A Bayesian network meta-analysis of 43 randomized controlled trials (2,433 participants) systematically compared lifestyle interventions for cardiometabolic health in women with polycystic ovary syndrome across 16 outcomes spanning body composition, glucose regulation, lipids, inflammation, and blood pressure. Within dietary interventions, the ketogenic diet produced the largest reductions in waist circumference (−5.74 cm, 95% CrI −8.48 to −3.04) and BMI (−2.61 kg/m², −3.53 to −0.77). Among exercise modalities, aerobic exercise ranked highest for reducing waist-to-hip ratio.
PCOS affects 8–13% of reproductive-age women and meaningfully elevates lifetime risk of type 2 diabetes and cardiovascular disease — making cardiometabolic risk management a genuine longevity issue, not merely a fertility concern. This network meta-analysis is methodologically stronger than prior pairwise reviews because it enables indirect comparisons across interventions never tested head-to-head. The ketogenic diet finding is notable but warrants caution: only 86 participants across two arms contributed that estimate, making the credible interval wide and the ranking potentially unstable. The aerobic exercise result is better supported given seven study arms. An important limitation is that most included trials were short-term, making it unclear whether these cardiometabolic improvements persist or translate to hard endpoints like incident diabetes or cardiovascular events. Still, the study's dose-response analysis and SUCRA rankings provide the most granular prescription-level guidance yet available, moving the field closer to individualized, evidence-based lifestyle recommendations for women with PCOS.