The Effects of the Portfolio Low-Carbohydrate Diet versus the Ketogenic Diet on Anthropometric Indices, Metabolic Status, and Hormonal Levels in Overweight or Obese Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial

The Effects of the Portfolio Low-Carbohydrate Diet versus the Ketogenic Diet on Anthropometric Indices, Metabolic Status, and Hormonal Levels in Overweight or Obese Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Effects of the Portfolio Low-Carbohydrate Diet versus the Ketogenic Diet on Anthropometric Indices, Metabolic Status, and Hormonal Levels in Overweight or Obese Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial Maryam Sharifi, Jalal Moludi, Yahya Salimi, Alireza Jahan-Mihan, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4460351/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Dec, 2024 Read the published version in Nutrition Journal → Version 1 posted 12 You are reading this latest preprint version Abstract Background Polycystic Ovary Syndrome (PCOS) is the most common hormonal disorder in women of reproductive age. It is believed that excessive androgen production is primarily caused by hyperinsulinemia, making it the main factor in the development of PCOS. The portfolio low-carbohydrate diet (PLCD) is a plant-based diet with a carbohydrate content of 40% and incorporates five cholesterol-lowering foods. While, the ketogenic diet is a high-fat diet that 70% of its calories come from fat, promoting a ketosis state. However, to the best of our knowledge, no study compared the therapeutic effects of these two diets in PCOS patients. Thus, this study aimed to compare the impact of PLCD and KD on anthropometric indices, metabolic status, and hormonal levels in overweight or obese women with PCOS. Methods This randomized clinical trial was conducted on forty-six overweight or obese women diagnosed with PCOS. Participants were randomly allocated into either the PLCD or the KD group for 8 weeks. The anthropometric indices including body mass index (BMI), fat body mass (FBM), and waist circumference (WC), as well as metabolic markers including fasting blood glucose (FBG), plasma insulin levels, HOMA-IR, and plasma lipid profiles including total cholesterol (TC), low-density lipoprotein (LDL), triglycerides (TG), and high-density lipoproteins (HDL), were measured. Reproductive hormones including follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone, as well as Ferriman Gallwey score were assessed at the baseline and after the intervention. Results After 8 weeks, both diets demonstrated enhancements in anthropometric, metabolic, and reproductive hormonal status. However, the mean difference in weight reduction, BMI, WC, FBG, HOMA-IR, LH, and FSH was significantly greater in the KD group than in the PLCD group (P < 0.05). Nevertheless, plasma lipid profiles including TC, LDL, and HDL indicated more improvement in the PLCD compared to the KD group. There were no significant changes in the Ferriman-Gallwey score within or between the two groups. Conclusions The study findings revealed that both the PLCD and the KD diets were effective in improving PCOS manifestations. However, the KD exhibited greater effectiveness in enhancing body measurements, metabolic factors, and hormone levels compared to the PLCD in women with PCOS. Registration number of Clinical Trial: IRCT20200912048693N3, Trial registered 2022–12–14. https://www.irct.ir/trial/67548 polycystic ovary syndrome insulin resistance ketogenic diet portfolio low-carbohydrate diet Figures Figure 1 Background Polycystic Ovary Syndrome (PCOS) is the most common endocrine-metabolic disorder among women of reproductive age, with a global prevalence of 20% ( 1 ). PCOS is primarily caused by the overproduction of androgens from the ovaries and/or adrenal glands, although in certain women, it is associated with insulin resistance and metabolic imbalances ( 2 ). The main clinical symptoms of this disease are hyperandrogenism, menstrual disturbances (oligomenorrhea, amenorrhea, prolonged irregular menstrual bleeding), alteration in the ovarian morphology, hirsutism, acne, and alopecia ( 3 ). Moreover, women with PCOS are more likely to meet metabolic abnormalities such as abdominal obesity, peripheral insulin resistance (IR), hyperinsulinemia, impaired glucose metabolism, infertility, hypertension, and lipid profile disorders, which markedly increase the risk of chronic diseases for instance type 2 diabetes mellitus, cardiovascular disease, and metabolic syndrome ( 4 – 6 ). PCOS diagnosis follows the Rotterdam criteria, requiring the presence of at least two out of three criteria: (A) clinical signs of hyperandrogenism (such as hirsutism, acne, seborrhea, and alopecia) and/or elevated levels of circulating androgens; (B) presence of ovarian cysts assessed by ultrasound examination; and (C) oligo-amenorrhea with oligo-or anovulation ( 7 ). Accordingly, four phenotype groups have been introduced ( 8 ). Phenotype A is the most vigorous phenotype which manifests all three symptoms of PCOS, phenotype B demonstrates clinical hyperandrogenism and oligo-or anovulation, phenotype C represents clinical hyperandrogenism as well as ovarian cysts, whereas phenotype D is the weakest one along an axis of metabolic and ovarian dysfunction which is observed as oligo-or anovulation and ovarian cysts. One study defined phenotypes A, B, and C as endocrine-metabolic syndromes, while phenotype D is characterized as non-hyperandrogenic PCOS ( 9 ). Observational studies have found a high prevalence of overweight and obesity in women with PCOS, with an estimated 75% being affected. This is attributed to elevated androgen levels and an imbalance in the FSH/LH ratio ( 10 ). Additionally, both normal weight and overweight women with PCOS were found to exhibit android fat distribution ( 11 ). This pattern of fat distribution, known as central obesity, is not only linked to metabolic syndrome, which includes insulin resistance, high insulin levels, and abnormal lipid levels but also plays a role in ovarian hyperandrogenism and worsens the severity of PCOS ( 12 ). Hence, there is a mutually instrumental relationship between obesity and PCOS. Although, the treatment approaches for PCOS are based on the phenotype of patients and the severity of complications, the cornerstone of PCOS treatment is based on lifestyle changes approach, with an emphasis on modifying diet and engaging in regular exercise ( 13 ). Despite the absence of a study indicating the ideal and proven dietary composition for treating PCOS symptoms, numerous studies have shown the positive impact of low carbohydrate diets in relieving PCOS symptoms compared to traditional calorie-restricted diets ( 14 ). The Portfolio low-carbohydrate diet (PLCD) is a plant-based diet consisting of 40% carbohydrates, 20% protein, and 40% fat. It is designed to lower cholesterol levels by incorporating five specific cholesterol-lowering foods and nutrients, including plant protein, viscous fiber, nuts, and phytosterols ( 15 ). These nutrients have been shown to have beneficial effects on lipid profile in previous studies ( 16 ). A systematic review of twenty studies showed that adhering to a low carbohydrate diet (providing less than 45% of total energy from carbohydrates) while maintaining an energy deficit led to positive changes in body measurements, blood sugar levels, fasting insulin levels, insulin response during a 3-hour oral glucose tolerance test, and reproductive hormones like FSH, LH, DHEA, SHBG, and free testosterone in women with PCOS ( 17 ). Thomson and colleagues found that by adhering to a low-carbohydrate diet consisting of 40% carbohydrates, 30% protein, and 30% fat for 20 weeks, there was a reduction in fat mass and lean body mass by 3 and 2 kg, respectively. Furthermore, there was a decrease in fasting glucose, insulin, testosterone, and free androgen index levels, and a restoration of normal menstrual cycles ( 18 ). Ketogenic diet (KD) has also been utilized for various purposes. It is characterized by high fat intake (70%), very low carbohydrate intake (10%), and moderate protein levels (20%), resulting in the production of ketone bodies ( 19 ). The KD has demonstrated many beneficial effects in various numbers of diseases, including obesity, neurological disorders, type 2 diabetes mellitus, cancer, as well as PCOS ( 20 – 22 ). A recent parallel randomized trial on 20 obese women with PCOS and liver dysfunction demonstrated that after 12 weeks the KD considerably reduced the body weight, blood glucose, plasma estradiol, progesterone levels, and liver function markers compared to the control diet ( 23 ). Based on above evidence, both the PLCD and the KD offer beneficial effects on PCOS manifestations due to their low carbohydrate content and consequently minimal insulin secretion. Inevitably, these two diets could effectively reduce hyperandrogenism, which was beneficial for patients with phenotypes A, B, and C of PCOS. While PCOS patients with phenotype D, which lacks hyperandrogenism, did not hold therapeutic rationale for these dietary interventions due to the distinct etiology. Overall, to the best of our knowledge, there was no study comparing the therapeutic effects of these two diets in PCOS patients. Therefore, the present study aimed to compare the effects of the PLCD and the KD on PCOS manifestations, through the evaluation of anthropometric measurements, metabolic status, reproductive hormone levels, dietary intake, and Ferriman-Gallwey score. Methods Study design The entire protocol of this study has been previously published ( 24 ). Briefly, this parallel randomized clinical trial took place at Fatahi Clinic of Kermanshah University of Medical Sciences (KUMS), Iran, from January 2023 to May 2023. The eligible participants were randomly assigned to follow either the PLCD group (N = 23) or the KD group (N = 23), using a computer-generated random sealed envelope. The protocol was approved by the Medical University of Kermanshah Research Ethics Board (IR.KUMS. REC.1401.404). Furthermore, the trial was registered at the Iranian Registry of Clinical Trials (IRCT20200912048693N3) on 2022 December 14. The procedures were carried out following the World Medical Association Declaration of Helsinki, the Guidelines of the International Conference on Harmonization on Good Clinical Practice, and we followed the Consolidated Standards of Reporting Trials (CONSORT). Before the commencement of the study, written informed consent was obtained from all participants. It was not possible to blind the participants due to the nature of the diet; however, there was no interaction between the two groups. Furthermore, to minimize bias, the outcome assessors and the data analysts were blinded. The primary outcome of this investigation was determining the effectiveness of the PLCD compared to the KD in improving PCOS disease manifestations by measuring weight loss before and after the intervention. The secondary outcomes were BMI, FBM, LBM, WC, HC, FBS, insulin level, HOMA-IR, HOMA-B, reproductive hormones (LH, FSH, DHEA, and testosterone), lipid profile (total cholesterol, triglycerides, LDL, HDL), and Ferriman-Gallwey score before and after the intervention. Sample size The sample size for the study was calculated based on the formula used in a randomized clinical trial ( 25 ). The sample size required to have 80% power to detect a difference of 2 units of weight change would be 18 people in each group. Considering the possibility of 25% missing people in the follow-up, the sample size increases to 23 in each group. Also, a type I error of 5% (α = 0.05) and a type II error of 20% (β = 0.2, power = 80%) were considered. Participants We recruited 46 overweight or obese women diagnosed with PCOS through a public advertisement in the medical centers, healthcare establishments, physician offices, pharmacies, and hospitals of Kermanshah. Participants were asked to first visit Fatahi Clinics where the screening was performed by a dietitian as well as an obstetrician-gynecologist to determine eligible patients according to the inclusion criteria. Written informed consent was provided after a detailed explanation of the study. Also, the demographic characteristics questionnaire, the physical activity questionnaire (IPAQ), as well as 3-day food records questionnaires of all participants were completed by a professional dietitian. Then the subjects were randomly allocated to receive either the PLCD or the KD by a random block method of 6 from the website https://www.sealedenvelope.com . The inclusion criteria were: diagnosis of PCOS according to the Rotterdam Criteria by an obstetrician-gynecologist, fertile age (18–45 years), and BMI ≥ 25 kg/m 2 . The exclusion criteria were: currently pregnancy or lactation, taking anti-psychotic or anti-seizure medication due to their induced effect on insulin resistance, following a specific nutritional diet or hypocaloric diet in the last 3 months, history of diabetes or other endocrine disorders (thyroid dysfunction and adrenal disorders), using medications that impact carbohydrate or lipid metabolism (oral contraceptive pills, antiepileptic, antipsychotics, statins, and fish oil), using fertility-enhancing or weight loss medications, history of hormonal therapy and/or insulin-sensitizers within the previous 2 months, and history of hepatic and renal disorders, hypertension, diagnosed anemia, severe respiratory disease (asthma and chronic bronchitis), and heart disease. Anthropometric Measurements Body composition analysis and resting metabolic rate (RMR) were conducted using an electronic scale with bioimpedance analysis (Plus Avis 333 Body Analyzer, China). The analysis included measurements of fat body mass (FBM), lean body mass (LBM), total body water (TBW), total body protein (TBP), and total body mineral (TBM), conducted with subjects wearing light clothing and with shoes and socks removed. The measurements were taken to the nearest 0.1 kg. The resting metabolic rate (RMR) was reported in Kcal. Height was determined to the nearest 1 cm using a well-mounted portable stadiometer (Holtain Ltd, UK). Moreover, BMI was calculated in kg/ m 2 . The WC was measured after removing clothes from the abdomen, as the smallest circumference was between the lowest rib and the iliac crest on the midaxillary line. The HC was determined at the level of the widest circumference over the great trochanters, and the WHR was calculated as waist measures divided by hip measurement. All parameters were measured at baseline and at the end of the study, after 8 weeks of dietary intervention. Biochemical Analysis At baseline and after 8 weeks of the study, 10 ml venous blood samples were drawn from each participant by a catheter. Blood samples were collected into BD vacutainer Tubes (SSTTM 2 advance, REE 397953) between 8: 00 a.m. and 9:00 a.m. after 10 to 12 hours of overnight fasting and resting in bed during the early follicular phase (day 2–5) of menstrual cycle. Blood samples were immediately centrifuged at 4000 RPM using centrifuge J6-MC by Beckman. Then the obtained serum was aliquoted and stored at -80°C until assay time. All samples were analyzed in the same analytical session for each test, using the same reagent lot and according to the manufacturer’s instructions with inter- and intra-assay coefficient variances (CVs) lower than 7%. Serum FBG was measured through enzymatic methods using the colorimetric technique, by commercial kits (Pars-Azmoon Co., Tehran, Iran) by an auto-analyzer (Hitachi-917, Tokyo, Japan). Serum insulin level was measured by chemiluminescence (IMMULITE 2000, SIEMENS). Total cholesterol, HDL, and LDL by enzymatic colorimetric in homogenous phase ((Roche Cobas e702, Roche Diagnostics, Mannheim, Germany), TGs by an enzymatic colorimetric method (Roche Cobas e702, Roche Diagnostics, Mannheim, Germany). Reproductive hormones including LH, FSH, DHEA, and testosterone were evaluated by ELISA kits (Bioassay Technology Laboratory, Shanghai Korean Biotech, Shanghai City, China). The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) index was calculated according to the formula (insulinemia mU/ml×glycemia mg/ dL/450). The homeostasis model assessment of β-cell dysfunction (HOMA-B) index was also calculated according to its formula (20 × fasting insulin (µU/ml)/[fasting plasma glucose (mg/dl) – 63]). Moreover, the visceral adipose tissue (VAI) index and lipid accumulation product (LAP) are both common markers to estimate cardiometabolic risks in women with PCOS, which were calculated according to their formula. (VAI = WC (cm) /36.58 + (1.89 × BMI (Kg/m 2 )) × TG (mmol/l)/0.81 × 1.52/HDL (mmol/l) and LAP = (WC (cm) – 58) × TG (mmol/l)). All biochemical tests were assessed clinically at the Reference Laboratory of Kermanshah University of Medical Science before and after the study. Diets Participants were randomly stratified to the PLCD or the KD designed by a professional dietician to follow for 8 weeks. The PLCD were a plant-based diet with a macronutrient distribution of 40% carbohydrate, 20% protein, and 40% fat. The Portfolio diet consisted of five food components added to the diet including 1) plant protein from soy products or dietary pulses such as beans, peas, chickpeas, and lentils; 2) viscous soluble fiber from oats, barley, psyllium, eggplant, okra, and certain fruit; 3) nuts from tree nuts or peanuts; 4) phytosterols; and 5) monounsaturated fats (MUFAs) in the form of olive, canola, or high oleic sunflower oils that indicated improvements of blood lipids ( 26 ). Each diet was determined according to the prescribed daily calorie and macronutrient intake of individuals. The KD included of 10% carbohydrates, 20% protein, and 70% fat. Carbohydrates intake was < 30 g per day which was provided by a variety of vegetables as they are rich in fiber and have low amounts of carbohydrates ( 27 ). Protein sources were fish, poultry, meat, and eggs. Furthermore, fat components were consumed in the form of olive oil, sesame, and oilseeds. Unsweetened drinks like herbal teas, tea, and infused coffee were allowed as they would not induce ketosis. Both groups had taken a multivitamin-mineral supplement (Dana Corp. Multi Daily, Tehran, Iran) every day. 500–700 kcal were removed from the total caloric intake of each person and then its macronutrient distribution was calculated based on the type of diet ( 28 ). Dietary Assessments To ensure that nutritional ketosis was induced and maintained in women who followed the KD, they were required to use urinary keto sticks (Kimia Pajohan Co., Tehran. Iran) two random times every week and send their picture to the dietitian. In addition, each patient was provided at least ninety minutes of dietary counseling with a professional dietitian to educate their diet and encouraged to have aerobic physical activity, for instance, walking or jogging at least 60 min per day. Also, they were reminded to stop continuing the diet if they realized that they were pregnant or manifested serious complications. The dietitian was readily available to guide and advise individuals via phone, email, and other media during 8 weeks of intervention. To monitor participants' dietary adherence, the dietitian called each patient every 2 weeks to document their 3-day food records, two working days, and the weekend, assess, and analyze their macronutrient composition and calorie intake to realize how they follow their diet. Daily intakes of macro-nutrients and micro-nutrients were calculated by analyzing food data using Nutritionist IV software (First Databank, San Bruno, CA). If the participants did not follow the protocol of the study they were withdrawn from the clinical trial. Ferriman-Gallwey Score Hirsutism is considered one of the common clinical symptoms of PCOS and approximately 70% of PCOS women represent it ( 29 ). It is evaluated by the Ferriman-Gallwey score. This scoring system evaluates nine androgen-dependent body parts such as the upper lip, chin, chest, upper abdomen, lower abdomen, upper arms, thigh, upper back, and lower back, with scores ranging from zero (no excessive terminal hair growth visible) to four (extensive hair growth visible) for each body part evaluated. A maximum score of 36 is possible ( 30 ). In this study, Hirsutism was considered positive when the Ferryman-Gallwey score was > 8. Statistical Analysis Statistical analyses were carried out according to intention to treat. Data analysis was performed using SPSS Statistics (version 19, New York, USA). The distribution of data was expressed as mean (SD) for normally distributed quantitative data, and frequency (percent) for qualitative data. Kolmogorov-Smirnov test was used to check the normality of the data distribution. To compare the two groups at the baseline, independent sample tests, Mann–Whitney, and chi-squared tests were used. Assessments of differences within the group were made by paired-sample t-tests or nonparametric Wilcoxon signed-rank test, and sign test. A comparison of the two groups at the end of the study was completed by the analysis of covariance (ANCOVA) after adjusting for the baseline parameters and covariates (changes in baseline values of evaluated parameters and potential covariates including age, baseline BMI, and the changes in weight, calorie intake, and physical activity level during the study). A significance level of P < 0.05 was used to evaluate the statistical analyses. Results As depicted in Fig. 1 , 46 women out of 184 individuals who responded to the recruitment advertisement met the eligibility criteria to take part in this study and were randomly assigned to the two diet groups. During 8 weeks of the intervention, 2 participants were excluded from the PLCD due to the loss of follow-up, while 4 women were excluded from the KD because of not responding and pregnancy. Overall, 21 and 19 women finished the study in the PLCD and the KD, respectively. Also, none of the participants of this study did not report any complications following the diets, which may be due to the short duration (8 weeks) of the trial. Baseline characteristics Following the CONSORT guidelines, the baseline data of individuals who were randomized is illustrated in Table 1 . The SD of age and BMI of studied women were 30.13 (7.27) years and 29.47 (4.25) kg/m 2 in the PLCD group and 30.30 (5.41) years and 29.21 (3.39) kg/m 2 in the KD group with no significant differences (P = 0.927 and P = 0.496 respectively). Moreover, there were no significant differences in demographical data, such as height, WHR, total energy intake, physical activity, and marital status of participants in both groups. None of the participants were smokers. Anthropometric index and body composition As shown in Table 2 , there were no notable disparities in the baseline anthropometric measurements between the two groups at the beginning of the study. After 8 weeks of intervention, significant changes were observed in anthropometric parameters including weight, BMI, WC, HC, FBM, LBM, TBW, TBP, TBM, and RMR within groups (P < 0.05). However, when comparing the two groups while adjusting for baseline values and changes in age, energy intake, RMR, and physical activity levels, it was found that the KD group showed a significant weight reduction (MD 5.64 CI: 8.53, 7.55 vs. MD 4.60 CI: 3.64, 5.56), improvement in BMI (MD 2.90 CI: 2.73, 3.07 vs. MD 1.71 CI: 1.36, 2.07), FBM, LBM, TBW, TBP, WC, and HC compared to the PLCD group. However, there were no significant differences in WHR, TBM, and RMR between the two groups. (The place of Table 2 ) Metabolic and reproductive hormonal status Although there were no remarkable differences in the baseline of the two groups, both the PLCD and KD led to significant enhancements in the metabolic status and reproductive hormone levels of participants at the beginning and after 8 weeks of the intervention. There was a significant reduction in the mean difference of the glycemic status such as FBS in the KD group compared to the PLCD group (MD 8.84 CI: 7.57, 10.10 vs. MD 5.00 CI: 3.00, 6.99), insulin levels of serum, HOMA-IR, triglycerides, and LAP. Furthermore, the mean difference of reproductive hormones including LH (MD 4.38 CL: 3.72, 5.05 vs. MD 2.48 CI: 1.98, 2.98), FSH, and testosterone levels indicated more improvement in the KD group compared to the PLCD group at the baseline and after adjusted cofactors (P < 0.05). However, the PLCD decreased the level of total cholesterol (MD 44.38 CI: 36.10, 52.65 vs. MD 38.15 CI: 34.36, 41.95) and LDL, while increasing the level of HDL more than the KD group. No obvious decreases were seen in the level of HOMA-B (P = 0.071), VAI (P = 0.608), and DHEA-s (P = 0.071) between the two groups (Table 3 ). (The place of Table 3 ) Dietary intake There were no significant differences in the baseline intake of calories, macronutrients, and micronutrients between the two groups (P > 0.05). After 8 weeks of intervention, the mean difference of carbohydrate intake decreased significantly in the KD group than the PLCD group (MD 279.67 CI: 251.75, 303.68 vs. MD 138.69 CI: 102.27, 160.02). Although the energy intake in both diets did not have differences (P = 0.025), all macronutrients as well as micronutrients were remarkably different between the two diets due to their intrinsic distinct. The ketogenic diet has higher levels of cholesterol, SFAs, PUFA, MUFA, and TFA compared to the plant-based PLCD. On the other hand, the PLCD has a higher amount of total fiber and phytosterols than the ketogenic diet ( Table 4 ). (The place of Table 4) In addition, the KD contains more vitamin B12 and iodine than the PLCD due to its higher animal protein sources. Whereas, the PLCD contains more vitamin C, B9, calcium, iron, zinc, copper, sodium, potassium, magnesium, and phosphorus than the KD because of the soy and soy products as a source of plant protein. The main source of iron in the PLCD was non-hem, while it was mostly hem in the KD group (Table 5 ). (The place of Table 5 ) Discussion The present study aimed to compare two calorie-restricted diets, the PLCD and the KD among overweight or obese women with PCOS. Our study reveals that, although both diets have beneficial effects on body composition, metabolic status, and reproductive hormones in these patients, without differences in the total energy intake between the two diets, the KD was likely more effective due to the inducing ketosis. Nevertheless, there was a more significant improvement in lipid profiles in the PLCD group compared to the KD group. PCOS is recognized as one of the most common endocrinopathies affecting women of reproductive age, causing infertility and linked to a wide range of chronic cardiovascular and metabolic issues, resulting in 0.43 million disability-adjusted life-years (DALY) ( 31 ). PCOS is a multifactorial disease, that not only includes genetic agents, but also environmental, metabolic, and endocrine factors ( 32 ). The high prevalence of overweight, obesity, and central fat with an estimation of 75% among PCOS women indicates the important role of environmental factors which are directly associated with lifestyle habits ( 33 ). Excessive adipose tissue particularly abdominal adipocytes as an endocrine organ, increases the production of estrogen and estrone ( 34 ). In the hypothalamus, the additional levels of estrogen and estrone lead to more secretion of GnRH, and consequently increase preferential production of LH as well as hyperandrogenism ( 35 ). Although the etiology of PCOS has not been exactly clarified, studies hypothesized that insulin resistance has the principal role in manifesting this disorder since it appears to have a positive correlation with both total and central fat which induces an increased risk of higher androgens ( 36 ). Therefore, both obesity and insulin resistance are two crucial aspects of causes of PCOS. According to recent guidelines from the American Society for Reproductive Medicine (ASRM), lifestyle adjustments, such as diet control, exercise, and weight management, are recommended as the first-line therapy for PCOS ( 37 ). Moreover, studies have demonstrated that a 5–10% weight loss in overweight or obese women with PCOS can improve ovarian function and increase pregnancy rates ( 38 ). Subsequently, numerous studies have reported that hypocaloric diets are effective in both desirable weight reduction and alleviating PCOS manifestations ( 39 ). Further investigations have shown that a low-carbohydrate diet can have numerous benefits for women with Polycystic Ovary Syndrome (PCOS), regardless of the severity of their symptoms. These benefits include improvements in endocrine and metabolic parameters, fertility, and weight loss. This is due to lower insulin secretion and increased fat oxidation when compared to conventional calorie-restricted diets ( 40 ). The results of our study align with Paoli and colleagues that following a Ketogenic-Mediterranean diet with extracts for 12 weeks, in 14 overweight women with PCOS, significantly improved anthropometric parameters, glycemic status, lipid profiles, and reproductive hormones ( 41 ). Another trial on 17 overweight and obese women diagnosed with PCOS represented that following a hypocaloric-ketogenic diet (carbohydrate intake 40–50 gr/day) for 45 days ameliorates anthropometric index, insulin sensitivity, and androgen production. It appears that the improvements observed were due to the ketosis state caused by the diet, which resulted in changes in LH, FSH, LH/FSH ratio, and SHBG ( 42 ). Also, a recent study compared the ketogenic diet (KD) with a standard, balanced hypocaloric diet like the Mediterranean diet (MD) for a short period. The study found that both diets showed significant improvements in anthropometric and biochemical parameters. However, the KD resulted in a greater reduction in all the parameters compared to the MD ( 43 ). The main mechanism of alleviating the symptoms of PCOS by the KD is through the ketone bodies ( 44 ). By reducing carbohydrate intake to less than 30 grams per day for 3 to 5 days, the concentration of insulin in the body decreases. As a result, the glycogen stored in the liver and muscles is replaced by an increase in fatty acid oxidation derived from adipose tissue. This process produces ketone bodies such as acetoacetate, acetone, and B-hydroxybutyrate that serve as fuel for the body ( 45 ). Nutritional ketosis is a condition in which the concentration of blood ketone is more than 0.5 mmol/L, suppressing hunger and increasing fat oxidation that leads to reduced fat mass and consequently weight loss ( 46 ). Additionally, in PCOS, ketosis activates the AMPK and SIRT1 pathways, improving glucose homeostasis and insulin sensitivity ( 47 ). On the other hand, the PLCD was a plant-based diet rich in antioxidants, soluble fiber, and phytosterols. It contained lower amounts of saturated fatty acids and trans fatty acids, which had positive effects on the lipid profile of patients ( 48 ). PCOS women often have an atherogenic lipid profile, which includes high levels of LDL, total cholesterol, and triglycerides, along with low levels of HDL ( 49 ). Therefore, the PLCD may be particularly beneficial for those with lipid profile disorders. Both diets decrease insulin, IGF-1, and IGFBP1 levels due to their low carbohydrate content. However, the ketogenic diet (KD) is superior because it generates ketones which improve PCOS symptoms. Additionally, the present study found that the pregnancy rate was an important factor to consider. In this way, two married women from the KD group got pregnant despite many previous unsuccessful attempts. Besides, there were no significant changes in the Ferriman Gallwey score progression, possibly due to the short study duration which was inadequate to observe hair growth accurately. Moreover, it takes over three months to see measurable effects of the hair cycle and growth, which vary depending on the body area ( 50 ). The main advantage of the present study was the precise evaluation of dietary adherence in both groups. For the KD group, we utilized urinary keto strips twice a week at random to confirm the induction of ketosis in the patients' bodies. Also, despite the short duration of the trial (8 weeks), we observed positive effects of both diets without any complications. The adherence to both diets was high and only two people from each group were withdrawn from the study. The study encountered several limitations, one of which was the inability to assess inflammatory markers such as hs-CRP, TNF-a, and interleukin-6 due to limited financial support. In addition, we did not examine how different diets affect the gut microbiota. Conclusion The results of our study have revealed that both PLCD and KD diets, which are characterized by their low carbohydrate content, can have a significant positive impact on the outcomes of individuals with PCOS over an 8-week period. However, the study showed that inducing ketone status had a significant positive effect on various health parameters, including anthropometric indices, metabolic status, and reproductive hormones. While the PLCD indicates more beneficial effects on lipid profiles. Therefore, KD may be recommended as a viable, effective, and short-term treatment for overweight or obese women who have PCOS with a focus on micronutrient intake. On the other hand, the PLCD could be a beneficial treatment option for PCOS women who have lipid profile abnormalities. It is recommended to conduct more clinical trials with larger sample sizes and longer durations to confirm these findings. Also, further research should be conducted on the cellular mechanisms of these diets in women with PCOS. Abbreviations BMI Body mass index DHEA Dehydroepiandrosterone sulfate FBM Fat body mass FBG Fasting blood glucose FSH Follicle-stimulating hormone HDL High-density lipoprotein HOMA-IR Homeostasis model assessment-insulin resistance HOMA-B Homeostasis model assessment of beta cell function HC Hip circumference KD Ketogenic diet LH Luteinizing hormone LAP Lipid accumulation products LBM Lean body mass LDL Low-density lipoprotein PCOS Polycystic ovary syndrome MUFAs Mono-unsaturated fatty acids PLCD Portfolio low-carbohydrate diet PUFA Poly-unsaturated fatty acids RD Registered dietitian RMR Resting metabolic rate SFA Saturated fatty acids SHBG Sex hormone-binding globulin TBP Total body protein TBM Total body mineral TBW Total body water TC Total cholesterol TFA Trans fatty acids TG Triglycerides VAI Visceral adipose index WC Waist circumference WHC Waist to hip circumference Declarations Ethics approval and consent to participate This trial was approved by the Ethics Committee of Kermanshah University of medical sciences with code No. IR.KUMS.REC.1401.404 and conducted in accordance with the Declaration of Helsinki. In addition, all women were given written informed consent before participating in the study. Consent for publication Prior to data collection, the purpose of the study was explained to all participants. After being given a full explanation of the study procedures, written informed consent was obtained from all patients. Availability of data and materials Data that support the findings of this study are available from the corresponding author upon reasonable request. Conflict of Interests The authors declare that they do not have conflict of interests. Funding statement This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors’ Contributions MS wrote the manuscript, coordinated the study, and designed the diets plan. AS, JM, and AJM are the investigators; they designed the study and interpreted the results. YS analyzed and interpreted the results and provided statistical advice. All authors edited and approved the final manuscript. Not any AI and AI-assisted technologies were used for this article. Acknowledgements We would like to acknowledge all of the participants and their time and effort. Also, the Kermanshah University of Medical Sciences is gratefully acknowledged. We would like to thank Shima Moradi as the researcher in this study. References Khan R, Rehman R, Alam F. Situation analysis of polycystic ovary syndrome in Western Asia. Polycystic Ovary Syndrome: Elsevier; 2024. pp. 207–15. Ding H, Zhang J, Zhang F, Zhang S, Chen X, Liang W, et al. Resistance to the insulin and elevated level of androgen: a major cause of polycystic ovary syndrome. Front Endocrinol. 2021;12:741764. Ye W, Xie T, Song Y, Zhou L. The role of androgen and its related signals in PCOS. J Cell Mol Med. 2021;25(4):1825–37. Dumesic DA, Abbott DH, Sanchita S, Chazenbalk GD. Endocrine–metabolic dysfunction in polycystic ovary syndrome: An evolutionary perspective. 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P-value KD (n=23) PLCD (n=23) Variables 0.927 † 30.30 (5.41) 30.13 (7.27) Age (year) * 0.631 † 164.2 (7.59) 163.26 (5.69) Height (cm) * 0.496 † 29.21 (3.39) 29.47 (4.25) BMI (Kg/m 2 ) * 0.769 † 0.920 (0.026) 0.914 (0.034) WHR * 0.277 † 2531.78 (455.67) 2401.04 (342.70) Total energy intake (Kcal/day) * 0.320 † 391.49 (34.08) 403.13 (43.79) Physical activity ( MET minute/week) * 0.50 § 6 (26.1%) 5 (21.7%) Single Marital status ** 17 (73.9%) 18 (78.3%) Married Note: * Values are presented as mean (SD). † Based on independent samples t-test. ** Values are presented as number (%). § Based on Fisher exact test. Abbreviations: PCOS: polycystic ovary syndrome, WHR: waist to hip ratio Table 2. Anthropometric index and body composition characteristics at baseline and after 8 weeks of intervention. Variables PLCD (n=21) KD (n=19) MD (CI%95) P-value † P-value Weight (kg) Baseline 78.49 (11.61) 79.02 (12.34) -0.52 0.88 P<0.05 * 8 weeks 74.14 (11.29) 73.38 (11.35) 0.76 0.83 P<0.05 § MD (CI%95) 4.35 (3.64, 5.56) 5.64 (8.53, 7.55) P-value P<0.05 P<0.05 BMI (kg/m 2 ) Baseline 29.47 (4.25) 29.21 (3.39) 0.26 0.496 P<0.05 * 8 weeks 27.76 (3.89) 26.48 (3.56) 1.28 0.286 P<0.05 ** MD (CI%95) 1.71 (1.36, 2.07) 2.90 (2.73, 3.07) p-Value P<0.05 P<0.05 WC (cm) Baseline 104.19 (10.89) 105.62 (12.03) -1.42 0.67 P<0.05 * 8 weeks 101.49 (10.17) 100.18 (12.34) 1.30 0.71 P<0.05 ** MD (CI%95) 2.70 (2.07, 3.34) 5.44 (6.74, 8.10) P-value P<0.05 P<0.05 HC (cm) Baseline 113.96 (10.68) 114.65 (11.42) -0.68 0.83 P<0.05 * 8 weeks 110.73 (11.16) 109.61 (12.88) 1.12 0.76 P<0.05 ** MD (CI%95) 3.44 (2.81, 4.07) 7.31 (5.04, 9.57) P-value P<0.05 P<0.05 WHR Baseline 0.914 (0.034) 0.920 (0.026) -0.006 0.769 0.338 * 8 weeks 0.917 (0.039) 0.914 (0.049) 0.002 0.855 0.529 ** MD (CI%95) -0.005 (-0.01, 0.003) 0.004 (-0.014, 0.023) P-value 0.243 P<0.05 FBM (kg) Baseline 29.86 (6.93) 28.77 (7.04) 1.09 0.598 P<0.05 * 8 weeks 26.74 (6.26) 24.42 (6.99) 2.32 0.275 P<0.05 ** MD (CI%95) 3.08 (2.06, 4.10) 5.18 (4.26, 5.75) P-value P<0.05 P<0.05 LBM (kg) Baseline 50.01 (5.50) 50.24 (6.21) -0.230 0.895 P<0.05 * 8 weeks 48.61(5.31) 48.62 (5.14) -0.006 0.997 P<0.05 ** MD (CI%95) 1.35 (0.67, 2.04) 3.19 (2.64, 3.74) P-value P<0.05 P<0.05 TBW (kg) Baseline 36.00 (3.97) 36.18 (4.47) -0.17 0.887 P<0.05 * 8 weeks 35.01(4.07) 35.16 (3.52) -0.14 0.903 P<0.05 ** MD (CI%95) 0.96 (0.51, 1.41) 2.15(1.74, 2.55) P-value P<0.05 P<0.05 TBP (kg) Baseline 9.50 (0.98) 9.61 (1.13) -0.10 0.730 P<0.05 * 8 weeks 9.19(1.04) 9.35 (1.02) -0.16 0.622 P<0.05 ** MD (CI%95) 0.30 (0.21, 0.40) 0.56 (0.38, 0.74) P-value P<0.05 P<0.05 TBM (kg) Baseline 4.49 (0.63) 4.45 (0.67) 0.03 0.841 0.541 * 8 weeks 4.20 (0.71) 4.34 (0.68) -0.14 0.510 0.551 ** MD (CI%95) 0.29 (0.17, 0.40) 0.24 (0.15, 0.32) P-value P<0.05 P<0.05 RMR (Kcal) Baseline 1300.00 (80.60) 1305.86 (86.78) -5.86 0.813 0.665 * 8 weeks 1280.33(84.18) 1298.74 (73.15) -18.04 0.467 0.488 ** MD (CI%95) 18.19 (3.67, 32.70) 27.05 (4.26, 49.83) P-value P<0.05 P<0.05 Note: Data are expressed as mean (SD) and mean difference (95%CI). † Indicate comparison between groups at baseline (Independent samples t-test for baseline). * Indicate comparison between groups based on ANOVA without adjustment. ** Indicate comparison between groups based on ANOVA adjusted for baseline measures and confounding factors (age, baseline BMI, physical activity, and, energy intake). § Indicate comparison between groups based on ANOVA adjusted for baseline measures and confounding factors (age, physical activity, resting metabolite rate, and, energy intake). Abbreviations: BMI: body mass index, WC: waist circumferences, HC: hip circumferences, WHR: waist to hip ratio, FBM: fat body mass, LBM: lean body mass, TBW: total body water, TBP: total body protein, TBM: total body mineral, RMR: resting metabolic rate. Table 3: Metabolic and endocrine hormonal status at baseline and after 8 weeks of the intervention Variables PLCD (n=21) KD (n=19) MD (CI%95) P-value † P-value FBG (mg/dl) Baseline 95.95 (4.60) 96.21 (4.68) -0.26 0.850 P<0.05 * 8 weeks 90.90 (3.88) 87.94 (2.67) 2.95 0.030 P<0.05 ** MD (CI%95) 5.00 (3.00, 6.99) 8.84 (7.57, 10.10) P-value P<0.05 P<0.05 Insulin (µU/ml) Baseline 24.74 (3.83) 27.57 (3.17) -2.83 0.009 P<0.05 * 8 weeks 17.50 (3.48) 14.45 (3.10) 3.04 0.006 P<0.05 ** MD(CI%95) 7.35 (5.76, 8.93) 13.44(12.34, 14.55) P-value P<0.05 P<0.05 HOMA-IR Baseline 5.87 (1.05) 6.56 (0.92) -0.68 0.023 P<0.05 * 8 weeks 3.93 (0.82) 3.15 (0.75) 0.78 0.003 P<0.05 ** MD(CI%95) 1.96 (1.58, 2.35) 3.53 (3.24, 3.81) P-value P<0.05 P<0.05 HOMA-B Baseline 15.17 (2.32) 16.85 (2.62) -1.67 0.027 P=0.071 * 8 weeks 12.71 (2.79) 11.78 (2.40) 0.92 0.269 P=0.075 ** MD(CI%95) 2.57 (1.07, 4.06) 4.94 (3.92, 5.96) P-value P<0.05 P<0.05 TC (mg/dl) Baseline 224.21 (33.37) 230.21 (17.55) -6.00 0.449 P<0.05 * 8 weeks 185.09 (16.81) 193.94 (15.47) -8.85 0.092 P=0.030 ** MD(CI%95) 44.38 (36.10, 52.65) 38.15 (34.36, 41.95) P-value P<0.05 P<0.05 TG (mg/dl) Baseline 266.86 (32.85) 272.04 (34.72) -5.17 0.606 P<0.05 * 8 weeks 228.66 (37.29) 214.42 (31.97) 14.24 0.205 P<0.05 ** MD(CI%95) 40.71(35.81, 45.61) 61.42 (50.96, 71.87) P-value P<0.05 P<0.05 LDL-C (mg/dl) Baseline 133.95 (13.69) 134.86 (14.75) -0.91 0.829 P<0.05 * 8 weeks 100.00 (11.89) 111.52 (11.22) -11.52 0.003 P<0.05 ** MD(CI%95) 33.80 (30.46, 37.15) 21.52 (14.71, 28.33) P-value P<0.05 P<0.05 HDL-C (mg/dl) Baseline 50.21(10.18) 48.04 (8.91) 2.17 0.445 P<0.05 * 8 weeks 65.04 (8.91) 59.52 (9.54) 5.52 0.052 P<0.05 ** MD(CI%95) -13.71 (-15.46, -11.96) -10.42 (-12.71, -8.13) P-value P<0.05 P<0.05 LAP (cm. mmol/L) Baseline 138.43 (32.44) 146.90 (45.75) -8.46 0.047 P<0.05 * 8 weeks 111.30 (26.43) 102.53 (38.25) 8.77 0.040 P<0.05 ** MD(CI%95) 28.37 (23.81, 32.93) 44.37 (59.15, 45.43) P-value P<0.05 P<0.05 VAI Baseline 4.86 (1.17) 5.36 (1.26) -0.39 0.25 P=608.0 * 8 weeks 3.20 (60.0) 3.37 (76.0) -0.16 0.44 P=628.0 ** MD(CI%95) 1.66 (1.33, 1.98) 1.99 (1.60, 2.37) P-value P<0.05 P<0.05 LH (mIU/ml) Baseline 12.15 (1.82) 12.10 (1.95) 0.04 0.93 P<0.05 * 8 weeks 9.69 (0.97) 7.97 (2.38) 1.71 0.00 P<0.05 ** MD (CI%95) 2.48 (1.98, 2.98) 4.38 (3.72, 5.05) P-value P<0.05 P<0.05 FSH (mIU/ml) Baseline 4.39 (2.17) 4.06 (1.30) 0.32 0.85 P<0.05 * 8 weeks 4.63 (2.14) 4.74 (1.41) -0.10 0.53 P<0.05 ** MD(CI%95) -0.24 (-0.54, -0.35) -0.68 (-0.69, -0.40) P-value P<0.05 P<0.05 Testosterone (ng/ml) Baseline 0.61 (0.13) 0.67 (0.10) -0.05 0.12 P<0.05 * 8 weeks 0.48 (0.16) 0.49 (0.09) -0.01 0.79 P<0.05 ** MD(CI%95) 0.12 (0.07, 0.17) 0.18 (0.15, 0.20) P-value P<0.05 P<0.05 DHEA-s(µg/ml) Baseline 2.09 (0.59) 2.34 (0.55) -0.24 0.15 P=0.071 * 8 weeks 1.86 (0.55) 1.93 (0.52) -0.07 0.64 P=0.075 ** MD(CI%95) 0.23 (0.17, 0.34) 0.41 (-0.69, -0.40) P-value P<0.05 P<0.05 Ferriman Gallway Score Baseline 12.34 (2.91) 12.82 (2.44) -0.47 0.55 P=0.771 * 8 weeks 11.52 (2.18) 12.05 (2.30) -0.52 0.457 MD(CI%95) 0.71 (-1.9, 1.62) 0.80 (1.01, 1.08) P-value 0.118 0.12 Note: Data are expressed as mean (SD) and mean difference (95%CI). † Indicate comparison between groups at baseline (Independent samples t-test for baseline). * Indicate comparison between groups based on ANOVA without adjustment. ** Indicate comparison between groups based on ANOVA adjusted for baseline measures and confounding factors (age, baseline BMI, physical activity, and, energy intake). § Indicate comparison between groups based on ANOVA adjusted for baseline measures and confounding factors (age, physical activity, resting metabolite rate, and, energy intake). Abbreviations: FBS: fasting blood glucose, HOMA-IR: homeostatic model assessment of insulin resistance, HOMA_B: homeostasis model assessment of beta cell function, TC: total cholesterol, TG: triglycerides, HDL: high-density lipoprotein, LDL-C: low-density lipoprotein, LAP: lipid accumulation products, VAI: visceral adipose index, LH: luteinizing hormone, FSH: follicle-stimulating hormone, DHEA-s: dehydroepiandrosterone sulfate Table 4. Energy and macronutrient intake at baseline and after 8 weeks of intervention PLCD (n=21) KD (n=19) MD (CI%95) P-value † Energy (Kcal/day) Baseline 2401.04 (342.70) 2531.78 (455.67) -130.73 0.277 8 weeks 1630.95 (150.39) 1828.95 (333.88) 197.99 0.019 MD (CI%95) 723.47 (562.23, 884.71) 642.84 (524.01, 761.67) P-value P<0.05 P<0.05 Carbohydrate (gr/day) Baseline 294.78 (62.76) 303.00 (51.51) -8.21 0.630 8 weeks 156.09 (19.53) 23.33 (2.42) 132.75 0.00 MD(CI%95) 131.14 (102.27, 160.02) 277.72 (251.75, 303.68) p-Value P<0.05 P<0.05 Protein (gr/day) Baseline 68.0 (6.78) 67.65 (6.66) 0.34 0.862 8 weeks 109.49 (10.45) 118.61 (6.81) -9.12 0.003 MD(CI%95) -42.11 (-48.01, -36.21) -51.93 (-56.91, -46.94) P-value P<0.05 P<0.05 Fat (gr/day) Baseline 106.48 (9.30) 107.45 (11.03) -0.96 0.749 8 weeks 64.37 (13.67) 139.46 (21.93) -75.09 0.00 MD(CI%95) 41.20 (33.93, 48.47) -32.71 (-39.58, -25.83) P-value P<0.05 P<0.05 Total cholesterol (gr/day) Baseline 155.39 (41.32) 163.86 (44.91) -8.47 0.509 8 weeks 3.63 (0.53) 576.11 (142.17) -572.47 0.00 MD(CI%95) 146.27 (128.99, 163.54) -417.8 (-487.9, -347.8) P-value P<0.05 P<0.05 Baseline 25.03 (5.71) 23.89 (5.30) 1.15 0.481 Total Fiber (gr/day) 8 weeks 38.97 (4.57) 12.87(1.67) 26.10 0.00 MD(CI%95) -14.58 (-17.73, -11.43) 10.24 (7.79, 12.68) P-value P<0.05 P<0.05 MUFA (gr/day) Baseline 41.58 (3.56) 42.96 (3.56) -1.37 0.196 8 weeks 20.40 (5.31) 48.51 (4.08) -28.11 0.00 MD(CI%95) 20.75 (17.64, 23.86) -6.02 (-7.90, -4.13) P-value P<0.05 P<0.05 PUFA (gr/day) Baseline 12.70 (1.97) 13.00 (1.91) -0.30 0.593 8 weeks 51.14 (2.84) 52.25 (2.81) -10.68 0.00 MD(CI%95) -38.44 (-15.07, -12.24) -39.25 (-24.91, -23.13) P-value P<0.05 P<0.05 SFAs (gr/day) Baseline 51.14 (2.84) 52.25 (2.81) -1.10 0.192 8 weeks 11.82 (6.12) 41.25 (2.24) -29.43 0.00 MD(CI%95) 39.00 (35.76, 42.23) 10.73 (8.94, 12.52) P-value P<0.05 P<0.05 TFA (gr/day) Baseline 0.079 (0.016) 0.080 (0.018) -0.001 0.804 8 weeks 0.005 (0.008) 0.156 (0.021) -0.15 0.00 MD(CI%95) 0.07 (0.06, 0.08) -0.07 (-0.09, -0.06) P-value P<0.05 P<0.05 Phytosterols (gr/day) Baseline 73.77 (4.08) 75.54 (3.73) -1.7 0.136 8 weeks 162.42(39.39) 1.55 (42.0) 160.87 0.00 MD(CI%95) -88.75 (-106.72, -70.78) 73.86 (71.95, 75.77) P-value P<0.05 P<0.05 Note: Data are expressed as mean (SD) and mean difference (95%CI). † Indicate comparison between groups at baseline (Independent samples t-test for baseline) * Indicate comparison between groups based on ANOVA without adjustment. Abbreviations: MUFA: mono-unsaturated fatty acids, PUFA: poly-unsaturated fatty acids, SFA: saturated fatty acids, TFA: trans fatty acids Table 5. Micronutrient intake at baseline and after 8 weeks of the intervention. PLCD (n=21) KD (n=19) MD (CI%95) P-value † Vitamin C (mg/day) Baseline 253.93 (5.28) 256.79 (6.83) -2.86 0.119 8 weeks 162.49 (6.02) 88.73 (4.64) 73.76 0.00 MD (CI%95) 91.19 (87.74, 94.64) 167.70 (163.6, 171.80) P-value P<0.05 P<0.05 Vitamin B9 (mg/day) Baseline 329.13 (8.87) 332.10 (4.83) -2.96 0.166 8 weeks 339.74 (8.42) 192.12 (5.01) 147.62 0.00 MD(CI%95) -10.68 (-15.44, -5.91) 139.49 (136.34, 142.64) p-Value P<0.05 P<0.05 Vitamin B12 (mic/day) Baseline 1.85 (0.12) 1.91 (0.13) -0.06 0.105 8 weeks 0.18(0.03) 6.65 (1.54) -6.46 0.00 MD(CI%95) 1.67 (1.60, 1.73) -4.72 (-5.44, -4.00) P-value P<0.05 P<0.05 Calcium (mg/day) Baseline 458.93 (21.17) 469.04 (14.15) -10.11 0.064 8 weeks 634.93 (13.15) 241.77 (13.22) 293.15 0.00 MD(CI%95) -176.65 (-189.25, -164.05) 127.05(116.34, 137.77) P-value P<0.05 P<0.05 Iron (mg/day) Baseline 9.82 (0.67) 9.37 (0.77) 0.44 0.043 8 weeks 24.05 (2.32) 11.51 (0.99) 12.54 0.00 MD(CI%95) -14.18 (-15.25, -13.10) -2.17 (-2.80, -1.54) P-value P<0.05 P<0.05 Zinc (mg/day) Baseline 6.57 (0.75) 6.75 (0.64) -0.17 0.393 8 weeks 13.21 (0.89) 10.15 (0.66) 3.06 0.00 MD(CI%95) -6.56 (-7.06, -6.06) -3.40 (-3.85, -2.95) P-value P<0.05 P<0.05 Copper (mg/day) Baseline 1.96 (0.58) 2.03 (0.55) -0.06 0.70 8 weeks 3.42 (0.57) 2.21 (0.48) 1.21 0.00 MD(CI%95) -1.42 (-1.82, -1.02) -0.18 (-0.46, 0.08) P-value P<0.05 P<0.05 Sodium (mg/day) Baseline 1989.52 (6.8) 1991.38 (8.05) -1.85 0.405 8 weeks 6051.53 (11.91) 1690.40 (5.83) 4361.13 0.00 MD(CI%95) -4061.89 (-4067.65, -4056.12) 301.07 (296.21, 305.93) P-value P<0.05 P<0.05 Potassium (mg/day) Baseline 4621.36 (8.56) 4626.70 (5.18) -5.33 0.014 8 weeks 5124.27 (6.72) 1982.02 (7.12) 3142.24 0.00 MD(CI%95) -502.38 (-506.69, -498.07) 2644.70 (2640.21, 2649.19) P-value P<0.05 P<0.05 Magnesium (mg/day) Baseline 246.11 (8.51) 251.26 (7.12) -5.15 0.031 8 weeks 620.04 (8.23) 337.53 (68.62) 282.51 0.00 MD(CI%95) -374.65 (-381.13, -368.18) -86.57 (-118.01, -55.13) P-value P<0.05 P<0.05 Phosphors (mg/day) Baseline 1031.08 (6.43) 1038.61 (5.32) -7.52 0.00 8 weeks 1613.63 (7.19) 1309.09 (9.17) 304.54 0.00 MD(CI%95) -582.94 (-587.85, -578.03) -270.66 (-274.95, -266.36) P-value P<0.05 P<0.05 Iodine (mg/day) Baseline 72.55 (6.20) 74.43 (6.53) -1.87 0.324 8 weeks 23.46 (3.77) 86.05 (15.06) -62.58 0.00 MD(CI%95) 49.29 (45.65, 52.92) -11.34 (-17.63, -5.04) P-value P<0.05 P<0.05 Note: Data are expressed as mean (SD) and mean difference (95%CI). † Indicate comparison between groups at baseline (Independent samples t-test for baseline) * Indicate comparison between groups based on ANOVA without adjustment. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 02 Dec, 2024 Read the published version in Nutrition Journal → Version 1 posted Editorial decision: Revision requested 01 Oct, 2024 Reviews received at journal 22 Sep, 2024 Reviews received at journal 18 Sep, 2024 Reviewers agreed at journal 18 Sep, 2024 Reviewers agreed at journal 18 Sep, 2024 Reviewers agreed at journal 21 Aug, 2024 Reviewers agreed at journal 19 Aug, 2024 Reviewers agreed at journal 28 Jul, 2024 Reviewers invited by journal 27 Jul, 2024 Editor assigned by journal 06 Jun, 2024 Submission checks completed at journal 26 May, 2024 First submitted to journal 22 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4460351","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":311498476,"identity":"acb26af2-b1c8-4ca7-98f8-e62781242164","order_by":0,"name":"Maryam Sharifi","email":"","orcid":"","institution":"Kermanshah University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Maryam","middleName":"","lastName":"Sharifi","suffix":""},{"id":311498477,"identity":"a70559de-ee2e-4b6d-b785-a8e56799a5dd","order_by":1,"name":"Jalal Moludi","email":"","orcid":"","institution":"Kermanshah University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Jalal","middleName":"","lastName":"Moludi","suffix":""},{"id":311498478,"identity":"9c16d39c-3c16-4c8e-97f3-b4d0095853ba","order_by":2,"name":"Yahya Salimi","email":"","orcid":"","institution":"Kermanshah University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Yahya","middleName":"","lastName":"Salimi","suffix":""},{"id":311498479,"identity":"37df485c-47f1-4253-911e-e07073026ee1","order_by":3,"name":"Alireza Jahan-Mihan","email":"","orcid":"","institution":"University of North Florida","correspondingAuthor":false,"prefix":"","firstName":"Alireza","middleName":"","lastName":"Jahan-Mihan","suffix":""},{"id":311498481,"identity":"3421b86f-b26e-4741-a507-7a812bf719f1","order_by":4,"name":"Amir Saber","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYFACxgYQmcDAwHwYLnaASC1sycRqgQCgFh5j4pzFP+1w2weGP3Z5/NJnPhvz5tQx8LcfYDxcgUeLxO3E5hmMbcnFkn25m5N5tx1mkDiTwHDwDD5rgFqA3mFO3HCGd/Nh3m1AX9xgYDjYgEeHPEgLw5/6xP1neB4DtdQxyBPSYgDWwnY4cQMPDzPQYcwMBoS0GIK0JLYdL5Y4w2ZsOHfbYR7DM4kNeLXI3U5/zPDhT3Uefw/zY4m32+rk5I4fPvwRnxYwSEBi88AidxSMglEwCkYBBQAARwNM5xMTEsYAAAAASUVORK5CYII=","orcid":"","institution":"Kermanshah University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Amir","middleName":"","lastName":"Saber","suffix":""}],"badges":[],"createdAt":"2024-05-22 10:51:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4460351/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4460351/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12937-024-01056-7","type":"published","date":"2024-12-02T15:58:07+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":58145995,"identity":"31fcfce8-6eb7-4aef-a8a7-d469a13c9e3b","added_by":"auto","created_at":"2024-06-11 18:34:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":64238,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT flow diagram of study design for portfolio low-carbohydrate (PLCD) and the ketogenic diet (KD) in women with polycystic ovary syndrome.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4460351/v1/c0750d4936f47cf3fb2d56d8.png"},{"id":70965875,"identity":"b9312f94-63ce-4fc5-bf79-048baf787d27","added_by":"auto","created_at":"2024-12-09 16:20:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2095897,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4460351/v1/404fa5f9-1deb-4bb8-ba3a-b82884cacd75.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Effects of the Portfolio Low-Carbohydrate Diet versus the Ketogenic Diet on Anthropometric Indices, Metabolic Status, and Hormonal Levels in Overweight or Obese Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial","fulltext":[{"header":"Background","content":"\u003cp\u003ePolycystic Ovary Syndrome (PCOS) is the most common endocrine-metabolic disorder among women of reproductive age, with a global prevalence of 20% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). PCOS is primarily caused by the overproduction of androgens from the ovaries and/or adrenal glands, although in certain women, it is associated with insulin resistance and metabolic imbalances (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The main clinical symptoms of this disease are hyperandrogenism, menstrual disturbances (oligomenorrhea, amenorrhea, prolonged irregular menstrual bleeding), alteration in the ovarian morphology, hirsutism, acne, and alopecia (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Moreover, women with PCOS are more likely to meet metabolic abnormalities such as abdominal obesity, peripheral insulin resistance (IR), hyperinsulinemia, impaired glucose metabolism, infertility, hypertension, and lipid profile disorders, which markedly increase the risk of chronic diseases for instance type 2 diabetes mellitus, cardiovascular disease, and metabolic syndrome (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). PCOS diagnosis follows the Rotterdam criteria, requiring the presence of at least two out of three criteria: (A) clinical signs of hyperandrogenism (such as hirsutism, acne, seborrhea, and alopecia) and/or elevated levels of circulating androgens; (B) presence of ovarian cysts assessed by ultrasound examination; and (C) oligo-amenorrhea with oligo-or anovulation (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Accordingly, four phenotype groups have been introduced (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Phenotype A is the most vigorous phenotype which manifests all three symptoms of PCOS, phenotype B demonstrates clinical hyperandrogenism and oligo-or anovulation, phenotype C represents clinical hyperandrogenism as well as ovarian cysts, whereas phenotype D is the weakest one along an axis of metabolic and ovarian dysfunction which is observed as oligo-or anovulation and ovarian cysts. One study defined phenotypes A, B, and C as endocrine-metabolic syndromes, while phenotype D is characterized as non-hyperandrogenic PCOS (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eObservational studies have found a high prevalence of overweight and obesity in women with PCOS, with an estimated 75% being affected. This is attributed to elevated androgen levels and an imbalance in the FSH/LH ratio (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Additionally, both normal weight and overweight women with PCOS were found to exhibit android fat distribution (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). This pattern of fat distribution, known as central obesity, is not only linked to metabolic syndrome, which includes insulin resistance, high insulin levels, and abnormal lipid levels but also plays a role in ovarian hyperandrogenism and worsens the severity of PCOS (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Hence, there is a mutually instrumental relationship between obesity and PCOS.\u003c/p\u003e \u003cp\u003eAlthough, the treatment approaches for PCOS are based on the phenotype of patients and the severity of complications, the cornerstone of PCOS treatment is based on lifestyle changes approach, with an emphasis on modifying diet and engaging in regular exercise (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Despite the absence of a study indicating the ideal and proven dietary composition for treating PCOS symptoms, numerous studies have shown the positive impact of low carbohydrate diets in relieving PCOS symptoms compared to traditional calorie-restricted diets (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Portfolio low-carbohydrate diet (PLCD) is a plant-based diet consisting of 40% carbohydrates, 20% protein, and 40% fat. It is designed to lower cholesterol levels by incorporating five specific cholesterol-lowering foods and nutrients, including plant protein, viscous fiber, nuts, and phytosterols (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). These nutrients have been shown to have beneficial effects on lipid profile in previous studies (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). A systematic review of twenty studies showed that adhering to a low carbohydrate diet (providing less than 45% of total energy from carbohydrates) while maintaining an energy deficit led to positive changes in body measurements, blood sugar levels, fasting insulin levels, insulin response during a 3-hour oral glucose tolerance test, and reproductive hormones like FSH, LH, DHEA, SHBG, and free testosterone in women with PCOS (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Thomson and colleagues found that by adhering to a low-carbohydrate diet consisting of 40% carbohydrates, 30% protein, and 30% fat for 20 weeks, there was a reduction in fat mass and lean body mass by 3 and 2 kg, respectively. Furthermore, there was a decrease in fasting glucose, insulin, testosterone, and free androgen index levels, and a restoration of normal menstrual cycles (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eKetogenic diet (KD) has also been utilized for various purposes. It is characterized by high fat intake (70%), very low carbohydrate intake (10%), and moderate protein levels (20%), resulting in the production of ketone bodies (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The KD has demonstrated many beneficial effects in various numbers of diseases, including obesity, neurological disorders, type 2 diabetes mellitus, cancer, as well as PCOS (\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). A recent parallel randomized trial on 20 obese women with PCOS and liver dysfunction demonstrated that after 12 weeks the KD considerably reduced the body weight, blood glucose, plasma estradiol, progesterone levels, and liver function markers compared to the control diet (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBased on above evidence, both the PLCD and the KD offer beneficial effects on PCOS manifestations due to their low carbohydrate content and consequently minimal insulin secretion. Inevitably, these two diets could effectively reduce hyperandrogenism, which was beneficial for patients with phenotypes A, B, and C of PCOS. While PCOS patients with phenotype D, which lacks hyperandrogenism, did not hold therapeutic rationale for these dietary interventions due to the distinct etiology.\u003c/p\u003e \u003cp\u003eOverall, to the best of our knowledge, there was no study comparing the therapeutic effects of these two diets in PCOS patients. Therefore, the present study aimed to compare the effects of the PLCD and the KD on PCOS manifestations, through the evaluation of anthropometric measurements, metabolic status, reproductive hormone levels, dietary intake, and Ferriman-Gallwey score.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThe entire protocol of this study has been previously published (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Briefly, this parallel randomized clinical trial took place at Fatahi Clinic of Kermanshah University of Medical Sciences (KUMS), Iran, from January 2023 to May 2023. The eligible participants were randomly assigned to follow either the PLCD group (N\u0026thinsp;=\u0026thinsp;23) or the KD group (N\u0026thinsp;=\u0026thinsp;23), using a computer-generated random sealed envelope. The protocol was approved by the Medical University of Kermanshah Research Ethics Board (IR.KUMS. REC.1401.404). Furthermore, the trial was registered at the Iranian Registry of Clinical Trials (IRCT20200912048693N3) on 2022 December 14. The procedures were carried out following the World Medical Association Declaration of Helsinki, the Guidelines of the International Conference on Harmonization on Good Clinical Practice, and we followed the Consolidated Standards of Reporting Trials (CONSORT). Before the commencement of the study, written informed consent was obtained from all participants. It was not possible to blind the participants due to the nature of the diet; however, there was no interaction between the two groups. Furthermore, to minimize bias, the outcome assessors and the data analysts were blinded. The primary outcome of this investigation was determining the effectiveness of the PLCD compared to the KD in improving PCOS disease manifestations by measuring weight loss before and after the intervention. The secondary outcomes were BMI, FBM, LBM, WC, HC, FBS, insulin level, HOMA-IR, HOMA-B, reproductive hormones (LH, FSH, DHEA, and testosterone), lipid profile (total cholesterol, triglycerides, LDL, HDL), and Ferriman-Gallwey score before and after the intervention.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSample size\u003c/h2\u003e \u003cp\u003eThe sample size for the study was calculated based on the formula used in a randomized clinical trial (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The sample size required to have 80% power to detect a difference of 2 units of weight change would be 18 people in each group. Considering the possibility of 25% missing people in the follow-up, the sample size increases to 23 in each group. Also, a type I error of 5% (α\u0026thinsp;=\u0026thinsp;0.05) and a type II error of 20% (β\u0026thinsp;=\u0026thinsp;0.2, power\u0026thinsp;=\u0026thinsp;80%) were considered.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eWe recruited 46 overweight or obese women diagnosed with PCOS through a public advertisement in the medical centers, healthcare establishments, physician offices, pharmacies, and hospitals of Kermanshah. Participants were asked to first visit Fatahi Clinics where the screening was performed by a dietitian as well as an obstetrician-gynecologist to determine eligible patients according to the inclusion criteria. Written informed consent was provided after a detailed explanation of the study. Also, the demographic characteristics questionnaire, the physical activity questionnaire (IPAQ), as well as 3-day food records questionnaires of all participants were completed by a professional dietitian. Then the subjects were randomly allocated to receive either the PLCD or the KD by a random block method of 6 from the website \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sealedenvelope.com\u003c/span\u003e\u003cspan address=\"https://www.sealedenvelope.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. The inclusion criteria were: diagnosis of PCOS according to the Rotterdam Criteria by an obstetrician-gynecologist, fertile age (18\u0026ndash;45 years), and BMI\u0026thinsp;\u0026ge;\u0026thinsp;25 kg/m\u003csup\u003e2\u003c/sup\u003e. The exclusion criteria were: currently pregnancy or lactation, taking anti-psychotic or anti-seizure medication due to their induced effect on insulin resistance, following a specific nutritional diet or hypocaloric diet in the last 3 months, history of diabetes or other endocrine disorders (thyroid dysfunction and adrenal disorders), using medications that impact carbohydrate or lipid metabolism (oral contraceptive pills, antiepileptic, antipsychotics, statins, and fish oil), using fertility-enhancing or weight loss medications, history of hormonal therapy and/or insulin-sensitizers within the previous 2 months, and history of hepatic and renal disorders, hypertension, diagnosed anemia, severe respiratory disease (asthma and chronic bronchitis), and heart disease.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eAnthropometric Measurements\u003c/h2\u003e \u003cp\u003eBody composition analysis and resting metabolic rate (RMR) were conducted using an electronic scale with bioimpedance analysis (Plus Avis 333 Body Analyzer, China). The analysis included measurements of fat body mass (FBM), lean body mass (LBM), total body water (TBW), total body protein (TBP), and total body mineral (TBM), conducted with subjects wearing light clothing and with shoes and socks removed. The measurements were taken to the nearest 0.1 kg. The resting metabolic rate (RMR) was reported in Kcal. Height was determined to the nearest 1 cm using a well-mounted portable stadiometer (Holtain Ltd, UK). Moreover, BMI was calculated in kg/ m\u003csup\u003e2\u003c/sup\u003e. The WC was measured after removing clothes from the abdomen, as the smallest circumference was between the lowest rib and the iliac crest on the midaxillary line. The HC was determined at the level of the widest circumference over the great trochanters, and the WHR was calculated as waist measures divided by hip measurement. All parameters were measured at baseline and at the end of the study, after 8 weeks of dietary intervention.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eBiochemical Analysis\u003c/h2\u003e \u003cp\u003eAt baseline and after 8 weeks of the study, 10 ml venous blood samples were drawn from each participant by a catheter. Blood samples were collected into BD vacutainer Tubes (SSTTM 2 advance, REE 397953) between 8: 00 a.m. and 9:00 a.m. after 10 to 12 hours of overnight fasting and resting in bed during the early follicular phase (day 2\u0026ndash;5) of menstrual cycle. Blood samples were immediately centrifuged at 4000 RPM using centrifuge J6-MC by Beckman. Then the obtained serum was aliquoted and stored at -80\u0026deg;C until assay time. All samples were analyzed in the same analytical session for each test, using the same reagent lot and according to the manufacturer\u0026rsquo;s instructions with inter- and intra-assay coefficient variances (CVs) lower than 7%. Serum FBG was measured through enzymatic methods using the colorimetric technique, by commercial kits (Pars-Azmoon Co., Tehran, Iran) by an auto-analyzer (Hitachi-917, Tokyo, Japan). Serum insulin level was measured by chemiluminescence (IMMULITE 2000, SIEMENS). Total cholesterol, HDL, and LDL by enzymatic colorimetric in homogenous phase ((Roche Cobas e702, Roche Diagnostics, Mannheim, Germany), TGs by an enzymatic colorimetric method (Roche Cobas e702, Roche Diagnostics, Mannheim, Germany). Reproductive hormones including LH, FSH, DHEA, and testosterone were evaluated by ELISA kits (Bioassay Technology Laboratory, Shanghai Korean Biotech, Shanghai City, China).\u003c/p\u003e \u003cp\u003eThe Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) index was calculated according to the formula (insulinemia mU/ml\u0026times;glycemia mg/ dL/450). The homeostasis model assessment of β-cell dysfunction (HOMA-B) index was also calculated according to its formula (20 \u0026times; fasting insulin (\u0026micro;U/ml)/[fasting plasma glucose (mg/dl) \u0026ndash; 63]). Moreover, the visceral adipose tissue (VAI) index and lipid accumulation product (LAP) are both common markers to estimate cardiometabolic risks in women with PCOS, which were calculated according to their formula. (VAI\u0026thinsp;=\u0026thinsp;WC (cm) /36.58 + (1.89 \u0026times; BMI (Kg/m\u003csup\u003e2\u003c/sup\u003e)) \u0026times; TG (mmol/l)/0.81 \u0026times; 1.52/HDL (mmol/l) and LAP = (WC (cm) \u0026ndash; 58) \u0026times; TG (mmol/l)). All biochemical tests were assessed clinically at the Reference Laboratory of Kermanshah University of Medical Science before and after the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eDiets\u003c/h2\u003e \u003cp\u003eParticipants were randomly stratified to the PLCD or the KD designed by a professional dietician to follow for 8 weeks. The PLCD were a plant-based diet with a macronutrient distribution of 40% carbohydrate, 20% protein, and 40% fat. The Portfolio diet consisted of five food components added to the diet including 1) plant protein from soy products or dietary pulses such as beans, peas, chickpeas, and lentils; 2) viscous soluble fiber from oats, barley, psyllium, eggplant, okra, and certain fruit; 3) nuts from tree nuts or peanuts; 4) phytosterols; and 5) monounsaturated fats (MUFAs) in the form of olive, canola, or high oleic sunflower oils that indicated improvements of blood lipids (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Each diet was determined according to the prescribed daily calorie and macronutrient intake of individuals. The KD included of 10% carbohydrates, 20% protein, and 70% fat. Carbohydrates intake was \u0026lt;\u0026thinsp;30 g per day which was provided by a variety of vegetables as they are rich in fiber and have low amounts of carbohydrates (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Protein sources were fish, poultry, meat, and eggs. Furthermore, fat components were consumed in the form of olive oil, sesame, and oilseeds. Unsweetened drinks like herbal teas, tea, and infused coffee were allowed as they would not induce ketosis. Both groups had taken a multivitamin-mineral supplement (Dana Corp. Multi Daily, Tehran, Iran) every day. 500\u0026ndash;700 kcal were removed from the total caloric intake of each person and then its macronutrient distribution was calculated based on the type of diet (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eDietary Assessments\u003c/h2\u003e \u003cp\u003eTo ensure that nutritional ketosis was induced and maintained in women who followed the KD, they were required to use urinary keto sticks (Kimia Pajohan Co., Tehran. Iran) two random times every week and send their picture to the dietitian. In addition, each patient was provided at least ninety minutes of dietary counseling with a professional dietitian to educate their diet and encouraged to have aerobic physical activity, for instance, walking or jogging at least 60 min per day. Also, they were reminded to stop continuing the diet if they realized that they were pregnant or manifested serious complications. The dietitian was readily available to guide and advise individuals via phone, email, and other media during 8 weeks of intervention. To monitor participants' dietary adherence, the dietitian called each patient every 2 weeks to document their 3-day food records, two working days, and the weekend, assess, and analyze their macronutrient composition and calorie intake to realize how they follow their diet. Daily intakes of macro-nutrients and micro-nutrients were calculated by analyzing food data using Nutritionist IV software (First Databank, San Bruno, CA). If the participants did not follow the protocol of the study they were withdrawn from the clinical trial.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eFerriman-Gallwey Score\u003c/h2\u003e \u003cp\u003eHirsutism is considered one of the common clinical symptoms of PCOS and approximately 70% of PCOS women represent it (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). It is evaluated by the Ferriman-Gallwey score. This scoring system evaluates nine androgen-dependent body parts such as the upper lip, chin, chest, upper abdomen, lower abdomen, upper arms, thigh, upper back, and lower back, with scores ranging from zero (no excessive terminal hair growth visible) to four (extensive hair growth visible) for each body part evaluated. A maximum score of 36 is possible (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). In this study, Hirsutism was considered positive when the Ferryman-Gallwey score was \u0026gt;\u0026thinsp;8.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were carried out according to intention to treat. Data analysis was performed using SPSS Statistics (version 19, New York, USA). The distribution of data was expressed as mean (SD) for normally distributed quantitative data, and frequency (percent) for qualitative data. Kolmogorov-Smirnov test was used to check the normality of the data distribution. To compare the two groups at the baseline, independent sample tests, Mann\u0026ndash;Whitney, and chi-squared tests were used. Assessments of differences within the group were made by paired-sample t-tests or nonparametric Wilcoxon signed-rank test, and sign test. A comparison of the two groups at the end of the study was completed by the analysis of covariance (ANCOVA) after adjusting for the baseline parameters and covariates (changes in baseline values of evaluated parameters and potential covariates including age, baseline BMI, and the changes in weight, calorie intake, and physical activity level during the study). A significance level of P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was used to evaluate the statistical analyses.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAs depicted in Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, 46 women out of 184 individuals who responded to the recruitment advertisement met the eligibility criteria to take part in this study and were randomly assigned to the two diet groups. During 8 weeks of the intervention, 2 participants were excluded from the PLCD due to the loss of follow-up, while 4 women were excluded from the KD because of not responding and pregnancy. Overall, 21 and 19 women finished the study in the PLCD and the KD, respectively. Also, none of the participants of this study did not report any complications following the diets, which may be due to the short duration (8 weeks) of the trial.\u003c/p\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eBaseline characteristics\u003c/h2\u003e\n \u003cp\u003eFollowing the CONSORT guidelines, the baseline data of individuals who were randomized is illustrated in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. The SD of age and BMI of studied women were 30.13 (7.27) years and 29.47 (4.25) kg/m\u003csup\u003e2\u003c/sup\u003e in the PLCD group and 30.30 (5.41) years and 29.21 (3.39) kg/m\u003csup\u003e2\u003c/sup\u003e in the KD group with no significant differences (P\u0026thinsp;=\u0026thinsp;0.927 and P\u0026thinsp;=\u0026thinsp;0.496 respectively). Moreover, there were no significant differences in demographical data, such as height, WHR, total energy intake, physical activity, and marital status of participants in both groups. None of the participants were smokers.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eAnthropometric index and body composition\u003c/h2\u003e\n \u003cp\u003eAs shown in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, there were no notable disparities in the baseline anthropometric measurements between the two groups at the beginning of the study. After 8 weeks of intervention, significant changes were observed in anthropometric parameters including weight, BMI, WC, HC, FBM, LBM, TBW, TBP, TBM, and RMR within groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, when comparing the two groups while adjusting for baseline values and changes in age, energy intake, RMR, and physical activity levels, it was found that the KD group showed a significant weight reduction (MD 5.64 CI: 8.53, 7.55 vs. MD 4.60 CI: 3.64, 5.56), improvement in BMI (MD 2.90 CI: 2.73, 3.07 vs. MD 1.71 CI: 1.36, 2.07), FBM, LBM, TBW, TBP, WC, and HC compared to the PLCD group. However, there were no significant differences in WHR, TBM, and RMR between the two groups.\u003c/p\u003e\n \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003cp\u003e(The place of Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\n \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\n \u003ch2\u003eMetabolic and reproductive hormonal status\u003c/h2\u003e\n \u003cp\u003eAlthough there were no remarkable differences in the baseline of the two groups, both the PLCD and KD led to significant enhancements in the metabolic status and reproductive hormone levels of participants at the beginning and after 8 weeks of the intervention. There was a significant reduction in the mean difference of the glycemic status such as FBS in the KD group compared to the PLCD group (MD 8.84 CI: 7.57, 10.10 vs. MD 5.00 CI: 3.00, 6.99), insulin levels of serum, HOMA-IR, triglycerides, and LAP. Furthermore, the mean difference of reproductive hormones including LH (MD 4.38 CL: 3.72, 5.05 vs. MD 2.48 CI: 1.98, 2.98), FSH, and testosterone levels indicated more improvement in the KD group compared to the PLCD group at the baseline and after adjusted cofactors (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, the PLCD decreased the level of total cholesterol (MD 44.38 CI: 36.10, 52.65 vs. MD 38.15 CI: 34.36, 41.95) and LDL, while increasing the level of HDL more than the KD group. No obvious decreases were seen in the level of HOMA-B (P\u0026thinsp;=\u0026thinsp;0.071), VAI (P\u0026thinsp;=\u0026thinsp;0.608), and DHEA-s (P\u0026thinsp;=\u0026thinsp;0.071) between the two groups (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003cp\u003e(The place of Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\n \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\n \u003ch2\u003eDietary intake\u003c/h2\u003e\n \u003cp\u003eThere were no significant differences in the baseline intake of calories, macronutrients, and micronutrients between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). After 8 weeks of intervention, the mean difference of carbohydrate intake decreased significantly in the KD group than the PLCD group (MD 279.67 CI: 251.75, 303.68 vs. MD 138.69 CI: 102.27, 160.02). Although the energy intake in both diets did not have differences (P\u0026thinsp;=\u0026thinsp;0.025), all macronutrients as well as micronutrients were remarkably different between the two diets due to their intrinsic distinct. The ketogenic diet has higher levels of cholesterol, SFAs, PUFA, MUFA, and TFA compared to the plant-based PLCD. On the other hand, the PLCD has a higher amount of total fiber and phytosterols than the ketogenic diet (\u003cstrong\u003eTable\u0026nbsp;4\u003c/strong\u003e).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003cp\u003e(The place of Table 4)\u003c/p\u003e\n \u003cp\u003eIn addition, the KD contains more vitamin B12 and iodine than the PLCD due to its higher animal protein sources. Whereas, the PLCD contains more vitamin C, B9, calcium, iron, zinc, copper, sodium, potassium, magnesium, and phosphorus than the KD because of the soy and soy products as a source of plant protein. The main source of iron in the PLCD was non-hem, while it was mostly hem in the KD group (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n \u003cp\u003e(The place of Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study aimed to compare two calorie-restricted diets, the PLCD and the KD among overweight or obese women with PCOS. Our study reveals that, although both diets have beneficial effects on body composition, metabolic status, and reproductive hormones in these patients, without differences in the total energy intake between the two diets, the KD was likely more effective due to the inducing ketosis. Nevertheless, there was a more significant improvement in lipid profiles in the PLCD group compared to the KD group.\u003c/p\u003e \u003cp\u003ePCOS is recognized as one of the most common endocrinopathies affecting women of reproductive age, causing infertility and linked to a wide range of chronic cardiovascular and metabolic issues, resulting in 0.43\u0026nbsp;million disability-adjusted life-years (DALY) (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). PCOS is a multifactorial disease, that not only includes genetic agents, but also environmental, metabolic, and endocrine factors (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). The high prevalence of overweight, obesity, and central fat with an estimation of 75% among PCOS women indicates the important role of environmental factors which are directly associated with lifestyle habits (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Excessive adipose tissue particularly abdominal adipocytes as an endocrine organ, increases the production of estrogen and estrone (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). In the hypothalamus, the additional levels of estrogen and estrone lead to more secretion of GnRH, and consequently increase preferential production of LH as well as hyperandrogenism (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Although the etiology of PCOS has not been exactly clarified, studies hypothesized that insulin resistance has the principal role in manifesting this disorder since it appears to have a positive correlation with both total and central fat which induces an increased risk of higher androgens (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Therefore, both obesity and insulin resistance are two crucial aspects of causes of PCOS. According to recent guidelines from the American Society for Reproductive Medicine (ASRM), lifestyle adjustments, such as diet control, exercise, and weight management, are recommended as the first-line therapy for PCOS (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Moreover, studies have demonstrated that a 5\u0026ndash;10% weight loss in overweight or obese women with PCOS can improve ovarian function and increase pregnancy rates (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Subsequently, numerous studies have reported that hypocaloric diets are effective in both desirable weight reduction and alleviating PCOS manifestations (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Further investigations have shown that a low-carbohydrate diet can have numerous benefits for women with Polycystic Ovary Syndrome (PCOS), regardless of the severity of their symptoms. These benefits include improvements in endocrine and metabolic parameters, fertility, and weight loss. This is due to lower insulin secretion and increased fat oxidation when compared to conventional calorie-restricted diets (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe results of our study align with Paoli and colleagues that following a Ketogenic-Mediterranean diet with extracts for 12 weeks, in 14 overweight women with PCOS, significantly improved anthropometric parameters, glycemic status, lipid profiles, and reproductive hormones (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Another trial on 17 overweight and obese women diagnosed with PCOS represented that following a hypocaloric-ketogenic diet (carbohydrate intake 40\u0026ndash;50 gr/day) for 45 days ameliorates anthropometric index, insulin sensitivity, and androgen production. It appears that the improvements observed were due to the ketosis state caused by the diet, which resulted in changes in LH, FSH, LH/FSH ratio, and SHBG (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Also, a recent study compared the ketogenic diet (KD) with a standard, balanced hypocaloric diet like the Mediterranean diet (MD) for a short period. The study found that both diets showed significant improvements in anthropometric and biochemical parameters. However, the KD resulted in a greater reduction in all the parameters compared to the MD (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). The main mechanism of alleviating the symptoms of PCOS by the KD is through the ketone bodies (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). By reducing carbohydrate intake to less than 30 grams per day for 3 to 5 days, the concentration of insulin in the body decreases. As a result, the glycogen stored in the liver and muscles is replaced by an increase in fatty acid oxidation derived from adipose tissue. This process produces ketone bodies such as acetoacetate, acetone, and B-hydroxybutyrate that serve as fuel for the body (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). Nutritional ketosis is a condition in which the concentration of blood ketone is more than 0.5 mmol/L, suppressing hunger and increasing fat oxidation that leads to reduced fat mass and consequently weight loss (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). Additionally, in PCOS, ketosis activates the AMPK and SIRT1 pathways, improving glucose homeostasis and insulin sensitivity (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOn the other hand, the PLCD was a plant-based diet rich in antioxidants, soluble fiber, and phytosterols. It contained lower amounts of saturated fatty acids and trans fatty acids, which had positive effects on the lipid profile of patients (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). PCOS women often have an atherogenic lipid profile, which includes high levels of LDL, total cholesterol, and triglycerides, along with low levels of HDL (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). Therefore, the PLCD may be particularly beneficial for those with lipid profile disorders. Both diets decrease insulin, IGF-1, and IGFBP1 levels due to their low carbohydrate content. However, the ketogenic diet (KD) is superior because it generates ketones which improve PCOS symptoms. Additionally, the present study found that the pregnancy rate was an important factor to consider. In this way, two married women from the KD group got pregnant despite many previous unsuccessful attempts. Besides, there were no significant changes in the Ferriman Gallwey score progression, possibly due to the short study duration which was inadequate to observe hair growth accurately. Moreover, it takes over three months to see measurable effects of the hair cycle and growth, which vary depending on the body area (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe main advantage of the present study was the precise evaluation of dietary adherence in both groups. For the KD group, we utilized urinary keto strips twice a week at random to confirm the induction of ketosis in the patients' bodies. Also, despite the short duration of the trial (8 weeks), we observed positive effects of both diets without any complications. The adherence to both diets was high and only two people from each group were withdrawn from the study. The study encountered several limitations, one of which was the inability to assess inflammatory markers such as hs-CRP, TNF-a, and interleukin-6 due to limited financial support. In addition, we did not examine how different diets affect the gut microbiota.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of our study have revealed that both PLCD and KD diets, which are characterized by their low carbohydrate content, can have a significant positive impact on the outcomes of individuals with PCOS over an 8-week period. However, the study showed that inducing ketone status had a significant positive effect on various health parameters, including anthropometric indices, metabolic status, and reproductive hormones. While the PLCD indicates more beneficial effects on lipid profiles. Therefore, KD may be recommended as a viable, effective, and short-term treatment for overweight or obese women who have PCOS with a focus on micronutrient intake. On the other hand, the PLCD could be a beneficial treatment option for PCOS women who have lipid profile abnormalities. It is recommended to conduct more clinical trials with larger sample sizes and longer durations to confirm these findings. Also, further research should be conducted on the cellular mechanisms of these diets in women with PCOS.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDHEA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDehydroepiandrosterone sulfate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFBM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFat body mass\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFBG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFasting blood glucose\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFSH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFollicle-stimulating hormone\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHDL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHigh-density lipoprotein\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHOMA-IR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHomeostasis model assessment-insulin resistance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHOMA-B\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHomeostasis model assessment of beta cell function\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHip circumference\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eKD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eKetogenic diet\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLuteinizing hormone\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLipid accumulation products\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLBM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLean body mass\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLDL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow-density lipoprotein\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePCOS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePolycystic ovary syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMUFAs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMono-unsaturated fatty acids\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePLCD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePortfolio low-carbohydrate diet\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePUFA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePoly-unsaturated fatty acids\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRegistered dietitian\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRMR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eResting metabolic rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSFA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSaturated fatty acids\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSHBG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSex hormone-binding globulin\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTBP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTotal body protein\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTBM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTotal body mineral\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTBW\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTotal body water\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTotal cholesterol\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTFA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTrans fatty acids\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTriglycerides\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVAI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVisceral adipose index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWaist circumference\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWaist to hip circumference\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis trial was approved by the Ethics Committee of Kermanshah University of medical sciences with code No. IR.KUMS.REC.1401.404 and conducted in accordance with the Declaration of Helsinki. In addition, all women were given written informed consent before participating in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrior to data collection, the purpose of the study was explained to all participants. After being given a full explanation of the study procedures, written informed consent was obtained from all patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they do not have conflict of interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMS wrote the manuscript, coordinated the study, and designed the diets plan. AS, JM, and AJM are the investigators; they designed the study and interpreted the results. YS analyzed and interpreted the results and provided statistical advice. All authors edited and approved the final manuscript. Not any AI and AI-assisted technologies were used for this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge all of the participants and their time and effort. Also, the Kermanshah University of Medical Sciences is gratefully acknowledged. We would like to thank Shima Moradi as the researcher in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKhan R, Rehman R, Alam F. Situation analysis of polycystic ovary syndrome in Western Asia. Polycystic Ovary Syndrome: Elsevier; 2024. pp. 207\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDing H, Zhang J, Zhang F, Zhang S, Chen X, Liang W, et al. Resistance to the insulin and elevated level of androgen: a major cause of polycystic ovary syndrome. Front Endocrinol. 2021;12:741764.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYe W, Xie T, Song Y, Zhou L. The role of androgen and its related signals in PCOS. J Cell Mol Med. 2021;25(4):1825\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDumesic DA, Abbott DH, Sanchita S, Chazenbalk GD. Endocrine\u0026ndash;metabolic dysfunction in polycystic ovary syndrome: An evolutionary perspective. Curr Opin Endocr metabolic Res. 2020;12:41\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSanchez-Garrido MA, Tena-Sempere M. Metabolic dysfunction in polycystic ovary syndrome: Pathogenic role of androgen excess and potential therapeutic strategies. Mol metabolism. 2020;35:100937.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo F, Gong Z, Fernando T, Zhang L, Zhu X, Shi Y. 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Nutrients. 2023;15(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi J, Bai WP, Jiang B, Bai LR, Gu B, Yan SX, et al. Ketogenic diet in women with polycystic ovary syndrome and liver dysfunction who are obese: A randomized, open-label, parallel-group, controlled pilot trial. J Obstet Gynaecol Res. 2021;47(3):1145\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNajafabadi MS, Moludi J, Salimi Y, Saber A. A comparison of the portfolio low-carbohydrate diet and the ketogenic diet in overweight and obese women with polycystic ovary syndrome: study protocol for a randomized controlled trial. Trials. 2023;24(1):509.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTabrizi FPF, Farhangi MA, Vaezi M, Hemmati S. 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Disclosure: Kalyan Uppaluri declares no relevant financial relationships with ineligible companies.: StatPearls Publishing Copyright \u0026copy;. 2023, StatPearls Publishing LLC.; 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDrapeau V, Jacob R, Panahi S, Tremblay A. Effect of energy restriction on eating behavior traits and psychobehavioral factors in the low satiety phenotype. Nutrients. 2019;11(2):245.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpritzer PM, Marchesan LB, Santos BR, Fighera TM. Hirsutism, normal androgens and diagnosis of PCOS. Diagnostics. 2022;12(8):1922.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBazarganipour F, Ziaei S, Montazeri A, Faghihzadeh S, Frozanfard F. Psychometric properties of the Iranian version of modified polycystic ovary syndrome health-related quality-of-life questionnaire. Hum Reprod. 2012;27(9):2729\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu J, Wu Q, Hao Y, Jiao M, Wang X, Jiang S, et al. Measuring the global disease burden of polycystic ovary syndrome in 194 countries: Global Burden of Disease Study 2017. Hum Reprod. 2021;36(4):1108\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSUKUL S, RAMESH PS. AGASTI N. Understanding Polycystic Ovary Syndrome: A Multifactorial Endocrine Disorder. J Clin Diagn Res. 2021;15(10).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAshraf S, Aslam R, Bashir I, Majeed I, Jamshaid M. Environmental determinants and PCOS symptoms severity: A cross-sectional study. Health Care Women Int. 2022;43(1\u0026ndash;3):98\u0026ndash;113.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBril F, Ezeh U, Amiri M, Hatoum S, Pace L, Chen Y-H, et al. Adipose tissue dysfunction in polycystic ovary syndrome. J Clin Endocrinol Metabolism. 2024;109(1):10\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAzziz R. Adiposity in polycystic ovary syndrome: excess versus dysfunction. Fertil Steril. 2021;116(1):87\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShang Y, Zhou H, Hu M, Feng H. Effect of diet on insulin resistance in polycystic ovary syndrome. J Clin Endocrinol Metabolism. 2020;105(10):3346\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod (Oxford England). 2018;33(9):1602\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFong SL, Douma A, Verhaeghe J. Implementing the international evidence-based guideline of assessment and management of polycystic ovary syndrome (PCOS): how to achieve weight loss in overweight and obese women with PCOS? J Gynecol Obstet Hum Reprod. 2021;50(6):101894.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKulshreshtha B, Sharma N, Pant S, Sharma L, Pahuja B, Singh P. Isocaloric diet is as effective as the hypocaloric diet in ameliorating symptoms in PCOS patients. Int J Diabetes Developing Ctries. 2023:1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarrea L, Marzullo P, Muscogiuri G, Di Somma C, Scacchi M, Orio F, et al. Source and amount of carbohydrate in the diet and inflammation in women with polycystic ovary syndrome. Nutr Res Rev. 2018;31(2):291\u0026ndash;301.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaoli A, Mancin L, Giacona MC, Bianco A, Caprio M. Effects of a ketogenic diet in overweight women with polycystic ovary syndrome. J translational Med. 2020;18(1):1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCincione RI, Losavio F, Ciolli F, Valenzano A, Cibelli G, Messina G, et al. Effects of mixed of a ketogenic diet in overweight and obese women with polycystic ovary syndrome. Int J Environ Res Public Health. 2021;18(23):12490.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCincione IR, Graziadio C, Marino F, Vetrani C, Losavio F, Savastano S, et al. Short-time effects of ketogenic diet or modestly hypocaloric Mediterranean diet on overweight and obese women with polycystic ovary syndrome. J Endocrinol Invest. 2023;46(4):769\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMakievskaya CI, Popkov VA, Andrianova NV, Liao X, Zorov DB, Plotnikov EY. Ketogenic diet and ketone bodies against ischemic injury: Targets, mechanisms, and therapeutic potential. Int J Mol Sci. 2023;24(3):2576.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnderson JC, Mattar SG, Greenway FL, Lindquist RJ. Measuring ketone bodies for the monitoring of pathologic and therapeutic ketosis. Obes Sci Pract. 2021;7(5):646\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarrea L, Verde L, Camajani E, Cernea S, Frias-Toral E, Lamabadusuriya D, et al. Ketogenic diet as medical prescription in women with polycystic ovary syndrome (PCOS). Curr Nutr Rep. 2023;12(1):56\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlharbi A, Al-Sowayan NS. The effect of ketogenic-diet on health. Food Nutr Sci. 2020;11(4):301\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGlenn A, Lo K, Boucher B, Vitolins M, Manson J, Snetselaar L, et al. Association of the Portfolio Diet with Total and Cardiovascular Disease Mortality in the Women's Health Initiative. Annals Nutr metabolism. 2023;79(Suppl 1):337\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLivadas S, Macut D, Bothou C, Kuliczkowska-Płaksej J, Vryonidou A, Bjekic-Macut J, et al. Insulin resistance, androgens, and lipids are gradually improved in an age-dependent manner in lean women with polycystic ovary syndrome: insights from a large Caucasian cohort. Hormones. 2020;19:531\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrymowicz M, Rudnicka E, Podfigurna A, Napierala P, Smolarczyk R, Smolarczyk K, et al. Hormonal effects on hair follicles. Int J Mol Sci. 2020;21(15):5342.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eBaseline characteristics of women with PCOS.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.32263242375602%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan dir=\"LTR\"\u003eP-value\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.224719101123597%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eKD (n=23)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.150882825040128%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003ePLCD (n=23)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.301765650080256%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\" style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eVariables\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.32263242375602%\"\u003e\n \u003cp dir=\"LTR\"\u003e0.927 \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.224719101123597%\"\u003e\n \u003cp dir=\"LTR\"\u003e30.30 (5.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.150882825040128%\"\u003e\n \u003cp dir=\"LTR\"\u003e30.13 (7.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.301765650080256%\" colspan=\"2\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eAge (year)\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e\u0026nbsp;*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.32263242375602%\"\u003e\n \u003cp dir=\"LTR\"\u003e0.631\u003csup\u003e\u0026nbsp;\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.224719101123597%\"\u003e\n \u003cp dir=\"LTR\"\u003e164.2 (7.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.150882825040128%\"\u003e\n \u003cp dir=\"LTR\"\u003e163.26 (5.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.301765650080256%\" colspan=\"2\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eHeight\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(cm)\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e\u0026nbsp;*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.32263242375602%\"\u003e\n \u003cp dir=\"LTR\"\u003e0.496 \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.224719101123597%\"\u003e\n \u003cp dir=\"LTR\"\u003e29.21 (3.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.150882825040128%\"\u003e\n \u003cp dir=\"LTR\"\u003e29.47 (4.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.301765650080256%\" colspan=\"2\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eBMI\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(Kg/m\u003csup\u003e2\u003c/sup\u003e) \u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.32263242375602%\"\u003e\n \u003cp dir=\"LTR\"\u003e0.769 \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.224719101123597%\"\u003e\n \u003cp dir=\"LTR\"\u003e0.920 (0.026)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.150882825040128%\"\u003e\n \u003cp dir=\"LTR\"\u003e0.914 (0.034)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.301765650080256%\" colspan=\"2\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eWHR\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.32263242375602%\"\u003e\n \u003cp dir=\"LTR\"\u003e0.277 \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.224719101123597%\"\u003e\n \u003cp dir=\"LTR\"\u003e2531.78 (455.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.150882825040128%\"\u003e\n \u003cp dir=\"LTR\"\u003e2401.04 (342.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.301765650080256%\" colspan=\"2\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eTotal energy intake (Kcal/day)\u003csup\u003e\u0026nbsp;*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.32263242375602%\"\u003e\n \u003cp dir=\"LTR\"\u003e0.320 \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.224719101123597%\"\u003e\n \u003cp dir=\"LTR\"\u003e391.49 (34.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.150882825040128%\"\u003e\n \u003cp dir=\"LTR\"\u003e403.13 (43.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.301765650080256%\" colspan=\"2\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003ePhysical activity (\u003c/strong\u003e\u003cstrong\u003eMET\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eminute/week)\u003csup\u003e\u0026nbsp;*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.32263242375602%\"\u003e\n \u003cp dir=\"LTR\"\u003e0.50 \u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.224719101123597%\"\u003e\n \u003cp dir=\"LTR\"\u003e6 (26.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.150882825040128%\"\u003e\n \u003cp dir=\"LTR\"\u003e5 (21.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.113964686998393%\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eSingle\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.187800963081862%\" rowspan=\"2\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eMarital status\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e**\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.90427698574338%\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.661914460285132%\"\u003e\n \u003cp dir=\"LTR\"\u003e17 (73.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.105906313645622%\"\u003e\n \u003cp dir=\"LTR\"\u003e18 (78.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.327902240325866%\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eMarried\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\"\u003e\n \u003cp dir=\"LTR\"\u003eNote: \u003csup\u003e*\u003c/sup\u003e Values are presented as mean (SD).\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003eBased on independent samples t-test.\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u003csup\u003e\u0026nbsp;**\u003c/sup\u003eValues are presented as number (%).\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u003csup\u003e\u0026sect;\u0026nbsp;\u003c/sup\u003eBased on\u003csup\u003e\u0026nbsp;\u003c/sup\u003eFisher exact test.\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003eAbbreviations: PCOS: polycystic ovary syndrome, WHR: waist to hip ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"698\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2. Anthropometric index and body composition characteristics at baseline and after 8 weeks of intervention.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePLCD (n=21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eKD (n=19)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMD\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003eWeight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e78.49 (11.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e79.02 (12.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.88\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u0026lt;0.05 \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e74.14 (11.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e73.38 (11.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u0026lt;0.05 \u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMD (CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.35 (3.64, 5.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.64 (8.53, 7.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29.47 (4.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29.21 (3.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.496\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u0026lt;0.05 \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.76 (3.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26.48 (3.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u0026lt;0.05 \u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMD (CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.71 (1.36, 2.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.90 (2.73, 3.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-Value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003eWC (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e104.19 (10.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e105.62 (12.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u0026lt;0.05 \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e101.49 (10.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.18 (12.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u0026lt;0.05 \u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMD (CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.70 (2.07, 3.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.44 (6.74, 8.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003eHC (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e113.96 (10.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e114.65 (11.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u0026lt;0.05 \u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e110.73 (11.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e109.61 (12.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u0026lt;0.05 \u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMD (CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.44 (2.81, 4.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.31 (5.04, 9.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003eWHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.914 (0.034)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.920 (0.026)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.769\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.338 \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.917 (0.039)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.914 (0.049)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.855\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.529 \u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMD (CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.005 (-0.01, 0.003)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.004 (-0.014, 0.023) \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.243\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003eFBM (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29.86 (6.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28.77 (7.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.598\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u0026lt;0.05 \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26.74 (6.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24.42 (6.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u0026lt;0.05 \u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMD (CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.08 (2.06, 4.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.18 (4.26, 5.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003eLBM (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50.01 (5.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50.24 (6.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.895\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u0026lt;0.05 \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e48.61(5.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e48.62 (5.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.997\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u0026lt;0.05 \u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMD (CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.35\u0026nbsp;(0.67, 2.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.19 (2.64, 3.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003eTBW (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36.00 (3.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36.18 (4.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.887\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u0026lt;0.05 \u003csup\u003e*\u003c/sup\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35.01(4.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35.16 (3.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.903\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u0026lt;0.05 \u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMD (CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.96 (0.51, 1.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.15(1.74, 2.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003eTBP (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.50 (0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.61 (1.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.730\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u0026lt;0.05 \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.19(1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.35 (1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.622\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u0026lt;0.05 \u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMD (CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.30 (0.21, 0.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.56 (0.38, 0.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003eTBM (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.49 (0.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.45 (0.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.841\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.541\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.20 (0.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.34 (0.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.510\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.551 \u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMD (CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.29 (0.17, 0.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.24 (0.15, 0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003eRMR (Kcal)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1300.00 (80.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1305.86 (86.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-5.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.813\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.665 \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1280.33(84.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1298.74 (73.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-18.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.467\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.488 \u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMD (CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18.19 (3.67, 32.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.05 (4.26, 49.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e\n \u003cp\u003eNote:\u0026nbsp;Data are expressed as mean (SD) and mean difference (95%CI).\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eIndicate comparison between groups at baseline (Independent samples t-test for baseline).\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e Indicate comparison between groups based on ANOVA without adjustment.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e Indicate comparison between groups based on ANOVA adjusted for baseline measures and confounding factors (age, baseline BMI, physical activity, and, energy intake).\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e\u0026sect;\u0026nbsp;\u003c/sup\u003eIndicate comparison between groups based on ANOVA adjusted for baseline measures and confounding factors (age, physical activity, resting metabolite rate, and, energy intake).\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAbbreviations: BMI: body mass index, WC: waist circumferences, HC: hip circumferences, WHR: waist to hip ratio, FBM: fat body mass, LBM: lean body mass, TBW: total body water, TBP: total body protein, TBM: total body mineral, RMR: resting metabolic rate.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"684\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3: Metabolic and endocrine hormonal status at baseline and after 8 weeks of the intervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.157894736842104%\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.17543859649123%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePLCD (n=21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.29824561403509%\"\u003e\n \u003cp\u003e\u003cstrong\u003eKD (n=19)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.865497076023392%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.456140350877193%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.257309941520468%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.157894736842104%\" rowspan=\"4\"\u003e\n \u003cp\u003eFBG\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.17543859649123%\"\u003e\n \u003cp\u003e95.95 (4.60)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.29824561403509%\"\u003e\n \u003cp\u003e96.21 (4.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.865497076023392%\"\u003e\n \u003cp\u003e-0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.456140350877193%\"\u003e\n \u003cp\u003e0.850\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.257309941520468%\"\u003e\n \u003cp\u003eP\u0026lt;0.05\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e90.90 (3.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e87.94 (2.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.814814814814815%\"\u003e\n \u003cp\u003e2.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.585858585858587%\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003eP\u0026lt;0.05\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD (CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e5.00 (3.00, 6.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e8.84 (7.57, 10.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.814814814814815%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.585858585858587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003e\u003cem\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.814814814814815%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.585858585858587%\"\u003e\n \u003cp\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.157894736842104%\" rowspan=\"4\"\u003e\n \u003cp\u003eInsulin (\u0026micro;U/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.17543859649123%\"\u003e\n \u003cp\u003e24.74 (3.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.29824561403509%\"\u003e\n \u003cp\u003e27.57 (3.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.865497076023392%\"\u003e\n \u003cp\u003e-2.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.456140350877193%\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.257309941520468%\"\u003e\n \u003cp\u003eP\u0026lt;0.05\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e17.50 (3.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e14.45 (3.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.814814814814815%\"\u003e\n \u003cp\u003e3.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.585858585858587%\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003eP\u0026lt;0.05\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e7.35 (5.76, 8.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e13.44(12.34, 14.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.814814814814815%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.585858585858587%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.814814814814815%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.585858585858587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.157894736842104%\" rowspan=\"4\"\u003e\n \u003cp\u003eHOMA-IR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.17543859649123%\"\u003e\n \u003cp\u003e5.87 (1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.29824561403509%\"\u003e\n \u003cp\u003e6.56 (0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.865497076023392%\"\u003e\n \u003cp\u003e-0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.456140350877193%\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.257309941520468%\"\u003e\n \u003cp\u003eP\u0026lt;0.05\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e3.93 (0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e3.15 (0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.814814814814815%\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.585858585858587%\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003eP\u0026lt;0.05\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e1.96 (1.58, 2.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e3.53 (3.24, 3.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.814814814814815%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.585858585858587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.814814814814815%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.585858585858587%\"\u003e\n 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\u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e12.71 (2.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e11.78 (2.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.814814814814815%\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.585858585858587%\"\u003e\n \u003cp\u003e0.269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003eP=0.075\u003csup\u003e\u0026nbsp;**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e2.57 (1.07, 4.06)\u003c/p\u003e\n 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dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.571428571428573%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.507936507936506%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.92063492063492%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.157894736842104%\" rowspan=\"4\"\u003e\n \u003cp\u003eTG (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.17543859649123%\"\u003e\n 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\u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.507936507936506%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.92063492063492%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.157894736842104%\" rowspan=\"4\"\u003e\n \u003cp\u003eLDL-C (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.17543859649123%\"\u003e\n \u003cp\u003e133.95 (13.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.29824561403509%\"\u003e\n \u003cp\u003e134.86 (14.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.865497076023392%\"\u003e\n \u003cp\u003e-0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.456140350877193%\"\u003e\n \u003cp\u003e0.829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.257309941520468%\"\u003e\n \u003cp\u003eP\u0026lt;0.05\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e100.00 (11.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e111.52 (11.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.814814814814815%\"\u003e\n \u003cp\u003e-11.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.585858585858587%\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003eP\u0026lt;0.05\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e33.80 (30.46, 37.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e21.52 (14.71, 28.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.36363636363637%\" colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.571428571428573%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.507936507936506%\"\u003e\n 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\u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e-13.71 (-15.46, -11.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e-10.42 (-12.71, -8.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.36363636363637%\" colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.571428571428573%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.507936507936506%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.92063492063492%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.157894736842104%\" rowspan=\"4\"\u003e\n \u003cp\u003eLAP (cm. mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.17543859649123%\"\u003e\n \u003cp\u003e138.43 (32.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.29824561403509%\"\u003e\n \u003cp\u003e146.90 (45.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.865497076023392%\"\u003e\n \u003cp\u003e-8.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.456140350877193%\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.257309941520468%\"\u003e\n \u003cp\u003eP\u0026lt;0.05\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e111.30 (26.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e102.53 (38.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.814814814814815%\"\u003e\n \u003cp\u003e8.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.585858585858587%\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003eP\u0026lt;0.05\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e28.37 (23.81, 32.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e44.37 (59.15, 45.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.36363636363637%\" colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.571428571428573%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.507936507936506%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.92063492063492%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.157894736842104%\" rowspan=\"4\"\u003e\n \u003cp\u003eVAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.17543859649123%\"\u003e\n \u003cp\u003e4.86 (1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.29824561403509%\"\u003e\n \u003cp\u003e5.36 (1.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.865497076023392%\"\u003e\n \u003cp\u003e-0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.456140350877193%\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.257309941520468%\"\u003e\n \u003cp\u003eP=608.0\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e3.20 (60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e3.37 (76.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.814814814814815%\"\u003e\n \u003cp\u003e-0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.585858585858587%\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003eP=628.0\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e1.66 (1.33, 1.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e1.99 (1.60, 2.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.36363636363637%\" colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.571428571428573%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.507936507936506%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.92063492063492%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.157894736842104%\" rowspan=\"4\"\u003e\n \u003cp\u003eLH (mIU/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.17543859649123%\"\u003e\n \u003cp\u003e12.15 (1.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.29824561403509%\"\u003e\n \u003cp\u003e12.10 (1.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.865497076023392%\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.456140350877193%\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.257309941520468%\"\u003e\n \u003cp\u003eP\u0026lt;0.05\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e9.69 (0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e7.97 (2.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.814814814814815%\"\u003e\n \u003cp\u003e1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.585858585858587%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003eP\u0026lt;0.05\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD (CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e2.48 (1.98, 2.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e4.38 (3.72, 5.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.36363636363637%\" colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.571428571428573%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.507936507936506%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.92063492063492%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.157894736842104%\" rowspan=\"4\"\u003e\n \u003cp\u003eFSH (mIU/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.17543859649123%\"\u003e\n \u003cp\u003e4.39 (2.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.29824561403509%\"\u003e\n \u003cp\u003e4.06 (1.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.865497076023392%\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.456140350877193%\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.257309941520468%\"\u003e\n \u003cp\u003eP\u0026lt;0.05\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e4.63 (2.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e4.74 (1.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.814814814814815%\"\u003e\n \u003cp\u003e-0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.585858585858587%\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003eP\u0026lt;0.05\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e-0.24 (-0.54, -0.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e-0.68 (-0.69, -0.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.36363636363637%\" colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.571428571428573%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.507936507936506%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.92063492063492%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.157894736842104%\" rowspan=\"4\"\u003e\n \u003cp\u003eTestosterone (ng/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.17543859649123%\"\u003e\n \u003cp\u003e0.61 (0.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.29824561403509%\"\u003e\n \u003cp\u003e0.67 (0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.865497076023392%\"\u003e\n \u003cp\u003e-0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.456140350877193%\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.257309941520468%\"\u003e\n \u003cp\u003eP\u0026lt;0.05\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e0.48 (0.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e0.49 (0.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.814814814814815%\"\u003e\n \u003cp\u003e-0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.585858585858587%\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003eP\u0026lt;0.05\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e0.12 (0.07, 0.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e0.18 (0.15, 0.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.36363636363637%\" colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.571428571428573%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.507936507936506%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.92063492063492%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.157894736842104%\" rowspan=\"4\"\u003e\n \u003cp\u003eDHEA-s(\u0026micro;g/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.17543859649123%\"\u003e\n \u003cp\u003e2.09 (0.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.29824561403509%\"\u003e\n \u003cp\u003e2.34 (0.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.865497076023392%\"\u003e\n \u003cp\u003e-0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.456140350877193%\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.257309941520468%\"\u003e\n \u003cp\u003eP=0.071\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e1.86 (0.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e1.93 (0.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.814814814814815%\"\u003e\n \u003cp\u003e-0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.585858585858587%\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003eP=0.075\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e0.23 (0.17, 0.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e0.41 (-0.69, -0.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.36363636363637%\" colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.571428571428573%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.507936507936506%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.92063492063492%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.157894736842104%\" rowspan=\"4\"\u003e\n \u003cp\u003eFerriman Gallway Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.17543859649123%\"\u003e\n \u003cp\u003e12.34 (2.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.29824561403509%\"\u003e\n \u003cp\u003e12.82 (2.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.865497076023392%\"\u003e\n \u003cp\u003e-0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.456140350877193%\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.257309941520468%\"\u003e\n \u003cp\u003eP=0.771\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e11.52 (2.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e12.05 (2.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.814814814814815%\"\u003e\n \u003cp\u003e-0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.585858585858587%\"\u003e\n \u003cp\u003e0.457\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\"\u003e\n \u003cp\u003e0.71 (-1.9, 1.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\"\u003e\n \u003cp\u003e0.80 (1.01, 1.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.36363636363637%\" colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.571428571428573%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.507936507936506%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.118\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.92063492063492%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.12\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\"\u003e\n \u003cp\u003eNote:\u0026nbsp;Data are expressed as mean (SD) and mean difference (95%CI).\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eIndicate comparison between groups at baseline (Independent samples t-test for baseline).\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e Indicate comparison between groups based on ANOVA without adjustment.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e Indicate comparison between groups based on ANOVA adjusted for baseline measures and confounding factors (age, baseline BMI, physical activity, and, energy intake).\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e\u0026sect;\u0026nbsp;\u003c/sup\u003eIndicate comparison between groups based on ANOVA adjusted for baseline measures and confounding factors (age, physical activity, resting metabolite rate, and, energy intake).\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAbbreviations: FBS: fasting blood glucose, HOMA-IR: homeostatic model assessment of insulin resistance, HOMA_B: homeostasis model assessment of beta cell function, TC: total cholesterol, TG: triglycerides, HDL: high-density lipoprotein, LDL-C: low-density lipoprotein, LAP: lipid accumulation products, VAI: visceral adipose index, LH: luteinizing hormone, FSH: follicle-stimulating hormone, DHEA-s: dehydroepiandrosterone sulfate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"685\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 4. Energy and macronutrient intake at baseline and after 8 weeks of intervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.642335766423358%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.16058394160584%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePLCD (n=21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e\u003cstrong\u003eKD (n=19)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.386861313868613%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.510948905109489%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.642335766423358%\" rowspan=\"4\"\u003e\n \u003cp\u003eEnergy (Kcal/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.16058394160584%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e2401.04 (342.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e2531.78 (455.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.386861313868613%\"\u003e\n \u003cp\u003e-130.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.510948905109489%\" colspan=\"2\"\u003e\n \u003cp\u003e0.277\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e1630.95 (150.39)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e1828.95 (333.88)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e197.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD (CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e723.47 (562.23, 884.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e642.84 (524.01, 761.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.642335766423358%\" rowspan=\"4\"\u003e\n \u003cp\u003eCarbohydrate (gr/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.16058394160584%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e294.78 (62.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e303.00 (51.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.386861313868613%\"\u003e\n \u003cp\u003e-8.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.510948905109489%\" colspan=\"2\"\u003e\n \u003cp\u003e0.630\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e156.09 (19.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e23.33 (2.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e132.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e131.14 (102.27, 160.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e277.72 (251.75, 303.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-Value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.642335766423358%\" rowspan=\"4\"\u003e\n \u003cp\u003eProtein (gr/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.16058394160584%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e68.0 (6.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e67.65 (6.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.386861313868613%\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.510948905109489%\" colspan=\"2\"\u003e\n \u003cp\u003e0.862\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e109.49 (10.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e118.61 (6.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e-9.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e-42.11 (-48.01, -36.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e-51.93 (-56.91, -46.94)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.642335766423358%\" rowspan=\"4\"\u003e\n \u003cp\u003eFat (gr/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.16058394160584%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e106.48 (9.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e107.45 (11.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.386861313868613%\"\u003e\n \u003cp\u003e-0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.510948905109489%\" colspan=\"2\"\u003e\n \u003cp\u003e0.749\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e64.37 (13.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e139.46 (21.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e-75.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e41.20 (33.93, 48.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e-32.71 (-39.58, -25.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.642335766423358%\" rowspan=\"4\"\u003e\n \u003cp\u003eTotal cholesterol (gr/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.16058394160584%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e155.39 (41.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e163.86 (44.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.386861313868613%\"\u003e\n \u003cp\u003e-8.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.510948905109489%\" colspan=\"2\"\u003e\n \u003cp\u003e0.509\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e3.63 (0.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e576.11 (142.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e-572.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e146.27 (128.99, 163.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e-417.8 (-487.9, -347.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.642335766423358%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.16058394160584%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e25.03 (5.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e23.89 (5.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.386861313868613%\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.510948905109489%\" colspan=\"2\"\u003e\n \u003cp\u003e0.481\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.642335766423358%\" rowspan=\"3\"\u003e\n \u003cp\u003eTotal Fiber (gr/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.16058394160584%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e38.97 (4.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e12.87(1.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.386861313868613%\"\u003e\n \u003cp\u003e26.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.510948905109489%\" colspan=\"2\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e-14.58 (-17.73, -11.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e10.24 (7.79, 12.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.26970227670753%\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.040380047505938%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.47980997624703%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.47980997624703%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.642335766423358%\" rowspan=\"4\"\u003e\n \u003cp\u003eMUFA (gr/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.16058394160584%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e41.58 (3.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e42.96 (3.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.386861313868613%\"\u003e\n \u003cp\u003e-1.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.510948905109489%\" colspan=\"2\"\u003e\n \u003cp\u003e0.196\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e20.40 (5.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e48.51 (4.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e-28.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e20.75 (17.64, 23.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e-6.02 (-7.90, -4.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.642335766423358%\" rowspan=\"4\"\u003e\n \u003cp\u003ePUFA (gr/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.16058394160584%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e12.70 (1.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e13.00 (1.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.386861313868613%\"\u003e\n \u003cp\u003e-0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.510948905109489%\" colspan=\"2\"\u003e\n \u003cp\u003e0.593\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e51.14 (2.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e52.25 (2.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e-10.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e-38.44 (-15.07, -12.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e-39.25 (-24.91, -23.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.26970227670753%\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.040380047505938%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.47980997624703%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.47980997624703%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.642335766423358%\" rowspan=\"4\"\u003e\n \u003cp\u003eSFAs (gr/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.16058394160584%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e51.14 (2.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e52.25 (2.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.386861313868613%\"\u003e\n \u003cp\u003e-1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.510948905109489%\" colspan=\"2\"\u003e\n \u003cp\u003e0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e11.82 (6.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e41.25 (2.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e-29.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e39.00 (35.76, 42.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e10.73 (8.94, 12.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.26970227670753%\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.040380047505938%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.47980997624703%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.47980997624703%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.642335766423358%\" rowspan=\"4\"\u003e\n \u003cp\u003eTFA (gr/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.16058394160584%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e0.079\u0026nbsp;(0.016)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e0.080 (0.018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.386861313868613%\"\u003e\n \u003cp\u003e-0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.510948905109489%\" colspan=\"2\"\u003e\n \u003cp\u003e0.804\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e0.005 (0.008)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e0.156 (0.021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e-0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e0.07 (0.06, 0.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e-0.07 (-0.09, -0.06)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.26970227670753%\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.040380047505938%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.47980997624703%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.47980997624703%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.642335766423358%\" rowspan=\"4\"\u003e\n \u003cp\u003ePhytosterols (gr/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.16058394160584%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e73.77 (4.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.64963503649635%\"\u003e\n \u003cp\u003e75.54 (3.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.386861313868613%\"\u003e\n \u003cp\u003e-1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.510948905109489%\" colspan=\"2\"\u003e\n \u003cp\u003e0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e162.42(39.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e1.55 (42.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.660245183887916%\"\u003e\n \u003cp\u003e160.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.609457092819614%\" colspan=\"2\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.987740805604204%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e-88.75 (-106.72, -70.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.371278458844134%\"\u003e\n \u003cp\u003e73.86 (71.95, 75.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.26970227670753%\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.040380047505938%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.47980997624703%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.47980997624703%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\"\u003e\n \u003cp\u003eNote: Data are expressed as mean (SD) and mean difference (95%CI).\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eIndicate comparison between groups at baseline (Independent samples t-test for baseline)\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e Indicate comparison between groups based on ANOVA without adjustment.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAbbreviations:\u0026nbsp;MUFA: mono-unsaturated fatty acids, PUFA: poly-unsaturated fatty acids, SFA: saturated fatty acids, TFA: trans fatty acids\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"695\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 5. Micronutrient intake at baseline and after 8 weeks of the intervention.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.81294964028777%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.26618705035971%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.309352517985612%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePLCD (n=21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.309352517985612%\"\u003e\n \u003cp\u003e\u003cstrong\u003eKD (n=19)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.942446043165468%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359712230215827%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.81294964028777%\" rowspan=\"4\"\u003e\n \u003cp\u003eVitamin C (mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.26618705035971%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.309352517985612%\"\u003e\n \u003cp\u003e253.93 (5.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.309352517985612%\"\u003e\n \u003cp\u003e256.79 (6.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.942446043165468%\"\u003e\n \u003cp\u003e-2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359712230215827%\"\u003e\n \u003cp\u003e0.119\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03338898163606%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e162.49 (6.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e88.73 (4.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.856427378964941%\"\u003e\n \u003cp\u003e73.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.020033388981636%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03338898163606%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD (CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e91.19 (87.74, 94.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e167.70 (163.6, 171.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.856427378964941%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.020033388981636%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03338898163606%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.856427378964941%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.020033388981636%\"\u003e\n \u003cp\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.81294964028777%\" rowspan=\"4\"\u003e\n \u003cp\u003eVitamin B9 (mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.26618705035971%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.309352517985612%\"\u003e\n \u003cp\u003e329.13 (8.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.309352517985612%\"\u003e\n \u003cp\u003e332.10 (4.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.942446043165468%\"\u003e\n \u003cp\u003e-2.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359712230215827%\"\u003e\n \u003cp\u003e0.166\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03338898163606%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e339.74 (8.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e192.12 (5.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.856427378964941%\"\u003e\n \u003cp\u003e147.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.020033388981636%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03338898163606%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e-10.68 (-15.44, -5.91)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e139.49 (136.34, 142.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.856427378964941%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.020033388981636%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03338898163606%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-Value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.856427378964941%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.020033388981636%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.81294964028777%\" rowspan=\"4\"\u003e\n \u003cp\u003eVitamin B12 (mic/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.26618705035971%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.309352517985612%\"\u003e\n \u003cp\u003e1.85 (0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.309352517985612%\"\u003e\n \u003cp\u003e1.91 (0.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.942446043165468%\"\u003e\n \u003cp\u003e-0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359712230215827%\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03338898163606%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e0.18(0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e6.65 (1.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.856427378964941%\"\u003e\n \u003cp\u003e-6.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.020033388981636%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03338898163606%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e1.67 (1.60, 1.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e-4.72 (-5.44, -4.00)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.856427378964941%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.020033388981636%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03338898163606%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.856427378964941%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.020033388981636%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.81294964028777%\" rowspan=\"4\"\u003e\n \u003cp\u003eCalcium (mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.26618705035971%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.309352517985612%\"\u003e\n \u003cp\u003e458.93 (21.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.309352517985612%\"\u003e\n \u003cp\u003e469.04 (14.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.942446043165468%\"\u003e\n \u003cp\u003e-10.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359712230215827%\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03338898163606%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e634.93 (13.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e241.77 (13.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.856427378964941%\"\u003e\n \u003cp\u003e293.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.020033388981636%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03338898163606%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e-176.65 (-189.25, -164.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e127.05(116.34, 137.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.856427378964941%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.020033388981636%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03338898163606%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.856427378964941%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.020033388981636%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.81294964028777%\" rowspan=\"4\"\u003e\n \u003cp\u003eIron (mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.26618705035971%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.309352517985612%\"\u003e\n \u003cp\u003e9.82 (0.67)\u003c/p\u003e\n \u003c/td\u003e\n 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\u003ctd width=\"17.26618705035971%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.309352517985612%\"\u003e\n \u003cp\u003e1031.08 (6.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.309352517985612%\"\u003e\n \u003cp\u003e1038.61 (5.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.942446043165468%\"\u003e\n \u003cp\u003e-7.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359712230215827%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03338898163606%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e1613.63 (7.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e1309.09 (9.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.856427378964941%\"\u003e\n \u003cp\u003e304.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.020033388981636%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03338898163606%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e-582.94 (-587.85, -578.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e-270.66 (-274.95, -266.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.856427378964941%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.020033388981636%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03338898163606%\"\u003e\n 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\u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.309352517985612%\"\u003e\n \u003cp\u003e72.55 (6.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.309352517985612%\"\u003e\n \u003cp\u003e74.43 (6.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.942446043165468%\"\u003e\n \u003cp\u003e-1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359712230215827%\"\u003e\n \u003cp\u003e0.324\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03338898163606%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e23.46 (3.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e86.05 (15.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.856427378964941%\"\u003e\n \u003cp\u003e-62.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.020033388981636%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03338898163606%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMD(CI%95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e49.29 (45.65, 52.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e-11.34 (-17.63, -5.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.856427378964941%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.020033388981636%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.03338898163606%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.04507512520868%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026lt;0.05\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.856427378964941%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.020033388981636%\"\u003e\n \u003cp\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\"\u003e\n \u003cp\u003eNote: Data are expressed as mean (SD) and mean difference (95%CI).\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026dagger;\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eIndicate comparison between groups at baseline (Independent samples t-test for baseline)\u003c/p\u003e\n \u003cp\u003e* Indicate comparison between groups based on ANOVA without adjustment.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"nutrition-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutj","sideBox":"Learn more about [Nutrition Journal](http://nutritionj.biomedcentral.com/)","snPcode":"12937","submissionUrl":"https://submission.nature.com/new-submission/12937/3","title":"Nutrition Journal","twitterHandle":"@NutrJournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"polycystic ovary syndrome, insulin resistance, ketogenic diet, portfolio low-carbohydrate diet","lastPublishedDoi":"10.21203/rs.3.rs-4460351/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4460351/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePolycystic Ovary Syndrome (PCOS) is the most common hormonal disorder in women of reproductive age. It is believed that excessive androgen production is primarily caused by hyperinsulinemia, making it the main factor in the development of PCOS. The portfolio low-carbohydrate diet (PLCD) is a plant-based diet with a carbohydrate content of 40% and incorporates five cholesterol-lowering foods. While, the ketogenic diet is a high-fat diet that 70% of its calories come from fat, promoting a ketosis state. However, to the best of our knowledge, no study compared the therapeutic effects of these two diets in PCOS patients. Thus, this study aimed to compare the impact of PLCD and KD on anthropometric indices, metabolic status, and hormonal levels in overweight or obese women with PCOS.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis randomized clinical trial was conducted on forty-six overweight or obese women diagnosed with PCOS. Participants were randomly allocated into either the PLCD or the KD group for 8 weeks. The anthropometric indices including body mass index (BMI), fat body mass (FBM), and waist circumference (WC), as well as metabolic markers including fasting blood glucose (FBG), plasma insulin levels, HOMA-IR, and plasma lipid profiles including total cholesterol (TC), low-density lipoprotein (LDL), triglycerides (TG), and high-density lipoproteins (HDL), were measured. Reproductive hormones including follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone, as well as Ferriman Gallwey score were assessed at the baseline and after the intervention.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAfter 8 weeks, both diets demonstrated enhancements in anthropometric, metabolic, and reproductive hormonal status. However, the mean difference in weight reduction, BMI, WC, FBG, HOMA-IR, LH, and FSH was significantly greater in the KD group than in the PLCD group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Nevertheless, plasma lipid profiles including TC, LDL, and HDL indicated more improvement in the PLCD compared to the KD group. There were no significant changes in the Ferriman-Gallwey score within or between the two groups.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe study findings revealed that both the PLCD and the KD diets were effective in improving PCOS manifestations. However, the KD exhibited greater effectiveness in enhancing body measurements, metabolic factors, and hormone levels compared to the PLCD in women with PCOS.\u003c/p\u003e\u003ch2\u003eRegistration number of Clinical Trial:\u003c/h2\u003e \u003cp\u003eIRCT20200912048693N3, Trial registered 2022\u0026ndash;12\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.irct.ir/trial/67548\u003c/span\u003e\u003cspan address=\"https://www.irct.ir/trial/67548\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e","manuscriptTitle":"The Effects of the Portfolio Low-Carbohydrate Diet versus the Ketogenic Diet on Anthropometric Indices, Metabolic Status, and Hormonal Levels in Overweight or Obese Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-11 18:34:22","doi":"10.21203/rs.3.rs-4460351/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-01T16:35:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-22T09:28:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-18T13:57:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"284190429531606802225034570690183675651","date":"2024-09-18T09:26:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"8226660481456091778301509667848635627","date":"2024-09-18T07:37:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"81603313605281514007559986600980547879","date":"2024-08-21T17:17:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"250877448526583779301895527099289464425","date":"2024-08-19T11:55:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"207237763518377222865723368727582423110","date":"2024-07-28T09:10:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-27T16:26:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-06T19:20:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-27T03:19:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"Nutrition Journal","date":"2024-05-22T10:48:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"nutrition-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutj","sideBox":"Learn more about [Nutrition Journal](http://nutritionj.biomedcentral.com/)","snPcode":"12937","submissionUrl":"https://submission.nature.com/new-submission/12937/3","title":"Nutrition Journal","twitterHandle":"@NutrJournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4020e608-8dbf-4009-bf4f-1af2cf1baeea","owner":[],"postedDate":"June 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-09T16:17:32+00:00","versionOfRecord":{"articleIdentity":"rs-4460351","link":"https://doi.org/10.1186/s12937-024-01056-7","journal":{"identity":"nutrition-journal","isVorOnly":false,"title":"Nutrition Journal"},"publishedOn":"2024-12-02 15:58:07","publishedOnDateReadable":"December 2nd, 2024"},"versionCreatedAt":"2024-06-11 18:34:22","video":"","vorDoi":"10.1186/s12937-024-01056-7","vorDoiUrl":"https://doi.org/10.1186/s12937-024-01056-7","workflowStages":[]},"version":"v1","identity":"rs-4460351","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4460351","identity":"rs-4460351","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}