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This pilot study aimed to determine if a short-term hypocaloric dietary intervention induced changes in the phenotypic presentation of PCOS. Methods: Twenty women with PCOS and overweight\/obesity participated in a 3-month hypocaloric dietary intervention with a 6-month follow-up. At pre-intervention, post-intervention, and follow-up, assessments of menstrual cycle status, hyperandrogenism, and polycystic ovarian morphology were performed, and PCOS phenotype status was determined using the following scale of decreasing severity: Phenotype A (ovulatory dysfunction, hyperandrogenism, and polycystic ovaries), Phenotype B (ovulatory dysfunction and hyperandrogenism), Phenotype C (hyperandrogenism and polycystic ovaries), or Phenotype D (ovulatory dysfunction and polycystic ovaries). Results: The participants lost 8 \u00b1 3% of their initial body weight with the intervention (p &lt; 0.001). Eight (40%) participants experienced a favorable shift in PCOS phenotype, while the remaining 12 (60%) participants had an unfavorable shift or no change. Changes in PCOS phenotype were primarily driven by reductions in menstrual cycle length (p = 0.010) and follicle number per ovary (p = 0.017), albeit no baseline clinical variable predicted a favorable-change PCOS presentation. At the 6-month follow-up (N = 12), weight was increased (p &lt; 0.05), and seven participants (58%) had reverted to a more severe phenotype. Conclusions: Weight loss may provide temporary improvement in the phenotypic presentation of PCOS, yet sustained lifestyle change may be required to maintain these benefits.<\/jats:p>","DOI":"10.3390\/nu17132223","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T11:20:11Z","timestamp":1751628011000},"page":"2223","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of Hypocaloric Dietary Intervention on Phenotypic Presentations of Polycystic Ovary Syndrome (PCOS)"],"prefix":"10.3390","volume":"17","author":[{"given":"Faith E.","family":"Carter","sequence":"first","affiliation":[{"name":"Division of Nutritional Sciences, Cornell University, Ithaca, NY 14850, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7328-7186","authenticated-orcid":false,"given":"Brittany Y.","family":"Jarrett","sequence":"additional","affiliation":[{"name":"Division of Nutritional Sciences, Cornell University, Ithaca, NY 14850, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4511-3514","authenticated-orcid":false,"given":"Alexis L.","family":"Oldfield","sequence":"additional","affiliation":[{"name":"Division of Nutritional Sciences, Cornell University, Ithaca, NY 14850, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0964-5097","authenticated-orcid":false,"given":"Heidi","family":"Vanden Brink","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Texas A&M University, College Station, TX 77840, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5255-2873","authenticated-orcid":false,"given":"Joy Y.","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Nutritional Sciences, Cornell University, Ithaca, NY 14850, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7203-5814","authenticated-orcid":false,"given":"Marla E.","family":"Lujan","sequence":"additional","affiliation":[{"name":"Division of Nutritional Sciences, Cornell University, Ithaca, NY 14850, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1602","DOI":"10.1093\/humrep\/dey256","article-title":"Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome","volume":"33","author":"Teede","year":"2018","journal-title":"Hum. 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