{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T22:40:09Z","timestamp":1793400009659,"version":"4.5.0"},"reference-count":99,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012175","name":"Zhejiang Traditional Chinese Medicine Administration","doi-asserted-by":"publisher","award":["GZY-ZJ-KJ-23089"],"award-info":[{"award-number":["GZY-ZJ-KJ-23089"]}],"id":[{"id":"10.13039\/501100012175","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:p>Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine-metabolic disorder affecting 11%-13% of women of reproductive age. Based on body mass index (BMI), patients can be phenotypically classified into obese and non-obese subgroups: the obese PCOS is characterized by insulin resistance, hyperandrogenemia, and metabolic syndrome, with more pronounced metabolic risks; non-obese PCOS primarily manifests as reproductive endocrine dysfunction. In recent years, studies have shown that the Gut microbiota plays a key role in the pathogenesis of PCOS, and dysbiosis in the obese subgroup is generally more pronounced, potentially amplifying metabolic abnormalities through pathways such as short-chain fatty acids, bile acid disturbances, and endotoxin-related low-grade inflammation. This review systematically summarizes the clinically heterogeneous features of BMI-stratified PCOS and its gut microbiota characteristics, with a focus on elucidating the mechanistic differences between obese and non-obese individuals in terms of inflammation, metabolites, and endocrine regulatory pathways. Based on current evidence, individualized intervention strategies targeting different BMI subtypes are proposed, including dietary and lifestyle modifications, interventions with probiotics\/prebiotics\/synbiotics, and exploration of emerging precision microbiome therapies such as fecal microbiota transplantation. The interaction between BMI and gut microbiota provides new directions for stratified management and personalized treatment of PCOS; however, high-quality longitudinal and interventional studies are still needed to clarify causal relationships and optimize microbiota-targeted strategies.<\/jats:p>","DOI":"10.3389\/fendo.2026.1734041","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T05:22:01Z","timestamp":1770355321000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["BMI-stratified phenotypes of polycystic ovary syndrome: advances in gut microbiota research and personalized management strategies"],"prefix":"10.3389","volume":"17","author":[{"given":"Bisha","family":"Su","sequence":"first","affiliation":[{"name":"Fourth Clinical Medical College of Zhejiang Chinese Medical University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yining","family":"Cao","sequence":"additional","affiliation":[{"name":"Fourth Clinical Medical College of Zhejiang Chinese Medical University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Ma","sequence":"additional","affiliation":[{"name":"Hangzhou Women\u2019s Hospital","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Huang","sequence":"additional","affiliation":[{"name":"Hangzhou Women\u2019s Hospital","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1038\/s41572-024-00511-3","article-title":"Polycystic ovary syndrome","volume":"10","author":"Stener-Victorin","year":"2024","journal-title":"Nat Rev Dis Primers"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1093\/ejendo\/lvad096","article-title":"Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome","volume":"189","author":"Teede","year":"2023","journal-title":"Eur J Endocrinol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3803\/EnM.2025.2590","article-title":"From old to new: a comprehensive review of obesity diagnostic criteria and their implications","volume":"40","author":"Hong","year":"2025","journal-title":"Endocrinol Metab"},{"key":"B4","doi-asserted-by":"publisher","first-page":"757","DOI":"10.3390\/ijerph21060757","article-title":"Advantages and limitations of the body mass index (BMI) to assess adult obesity","volume":"21","author":"Wu","year":"2024","journal-title":"Int J Environ Res Public Health"},{"key":"B5","first-page":"1","article-title":"preventing and managing the global epidemic. Report of a WHO consultation","volume":"894","year":"2000","journal-title":"World Health Organ Tech Rep Ser"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1111\/cen.14421","article-title":"Obesity: preventing and polycystic ovary syndrome","volume":"95","author":"Barber","year":"2021","journal-title":"Clin Endocrinol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)02750-2","article-title":"Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults","volume":"403","author":"Phelps","year":"2024","journal-title":"Lancet"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgae488","article-title":"The association between obesity and polycystic ovary syndrome: an epidemiologic study of observational data","volume":"109","author":"Amiri","year":"2024","journal-title":"J Clin Endocrinol Metab"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmaa029","article-title":"Long-term cardiometabolic disease risk in women with PCOS: a systematic review and meta-analysis","volume":"26","author":"Wekker","year":"2020","journal-title":"Hum Reprod Update"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1500","DOI":"10.3390\/jcm12041500","article-title":"Polycystic ovary syndrome: challenges and possible solutions","volume":"12","author":"Y","year":"2023","journal-title":"J Clin Med"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1526468","article-title":"Metabolic disorders in polycystic ovary syndrome: from gut microbiota biodiversity to clinical intervention","volume":"16","author":"Li","year":"2025","journal-title":"Front Endocrinol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1186\/s13048-022-01051-8","article-title":"Alterations of bacteriome, mycobiome and metabolome characteristics in PCOS patients with normal\/overweight individuals","volume":"15","author":"Yin","year":"2022","journal-title":"J Ovarian Res"},{"key":"B13","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3390\/nu14010012","article-title":"Gut microbiome composition in obese and non-obese persons: a systematic review and meta-analysis","volume":"14","author":"Pinart","year":"2021","journal-title":"Nutrients"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-020-01481-5","article-title":"Gut microbiota alterations reveal potential gut-brain axis changes in polycystic ovary syndrome","volume":"44","author":"Z","year":"2021","journal-title":"J Endocrinol Invest"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.2147\/DMSO.S329108","article-title":"Analysis of endocrine and metabolic indexes in non-obese patients with polycystic ovary syndrome and its compare with obese patients","volume":"14","author":"Shi","year":"2021","journal-title":"Diabetes Metab Syndr Obes: Targets Ther"},{"key":"B16","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.fertnstert.2011.11.036","article-title":"Should all women with PCOS be treated for insulin resistance","volume":"97","author":"Marshall","year":"2012","journal-title":"Fertil Steril"},{"key":"B17","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1186\/s12902-024-01720-3","article-title":"Insulin resistance and insulin secretory defect among bangalee PCOS women: a case-control study","volume":"24","author":"Nayeem","year":"2024","journal-title":"BMC Endocr Disord"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13860","article-title":"Prevalence and degree of insulin resistance in chinese han women with PCOS: results from euglycemic-hyperinsulinemic clamps","volume":"90","author":"Li","year":"2019","journal-title":"Clin Endocrinol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2313","DOI":"10.3390\/diagnostics12102313","article-title":"Comparing lean and obese PCOS in different PCOS phenotypes: evidence that the body weight is more important than the rotterdam phenotype in influencing the metabolic status","volume":"12","author":"E","year":"2022","journal-title":"Diagn (Basel Switz)"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-024-07916-1","article-title":"Unmet clinical needs in women with polycystic ovary syndrome regarding fertility and obesity: a cross-sectional study from the patient\u2019s perspective","volume":"311","author":"Bachmann","year":"2025","journal-title":"Arch Gynecol Obstet"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1578","DOI":"10.3390\/jcm13061578","article-title":"The impact of high BMI on pregnancy outcomes and complications in women with PCOS undergoing IVF-a systematic review and meta-analysis","volume":"13","author":"Alenezi","year":"2024","journal-title":"J Clin Med"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1204623","article-title":"Influencing of serum inflammatory factors on IVF\/ICSI outcomes among PCOS patients with different BMI","volume":"14","author":"He","year":"2023","journal-title":"Front Endocrinol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"5591","DOI":"10.1038\/s41467-024-49749-1","article-title":"Systematic review and meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome","volume":"15","author":"Bahri Khomami","year":"2024","journal-title":"Nat Commun"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2019-00383","article-title":"A narrative review of placental contribution to adverse pregnancy outcomes in women with polycystic ovary syndrome","volume":"104","author":"Kelley","year":"2019","journal-title":"J Clin Endocrinol Metab"},{"key":"B25","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1186\/s12864-024-09990-w","article-title":"Body mass index stratified meta-analysis of genome-wide association studies of polycystic ovary syndrome in women of european ancestry","volume":"25","author":"Burns","year":"2024","journal-title":"BMC Genomics"},{"key":"B26","doi-asserted-by":"publisher","first-page":"l4067","DOI":"10.1136\/bmj.l4067","article-title":"Quantifying the impact of genes on body mass index during the obesity epidemic: longitudinal findings from the HUNT Study","volume":"366","author":"Brandkvist","year":"2019","journal-title":"BMJ"},{"key":"B27","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1016\/j.jsps.2016.12.001","article-title":"Ovulation induction by metformin among obese versus non-obese women with polycystic ovary syndrome","volume":"25","author":"Al-Ruthia","year":"2017","journal-title":"Saudi Pharm J"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2003.08.012","article-title":"Nonobese women with polycystic ovary syndrome respond better than obese women to treatment with metformin","volume":"81","author":"Maciel","year":"2004","journal-title":"Fertil Steril"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1111\/obr.13704","article-title":"Anti-obesity pharmacological agents for polycystic ovary syndrome: a systematic review and meta-analysis to inform the 2023 international evidence-based guideline","volume":"25","author":"Goldberg","year":"2024","journal-title":"Obes Rev"},{"key":"B30","doi-asserted-by":"publisher","first-page":"108834","DOI":"10.1016\/j.jdiacomp.2024.108834","article-title":"The efficacy and safety of GLP-1 agonists in PCOS women living with obesity in promoting weight loss and hormonal regulation: a meta-analysis of randomized controlled trials","volume":"38","author":"Austreg\u00e9silo De Athayde De Hollanda Morais","year":"2024","journal-title":"J Diabetes its Complications"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1275419","article-title":"Gut microbiota and polycystic ovary syndrome, focus on genetic associations: a bidirectional mendelian randomization study","volume":"15","author":"Wang","year":"2024","journal-title":"Front Endocrinol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1280983","article-title":"Causal relationship between gut microbiota and polycystic ovary syndrome: a literature review and Mendelian randomization study","volume":"15","author":"J","year":"2024","journal-title":"Front Endocrinol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2023.e22155","article-title":"Gut microbiota and risk of polycystic ovary syndrome: insights from mendelian randomization","volume":"9","author":"Li","year":"2023","journal-title":"Heliyon"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2021.634981","article-title":"16S rDNA full-length assembly sequencing technology analysis of intestinal microbiome in polycystic ovary syndrome","volume":"11","author":"Dong","year":"2021","journal-title":"Front Cell Infect Microbiol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.resmic.2018.09.002","article-title":"Structural and functional profiles of the gut microbial community in polycystic ovary syndrome with insulin resistance (IR-PCOS): a pilot study","volume":"170","author":"Zeng","year":"2019","journal-title":"Res Microbiol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1186\/s12916-023-02975-8","article-title":"Perturbations in gut microbiota composition in patients with polycystic ovary syndrome: a systematic review and meta-analysis","volume":"21","author":"P","year":"2023","journal-title":"BMC Med"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pbio.1002533","article-title":"Revised estimates for the number of human and bacteria cells in the body","volume":"14","author":"Sender","year":"2016","journal-title":"PloS Biol"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2012.01.035","article-title":"The impact of the gut microbiota on human health: an integrative view","volume":"148","author":"Clemente","year":"2012","journal-title":"Cell"},{"key":"B39","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1186\/s12967-024-05175-x","article-title":"Impact of fundamental components of the Mediterranean diet on the microbiota composition in blood pressure regulation","volume":"22","author":"Zambrano","year":"2024","journal-title":"J Transl Med"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1093\/gastro\/goae033","article-title":"Gastrointestinal microbiota-directed nutritional and therapeutic interventions for inflammatory bowel disease: opportunities and challenges","volume":"12","author":"Paudel","year":"2023","journal-title":"Gastroenterol Rep"},{"key":"B41","doi-asserted-by":"publisher","first-page":"102884","DOI":"10.1016\/j.eclinm.2024.102884","article-title":"Gut microbiota in women with polycystic ovary syndrome: an individual based analysis of publicly available data","volume":"77","author":"Yang","year":"2024","journal-title":"Eclinicalmedicine"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2025.1549499","article-title":"Systematic review of gut microbiota composition, metabolic alterations, and the effects of treatments on PCOS and gut microbiota across human and animal studies","volume":"16","author":"Hanna","year":"2025","journal-title":"Front Microbiol"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2021-326789","article-title":"Gut microbiome and health: mechanistic insights","volume":"71","author":"De Vos","year":"2022","journal-title":"Gut"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-023-06466-x","article-title":"Gut microbial carbohydrate metabolism contributes to insulin resistance","volume":"621","author":"Takeuchi","year":"2023","journal-title":"Nature"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(22)00163-2","article-title":"Polycystic ovary syndrome","volume":"10","author":"Joham","year":"2022","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgz263","article-title":"Obese adolescents with PCOS have altered biodiversity and relative abundance in gastrointestinal microbiota","volume":"105","author":"Jobira","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"key":"B47","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2147\/DMSO.S388067","article-title":"Impact of visceral obesity on structural and functional alterations of gut microbiota in polycystic ovary syndrome (PCOS): a pilot study using metagenomic analysis","volume":"16","author":"Bai","year":"2023","journal-title":"Diabetes Metab Syndr Obes"},{"key":"B48","article-title":"Dysbiosis of gut microbiota associated with clinical parameters in polycystic ovary syndrome","volume":"8","author":"Liu","year":"2017","journal-title":"Front Microbiol"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-020-06097-6","article-title":"GLP-2 acutely prevents endotoxin-related increased intestinal paracellular permeability in rats","volume":"65","author":"Maruta","year":"2020","journal-title":"Dig Dis Sci"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0279915","article-title":"Increased intestinal-fatty acid binding protein in obesity-associated type 2 diabetes mellitus","volume":"18","author":"Tahapary","year":"2023","journal-title":"PloS One"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmy007","article-title":"Ethnicity, obesity and the prevalence of impaired glucose tolerance and type 2 diabetes in PCOS: a systematic review and meta-regression","volume":"24","author":"Kakoly","year":"2018","journal-title":"Hum Reprod Update"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2022.02.028","article-title":"Subclinical cardiovascular disease and polycystic ovary syndrome","volume":"117","author":"Gomez","year":"2022","journal-title":"Fertil Steril"},{"key":"B53","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1530\/EC-19-0522","article-title":"Characteristic gut microbiota and predicted metabolic functions in women with PCOS","volume":"9","author":"Zhou","year":"2020","journal-title":"Endocr Conn"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1139\/cjpp-2019-0413","article-title":"Gut microbiota dysbiosis in polycystic ovary syndrome: association with obesity \u2014 a preliminary report","volume":"98","author":"Liang","year":"2020","journal-title":"Can J Physiol Pharmacol"},{"key":"B55","doi-asserted-by":"publisher","first-page":"1849998","DOI":"10.1080\/19490976.2020.1849998","article-title":"From correlation to causality: the case of subdoligranulum","volume":"12","author":"Van Hul","year":"2020","journal-title":"Gut Microbes"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003132","article-title":"Distinct subtypes of polycystic ovary syndrome with novel genetic associations: an unsupervised, phenotypic clustering analysis","volume":"17","author":"Dapas","year":"2020","journal-title":"PloS Med"},{"key":"B57","doi-asserted-by":"publisher","first-page":"100793","DOI":"10.1016\/j.fbio.2020.100793","article-title":"Review of short-chain fatty acids effects on the immune system and cancer","volume":"38","author":"Fattahi","year":"2020","journal-title":"Food Biosci"},{"key":"B58","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1210\/er.2011-1034","article-title":"Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications","volume":"33","author":"Diamanti-Kandarakis","year":"2012","journal-title":"Endocr Rev"},{"key":"B59","doi-asserted-by":"publisher","first-page":"1363","DOI":"10.1053\/j.gastro.2014.08.033","article-title":"Intestinal epithelial cell toll-like receptor 5 regulates the intestinal microbiota to prevent low-grade inflammation and metabolic syndrome in mice","volume":"147","author":"Chassaing","year":"2014","journal-title":"Gastroenterology"},{"key":"B60","doi-asserted-by":"publisher","first-page":"14982","DOI":"10.3390\/ijms232314982","article-title":"The role of adipokines in inflammatory mechanisms of obesity","volume":"23","author":"Kirichenko","year":"2022","journal-title":"Int J Mol Sci"},{"key":"B61","doi-asserted-by":"publisher","first-page":"2828","DOI":"10.3390\/nu12092828","article-title":"Obese adipose tissue secretion induces inflammation in preadipocytes: role of toll-like receptor-4","volume":"12","author":"Renovato-Martins","year":"2020","journal-title":"Nutrients"},{"key":"B62","doi-asserted-by":"publisher","first-page":"114338","DOI":"10.1016\/j.foodres.2024.114338","article-title":"Obesity and polycystic ovary syndrome influence on intestinal permeability at fasting, and modify the effect of diverse macronutrients on the gut barrier","volume":"186","author":"M\u00e1","year":"2024","journal-title":"Food Res Int"},{"key":"B63","article-title":"Alterations of gut microbiome and fecal fatty acids in patients with polycystic ovary syndrome in central China","volume":"13","author":"Li","year":"2022","journal-title":"Front Microbiol"},{"key":"B64","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2024.1394873","article-title":"Fecal propionate is a signature of insulin resistance in polycystic ovary syndrome","volume":"14","author":"Dong","year":"2025","journal-title":"Front Cell Infect Microbiol"},{"key":"B65","doi-asserted-by":"publisher","first-page":"10636","DOI":"10.3390\/ijms251910636","article-title":"Impact of gut microbiota and SCFAs in the pathogenesis of PCOS and the effect of metformin therapy","volume":"25","author":"Kukaev","year":"2024","journal-title":"Int J Mol Sci"},{"key":"B66","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1186\/s13048-024-01550-w","article-title":"Gut microbiota and gut-derived metabolites are altered and associated with dietary intake in women with polycystic ovary syndrome","volume":"17","author":"da Silva","year":"2024","journal-title":"J Ovarian Res"},{"key":"B67","doi-asserted-by":"publisher","DOI":"10.1007\/s10557-024-07649-y","article-title":"Butyrate-mediated modulation of paraoxonase-1 alleviates cardiorenometabolic abnormalities in a rat model of polycystic ovarian syndrome","volume":"39","author":"Olaniyi","year":"2025","journal-title":"Cardiovasc Drugs Ther"},{"key":"B68","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.747888","article-title":"Effects of sleeve gastrectomy on fecal gut microbiota and short-chain fatty acid content in a rat model of polycystic ovary syndrome","volume":"12","author":"Lin","year":"2021","journal-title":"Front Endocrinol"},{"key":"B69","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-019-0509-0","article-title":"Gut microbiota-bile acid-interleukin-22 axis orchestrates polycystic ovary syndrome","volume":"25","author":"X","year":"2019","journal-title":"Nat Med"},{"key":"B70","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1529703","article-title":"Unraveling the gut microbiota\u2019s role in PCOS: a new frontier in metabolic health","volume":"16","author":"Li","year":"2025","journal-title":"Front Endocrinol"},{"key":"B71","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2018.01210","article-title":"Gut microbiota markers in obese adolescent and adult patients: age-dependent differential patterns","volume":"9","author":"Del Chierico","year":"2018","journal-title":"Front Microbiol"},{"key":"B72","doi-asserted-by":"publisher","first-page":"102766","DOI":"10.1016\/j.ebiom.2020.102766","article-title":"A dysregulated bile acid-gut microbiota axis contributes to obesity susceptibility","volume":"55","author":"Wei","year":"2020","journal-title":"eBioMedicine"},{"key":"B73","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.chom.2024.12.006","article-title":"The intestinal fungus aspergillus tubingensis promotes polycystic ovary syndrome through a secondary metabolite","volume":"33","author":"Wu","year":"2025","journal-title":"Cell Host Microbe"},{"key":"B74","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmgh.2018.04.003","article-title":"The brain-gut-microbiome axis","volume":"6","author":"Martin","year":"2018","journal-title":"Cell Mol Gastroenterol Hepatol"},{"key":"B75","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.667422","article-title":"Central regulation of PCOS: abnormal neuronal-reproductive-metabolic circuits in PCOS pathophysiology","volume":"12","author":"Liao","year":"2021","journal-title":"Front Endocrinol"},{"key":"B76","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2005-2099","article-title":"Inverse relationship between luteinizing hormone and body mass index in polycystic ovarian syndrome: investigation of hypothalamic and pituitary contributions","volume":"91","author":"Pag\u00e1n","year":"2006","journal-title":"J Clin Endocrinol Metab"},{"key":"B77","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2020.612773","article-title":"Gut microbiota and type 1 diabetes mellitus: the effect of Mediterranean diet","volume":"7","author":"Calabrese","year":"2021","journal-title":"Front Nutr"},{"key":"B78","doi-asserted-by":"publisher","first-page":"1298","DOI":"10.3390\/foods11091298","article-title":"Structural characteristics of insoluble dietary fiber from okara with different particle sizes and their prebiotic effects in rats fed high-fat diet","volume":"11","author":"Fan","year":"2022","journal-title":"Foods (Basel Switz)"},{"key":"B79","doi-asserted-by":"publisher","DOI":"10.1590\/s0004-2803.202302022-96","article-title":"High-fiber diet promotes metabolic, hormonal, and satiety effects in obese women on a short-term caloric restriction","volume":"60","author":"Triffoni-Melo","year":"2023","journal-title":"Arq Gastroenterol"},{"key":"B80","doi-asserted-by":"publisher","DOI":"10.1016\/j.mam.2018.03.001","article-title":"Omega-3 fatty acids and non-alcoholic fatty liver disease: Evidence of efficacy and mechanism of action","volume":"64","author":"Scorletti","year":"2018","journal-title":"Mol Aspect Med"},{"key":"B81","doi-asserted-by":"publisher","first-page":"3144","DOI":"10.3390\/nu15143144","article-title":"Probiotics and polycystic ovary syndrome: a perspective for management in adolescents with obesity","volume":"15","author":"Calcaterra","year":"2023","journal-title":"Nutrients"},{"key":"B82","doi-asserted-by":"publisher","first-page":"3916","DOI":"10.3390\/nu16223916","article-title":"Effectiveness of probiotics, prebiotics, and synbiotics in managing insulin resistance and hormonal imbalance in women with polycystic ovary syndrome (PCOS): a systematic review of randomized clinical trials","volume":"16","author":"Martinez Guevara","year":"2024","journal-title":"Nutrients"},{"key":"B83","doi-asserted-by":"publisher","DOI":"10.1038\/s41574-019-0156-z","article-title":"Gut microbial metabolites in obesity, NAFLD and T2DM","volume":"15","author":"Canfora","year":"2019","journal-title":"Nat Rev Endocrinol"},{"key":"B84","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/s12902-018-0248-0","article-title":"The effects of synbiotic supplementation on hormonal status, biomarkers of inflammation and oxidative stress in subjects with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial","volume":"18","author":"Nasri","year":"2018","journal-title":"BMC Endocr Disord"},{"key":"B85","doi-asserted-by":"publisher","first-page":"4555","DOI":"10.3390\/nu14214555","article-title":"The role of individually selected diets in obese women with PCOS\u2014a review","volume":"14","author":"Chudzicka-Struga\u0142a","year":"2022","journal-title":"Nutrients"},{"key":"B86","doi-asserted-by":"publisher","first-page":"10275","DOI":"10.3390\/ijms221910275","article-title":"Metabolomic approaches to investigate the effect of metformin: an overview","volume":"22","author":"Kim","year":"2021","journal-title":"Int J Mol Sci"},{"key":"B87","doi-asserted-by":"publisher","first-page":"5915","DOI":"10.3390\/jcm12185915","article-title":"Do GLP-1 analogs have a place in the treatment of PCOS? New insights and promising therapies","volume":"12","author":"Szczesnowicz","year":"2023","journal-title":"J Clin Med"},{"key":"B88","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbmo.2019.04.017","article-title":"GLP-1 receptor agonists versus metformin in PCOS: a systematic review and meta-analysis","volume":"39","author":"Han","year":"2019","journal-title":"Reprod BioMed Online"},{"key":"B89","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2025.1575770","article-title":"Epithelial barrier hypothesis in the context of nutrition, microbial dysbiosis, and immune dysregulation in metabolic dysfunction-associated steatotic liver","volume":"16","author":"Cebi","year":"2025","journal-title":"Front Immunol"},{"key":"B90","doi-asserted-by":"publisher","DOI":"10.1080\/09513590.2022.2119219","article-title":"Effect of probiotics combined with metformin on improvement of menstrual and metabolic patterns in women with polycystic ovary syndrome: a randomized clinical trial","volume":"38","author":"Ji","year":"2022","journal-title":"Gynecol Endocrinol"},{"key":"B91","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0153196","article-title":"Association between polycystic ovary syndrome and gut microbiota","volume":"11","author":"Guo","year":"2016","journal-title":"PloS One"},{"key":"B92","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2018.09.013","article-title":"Metabolic disturbances in non-obese women with polycystic ovary syndrome: a systematic review and meta-analysis","volume":"111","author":"Zhu","year":"2019","journal-title":"Fertil Steril"},{"key":"B93","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.fertnstert.2016.05.003","article-title":"Criteria, prevalence, and phenotypes of polycystic ovary syndrome","volume":"106","author":"Lizneva","year":"2016","journal-title":"Fertil Steril"},{"key":"B94","first-page":"E37809","article-title":"Clinico-metabolic profile in lean versus obese polycystic ovarian syndrome women","volume":"15","author":"Makhija","year":"2023","journal-title":"Cureus"},{"key":"B95","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1186\/s12884-025-07480-9","article-title":"Hormonal and metabolic influences on outcomes in PCOS undergoing assisted reproduction: the role of BMI in fresh embryo transfers","volume":"25","author":"Wang","year":"2025","journal-title":"BMC Preg Childb"},{"key":"B96","doi-asserted-by":"publisher","first-page":"2312895","DOI":"10.1080\/09513590.2024.2312895","article-title":"Metabolic disparities between obese and non-obese patients with polycystic ovary syndrome: implications for endometrial receptivity indicators","volume":"40","author":"Li","year":"2024","journal-title":"Gynecol Endocrinol: Off J Int Soc Gynecol Endocrinol"},{"key":"B97","doi-asserted-by":"publisher","first-page":"257","DOI":"10.4103\/ijem.IJEM_637_18","article-title":"Obese and non-obese polycystic ovarian syndrome: comparison of clinical, metabolic, hormonal parameters, and their differential response to clomiphene","volume":"23","author":"G","year":"2019","journal-title":"Indian J Endocrinol Metab"},{"key":"B98","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1186\/s13048-025-01703-5","article-title":"Impact of obesity on proteomic profiles of follicular fluid-derived small extracellular vesicles: a comparison between PCOS and non-PCOS women","volume":"18","author":"Chang","year":"2025","journal-title":"J Ovarian Res"},{"key":"B99","doi-asserted-by":"publisher","DOI":"10.1111\/eci.13417","article-title":"Characterization of gut microbiota in polycystic ovary syndrome: findings from a lean population","volume":"51","author":"Mammadova","year":"2021","journal-title":"Eur J Clin Invest"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1734041\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T05:22:03Z","timestamp":1770355323000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1734041\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,6]]},"references-count":99,"alternative-id":["10.3389\/fendo.2026.1734041"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1734041","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,6]]},"article-number":"1734041"}}