., & Obermayer-Pietsch, B. (2011). Effect of vitamin D3 treatment on glucose metabolism and menstrual frequency in polycystic ovary syndrome women: A pilot study. Journal of Endocrinological Investigation, 34(10), 757–763. 10.3275/7748.
Wojtusik, J., & Johnson, P. A. (2012). Vitamin D regulates anti-Mullerian hormone expression in granulosa cells of the hen. Biology of Reproduction, 86(3), 91. 10.1095/biolreprod.111.094110.
Yela, D. (2019). Particularidades do diagnóstico e da terapêutica da síndrome dos ovários policísticos na adolescência. Revista Femina: publicação oficial da Federação Brasileira das Associações de Ginecologia e Obstetrícia.São Paulo, SP: Febrasgo. 47 (9),16-28. http://www.febrasgo.org.br/pt/femina/item/866-revista-femina-2019-vol-47-n-9
Zhang, X., Zheng, Y., Guo, Y., & Lai, Z. (2019). The effect of low carbohydrate diet on polycystic ovary syndrome: A meta-analysis of randomized controlled trials. International Journal of Endocrinology, 2019, 4386401. 10.1155/2019/4386401.
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