Weight-neutral approach and later sleep midpoint in adolescents with "emerging polycystic ovary syndrome phenotype" as vehicles for sustainable weight loss.

Objective: Incorporate sleep into a novel lifestyle intervention strategy in adolescents with Emerging symptoms of polycystic ovary syndrome (E-PCOS). Design: A single-center cohort study. Setting: University hospital-based clinic for adolescents with PCOS. Patients: Forty-three girls at an age between 10 and 18 years presenting with E-PCOS between March 2015 and September 2017 with clinical signs of androgen excess and/or accelerated weight gain, acanthosis nigricans, irregular periods, or delayed menarche and followed every 6 months for a minimum of 4 visits, to October 2020. Interventions: All patients received nutritional counseling, with a goal of "zero weight gain," daily moderate physical activity goals of 45 minutes per day, and education regarding age-appropriate sleep duration. Three treatment strategies for E-PCOS symptoms were applied depending on the chief clinical complaint: anti-insulin approach with metformin; antiandrogen approach with oral contraceptive and spironolactone; and surveillance. Main Outcome Measures: Body mass index (BMI) Z-score over time. Alanine Transaminase (ALT) levels as a risk factor for nonalcoholic fatty liver. Results: Average number of return visits was 4 with 58% having >4 return visits. Testosterone levels were correlated with ALT ( Conclusion: A novel approach for adolescent girls with E-PCOS that focuses on metabolic endpoints and includes sleep duration and timing as specific targets, led to significant weight loss irrespective of treatment group.