Seasonal effects on vitamin D status

influence outcomes of lifestyle

intervention in overweight and
obese women with polycystic
ovary syndrome
Rebecca L. Thomson, Ph.D.,a Simon Spedding, M.A.E.,a Grant D. Brinkworth, Ph.D.,b Manny Noakes, Ph.D.,b
and Jonathan D. Buckley, Ph.D.a
a
Nutritional Physiology Research Centre, Sansom Institute for Health Research, University of South Australia; and
b
Commonwealth Scientific and Industrial Research Organisation, Animal, Food and Health Sciences, Adelaide, South
Australia, Australia

Objective: To investigate the effect of undertaking lifestyle interventions during periods of seasonal change on vitamin D status and
health outcomes in overweight/obese women with polycystic ovary syndrome (PCOS).
Design: Retrospective, unplanned secondary analysis of two cohorts during different seasons.
Setting: Outpatient clinical research unit.
Patient(s): Fifty overweight/obese women with PCOS.
Intervention(s): Twenty-week lifestyle modification program (Clinical Trials registration no.: ACTRN12606000198527); one cohort
started in winter and finished in summer, and one started in summer and finished in winter.
Main Outcome Measure(s): 25-Hydroxyvitamin D (25OH-D), weight, waist circumference (WC), body composition, cardiovascular
disease (CVD) risk factors, and menstrual cycle length.
Result(s): Baseline 25OH-D levels were 27.6
9.0 nmol/L. The winter cohort had lower 25OH-D levels at baseline, which increased
over 20 weeks, whereas the summer cohort started with higher levels which decreased. Changes in 25OH-D were inversely correlated
with changes in WC and cholesterol when controlling for baseline values, such that increases in 25OH-D were associated with greater
reductions in WC and cholesterol.
Conclusion(s): Obesity and CVD risk profiles improved in vitamin D–deficient women with PCOS after a 20-week lifestyle intervention
during which vitamin D status improved with seasonal change.
Clinical Trial Registration Number: ACTRN12606000198527. (Fertil SterilÒ 2013;99:
1779–85. Ó2013 by American Society for Reproductive Medicine.) Use your smartphone
Key Words: 25-Hydroxyvitamin D, polycystic ovary syndrome, waist circumference, to scan this QR code
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P
olycystic ovary syndrome ductive age, presents in up to 18% of ries, menstrual dysfunction, infertility,
(PCOS), the most common endo- that population (1). PCOS is character- and biochemical (elevated androgens)
crine disorder in women of repro- ized by the presence of polycystic ova- and clinical (hirsutism and/or acne) hy-
perandrogenism (2). PCOS is also a ma-
Received September 24, 2012; revised December 20, 2012; accepted December 22, 2012; published jor cardiovascular disease (CVD) risk
online January 26, 2013.
R.L.T. has nothing to disclose. S.S. has nothing to disclose. G.D.B. has nothing to disclose. M.N. reports factor because of the increased preva-
travel accommodations/meeting expenses paid by Dairy Australia, Meat and Livestock Australia lence of subclinical atherosclerosis,
(unrelated to this work). J.D.B. has nothing to disclose.
The larger intervention was funded by a grant from the National Health and Medical Research Council
type 2 diabetes, dyslipidemia, and im-
of Australia (no. 401817). paired glucose tolerance (3, 4).
Reprint requests: Rebecca L. Thomson, Ph.D., Nutritional Physiology Research Centre, Sansom Insti- Vitamin D deficiency (serum 25-
tute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Aus-
tralia 5001 (E-mail: rebecca.thomson@unisa.edu.au). hydroxyvitamin D [25OH-D] <50
nmol/L [5]) is common in women with
Fertility and Sterility® Vol. 99, No. 6, May 2013 0015-0282/$36.00
Copyright ©2013 American Society for Reproductive Medicine, Published by Elsevier Inc.
PCOS, with reports of average 25OH-D
http://dx.doi.org/10.1016/j.fertnstert.2012.12.042 levels of 28–78 nmol/L (6–16) and the

VOL. 99 NO. 6 / MAY 2013 1779

ORIGINAL ARTICLE: REPRODUCTIVE ENDOCRINOLOGY
majority (67%–85%) having values <50 nmol/L (8–12, 17);
however, others have reported lower values of 31% (14) and
37% (16). Vitamin D may be linked to the pathology of
PCOS (18), with several studies demonstrating that various
PCOS symptoms are associated with low 25OH-D levels,
including insulin resistance (10, 11, 15, 17), infertility (19),
hirsutism and hyperandrogenism (10–12, 17), and other
CVD risk factors (11, 12, 17). 25OH-D levels have also been
consistently negatively associated with measures of obesity
(body mass index [BMI] [10–12, 15, 17], body fat [10], and
waist measurements [10, 11, 17]), with reports of 25OH-D
levels 30%–56% lower in obese women compared with
nonobese women (10, 11).
Several weight loss/diet interventions in the general popu-
lation have measured vitamin D before and after weight loss.
Two studies have observed a significant increase in 25OH-D
levels after 3–5 months of weight loss (20, 21). The
magnitude of increase in 25OH-D was also associated with
the magnitude of reduction in insulin resistance, weight, and
BMI (21). It has also been suggested that vitamin D status is
associated with weight loss success, with supplementation
resulting in weight loss (22), or higher baseline 25OH-D (23)
or greater increases in 25OH-D levels predicting greater
weight loss (24), although this has not been shown in all
studies (25, 26). Nevertheless, the majority of the evidence
suggests that higher 25OH-D may be associated with greater
weight loss and improvements in insulin resistance. Given
that 25OH-D is produced in humans as a result of exposure
to sunlight (i.e., UVB radiation) (5), 25OH-D levels are altered
with seasonal variation, with higher levels seen in summer
and lower levels in winter.
The aim of the present study was to investigate if under-
taking lifestyle interventions during periods of seasonal
change that are known to alter vitamin D status will influence
health outcomes in overweight and obese women with PCOS.
MATERIALS AND METHODS
Participants
The data analyzed for this study were obtained from a subset
of 50 women (age 30.3
6.3 y, BMI 36.5
5.7 kg/m2) from
a randomized controlled trial that concurrently evaluated the
effects of a hypocaloric diet with and without exercise train-
ing on metabolic and reproductive outcomes (27), who had
sufficient volume of frozen serum samples required for the
analysis of 25OH-D for this study. There were no differences
between participants allocated to the different lifestyle treat-
ments in the primary study for baseline values of 25OH-D
(P¼ .5) or changes in 25OH-D levels (P¼ .9) and compliance
with the exercise program (summer–winter, 78
20%; win-
ter–summer, 76
19%; P¼ .7), so data for the different life-
style interventions were combined. The study was
completed in two separate cohorts: One started in winter
(June/July) and finished in summer (November/December;
n ¼ 33) and the other started in summer (January/February)
and finished in winter (June/July; n ¼ 17). Both cohorts
were in Adelaide, South Australia (latitude 34 500 S, longitude
138 300 E; average daylight 14 hours in summer, 10 hours in
winter).
1780
PCOS was diagnosed according to the Rotterdam criteria
(28), by the presence of two of the following three criteria:
biochemical (elevated testosterone [>2.0 nmol/L] and free an-
drogen index [>5.4]) or clinical (hirsutism assessed by
Ferriman-Gallwey score >8) hyperandrogenism; menstrual
irregularity (oligo/anovulation [cycle length <21 days or
>35 days]); and presence of polycystic ovaries by transvagi-
nal or transabdominal ultrasound examination. Potential
participants were excluded if they were using fertility treat-
ments or oral contraceptives, smokers, pregnant, or breast-
feeding or had a history of cardiovascular, liver, kidney, or
respiratory disease, diabetes, uncontrolled hypertension
(>140/90 mm Hg), or cancer. Participants were also excluded
if they had any reproductive disorders unrelated to PCOS, thy-
roid abnormalities (hypothyroidism and hyperthyroidism), or
nonclassic adrenal hyperplasia. No participants were taking
vitamin D supplements during the study period. All experi-
mental procedures were approved by Human Ethics Commit-
tees of the Commonwealth Scientific and Industrial Research
Organisation and the University of South Australia, and each
participant provided written informed consent.
Study Design
At baseline (week 0) and end of the intervention (week 20)
participants attended the clinic after an overnight fast and
had height (baseline only), body weight, waist circumference
(WC), and body composition measured and a venous blood
sample collected for the measurement of serum 25OH-D and
CVD risk factors. During the month before study commence-
ment and throughout the intervention, menses calendars were
recorded to calculate menstrual cycle length.
Clinical and Biochemical Measurements
Height and weight were measured with the use of a stadiome-
ter (SECA) and electronic digital scales (Mercury AMZ 14), re-
spectively. BMI was calculated as weight (kg)/height (m)2. WC
was measured 2 cm above the uppermost lateral border of the
iliac crest with the use of an anthropometric tape (model
W606PM; Lufkin). The average of three measurements was
used as the measured value. Fat mass (FM) and fat-free
mass (FFM) were determined by dual-energy x-ray absorpti-
ometry (Lunar Prodigy; Lunar Radiation Corp.). Abdominal
fat mass (AbFM) was measured as previously described (29).
Fasting plasma and serum samples were collected and
stored at 80 C for analysis after study completion. Serum
total cholesterol, high-density lipoprotein cholesterol (HDL-
C), low-density lipoprotein cholesterol (LDL-C), triglycerides,
plasma glucose, and insulin were measured as previously de-
scribed (27). Plasma 25OH-D was measured with the use of
ELISA (Immunodiagnostic Systems) with intra- and interas-
say coefficients of variation of 5.3% and 4.6%, respectively.
Statistical Analysis
Statistical analysis was performed with the use of PAWS Sta-
tistics 18 (SPSS), and statistical significance was set at P< .05.
Data are presented as mean
SD. Data were checked for nor-
mality before analysis, and nonnormally distributed data
VOL. 99 NO. 6 / MAY 2013
 Fertility and Sterility®

(insulin and triglycerides) were transformed logarithmically.

41.5
15.8
2.9
14.1

40.7
22.1
25-Hydroxyvitamin D (25OH-D) levels, body composition, cardiovascular risk markers, and average menstrual cycle length in women with polycystic ovary syndrome at baseline and after 20 weeks of

3.1
26.7
For all data that could not be normalized by transformation

CL (d)
(glucose, HDL-C, menstrual cycle length), nonparametric sta-
tistics were performed. Participants were classified into two
subgroups: serum 25OH-D <25 nmol/L (severe deficiency; n

Glucose (mmol/L) Insulin (mU/L) TC (mmol/L) HDL-C (mmol/L) LDL-C (mmol/L) Triglycerides (mmol/L)
¼ 20) and serum 25OH-D 25–75 nmol/L (moderate deficiency
and insufficiency; n ¼ 30). These subgroups and the season

1.5
0.6
0.07
0.7

1.4
0.9
0.29
0.5
subgroups were compared with the use of independent-
samples t test and Mann-Whitney U test. Correlation analysis
with the use of Pearson correlation coefficient and Spearman
rank order correlation was used to determine relationships be-
tween baseline and changes in 25OH-D levels and measures
of obesity and CVD risk factors.

3.6
1.0
0.4
0.6

3.3
0.9
0.4
0.5
Note: Values are mean
SD. CL ¼ menstrual cycle length; HDL-C ¼ high-density lipoprotein cholesterol; LDL-C ¼ low-density lipoprotein cholesterol; TC ¼ total cholesterol; WC ¼ waist circumference.
RESULTS
The average baseline 25OH-D level was 27.6
9.0 nmol/L
(range: 12.6 to 52.3 nmol/L), with 98% of the sample being vi-
tamin D deficient (<50 nmol/L), 2% insufficient (50–75 nmol/

1.1
0.2
0.04
0.2

1.2
0.3
0.08
0.2
L), and none sufficient (>75 nmol/L). Women that started in
summer had higher baseline 25OH-D levels than those that
started in winter (P< .001; Table 1) and both groups had sig-
nificantly different 25OH-D levels at week 20 compared with
lifestyle intervention (change) that started in summer and finished in winter or started in winter and finished in summer.
week 0 (P< .001).

5.4
1.0
0.4
0.7

5.2
0.1
0.6
0.6
Baseline 25OH-D levels were inversely correlated with
WC (r ¼ 0.38; P¼ .007). Severely deficient women (25OH-
D <25 nmol/L) had higher levels of obesity compared with
moderately deficient and insufficient women (25OH-D >25

14.0
5.9b
nmol/L; P< .05; Table 2) and experienced greater weight
19.4
9.7
4.6
4.9

4.6
4.8
loss (25OH-D <25 nmol/L: 11.5
5.0 kg; 25OH-D >25
nmol/L: 8.0
6.1 kg; P¼ .038) and reductions in WC
(25OH-D <25 nmol/L: 14.0
5.9 cm; 25OH-D >25 nmol/L:
10.3
5.3 cm; P¼ .025) and FFM (25OH-D <25 nmol/L: 3.6

4.0 kg; 25OH-D >25 nmol/L: 1.3
2.2 kg; P¼ .007). How-
5.3
0.3
0.2
0.3

5.3
0.7
0.3
0.4

ever, when the differences in baseline weight, WC, and FFM

were controlled for, there were no longer significant differ-
ences in weight loss (P¼ .2) or the magnitude of reduction
in WC (P¼ .08) or FFM (P¼ .1). There was no difference in
age between groups (25OH-D <25 nmol/L: 31.0
4.9 y;
99.4
15.8

100.5
18.8 105.2
11.7

9.5
6.0 13.5
5.7a
8.4
4.6

25OH-D >25 nmol/L: 30.0
7.1 y; P¼ .5).

WC (cm)

Baseline serum 25OH-D levels were correlated with the

changes in 25OH-D levels at week 20 (r ¼ 0.71, P< .001;
Fig. 1). This was associated with the change in seasons, because
there were greater increases in serum 25OH-D in participants
102.8
25.1
Weight (kg)

9.2
5.8

Significantly different compared with summer–winter (P%.003).

who commenced the intervention in winter and completed in

Significantly different compared with summer–winter (P< .05).

summer (Table 1; P< .001). Serum 25OH-D increased in

all participants who commenced the intervention in winter
(n ¼ 33/33; Fig. 1) and decreased in most that started in
Thomson. PCOS and vitamin D. Fertil Steril 2013.
25OH-D (nmol/L)

summer (n ¼ 15/17; in 2 participants serum 25OH-D increased

23.5
6.9a
9.3
5.0a
9.0
6.6
35.7
7.1

2–2.5 nmol/L). The increase in 25OH-D in those that started

in winter remained significant when controlling for the reduc-
tion in WC (P¼ .007), indicating that the increase in 25OH-D
was independent from the decrease in WC and due to seasonal
changes. Baseline 25OH-D concentrations correlated with the
Winter–summer
Summer–winter

change in WC (r ¼ 0.43; P¼ .002), total cholesterol (r ¼ 0.30;

P¼ .03), LDL-C (r ¼ 0.31; P¼ .03), and average menstrual cycle
TABLE 1

Baseline

Baseline
Change

Change

length (r ¼ 0.36; P¼ .02), and these remained significant

after controlling for respective baseline values (Table 1). How-
b
a

ever, the relationships were such that those with lower 25OH-D

VOL. 99 NO. 6 / MAY 2013 1781

ORIGINAL ARTICLE: REPRODUCTIVE ENDOCRINOLOGY
TABLE 2
Baseline anthropometric measures in women with polycystic ovary syndrome and vitamin D deficiency.
Weight (kg)a BMI (kg/m2)a
Severe deficiency 109.4
21.9 38.7
6.4
25OH-D <25 nmol/L
Moderate deficiency 95.8
18.7 35.0
4.7
25OH-D >25 nmol/L
Note: Values are mean
SD. 25OH-D ¼ 25-hydroxyvitamin D; AbFM ¼ abdominal fat mass; BMI ¼ body mass index; FFM ¼ fat-free mass; FM ¼ fat mass; WC ¼ waist circumference.
a
Significant difference between groups (P< .05).
Thomson. PCOS and vitamin D. Fertil Steril 2013.
levels at baseline and greater increases in 25OH-D experienced
greater improvements in outcomes.
The changes in 25OH-D levels were related to the changes in
WC (r ¼ 0.51; P< .001), total cholesterol (r ¼ 0.30; P¼ .04),
and improvements in average menstrual cycle length (r ¼ 0.36;
P¼ .02), and there was a trend for an association with the changes
in triglycerides (r ¼ 0.27; P¼ .056). However, when controlling
for baseline values of these parameters, only the relationship with
changes in WC (r ¼ 0.48; P< .001; Fig. 2A) and total cholesterol
remained significant (r ¼ 0.36; P¼ .01; Fig. 2B).
DISCUSSION
The main finding of this study was that obesity and CVD risk
profiles changed in vitamin D–deficient overweight and obese
FIGURE 1
Relationship between baseline serum 25-hydroxyvitamin D (25OH-D)
levels and the change in serum 25OH-D levels after a 20-week lifestyle
intervention (r ¼ 0.71; P<.001) from summer to winter (triangles)
and from winter to summer (circles).
Thomson. PCOS and vitamin D. Fertil Steril 2013.
1782
WC (cm)a FM (kg)a FFM (kg)a AbFM (kg)a
110.6
13.3 51.6
10.8 56.8
12.3 3.2
0.9
98.3
11.1 44.5
10.9 50.6
8.9 2.5
0.8
women with PCOS after a 20-week lifestyle intervention dur-
ing which 25OH-D levels were altered as a result of seasonal
change. Lower 25OH-D concentrations at baseline were asso-
ciated with greater reductions in obesity, CVD risk factors,
and menstrual cycle length resulting from 20 weeks of life-
style intervention in women with PCOS. This relationship
with baseline levels was in the opposite direction from earlier
research (23) and may have been because women with lower
serum 25OH-D at baseline commenced the intervention in
winter and completed in summer, and as a result experienced
substantial increases in serum 25OH-D which were indepen-
dently associated with greater reductions in WC and serum
cholesterol concentrations. Earlier studies have also reported
greater improvements in weight loss and insulin resistance
with greater increases in 25OH-D levels (21, 24).
Collectively, these data suggest that it is not the baseline
level that is important but the increase in 25OH-D levels
that contributes to better health outcomes.
The present study found that greater increases in 25OH-D
levels were associated with greater reductions in total choles-
terol and WC. Low levels of 25OH-D have been associated with
CVD in other studies (30–32), and another study reported that
levels of total cholesterol, LDL-C, and triglycerides were sig-
nificantly higher in the lowest quartile of 25OH-D compared
with the highest quartiles (33). Two other larger population-
based studies also found low levels of 25OH-D to be associated
with high levels of triglycerides (30, 34). It is plausible that the
relationship between low 25OH-D levels and dyslipidemia
may explain the association between vitamin D status and
CVD (33).
The present study was unable to determine the causality
of the observed relationships between changes in serum
25OH-D and changes in CVD risk factors, owing to the ab-
sence of a control group. Although it is possible that greater
increases in 25OH-D levels led to better improvements in
WC and cholesterol, the possibility that greater reductions
in obesity led to an increase in 25OH-D levels through in-
creased bioavailability of endogenous vitamin D into the cir-
culation from fat tissue can not be dismissed. However, it
appears most likely that the former was the case, given that
the majority of women who started the intervention in sum-
mer and finished in winter decreased their 25OH-D levels de-
spite achieving similar weight and fat loss, suggesting that
increased 25OH-D may have contributed to greater weight
loss rather than weight loss contributing to 25OH-D levels.
Also, in women who started in winter and finished in summer,
the increase in 25OH-D was independent of WC reductions,
VOL. 99 NO. 6 / MAY 2013
 Fertility and Sterility®

FIGURE 2

0 1.5

1
-5

Change in total cholesterol (mmol/L)

Change in waist circumference (cm) 0.5

-10 0

-0.5
-15
-1

-20 -1.5

-2
-25
-2.5

-30 -3
-30 -10 10 30 -30 -10 10 30
Change in 25OHD levels (nmol/L) Change in 25OHD levels (nmol/L)
Relationship between the change in serum 25-hydroxyvitamin D (25OH-D) levels and the changes in (A) waist circumference (uncontrolled r ¼
0.51; P<.001; controlled for baseline values: r ¼ 0.48; P<.001) and (B) total cholesterol (uncontrolled r ¼ 0.30; P¼.04; controlled for
baseline values: r ¼ 0.36; P¼.01) after a 20-week lifestyle intervention from summer to winter (triangles) and from winter to summer (circles).
Thomson. PCOS and vitamin D. Fertil Steril 2013.

which are indicative of adipose tissue loss, suggesting that the vitamin D status triggers a hibernation-like state with
changes observed were seasonally related. Nevertheless, this a lower metabolic rate (40). It was somewhat surprising
preliminary observation requires confirmation of causation that differences in obesity were observed in relation to
in a controlled intervention. vitamin D status in the present study (i.e., the most obese
There is no general consensus on the minimum serum had the lowest 25OH-D), given that the study population
level of 25OH-D that is optimal for health, although serum included only overweight and obese women who were
levels <75 nmol/L are generally considered to reflect primarily deficient.
vitamin D insufficiency and <50 nmol/L vitamin D deficiency Some of the most commonly reported predictors of suffi-
(5, 35–37). The average value in the present study was 28 cient 25OH-D levels include body size, age, race, dietary and
nmol/L, which signifies deficiency and is at the low end of supplemental vitamin D intake, sunlight exposure, and phys-
other values reported in women with PCOS (27–78 nmol/L ical activity (41–44). Incorporating some of the modifiable
[6–16]). All participants in this study did not have sufficient predictors, such as increasing dietary vitamin D intake,
vitamin D levels, with the majority (98%) classified as being physical activity, and sun exposure into lifestyle
deficient and one as insufficient. Similar results have been modification programs may assist in achieving/maintaining
reported elsewhere (19), but others have reported smaller a healthy vitamin D status and associated health benefits
percentages of deficiency (31%–85%) (8–12, 14, 16, 17). (41, 44). It is possible that interventions that focus on
Participants in the present study were older and had higher weight loss while also increasing vitamin D intake through
levels of obesity, insulin resistance, and other CVD risk supplementation would offer greater benefit than weight
factors compared with some of the earlier studies, which loss alone in a vitamin D–deficient group. Preliminary
might explain the higher prevalence of deficiency seen in studies involving vitamin D supplementation in women
this study. with PCOS have shown beneficial effects on insulin (6, 8),
Obesity has been consistently associated with vitamin D glucose (13), triglycerides (6, 13, 45), total cholesterol (45),
deficiency (10–12, 15, 17, 38), and this is supported in the HDL-C (6), and menstrual frequency (9, 13). This suggests
present study by the significantly higher weight, BMI, and that there may be a place for vitamin D supplementation in
WC observed in the women with severe deficiency management of PCOS; however, this area requires further
compared with the women with moderate deficiency. There investigation.
are two possible explanations for this association. One is The present study represents a secondary analysis of a pri-
that it may be indirect, and those with greater levels of mary study, and a major limitation is that it was not designed
obesity may do less outdoor activity and subsequently to measure the influence of vitamin D on outcomes; therefore,
have less sun exposure. There may also be direct negative data on sun exposure or seasonally related changes in back-
effects of obesity because vitamin D is fat soluble and ground physical activity were not collected. However, owing
there is a sequestration of vitamin D in fat tissue, which to the nature of the lifestyle intervention used, every effort
decreases the bioavailability of endogenous vitamin D into was made to ensure that diet and physical activity were con-
circulation (39). It has also been hypothesized that low trolled. The exercise programs were the same in both cohorts

VOL. 99 NO. 6 / MAY 2013 1783

ORIGINAL ARTICLE: REPRODUCTIVE ENDOCRINOLOGY
and comprised aerobic training (walking/jogging) which was
done outside or inside on a treadmill, with or without resis-
tance training exercise which was conducted indoors at a local
fitness center using pin-loaded weight-stacked machines.
There were no differences in changes in serum 25OH-D be-
tween treatment groups and between those that exercised
and those that did not. Because there was no difference be-
tween treatment groups, this suggests that the interventions
themselves were not a source of variation in 25OH-D status.
Therefore, this study provided an opportunity to compare,
in a naturalistic setting, the effect of changes in serum
25OH-D on obesity, CVD factors, and menstrual cyclicity in
overweight women with PCOS, and even though the seasonal
effects on 25OH-D levels were small (
9 mmol/L), greater in-
creases were nonetheless associated with greater reductions in
WC and total cholesterol. The statistical power to detect the
correlation between change in 25OH-D and WC and total
cholesterol was >90% and 70%, respectively, with the sample
size of 50 at a ¼ .05. The mechanism for this is unclear, but it
is possible that vitamin D supplementation, which would
likely result in a much greater increase in 25OH-D levels
than was achieved due to seasonal effects in the present study,
may provide a greater magnitude of benefit.
Given the multifaceted health implications of PCOS, it is
important to identify effective therapies for the prevention
and treatment of the syndrome to reduce its health implications
and economic burdens. The clinical significance of the findings
of the present study is that WC and cholesterol are two of the
most important modifiable risk factors in CVD. Fertility is a ma-
jor concern for women with PCOS, and this study also indicated
some improvement in menstrual function. If future studies con-
firm these findings, this suggests therapeutic implications of vi-
tamin D in women with PCOS. Therapeutic implications of
vitamin D can not be demonstrated in an observational study,
so future studies should be interventions that control for vita-
min D supplementation to assess a therapeutic impact.
In conclusion, women with PCOS who increased serum
25OH-D more during lifestyle intervention achieved greater
improvement in WC and cholesterol. These preliminary re-
sults suggest that increasing vitamin D status during lifestyle
modification might result in greater reductions in obesity and
CVD risk in vitamin D–deficient overweight and obese
women with PCOS.
Acknowledgments: The authors gratefully acknowledge
Catherine Yandell for her guidance with the measurement
of 25OH-D. For the larger intervention, the authors gratefully
acknowledge Julia Weaver for assisting with trial manage-
ment, Lindy Lawson and Rosemary McArthur for their assis-
tance with nursing activities, Gemma Williams, Xenia
Cleanthous, Siew Lim, and Julianne McKeough for their die-
tetic guidance, and Mark Mano, Cathryn Seccafien, and Can-
dita Sullivan for laboratory assistance.
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