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Dieta chetogenica, fertilità femminile e sindrome dell’ovaio policistico

DOI:10.1007/s40619-022-01120-6
Authors:
Luigi Barrea at Università Telematica Pegaso
Luigi Barrea
Ludovica Verde at University of Naples Federico II
Ludovica Verde
Maria Grazia Tarsitano
Maria Grazia Tarsitano
Maria Grazia Tarsitano
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Giovanna Muscogiuri
Giovanna Muscogiuri
Giovanna Muscogiuri
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Abstract and Figures

Sommario La Sindrome dell’Ovaio Policistico (PCOS), disordine endocrino-metabolico tra i più comuni nelle donne in età fertile, determina un impatto negativo sull’intero stato di salute, riproduttivo e metabolico della donna e molto spesso coesiste con uno stato di obesità che sembra essere sia un fattore di rischio sia un fattore aggravante di questa sindrome. L’intervento dietetico e la successiva perdita di peso rappresentano la linea di intervento principale migliorando significativamente il decorso della patologia; tuttavia, non è ancora chiaro quale sia il miglior approccio nutrizionale da adottare nella PCOS. In particolare, un elevato apporto di carboidrati e l’infiammazione cronica di basso grado cooperano con l’insulino-resistenza e l’iperandrogenismo sull’espressione fisiopatologica della PCOS. L’insulina regola l’attività degli enzimi ovarici ed epatici coinvolti nella produzione di androgeni e innesca l’infiammazione cronica di basso grado associata a insulino-resistenza, dislipidemia e malattie cardio-metaboliche. Una dieta sbilanciata, associata tali alterazioni, è una componente chiave in questo “quartetto mortale” di fattori di rischio associati alla fisiopatologia della PCOS. Approcci dietetici nutrizionalmente equilibrati sono uno strumento primario sia preventivo che terapeutico nelle donne con PCOS, riducendo l’insulino-resistenza e promuovendo miglioramenti ormonali e metabolici e, di conseguenza, riproduttivi, conferendo al nutrizionista un ruolo chiave. In questo contesto, la dieta chetogenica è stata proposta come un’attraente strategia nutrizionale sia per la gestione dell’obesità che delle comorbidità della PCOS, metaboliche, endocrine e riproduttive. Nella presente rassegna, riportiamo le ultime e più recenti evidenze disponibili in letteratura scientifica sull’uso della dieta chetogenica nella PCOS.
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L’Endocrinologo (2022) 23:364–370
https://doi.org/10.1007/s40619-022-01120-6
RASSEGNA
Dieta chetogenica, fertilità femminile e sindrome dell’ovaio policistico
Luigi Barrea1,2 ·Ludovica Verde2·Maria Grazia Tarsitano3·Giovanna Muscogiuri2,4
Accettato: 11 marzo 2022 / Pubblicato online: 27 luglio 2022
© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022
Sommario
La Sindrome dell’Ovaio Policistico (PCOS), disordine endocrino-metabolico tra i più comuni nelle donne in età fertile,
determina un impatto negativo sull’intero stato di salute, riproduttivo e metabolico della donna e molto spesso coesiste con
uno stato di obesità che sembra essere sia un fattore di rischio sia un fattore aggravante di questa sindrome. L’intervento
dietetico e la successiva perdita di peso rappresentano la linea di intervento principale migliorando significativamente il
decorso della patologia; tuttavia, non è ancora chiaro quale sia il miglior approccio nutrizionale da adottare nella PCOS. In
particolare, un elevato apporto di carboidrati e l’infiammazione cronica di basso grado cooperano con l’insulino-resistenza
e l’iperandrogenismo sull’espressione fisiopatologica della PCOS. L’insulina regola l’attività degli enzimi ovarici ed epatici
coinvolti nella produzione di androgeni e innesca l’infiammazione cronica di basso grado associata a insulino-resistenza,
dislipidemia e malattie cardio-metaboliche. Una dieta sbilanciata, associata tali alterazioni, è una componente chiave in
questo “quartetto mortale” di fattori di rischio associati alla fisiopatologia della PCOS. Approcci dietetici nutrizionalmente
equilibrati sono uno strumento primario sia preventivo che terapeutico nelle donne con PCOS, riducendo l’insulino-resistenza
e promuovendo miglioramenti ormonali e metabolici e, di conseguenza, riproduttivi, conferendo al nutrizionista un ruolo
chiave. In questo contesto, la dieta chetogenica è stata proposta come un’attraente strategia nutrizionale sia per la gestione
dell’obesità che delle comorbidità della PCOS, metaboliche, endocrine e riproduttive. Nella presente rassegna, riportiamo le
ultime e più recenti evidenze disponibili in letteratura scientifica sull’uso della dieta chetogenica nella PCOS.
Parole chiave Sindrome dell’Ovaio Policistico ·Obesità ·Insulino-resistenza ·Infiammazione ·Dieta chetogenica
Introduzione
La sindrome dell’ovaio policistico (PCOS) è un disordi-
ne endocrino-metabolico a eziologia sconosciuta che col-
pisce, secondo l’utilizzo dei diversi criteri diagnostici, il
5–20% circa delle donne in età riproduttiva nel mondo [1].
La PCOS è caratterizzata da uno spettro di fenotipi diver-
si e viene diagnosticata quando sono presenti almeno due
dei tre criteri di Rotterdam: 1) iperandrogenismo clinico
(con irsutismo, acne, seborrea e alopecia) e/o con alti livel-
li di androgeni circolanti; 2) presenza di cisti ovariche va-
lutate mediante esame ecografico; 3) oligo-amenorrea con
oligo-anovulazione [2].
Come risultato della cronicità dello stato patologico del-
la PCOS, queste donne sono a maggior rischio di obesità,
disfunzioni metaboliche e vascolari, complicazioni ripro-
duttive, disturbi dell’umore e del sonno [3]. Oltre alle al-
terazioni ormonali, l’obesità, l’insulino-resistenza (IR) [4],
con associata iperinsulinemia compensatoria e uno stato in-
fiammatorio cronico di basso grado, spesso coesistono nella
PCOS [3].
Proposto da A. Faggiano.
L. Barrea
luigi.barrea@unipegaso.it
L. Verde
ludoverde96@gmail.com
M.G. Tarsitano
mariagrazia.tarsitano@unicz.it
G. Muscogiuri
giovanna.muscogiuri@unina.it
1Dipartimento di Scienze Umanistiche, Università Telematica
Pegaso, Via Porzio, isola F2, 80143, Napoli, Italia
2Unità di Endocrinologia, Dipartimento di Medicina Clinica e
Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio
Pansini 5, 80131, Napoli, Italia
3Dipartimento di Scienze Mediche e Chirurgiche, Università della
Magna Graecia, Catanzaro, Italia
4Cattedra Unesco “Educazione Alla Salute e Allo Sviluppo
Sostenibile”, Università degli Studi di Napoli Federico II, Via
Sergio Pansini 5, 80131, Napoli, Italia
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