DOI: https://doi.org/10.36347/sjams.2026.v14i10.006

Pages: 1211-1218

Polyendocrine metabolic ovarian syndrome (PMOS, formerly polycystic ovary syndrome, PCOS) is common in India and presents with a characteristic phenotype: high prevalence, frequent lean or normal-weight presentation, and central adiposity with insulin resistance at body mass indices that would be considered unremarkable in European populations. Depletion of short-chain fatty acid-producing bacteria is among the more reproducible microbial findings in PMOS internationally, which invites the assumption that Indian populations, traditionally regarded as consuming high-fibre diets, should be relatively protected. This review examines that assumption and finds it inverted. Contemporary Indian dietary fibre intake is low and falling, at roughly 15 to 20 g per day against a recommended 25 to 30 g, with fewer than one in seven adults meeting the recommendation, and with refined cereals displacing whole grains and pulses across all geographic zones. Yet the Indian gut microbiome retains a distinctive Prevotella-dominant configuration enriched in complex plant-polysaccharide-degrading enzymes, a signature that erodes with dietary acculturation on migration. India therefore presents not fibre without fermentation but the converse: a microbial community with high fermentative capacity encountering a diminishing supply of fermentable substrate. We propose that this capacity-substrate mismatch is a candidate contributor to the lean insulin-resistant Indian PMOS phenotype, set out what the single available Indian study of faecal short-chain fatty acids in PMOS does and does not show, explain why faecal concentration cannot resolve the question, and specify the healthy population-representative reference cohort that India currently lacks. We distinguish substrate-directed from metabolite-directed intervention, situate the latter within postbiotic and butyrate-delivery strategies, and argue that the mismatch described here is a measurement problem before it is an intervention opport