1
|
Effect of a Low-Glycemic Load Diet Intervention on Maternal and Pregnancy Outcomes in Obese Pregnant Women. Nutrients 2021; 13:nu13030748. [PMID: 33652705 PMCID: PMC7996780 DOI: 10.3390/nu13030748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 11/30/2022] Open
Abstract
The increased prevalence of obese, pregnant women who have a higher risk of glucose intolerance warrants the need for nutritional interventions to improve maternal glucose homeostasis. In this study, the effect of a low-glycemic load (GL) (n = 28) was compared to a high-GL (n = 34) dietary intervention during the second half of pregnancy in obese women (body mass index (BMI) > 30 or a body fat >35%). Anthropometric and metabolic parameters were assessed at baseline (20 week) and at 28 and 34 weeks gestation. For the primary outcome 3h-glucose-iAUC (3h-incremental area under the curve), mean between-group differences were non-significant at every study timepoint (p = 0.6, 0.3, and 0.8 at 20, 28, and 34 weeks, respectively) and also assessing the mean change over the study period (p = 0.6). Furthermore, there was no statistically significant difference between the two intervention groups for any of the other examined outcomes (p ≥ 0.07). In the pooled cohort, there was no significant effect of dietary GL on any metabolic or anthropometric outcome (p ≥ 0.2). A post hoc analysis comparing the study women to a cohort of overweight or obese pregnant women who received only routine care showed that the non-study women were more likely to gain excess weight (p = 0.046) and to deliver large-for-gestational-age (LGA) (p = 0.01) or macrosomic (p = 0.006) infants. Thus, a low-GL diet consumed during the last half of pregnancy did not improve pregnancy outcomes in obese women, but in comparison to non-study women, dietary counseling reduced the risk of adverse outcomes.
Collapse
|
2
|
Gontijo CA, Balieiro LCT, Teixeira GP, Fahmy WM, Crispim CA, Maia YCDP. Higher energy intake at night effects daily energy distribution and contributes to excessive weight gain during pregnancy. Nutrition 2020; 74:110756. [PMID: 32278857 DOI: 10.1016/j.nut.2020.110756] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/29/2019] [Accepted: 12/01/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the effect of nighttime energy intake on daily energy and macronutrient distribution and weight gain during pregnancy. METHODS This was a prospective cohort study carried out with 100 pregnant women and the data collection occurred once per trimester. A dietary intake was assessed by three 24-h dietary recalls in each trimester, totaling nine dietary recalls. The distribution of energy and macronutrient intake was evaluated at meals throughout the day in each trimester and overall pregnancy. Women were classified as having "lower" or "higher" nighttime intake (1900 to 0559) if consumption in this period were below or above the median of the population, respectively, for at least two trimesters. Recommendations from the Institute of Medicine were used to assess the adequacy of weight gain. Generalized estimating equation models were used to determine the effects of nighttime intake and gestational trimesters on daily energy distribution and weight gain. RESULTS In overall pregnancy, the higher group consumed a higher percentage of energy and macronutrients in the evening meals, and less energy, proteins, and lipids in morning meals when compared with the lower group. Also, women in the higher group had greater excessive weight gain in the third trimester compared with the lower group. CONCLUSION Pregnant women with a higher energy intake at night had a lower percentage of energy, protein, and lipid intake in morning meals and a higher percentage of energy and macronutrient intake in the evening meals during pregnancy. A worse standard of gestational weight gain in the third trimester was also observed in pregnant women with a higher energy intake at night.
Collapse
Affiliation(s)
- Cristiana Araújo Gontijo
- Graduate Program in Health Science, School of Medicine, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | | | - Gabriela Pereira Teixeira
- Graduate Program in Health Science, School of Medicine, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Walid Makin Fahmy
- Department of Obstetrics, Hospital and Municipal Maternity of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Cibele Aparecida Crispim
- Graduate Program in Health Science, School of Medicine, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Yara Cristina de Paiva Maia
- Graduate Program in Health Science, School of Medicine, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil.
| |
Collapse
|
3
|
Gandhi M, Gandhi R, Mack LM, Shypailo R, Adolph AL, Puyau MR, Wong WW, Deter RL, Sangi-Haghpeykar H, Lee W, Butte NF. Impact of changes in maternal body composition on birth weight and neonatal fat mass in dichorionic twin pregnancies. Am J Clin Nutr 2018; 108:716-721. [PMID: 30321273 DOI: 10.1093/ajcn/nqy180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/09/2018] [Indexed: 11/15/2022] Open
Abstract
Background Although the impact of gestational weight gain (GWG) on birth weight in twin pregnancies has been demonstrated, the specific components of GWG have not been delineated for twin gestations. Fetal body composition has been shown to be modifiable in singleton gestations based on nutritional intervention strategies and may prove to have similar modifications in twin gestations. Objective We aimed to determine the relation of maternal body composition changes to birth weight, birth length, and neonatal fat mass (FM) in dichorionic-diamniotic twin pregnancies. Design This is a prospective study of 20 women with twin gestations. Comparisons were made between body composition variables during each trimester and for the entire pregnancy and compared with the outcomes of birth weight, neonatal fat percentage, and birth length. Results GWG within or above compared with below the IOM recommendations was associated with higher birth weights (P = 0.03, P = 0.04, respectively), but also with higher postpartum weight retention (P = 0.001). Total maternal protein gain over the pregnancy was positively associated with birth weight (P = 0.03). Changes in maternal fat-free mass (FFM), total body water (TBW), and FM from the first to the third trimester were not associated with either birth weight or neonatal FM percentage. However, maternal FM change from the second to the third trimester was significantly correlated to neonatal FM percentage (P = 0.02). Third trimester GWG and total protein gain were positively correlated with neonatal birth length (P = 0.02 and 0.03, respectively). Maternal FFM over all 3 trimesters showed a positive relation with neonatal birth length (P = 0.01). Conclusions Significant increases in maternal protein are associated with greater birth weight and neonatal birth length. Protein accretion, in contrast to TBW and FM gains, may be the most critical component of maternal GWG in dichorionic twin gestations.
Collapse
Affiliation(s)
- Manisha Gandhi
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, TX
| | - Rajshi Gandhi
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, TX
| | - Lauren M Mack
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, TX
| | - Roman Shypailo
- USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Anne L Adolph
- USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Maurice R Puyau
- USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - William W Wong
- USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Russell L Deter
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, TX
| | - Haleh Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, TX
| | - Wesley Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, TX
| | - Nancy F Butte
- USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| |
Collapse
|
4
|
Bugatto F, Quintero-Prado R, Vilar-Sánchez JM, Perdomo G, Torrejón R, Bartha JL. Prepregnancy body mass index influences lipid oxidation rate during pregnancy. Acta Obstet Gynecol Scand 2016; 96:207-215. [PMID: 27861720 DOI: 10.1111/aogs.13058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 11/05/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The influence of maternal body mass index (BMI) on respiratory quotient during pregnancy is not clear. We aim to evaluate longitudinal changes in energy expenditure, respiratory quotient, and substrate oxidation rates in normal and overweight women with uncomplicated pregnancies. We hypothesized that the threshold period in switching from a predominantly carbohydrate to a predominantly lipid metabolism may be different in normal and overweight women. MATERIAL AND METHODS Forty healthy pregnant women were recruited for a prospective cohort study. They were divided into two groups, normal and overweight (BMI <25 kg/m2 or ≥25 kg/m2 ). Comparisons of indirect calorimetry data were performed monthly throughout pregnancy. The relationships between energy and substrate metabolism variables and maternal BMI were also analyzed. RESULTS There was a significant increase in oxygen consumption (Vo2 ), carbon dioxide production (Vco2 ) and resting energy expenditure during pregnancy in both normal and overweight women. In the normal weight group, respiratory quotient decreased during the second trimester and increased in the last trimester. Respiratory quotient was lower in the overweight group in the second trimester and decreased in the last trimester; between-group differences being significant at 20 and 36 weeks (0.85 ± 0.06 vs. 0.81 ± 0.01, p = 0.009; 0.87 ± 0.05 vs. 0.80 ± 0.03, p = 0.01, respectively). Lipid oxidation was significantly higher in overweight women at both 20 and 36 weeks (36.8 ± 19.7% vs. 55.2 ± 5.6%, p = 0.003 and 33.6 ± 18.2% vs. 59.6 ± 12.7%, p = 0.007, for normal and overweight group, respectively). CONCLUSION Prepregnancy maternal BMI influences lipid oxidation rate and respiratory quotient during pregnancy.
Collapse
Affiliation(s)
- Fernando Bugatto
- Department of Obstetrics and Gynecology, Division of Fetal-Maternal Medicine, University Hospital Puerta del Mar, Cádiz, Spain
| | - Rocío Quintero-Prado
- Department of Obstetrics and Gynecology, University Hospital of Jerez, Cádiz, Spain.,Clínicas Ginemed, Sevilla, Spain
| | - José M Vilar-Sánchez
- Department of Obstetrics and Gynecology, Division of Fetal-Maternal Medicine, University Hospital Puerta del Mar, Cádiz, Spain
| | - Germán Perdomo
- School of Environmental Sciences and Biochemistry, University of Castilla-La Mancha, Toledo, Spain
| | - Rafael Torrejón
- Department of Obstetrics and Gynecology, Division of Fetal-Maternal Medicine, University Hospital Puerta del Mar, Cádiz, Spain
| | - José L Bartha
- Department of Obstetrics, Division of Fetal-Maternal Medicine, University Hospital La Paz, Madrid, Spain
| |
Collapse
|
5
|
Melzer K, Kayser B, Schutz Y. Respiratory quotient evolution during normal pregnancy: what nutritional or clinical information can we get out of it? Eur J Obstet Gynecol Reprod Biol 2014; 176:5-9. [PMID: 24613151 DOI: 10.1016/j.ejogrb.2014.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 01/28/2014] [Accepted: 02/10/2014] [Indexed: 11/24/2022]
Abstract
Food intake increases to a varying extent during pregnancy to provide extra energy for the growing fetus. Measuring the respiratory quotient (RQ) during the course of pregnancy (by quantifying O2 consumption and CO2 production with indirect calorimetry) could be potentially useful since it gives an insight into the evolution of the proportion of carbohydrate vs. fat oxidized during pregnancy and thus allows recommendations on macronutrients for achieving a balanced (or slightly positive) substrate intake. A systematic search of the literature for papers reporting RQ changes during normal pregnancy identified 10 papers reporting original research. The existing evidence supports an increased RQ of varying magnitude in the third trimester of pregnancy, while the discrepant results reported for the first and second trimesters (i.e. no increase in RQ), explained by limited statistical power (small sample size) or fragmentary data, preclude safe conclusions about the evolution of RQ during early pregnancy. From a clinical point of view, measuring RQ during pregnancy requires not only sophisticated and costly indirect calorimeters but appears of limited value outside pure research projects, because of several confounding variables: (1) spontaneous changes in food intake and food composition during the course of pregnancy (which influence RQ); (2) inter-individual differences in weight gain and composition of tissue growth; (3) technical factors, notwithstanding the relatively small contribution of fetal metabolism per se (RQ close to 1.0) to overall metabolism of the pregnant mother.
Collapse
Affiliation(s)
| | - Bengt Kayser
- Faculty of Biology and Medicine, Institute of Sports Sciences, University of Lausanne, Lausanne, Switzerland
| | - Yves Schutz
- Switzerland & Integrative Cardiovascular and Metabolic Physiology, Faculty of Biology and Medicine, Department of Physiology, University of Lausanne, Lausanne, Switzerland.
| |
Collapse
|
6
|
|
7
|
Sex differences in energy metabolism need to be considered with lifestyle modifications in humans. J Nutr Metab 2011; 2011:391809. [PMID: 21773020 PMCID: PMC3136178 DOI: 10.1155/2011/391809] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 05/03/2011] [Indexed: 12/18/2022] Open
Abstract
Women have a higher proportion of body fat compared to men. However, women consume fewer kilojoules per kilogram lean mass and burn fat more preferentially during exercise compared with men. During gestation, women store even greater amounts of fat that cannot be solely attributed to increased energy intake. These observations suggest that the relationship between kilojoules consumed and kilojoules utilised is different in men and women. The reason for these sex differences in energy metabolism is not known; however, it may relate to sex steroids, differences in insulin resistance, or metabolic effects of other hormones such as leptin. When considering lifestyle modifications, sex differences in energy metabolism should be considered. Moreover, elucidating the regulatory role of hormones in energy homeostasis is important for understanding the pathogenesis of obesity and perhaps in the future may lead to ways to reduce body fat with less energy restriction.
Collapse
|
8
|
Pregnancy-related changes in activity energy expenditure and resting metabolic rate in Switzerland. Eur J Clin Nutr 2009; 63:1185-91. [DOI: 10.1038/ejcn.2009.49] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
9
|
Position of the American Dietetic Association and American Society for Nutrition: Obesity, Reproduction, and Pregnancy Outcomes. ACTA ACUST UNITED AC 2009; 109:918-27. [DOI: 10.1016/j.jada.2009.03.020] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
10
|
Secor SM. Specific dynamic action: a review of the postprandial metabolic response. J Comp Physiol B 2008; 179:1-56. [PMID: 18597096 DOI: 10.1007/s00360-008-0283-7] [Citation(s) in RCA: 382] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 05/19/2008] [Accepted: 05/30/2008] [Indexed: 11/24/2022]
Abstract
For more than 200 years, the metabolic response that accompanies meal digestion has been characterized, theorized, and experimentally studied. Historically labeled "specific dynamic action" or "SDA", this physiological phenomenon represents the energy expended on all activities of the body incidental to the ingestion, digestion, absorption, and assimilation of a meal. Specific dynamic action or a component of postprandial metabolism has been quantified for more than 250 invertebrate and vertebrate species. Characteristic among all of these species is a rapid postprandial increase in metabolic rate that upon peaking returns more slowly to prefeeding levels. The average maximum increase in metabolic rate stemming from digestion ranges from a modest 25% for humans to 136% for fishes, and to an impressive 687% for snakes. The type, size, composition, and temperature of the meal, as well as body size, body composition, and several environmental factors (e.g., ambient temperature and gas concentration) can each significantly impact the magnitude and duration of the SDA response. Meals that are large, intact or possess a tough exoskeleton require more digestive effort and thus generate a larger SDA than small, fragmented, or soft-bodied meals. Differences in the individual effort of preabsorptive (e.g., swallowing, gastric breakdown, and intestinal transport) and postabsorptive (e.g., catabolism and synthesis) events underlie much of the variation in SDA. Specific dynamic action is an integral part of an organism's energy budget, exemplified by accounting for 19-43% of the daily energy expenditure of free-ranging snakes. There are innumerable opportunities for research in SDA including coverage of unexplored taxa, investigating the underlying sources, determinants, and the central control of postprandial metabolism, and examining the integration of SDA across other physiological systems.
Collapse
Affiliation(s)
- Stephen M Secor
- Department of Biological Sciences, University of Alabama, Tuscaloosa, AL 35487-0344, USA.
| |
Collapse
|
11
|
Sferruzzi-Perri AN, Owens JA, Standen P, Taylor RL, Heinemann GK, Robinson JS, Roberts CT. Early treatment of the pregnant guinea pig with IGFs promotes placental transport and nutrient partitioning near term. Am J Physiol Endocrinol Metab 2007; 292:E668-76. [PMID: 17062842 DOI: 10.1152/ajpendo.00320.2006] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Appropriate partitioning of nutrients between the mother and conceptus is a major determinant of pregnancy success, with placental transfer playing a key role. Insulin-like growth factors (IGFs) increase in the maternal circulation during early pregnancy and are predictive of fetal and placental growth. We have previously shown in the guinea pig that increasing maternal IGF abundance in early to midpregnancy enhances fetal growth and viability near term. We now show that this treatment promotes placental transport to the fetus, fetal substrate utilization, and nutrient partitioning near term. Pregnant guinea pigs were infused with IGF-I, IGF-II (both 1 mg.kg-1.day-1) or vehicle subcutaneously from days 20-38 of pregnancy (term=69 days). Tissue uptake and placental transfer of the nonmetabolizable radio analogs [3H]methyl-D-glucose (MG) and [14C]aminoisobutyric acid (AIB) in vivo was measured on day 62. Early pregnancy exposure to elevated maternal IGF-I increased placental MG uptake by>70% (P=0.004), whereas each IGF increased fetal plasma MG concentrations by 40-50% (P<0.012). Both IGFs increased fetal tissue MG uptake (P<0.048), whereas IGF-I also increased AIB uptake by visceral organs (P=0.046). In the mother, earlier exposure to either IGF increased AIB uptake by visceral organs (P<0.014), whereas IGF-I also enhanced uptake of AIB by muscle (P=0.044) and MG uptake by visceral organs (P=0.016) and muscle (P=0.046). In conclusion, exogenous maternal IGFs in early pregnancy sustainedly increase maternal substrate utilization, placental transport of MG to the fetus, and fetal utilization of substrates near term. This was consistent with the previously observed increase in fetal growth and survival following IGF treatment.
Collapse
Affiliation(s)
- Amanda N Sferruzzi-Perri
- Research Centre for Reproductive Health, Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia 5005
| | | | | | | | | | | | | |
Collapse
|
12
|
Butte NF. Carbohydrate and lipid metabolism in pregnancy: normal compared with gestational diabetes mellitus. Am J Clin Nutr 2000; 71:1256S-61S. [PMID: 10799399 DOI: 10.1093/ajcn/71.5.1256s] [Citation(s) in RCA: 476] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This article reviews maternal metabolic strategies for accommodating fetal nutrient requirements in normal pregnancy and in gestational diabetes mellitus (GDM). Pregnancy is characterized by a progressive increase in nutrient-stimulated insulin responses despite an only minor deterioration in glucose tolerance, consistent with progressive insulin resistance. The hyperinsulinemic-euglycemic glucose clamp technique and intravenous-glucose-tolerance test have indicated that insulin action in late normal pregnancy is 50-70% lower than in nonpregnant women. Metabolic adaptations do not fully compensate in GDM and glucose intolerance ensues. GDM may reflect a predisposition to type 2 diabetes or may be an extreme manifestation of metabolic alterations that normally occur in pregnancy. In normal pregnant women, basal endogenous hepatic glucose production (R(a)) was shown to increase by 16-30% to meet the increasing needs of the placenta and fetus. Total gluconeogenesis is increased in late gestation, although the fractional contribution of total gluconeogenesis to R(a), quantified from (2)H enrichment on carbon 5 of glucose (65-85%), does not differ in pregnant women after a 16-h fast. Endogenous hepatic glucose production was shown to remain sensitive to increased insulin concentration in normal pregnancy (96% suppression), but is less sensitive in GDM (80%). Commensurate with the increased rate of glucose appearance, an increased contribution of carbohydrate to oxidative metabolism has been observed in late pregnancy compared with pregravid states. The 24-h respiratory quotient is significantly higher in late pregnancy than postpartum. Recent advances in carbohydrate metabolism during pregnancy suggest that preventive measures should be aimed at improving insulin sensitivity in women predisposed to GDM. Further research is needed to elucidate the mechanisms and consequences of alterations in lipid metabolism during pregnancy.
Collapse
Affiliation(s)
- N F Butte
- US Department of Agriculture, Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
| |
Collapse
|
13
|
Abstract
Pregnancy consists of a series of small, continuous physiologic adjustments that affect the metabolism of all nutrients. The adjustments undoubtedly vary widely from woman to woman depending on her prepregnancy nutrition, genetic determinants of fetal size, and maternal lifestyle behavior. Studies of protein and energy metabolism illustrate the potential of adjusting the use of those nutrients to conserve a fetal supply. Adjustments in the metabolism of nitrogenous compounds are in place by the second quarter of pregnancy. During the last quarter of pregnancy, when fetal demands are greatest, those adjustments allow a positive nitrogen retention. The energy requirement of basal metabolism is influenced by maternal prepregnant nutrition and by fetal size. If maternal energy reserves are low at conception, the basal metabolic rate is down-regulated to conserve energy. Also, women having larger babies tend to have greater increases in their basal metabolic rate and lower rates of maternal energy storage. Changes in maternal food and physical activity behaviors during gestation may augment the physiologic adjustments. However, the substantial variability in food intakes and physical activity makes it difficult to show those changes. Thresholds in the capacity to adjust nutrient use to the amount supplied exist for all nutrients. When intakes fall below the threshold, fetal growth and development is affected more than is maternal health. Efforts to achieve good maternal nutritional status preconception as well as throughout gestation best assure a good milieu for fetal growth and development.
Collapse
Affiliation(s)
- J C King
- Western Human Nutrition Research Center, University of California, Davis 95616, USA.
| |
Collapse
|
14
|
Kopp-Hoolihan LE, van Loan MD, Wong WW, King JC. Longitudinal assessment of energy balance in well-nourished, pregnant women. Am J Clin Nutr 1999; 69:697-704. [PMID: 10197571 DOI: 10.1093/ajcn/69.4.697] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Clinicians often recommend an additional energy intake of 1250 kJ/d to their pregnant patients. Previous studies have shown considerable variation in the metabolic response to pregnancy and thus in the additional energy required to support a pregnancy. OBJECTIVE The purpose of this study was to assess how well-nourished women meet the energy demands of pregnancy and to identify factors that predict an individual's metabolic response. DESIGN Resting metabolic rate (RMR), diet-induced thermogenesis (DIT), total energy expenditure (TEE), activity energy expenditure (AEE), energy intake (EI), and body fat mass (FM) were measured longitudinally in 10 women preconception; at 8-10, 24-26, and 34-36 wk of gestation; and 4-6 wk postpartum. RESULTS Compared with preconception values, individual RMRs increased from 456 to 3389 kJ/d by late pregnancy. DIT varied from -266 to 110 kJ/meal, TEE from -105 to 3421 kJ/d, AEE from -2301 to 2929 kJ/d, EI from -259 to 2176 kJ/d, and FM from a 0.6-kg loss to a 10.6-kg gain. The only prepregnant factor that predicted FM gain was RMR (r = 0.65, P < 0.05). Women with the largest cumulative increase in RMR deposited the least FM (r = -0.64, P < 0.05). CONCLUSIONS Well-nourished women use different strategies to meet the energy demands of pregnancy, including reductions in DIT or AEE, increases in EI, and deposition of less FM than anticipated. The combination of strategies used by individual women is not wholly predictable from prepregnant indexes. The use of a single recommendation for increased energy intake in all pregnant women is not justified.
Collapse
Affiliation(s)
- L E Kopp-Hoolihan
- Department of Nutritional Sciences, University of California, Berkeley, USA.
| | | | | | | |
Collapse
|
15
|
Butte NF, Hopkinson JM, Mehta N, Moon JK, Smith EO. Adjustments in energy expenditure and substrate utilization during late pregnancy and lactation. Am J Clin Nutr 1999; 69:299-307. [PMID: 9989696 DOI: 10.1093/ajcn/69.2.299] [Citation(s) in RCA: 150] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Metabolic adjustments occur during pregnancy and lactation to support fetal growth and milk synthesis; however, the effect of body composition and hormonal milieu on these changes is poorly understood. OBJECTIVE We hypothesized that energy metabolism changes during pregnancy and lactation to support fetal growth and milk synthesis, and that body composition and hormonal milieu influence these alterations. DESIGN We measured energy expenditure, body composition, and hormone, metabolite, and catecholamine concentrations in 76 women (40 lactating, 36 nonlactating) at 37 wk gestation and 3 and 6 mo postpartum. Total energy expenditure (TEE), basal metabolic rate (BMR), sleeping metabolic rate (SMR), and minimal SMR (MSMR) were measured with room calorimetry. Fat-free mass (FFM) and fat mass were estimated with a 4-component model. RESULTS TEE, BMR, SMR, and MSMR were 15-26% higher during pregnancy than postpartum after being adjusted for FFM, fat mass, and energy balance. TEE, SMR, and MSMR were higher in lactating than in nonlactating women. Fasting serum insulin, insulin-like growth factor I, fatty acids, and leptin, and 24-h urinary free norepinephrine, epinephrine, and dopamine correlated positively with TEE, BMR, SMR, and MSMR. In nonlactating women, the respiratory quotient decreased over time, carbohydrate oxidation decreased, and fat oxidation increased. Substrate utilization was not influenced by body composition, fasting serum hormones, or 24-h urinary catecholamines. CONCLUSIONS These results indicate increased energy expenditure and preferential use of carbohydrates during pregnancy and lactation. Elevated respiratory quotient and carbohydrate utilization during pregnancy continue during lactation, consistent with preferential use of glucose by the fetus and mammary gland.
Collapse
Affiliation(s)
- N F Butte
- US Department of Agriculture, Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
| | | | | | | | | |
Collapse
|
16
|
Abstract
This review has examined the factors that influence the thermic effect of food (TEF) by evaluating 49 studies that have compared subjects who are obese with those who are lean. Meal size, meal composition, the nature of the previous diet, insulin resistance, physical activity, and ageing influence TEF. In the studies of individuals who are obese or lean, of those who used intravenous glucose infusions, all but one found an impaired thermic response. A total of 29 out of 49 studies of individuals of normal weight or with obesity were identified where there was no difference in age between the groups, and where the subjects who were "overweight" were clearly obese. Of these 29, 22 reported a statistically significant reduction in TEF, 3 studies were not designed to look primarily at the effect of obesity on TEF, and the other 4 may not have had sufficiently palatable meals. From this review, we conclude that the reduction of TEF in obesity is related to the degree of insulin resistance, which may be influenced by a low level of sympathetic activity.
Collapse
Affiliation(s)
- L de Jonge
- Pennington Biomedical Research Center, Baton Rouge, LA 70808-4124, USA
| | | |
Collapse
|