Zahra Esmaeilinezhada - a Nutrition research center, Shiraz University of Medical Sciences, Shiraz, Iran.
Reza Barati-Boldajia - Assistant Professor of Nutrition, Nutrition Research Center, School of nutrition and food sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
Siavash Babajafaria - School of nutrition and food science, Razi Blvd, Shiraz, Iran

Objective: Polycystic Ovarian Syndrome is a common reproductive, endocrine, and metabolic disease in women. Pomegranate juice, known as a rich source of phytochemicals with high antioxidant activity, enriched with probiotic may improve PCOS. We aimed to evaluate the effect of synbiotic pomegranate juice glycemic, sex hormone profile and anthropometric indices in PCOS patients.Methods: A randomized, controlled, triple-blinded, parallel trial study was performed in PCOS patients (n=92). Three treatment groups (23 patients each) received 2 L of synbiotic pomegranate juice (SPJ), pomegranate juice (PJ), and synbiotic beverage (SB) weekly. The control group (23 patients) received 2 L of placebo beverage weekly. Primary outcome was any change in insulin resistance and secondary outcomes were fasting blood sugar (FBS), insulin sensitivity, testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH), body mass index (BMI), waist and hip circumference, from baseline to the end of the trial. Result: At the end of the study, 86 patients were analyzed. There was significant change in insulin resistance in the SPJ and SB groups. Insulin sensitivity increased significantly in the SPJ and SB groups. Insulin also changed significantly in the SPJ and SB groups. BMI, weight and waist circumference decreased significantly in the SPJ and SB groups. Testosterone level also decreased significantly in the SPJ and SB groups. There was no significant change in FPG, LH and FSH in any of the groups.Conclusion: SPJ in the form of a new beverage can improve insulin resistance, insulin, testosterone level, BMI, weight and waist circumference in PCOS. This trial was registered in Iranian Registry of Clinical Trials, with number: IRCT2017020732439N1.Index words: Synbiotic; Insulin Resistance; Polycystic Ovarian Syndrome; Punicaceae; Gut microbiota