● Oligomenorrhea or amenorrhea associated with decreased ovulation. The most common cause of anovulatory infertility is PCOs.
● Hyperandrogenaemia or clinical features of androgen excess, in the absence of other underlying disease states.
● Abnormal ovarian ultrasound with ≥ 12 follicles in each ovary having a diameter of 2 – 9 mm, or increased ovarian volume (Farshchi et al., 2007).
In the absence of treatment, PCOs can cause fertility problems such as infertility, impaired hemorrhage, endometrial carcinoma, depression, low self-confidence, anxiety and sleep apnea, sexual function abnormalities, metabolic disorders such as obesity, Impaired glucose tolerance, type 2 diabetes, hypertension and, and hypertension (Goodarzi et al., 2011, Palomba et al., 2015, Pastore et al., 2011, Wang et al., 2011). It also can lead to abortion by increasing levels of LH, insulin, obesity, as well as increased risk of gestational diabetes mellitus (GDM), lipid profiles, and biomarkers of oxidative stress. One of the common characteristics of PCOs is obesity. Many studies reported that 5-10 percent weight loss can reduce the risk of cardiovascular diseases, type 2 diabetes, endocrine, and reproductive parameters in PCOs women (Faghfoori et al., 2017).
Commonly used treatments include consumption of clomiphene, oral contraceptives, gonadotropins, GnRH agonists, co-utilization of vitamin D and calcium, as well as use of weight loss diets. In resistant cases, laparoscopy is required (Carmina et al., 2016, Cree-Green, 2017, Kalem et al., 2017). Insulin resistance is a major factor in pathogenesis of PCOs (Palomba et al., 2015). Therefore, extensive use of insulin lowering drugs such as metformin is recommended to treat this syndrome. Furthermore, recent studies indicated that some minerals can have positive effects on PCOs or complications of this syndrome: positive effects of chromium on insulin sensitivity (Amr and Abdel-Rahim, 2015), magnesium and selenium on serum testosterone level, as well as double bond unsaturated fatty acids such as omega-3 on risk factors of metabolic syndrome (Faghfoori et al., 2017). Many studies recommended decrease of weight, intake of fat from total calories (especially saturated fat and cholesterol), increase of physical activity, intake of dietary fibers, and change of diets. The investigated diets to improve this syndrome included increase of the protein/carbohydrate ratio (Sorensen et al., 2012), intake of high protein and low glycemic load (LGL) foods, low glycemic index (LGI) diets, low calorie diets (Love et al., 2016), and an iso-caloric diet with a LGI. In recent years, some researches were conducted over the healthy dietary patterns in women with PCOs. A few of these studies tried to find appropriate dietary patterns for this syndrome. In the present research, we only included the studies appropriate on dietary patterns for women with PCOs conducted over recent years in Iran.
Materials and Methods
We searched the databases of PubMed, Scopus, ISI Web of Science, SID, Magiran, and Google scholar to find the studies written in English conducted on dietary patterns, dietary intake, food intake, and PCOs in Iran. We searched the studies published up to   June 2017.
In order to conduct the search, we used the title/abstract, MeSH terms, and other related key words including (dietary pattern OR dietary intake) AND (polycystic ovary syndrome OR PCOs) as well as other related words. In addition to the mentioned databases, we conducted manual search over all eligible original articles, reviews, and other relevant articles.
Results
Table 1 shows the descriptive data of all seven studies. In the following sections, we represent the studies conducted over each category of subjects. Dietary approach for stopped hypertension (DASH) diet and weight loss, anti-mullerian hormone (AMH), metabolic profiles, androgens, body composition,  and antioxidant effect  in women with PCOs.
A randomized clinical trial study was designed to evaluate the effects of the DASH diet on weight loss, AMH, and metabolic profiles in women with PCOs (Foroozanfard et al., 2017). To this point, 60 overweight or obese women with PCOs were studies; 30 participants were in DASH diet group and 30 in control group. The DASH and control diets consisted of 52-55 percent carbohydrates, 16-18 percent proteins, and 30 percent total fats. The DASH diet was rich in fruits, vegetables, whole grains, low-fat, low cholesterol dairy products, refined grains, and sodium levels less than 2400 mg per day. The amounts of calories' intake were equal in both groups. These  results were obtained after 12 weeks: participants had significant reduction in body mass index (BMI) (1.6 ± 0.5 vs. -1.2 ± 0.7 kg/m², P = 0.02), AMH (-1.1 ± 3.1 vs. 0.3 ± 0.7 ng/mL, P = 0.01), malondialdehyde (MDA) (-0.5 ± 0.4 vs. 0.2 ± 0.3 μmol/L, P < 0.001), homeostasis model of assessment-estimated insulin resistance HOMA-IR, HOMA-B (-0.9 ± 2.0 vs. -0.1 ± 1.0, P = 0.02), and free androgen index (FAI) (-0.03 ± 0.09 vs. 0.06 ± 0.21, P = 0.02). However, the DASH group had significant increase in quantitative insulin sensitivity check index (0.01 ± 0.03 vs. 0.004 ± 0.01, P = 0.02), sex hormone-binding globulin (SHBG) (3.7 ± 8.5 vs. -1.5 ± 7.2 nmol/L, P = 0.01), and nitric oxide (NO) (9.0 ± 4.9 vs. 0.6 ± 2.3 μmol/L, P < 0.001) compared with the control group. After adjustment for the baseline values of biochemical variable, BMI, and age, the findings were not influenced.
The other study was a randomized controlled trial over DASH diet, androgens, antioxidant status, and body composition in overweight and obese women with PCOs (Azadi-Yazdi et al., 2017). In a period of 3 months, PCOs was diagnosed in 60 women with overweight or obesity aged 20-40 years (BMI: 25-40) according to the Rotterdam criteria. Anthropometric characteristics, dietary intake, and serum androgens were measured at the beginning and at the end of the study. Initial results showed differences in testosterone and the secondary outcomes included changes in androstenedione, (SHBG: Sex hormone-binding globulin), total antioxidant capacity, and body composition. The combination of macronutrients was similar in interventional and control groups, containing 50-55 percent carbohydrates, 15-20 percent protein, and 25-30 percent total fat. People were asked to write their 3-day food recall (two days of week days and one day in weekend) per month. The comparison between the two groups indicated a significant decrease in BMI, body mass, and serum androstenedione. Furthermore, concentrations of SHBG and free androgen index and 2,2′‐diphenyl‐1‐picryylhydrazyl (DPPH) scavenging activity increased in the DASH group compared to the control group. After adjusting for the potential confounding variables, the researcher reported that these differences were not significant.
Therefore, we can conclude that: DASH diet have high amount of antioxidant content and this dietary pattern may have beneficial effects on reduction of BMI, MDA, insulin resistance, free androgen index (FAI), and serum androstenedione. It also can have incremental effects on insulin sensitivity, SHBG, and NO in women with PCOs.
As mentioned before, DASH diet contains high amounts of total dietary fiber, phytoestrogens, antioxidants, isoflavones, magnesium, and calcium that have good effect on oxidative stress and serum hs-CRP. Moreover, intake of both antioxidants and magnesium was inversely associated with insulin resistance. Two studies were conducted in this regard:
Overweight or obese women with BMI ≥ 25 kg/m² in the age range of 18-40 years were diagnosed with PCOs according to the Rotterdam criteria.
The selected participants were categorized into two groups: 24 in the DASH diet and 24 in the control group. The DASH and control diets consisted of 52 percent carbohydrates, and 18 percent proteins, 30 percent total fats. . As a result, the researchers found a significant decrease in participants' weight (4.4 vs. -1.5 kg; P < 0.001), BMI (-1.7 vs. -0.6 kg/m²; P < 0.001), serum triglyceride (TG) (-10.0 vs. +19.2 mg/dL; P = 0.005), and VLDL-c levels (-2.0 vs. 3.9 mg/dL; P = 0.005). However, the concentrations of total antioxidant capacity (TAC) (+98.6 vs. 174.8 mmol/L; P < 0.001) and total glutathione (GSH)   (+66.4 vs. -155.6 μmol/L; P = 0.005) increased in the DASH group compared with the control group. After adjustment for weight, TG (-5.9 ± 7.5 vs. 15.2 ± 7.5 mg/dL, P = 0.07) and VLDL-c levels (-1.2 ± 1.5 vs. 3.0 ± 1.5 mg/dL, P = 0.07) reduced in the DASH group (Asemi et al., 2014).
Regarding the insulin resistance and serum hs-CRP, the study showed a significant reduction in serum insulin levels (−1.88 vs .2.89 μIU/mL, P = 0.03), HOMA-IR score (−0.45 vs. 0.80; P = 0.01), and serum hs-CRP levels (−763.29 vs. 665.95 ng/mL, P = 0.009) in DASH group. Furthermore, the waist size (-5.2 vs.-2.1cm; P = 0.003) and hip circumference (-5.9 vs. -1 cm; P < 0.0001) reduced in DASH group compared with the control group. No significant differences were observed in the mean changes of fasting plasma glucose and HOMA-B between the two groups. After adjusting for age and the baseline weight measure, no significant changes were reported in the findings. After adjustment for the baseline values of biomarkers, a significant difference was seen in quantitative insulin sensitivity check index (QUICKI) between the two groups (0.02 vs. −0.01, P = 0.04) (Asemi and Esmaillzadeh, 2015).
So, we found that the DASH diet could be an appropriate dietary pattern for women with PCOs. In recent years, some studies were conducted to evaluate and compare the dietary intakes of women with PCOs and healthy women. These studies also determined the relationship of the dietary patterns with cardiometabolic risk factors in women with PCOs in Iran.
Dietary intake in PCOs and healthy women: To achieve the difference between the dietary intake of PCOs and healthy women, a case-control study was conducted on 142 women with PCOs and 140 eumenorrheic non hirsute women (age and BMI were matched between the two study groups). In this study, the dietary intakes of the two groups were compared using a validated Food Frequency Questionnaire (FFQ). The findings showed that energy and macronutrient intakes were almost the same between the women with PCOs and the controls. Women with PCOs had significantly higher weight measures (case: 69.37 ± 14.97, control: 67.45 ± 12.92, P = 0.048) and hip circumferences (case: 104.9 ± 10.1, control: 101.5 ± 10.73, P = 0.007), but they had lower waist/hip ratio in comparison with the control group (case: 0.80 ± 0.73, control: 0.83 ± 0.09, P = 0.031). Consumption of high GI food items and egg in PCOs women was significantly higher than the controls, but intakes of vegetable and legume were significantly lower in PCOs women (P < 0.05) (Shishehgar et al., 2016).
Anthropometric characteristics and dietary patterns in women with PCOs: Recently, the researchers concluded that the dietary intake of women with PCOs should be determined. Therefore, a case-control study was conducted on 65 women with PCOs and 65 age-matched healthy women in 2013. Demographic, anthropometric, and dietary intake data were collected from each group and the results were compared. No significant difference was observed between the mean of the BMI of the two groups, but in PCOs group the mean of waist circumference was significantly higher  than the control group (P = 0.016). Consumption of calories and fat was significantly higher In PCOs women and the frequency of overweight patients with hirsutism was higher in PCOs group (Ahmadi et al., 2013).
This study was only about the food and dietary intakes in women with PCOs compared with the healthy women. So, it did not investigate the dietary patterns.
Dietary pattern and cardiometabolic risk factors in women with PCOs: A case- control study was conducted on 53 women with PCOs and 167 age-matched healthy women in 2017. The participants were selected from the population of Tehran lipid and glucose study. Dietary intakes were collected using a semi-quantitative FFQ. The relationship between the dietary patterns and cardiometabolic risks was investigated by Pearson's correlation and linear regression. The dietary pattern was characterized by high consumption of fried vegetables, vegetable oils (except olive oil), salty snacks, legumes, eggs, fast foods, onion, and garlic. However, it was defined with low intakes of traditional sweets, high fat dairy, low fat dairy, cruciferous vegetables, sugars, and honey, which had positive correlation with visceral adiposity index (VAI). Consumption of this dietary pattern had a significant association with higher TG and TG/HDL-c ratio as well as lower HDL-c in both groups. A positive correlation was also found for systolic blood pressure, waist circumference, total cholesterol (TC), and LDL-c in the control group. After adjusting for BMI and age, dietary pattern had an association with TG and TG/HDL-c in both groups. Compliance with this dietary pattern in the control group indicated a higher correlation with the cardio-metabolic risk in comparison with the PCOs group (Ehsani et al., 2016). The purpose of this study was to identify the VAI prediction model using a reduced rank regression. Moreover, it aimed to examine its associations with cardiometabolic risks in women with PCOs.