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Wei X, Zou H, Zhang T, Huo Y, Yang J, Wang Z, Li Y, Zhao J. Gestational Diabetes Mellitus: What Can Medical Nutrition Therapy Do? Nutrients 2024; 16:1217. [PMID: 38674907 PMCID: PMC11055016 DOI: 10.3390/nu16081217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Gestational diabetes mellitus (GDM) is one of the common complications during pregnancy. Numerous studies have shown that GDM is associated with a series of adverse effects on both mothers and offspring. Due to the particularity of pregnancy, medical nutrition treatment is considered to be the first choice for the treatment of GDM. This contribution reviews the research progress of medical nutrition treatment in GDM, summarizes the international recommendations on the intake of various nutrients and the influence of nutrients on the prevalence of GDM, and the improvement effect of nutritional intervention on it, in order to provide references for research in related fields of GDM and the targeted development of enteral nutrition.
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Affiliation(s)
- Xiaoyi Wei
- CAS Engineering Laboratory for Nutrition, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai 200031, China; (X.W.); (H.Z.); (T.Z.); (Y.H.); (Y.L.)
| | - Hong Zou
- CAS Engineering Laboratory for Nutrition, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai 200031, China; (X.W.); (H.Z.); (T.Z.); (Y.H.); (Y.L.)
| | - Tingting Zhang
- CAS Engineering Laboratory for Nutrition, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai 200031, China; (X.W.); (H.Z.); (T.Z.); (Y.H.); (Y.L.)
| | - Yanling Huo
- CAS Engineering Laboratory for Nutrition, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai 200031, China; (X.W.); (H.Z.); (T.Z.); (Y.H.); (Y.L.)
| | - Jianzhong Yang
- Sunline Research Laboratories, Jiangsu Sunline Deep Sea Fishery Co., Ltd., Lianyungang 222042, China; (J.Y.); (Z.W.)
| | - Zhi Wang
- Sunline Research Laboratories, Jiangsu Sunline Deep Sea Fishery Co., Ltd., Lianyungang 222042, China; (J.Y.); (Z.W.)
| | - Yu Li
- CAS Engineering Laboratory for Nutrition, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai 200031, China; (X.W.); (H.Z.); (T.Z.); (Y.H.); (Y.L.)
| | - Jiuxiang Zhao
- CAS Engineering Laboratory for Nutrition, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai 200031, China; (X.W.); (H.Z.); (T.Z.); (Y.H.); (Y.L.)
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The importance of nutrition in pregnancy and lactation: lifelong consequences. Am J Obstet Gynecol 2022; 226:607-632. [PMID: 34968458 PMCID: PMC9182711 DOI: 10.1016/j.ajog.2021.12.035] [Citation(s) in RCA: 131] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022]
Abstract
Most women in the United States do not meet the recommendations for healthful nutrition and weight before and during pregnancy. Women and providers often ask what a healthy diet for a pregnant woman should look like. The message should be “eat better, not more.” This can be achieved by basing diet on a variety of nutrient-dense, whole foods, including fruits, vegetables, legumes, whole grains, healthy fats with omega-3 fatty acids that include nuts and seeds, and fish, in place of poorer quality highly processed foods. Such a diet embodies nutritional density and is less likely to be accompanied by excessive energy intake than the standard American diet consisting of increased intakes of processed foods, fatty red meat, and sweetened foods and beverages. Women who report “prudent” or “health-conscious” eating patterns before and/or during pregnancy may have fewer pregnancy complications and adverse child health outcomes. Comprehensive nutritional supplementation (multiple micronutrients plus balanced protein energy) among women with inadequate nutrition has been associated with improved birth outcomes, including decreased rates of low birthweight. A diet that severely restricts any macronutrient class should be avoided, specifically the ketogenic diet that lacks carbohydrates, the Paleo diet because of dairy restriction, and any diet characterized by excess saturated fats. User-friendly tools to facilitate a quick evaluation of dietary patterns with clear guidance on how to address dietary inadequacies and embedded support from trained healthcare providers are urgently needed. Recent evidence has shown that although excessive gestational weight gain predicts adverse perinatal outcomes among women with normal weight, the degree of prepregnancy obesity predicts adverse perinatal outcomes to a greater degree than gestational weight gain among women with obesity. Furthermore, low body mass index and insufficient gestational weight gain are associated with poor perinatal outcomes. Observational data have shown that first-trimester gain is the strongest predictor of adverse outcomes. Interventions beginning in early pregnancy or preconception are needed to prevent downstream complications for mothers and their children. For neonates, human milk provides personalized nutrition and is associated with short- and long-term health benefits for infants and mothers. Eating a healthy diet is a way for lactating mothers to support optimal health for themselves and their infants.
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Hinkle SN, Li M, Grewal J, Yisahak SF, Grobman WA, Newman RB, Wing DA, Grantz KL, Zhang C. Changes in Diet and Exercise in Pregnant Women after Diagnosis with Gestational Diabetes: Findings from a Longitudinal Prospective Cohort Study. J Acad Nutr Diet 2021; 121:2419-2428.e4. [PMID: 34023277 PMCID: PMC8599498 DOI: 10.1016/j.jand.2021.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lifestyle changes are recommended for women diagnosed with gestational diabetes mellitus (GDM), yet there are few data available documenting whether women change their diet and exercise after GDM diagnosis. OBJECTIVE The aim of this study was to assess whether, and to what extent, pregnant women receiving usual prenatal care change their diet and exercise after a GDM diagnosis. DESIGN This study was a post-hoc secondary analysis using data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singletons (2009-2013), a prospective pregnancy cohort study. PARTICIPANTS/SETTING Pregnant US women without major chronic medical conditions were enrolled from 12 participating hospital centers at 8 to 13 weeks' gestation. Diet analyses were based on 5,194 dietary recalls from 1,371 women. Exercise analyses were based on 6,440 physical activity assessments from 1,875 women. GDM was ascertained from medical records according to Carpenter and Coustan criteria. Women completed 24-hour dietary recalls and exercise assessments at weeks 16 to 22, 24 to 29, 30 to 33, 34 to 37, and 38 to 41 (exercise only). MAIN OUTCOME MEASURES The main outcome was the diet and exercise change from before to after GDM diagnosis or screening. STATISTICAL ANALYSES Diet and exercise changes with 95% CIs from before to after GDM diagnosis or screening for women with and without GDM were estimated using weighted multivariable linear mixed models. RESULTS Women with GDM (n = 72) significantly reduced their total energy intake (-184 kcal/d; 95% CI -358 to -10 kcal/d) and carbohydrate intake (-47.6 g/d; 95% CI -71.4 to -23.7 g/d) from before to after GDM diagnosis; these changes were unique to women with GDM and not observed among women without GDM (n = 1,299). Women with GDM decreased intakes of juice (-0.4 cups/d; 95% CI -0.7 to -0.2 cups/d) and added sugar (-3.2 teaspoons/d; 95% CI -5.5 to -0.5 teaspoons/d) and increased cheese (0.3 cups/d; 95% CI 0.1 to 0.6 cups/d) and artificially sweetened beverages (0.2 cups/d; 95% CI 0.0 to 0.3 cups/d). Women with GDM (n = 84) did not change their exercise duration after diagnosis; women without GDM (n = 1,791) significantly decreased moderate (-19.5 min/wk; 95% CI -24.7 to -14.3 min/wk) and vigorous exercise (-8.8 min/wk; 05% CI -10.6 to -6.9 min/wk) after GDM screening. CONCLUSIONS Women with GDM made modest dietary improvements and maintained their prediagnosis exercise routine, yet opportunities remain to further improve dietary intake and exercise after a diagnosis of GDM.
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Affiliation(s)
- Stefanie N Hinkle
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
| | - Mengying Li
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Jagteshwar Grewal
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Samrawit F Yisahak
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - William A Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Roger B Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC
| | - Deborah A Wing
- Korn Ferry, Los Angeles, CA; Department of Obstetrics-Gynecology, University of California, Irvine, School of Medicine, Orange, CA; Miller Children' s and Women's Hospital Long Beach/Long Beach Memorial Medical Center, Long Beach, CA
| | - Katherine L Grantz
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Cuilin Zhang
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
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He W, Wang L, Zhang Y, Jiang Y, Chen X, Wang Y, Dou Y, Chen H, Yan W. Higher Serum Bilirubin Levels in Response to Higher Carbohydrate Intake During Early Pregnancy and Lower Gestational Diabetes Mellitus Occurrence in Overweight and Obese Gravidae. Front Nutr 2021; 8:701422. [PMID: 34527687 PMCID: PMC8435579 DOI: 10.3389/fnut.2021.701422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Aim: Serum bilirubin levels are recently shown to be a novel protector of gestational diabetes mellitus (GDM), yet whether they could be affected by carbohydrate quality is unclear. We aimed to examine the associations between dietary carbohydrate parameters and serum bilirubin levels during early pregnancy, with further exploration on a potential mediating role of serum bilirubin levels on carbohydrate parameters-GDM pathways. Methods: 260 healthy but overweight or obese gravidae (BMI ≥24 kg/m2) derived from a historical cohort in two hospitals in China were included. The associations between carbohydrate parameters (total carbohydrate intake, glycemic index GI, fiber intake, glycemic load GL) and serum bilirubin levels (total bilirubin, TB and direct bilirubin, DB) and GDM were evaluated by multivariable regression analysis. Generalized structural equation modeling was then applied to perform adjusted mediation analysis. Results: Increased serum bilirubin levels (mmol/L) and decreased GDM occurrence were observed following dietary carbohydrate intake (%E) and GL (g/1,000 kcal) in highest tertile compared to the lowest tertile [carbohydrate: TB: β = 0.926 (95%CI: 0.069, 1.782), DB: β = 0.554 (95%CI: 0.192, 0.916);GL:TB: β = 1.170 (95%CI: 0.339, 2.001); DB: β = 0.369 (95%CI: 0.016, 0.700); carbohydrate: adjusted OR = 0.43 (95%CI:0.19-0.99); GL: adjusted OR = 0.36 (95%CI:0.16, 0.84)]. The mediating effect of carbohydrate intake and GL on GDM through bilirubin levels was evaluated as modest (carbohydrate: 6.2% for TB, 1.3% for DB; GL: 8.7% for TB, 2.3% for DB). No association was observed regarding GI and fiber. Conclusions: Mildly elevated serum bilirubin levels appeared to be in response to higher energies consumed from carbohydrate during early pregnancy in healthy overweight or obese gravidae. However, the mediating effect of bilirubin levels on carbohydrate-GDM pathways is not evident. Larger investigation is further needed for solid evidence.
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Affiliation(s)
- Wennan He
- Department of Clinical Epidemiology & Clinical Trial Unit (CTU), Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Liping Wang
- International Peace Maternity and Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Yi Zhang
- Department of Clinical Epidemiology & Clinical Trial Unit (CTU), Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yuan Jiang
- Department of Clinical Epidemiology & Clinical Trial Unit (CTU), Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiaotian Chen
- Department of Clinical Epidemiology & Clinical Trial Unit (CTU), Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yin Wang
- Department of Clinical Epidemiology & Clinical Trial Unit (CTU), Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yalan Dou
- Department of Clinical Epidemiology & Clinical Trial Unit (CTU), Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Hongyan Chen
- Department of Clinical Epidemiology & Clinical Trial Unit (CTU), Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Weili Yan
- Department of Clinical Epidemiology & Clinical Trial Unit (CTU), Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
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Tsirou E, Grammatikopoulou MG, Nigdelis MP, Taousani E, Savvaki D, Assimakopoulos E, Tsapas A, Goulis DG. TIMER: A Clinical Study of Energy Restriction in Women with Gestational Diabetes Mellitus. Nutrients 2021; 13:nu13072457. [PMID: 34371966 PMCID: PMC8308500 DOI: 10.3390/nu13072457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 12/18/2022] Open
Abstract
Medical nutrition therapy is an integral part of gestational diabetes mellitus (GDM) management; however, the prescription of optimal energy intake is often a difficult task due to the limited available evidence. The present pilot, feasibility, parallel, open-label and non-randomized study aimed to evaluate the effect of a very low energy diet (VLED, 1600 kcal/day), or a low energy diet (LED, 1800 kcal/day), with or without personalized exercise sessions, among women with GDM in singleton pregnancies. A total of 43 women were allocated to one of four interventions at GDM diagnosis: (1) VLED (n = 15), (2) VLED + exercise (n = 4), (3) LED (n = 16) or (4) LED + exercise (n = 8). Primary outcomes were gestational weight gain (GWG), infant birth weight, complications at delivery and a composite outcomes score. Secondary outcomes included type of delivery, prematurity, small- for-gestational-age (SGA) or large-for-gestational-age (LGA) infants, macrosomia, Apgar score, insulin use, depression, respiratory quotient (RQ), resting metabolic rate (RMR) and middle-upper arm circumference (MUAC). GWG differed between intervention groups (LED median: 12.0 kg; VLED: 5.9 kg). No differences were noted in the type of delivery, infant birth weight, composite score, prevalence of prematurity, depression, RQ, Apgar score, MUAC, or insulin use among the four groups. Regarding components of the composite score, most infants (88.4%) were appropriate-for-gestational age (AGA) and born at a gestational age of 37–42 weeks (95.3%). With respect to the mothers, 9.3% experienced complications at delivery, with the majority being allocated at the VLED + exercise arm (p < 0.03). The composite score was low (range 0–2.5) for all mother-infant pairs, indicating a “risk-free” pregnancy outcome. The results indicate that adherence to a LED or VLED induces similar maternal, infant and obstetrics outcomes.
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Affiliation(s)
- Efrosini Tsirou
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-56429 Thessaloniki, Greece; (E.T.); (M.G.G.); (M.P.N.); (E.T.); (D.S.)
| | - Maria G. Grammatikopoulou
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-56429 Thessaloniki, Greece; (E.T.); (M.G.G.); (M.P.N.); (E.T.); (D.S.)
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, Alexander Campus, International Hellenic University, GR-57400 Thessaloniki, Greece
| | - Meletios P. Nigdelis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-56429 Thessaloniki, Greece; (E.T.); (M.G.G.); (M.P.N.); (E.T.); (D.S.)
| | - Eleftheria Taousani
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-56429 Thessaloniki, Greece; (E.T.); (M.G.G.); (M.P.N.); (E.T.); (D.S.)
- Department of Midwifery, Faculty of Health Sciences, Alexander Campus, International Hellenic University, GR-57400 Thessaloniki, Greece
| | - Dimitra Savvaki
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-56429 Thessaloniki, Greece; (E.T.); (M.G.G.); (M.P.N.); (E.T.); (D.S.)
- School of Physical Education and Sports Science, Democritus University of Thrace, GR-69100 Komotini, Greece
| | - Efstratios Assimakopoulos
- 2nd Department of Obstetrics and Gynecology, Hippokratio General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, GR-54642 Thessaloniki, Greece;
| | - Apostolos Tsapas
- Clinical Research and Evidence-Based Medicine Unit, Hippokration Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, GR-54642 Thessaloniki, Greece;
- Harris Manchester College, University of Oxford, Oxford OX1 3TD, UK
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-56429 Thessaloniki, Greece; (E.T.); (M.G.G.); (M.P.N.); (E.T.); (D.S.)
- Correspondence:
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Heweiqi, Tambovskij A. AEROBIC AND ANAEROBIC EXERCISE ABILITY OF ATHLETES COMBINED WITH BALANCED NUTRITION. REV BRAS MED ESPORTE 2021. [DOI: 10.1590/1517-8692202127022020_0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Balanced nutrition is very important for athletes’ health and competition performance, and balanced nutrition has become a hot topic in the sports industry. In this study, 30s anaerobic work test and maximal oxygen uptake test were used to test anaerobic exercise ability and aerobic exercise ability, respectively. Four groups were set up in the two test methods, and the corresponding functional test indexes, heart rate recovery index and blood lactic acid recovery value were determined. The anaerobic capacity test showed that the maximum power of male athletes in the experimental group had significant statistical difference before and after dietary balance management, and the fatigue index of female athletes in the experimental group had a significant downward trend. Five minutes and nine minutes after exercise, the blood lactic acid value of males in the experimental group was lower than before balanced nutrition. The aerobic capacity test showed that the exhaustion time of male athletes in the experimental group was significantly different before and after balanced nutrition. After the balanced nutrition, the blood lactic acid value of male athletes in the experimental group was lower than before the management immediately and nine minutes after exercise, and the heart rate value of the male athletes in the experimental group was far lower than before the management.
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Affiliation(s)
- Heweiqi
- Jiangsu normal university kewen college, China
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Liu Y, Yu Z, Sun H. Prediction Method of Gestational Diabetes Based on Electronic Medical Record Data. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6672072. [PMID: 33763194 PMCID: PMC7963898 DOI: 10.1155/2021/6672072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/21/2021] [Accepted: 02/25/2021] [Indexed: 01/31/2023]
Abstract
At present, the secondary application of electronic medical records is focused on auxiliary medical diagnosis to improve the accuracy of clinical diagnosis. The main research in this article is the prediction method of gestational diabetes based on electronic medical record data. In the original data, the ID number of the medical examiner did not match the medical examination record. In order to ensure the accuracy of the data, this part of the record was removed. First, the preparation stage before building the model is to determine the baseline accuracy of the original data, test the effectiveness of the machine learning algorithm, and then balance the target data set to solve the bias caused by the imbalance between data classes and the illusion of excessive model prediction results. Then, the disease prediction model is constructed by dividing the data set, selecting parameters and algorithms, and visualizing the model. Finally, the effect of predictive model construction is comprehensively judged based on multiple evaluation indicators and control experimental models. In this paper, the RF model can be used to rank the importance of the feature importance of the output feature on the importance of the classification result of the input feature. In order to test the accuracy of regression prediction, the experiment uses absolute mean error and root mean square error to evaluate the accuracy of fasting blood glucose prediction. A logistic regression model is constructed through the training set, and the test set data are brought into the prediction model for prediction. Experimental data show that when the features filtered by WBFS are used, the accuracy, F1 value, and AUC value of logistic regression are 0.809, 0.881, and 0.825, respectively, which is an increase of about 12% compared with when the feature is not used. The results show that the electronic medical record data drive can effectively improve the accuracy of predicting gestational diabetes.
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Affiliation(s)
- Yang Liu
- Department of Endocrine, Affiliated Hospital of Beihua University, Jilin 132012, China
| | - Zhaoxiang Yu
- Department of Anesthesiology, Affiliated Hospital of Beihua University, Jilin 132012, China
| | - Hua Sun
- Department of Endocrine, Affiliated Hospital of Beihua University, Jilin 132012, China
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Kapur K, Kapur A, Hod M. Nutrition Management of Gestational Diabetes Mellitus. ANNALS OF NUTRITION & METABOLISM 2021; 76:1-13. [PMID: 33524988 DOI: 10.1159/000509900] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/02/2020] [Indexed: 11/19/2022]
Abstract
Medical nutrition therapy (MNT) is the bedrock for the management of gestational diabetes mellitus (GDM). Several different types of dietary approaches are used globally, and there is no consensus among the various professional groups as to what constitutes an ideal approach. The conventional approach of limiting carbohydrates at the cost of increasing energy from the fat source may not be most optimal. Instead, allowing higher levels of complex, low-to-medium glycaemic index carbohydrates and adequate fibre through higher consumption of vegetables and fruits seems more beneficial. No particular diet or dietary protocol is superior to another as shown in several comparative studies. However, in each of these studies, one thing was common - the intervention arm included more intensive diet counselling and more frequent visits to the dieticians. For MNT to work, it is imperative that diet advice and nutrition counselling is provided by a dietician, which is easy to understand and use and includes healthy food options, cooking methods, and practical guidance that empower and motivate to make changes towards a healthy eating pattern. Various simple tools to achieve these objectives are available, and in the absence of qualified dieticians, they can be used to train other health care professionals to provide nutrition counselling to women with GDM. Given the impact of GDM on the future health of the mother and offspring, dietary and lifestyle behaviour changes during pregnancy in women with GDM are not only relevant for immediate pregnancy outcomes, but continued adherence is also important for future health.
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Affiliation(s)
| | - Anil Kapur
- World Diabetes Foundation, FIGO Pregnancy and NCD Committee, Bagsvaerd, Denmark
| | - Moshe Hod
- Clalit Health Services and Mor Women's Health Center, FIGO Pregnancy and NCD Committee, Tel Aviv, Israel,
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Meloncelli N, Wilkinson SA, de Jersey S. Searching for Utopia, the Challenge of Standardized Medical Nutrition Therapy Prescription in Gestational Diabetes Mellitus Management: A Critical Review. Semin Reprod Med 2021; 38:389-397. [PMID: 33429445 DOI: 10.1055/s-0040-1722316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gestational diabetes mellitus (GDM) is a common pregnancy disorder and the incidence is increasing worldwide. GDM is associated with adverse maternal outcomes which may be reduced with proper management. Lifestyle modification in the form of medical nutrition therapy and physical activity, as well as self-monitoring of blood glucose levels, is the cornerstone of GDM management. Inevitably, the search for the "ultimate" diet prescription has been ongoing. Identifying the amount and type of carbohydrate to maintain blood glucose levels below targets while balancing the nutritional requirements of pregnancy and achieving gestational weight gain within recommendations is challenging. Recent developments in the area of the gut microbiota and its impact on glycemic response add another layer of complexity to the success of medical nutrition therapy. This review critically explores the challenges to dietary prescription for GDM and why utopia may never be found.
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Affiliation(s)
- Nina Meloncelli
- Nutrition and Dietetics, Sunshine Coast University Hospital, Birtinya, Australia.,Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Shelley A Wilkinson
- School of Human Movements and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia.,Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Susan de Jersey
- Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
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Webb HM. And Baby Makes 2. PHYSICIAN ASSISTANT CLINICS 2020. [DOI: 10.1016/j.cpha.2019.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Pfeiffer S, Sánchez-Lechuga B, Donovan P, Halang L, Prehn JHM, Campos-Caro A, Byrne MM, López-Tinoco C. Circulating miR-330-3p in Late Pregnancy is Associated with Pregnancy Outcomes Among Lean Women with GDM. Sci Rep 2020; 10:908. [PMID: 31969632 PMCID: PMC6976655 DOI: 10.1038/s41598-020-57838-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 12/30/2019] [Indexed: 02/07/2023] Open
Abstract
Gestational Diabetes Mellitus (GDM) is characterised by insulin resistance accompanied by reduced beta-cell compensation to increased insulin demand, typically observed in the second and third trimester and associated with adverse pregnancy outcomes. There is a need for a biomarker that can accurately monitor status and predict outcome in GDM, reducing foetal-maternal morbidity and mortality risks. To this end, circulating microRNAs (miRNAs) present themselves as promising candidates, stably expressed in serum and known to play crucial roles in regulation of glucose metabolism. We analysed circulating miRNA profiles in a cohort of GDM patients (n = 31) and nondiabetic controls (n = 29) during the third trimester for miRNA associated with insulin-secretory defects and glucose homeostasis. We identified miR-330-3p as being significantly upregulated in lean women with GDM compared to nondiabetic controls. Furthermore, increased levels of miR-330-3p were associated with better response to treatment (diet vs. insulin), with lower levels associated with exogenous insulin requirement. We observed miR-330-3p to be significantly related to the percentage of caesarean deliveries, with miR-330-3p expression significantly higher in spontaneously delivered GDM patients. We report this strong novel association of circulating miR-330-3p with risk of primary caesarean delivery as a pregnancy outcome linked with poor maternal glycaemic control, strengthening the growing body of evidence for roles of diabetes-associated miRNAs in glucose homeostasis and adaptation to the complex changes related to pregnancy.
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Affiliation(s)
- Shona Pfeiffer
- Centre for Systems Medicine, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, 2, Ireland
| | - Begoña Sánchez-Lechuga
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Paul Donovan
- Centre for Systems Medicine, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, 2, Ireland
| | - Luise Halang
- Centre for Systems Medicine, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, 2, Ireland
| | - Jochen H M Prehn
- Centre for Systems Medicine, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, 2, Ireland
| | - Antonio Campos-Caro
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Maria M Byrne
- Centre for Systems Medicine, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, 2, Ireland.,Department of Endocrinology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Cristina López-Tinoco
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta del Mar, Cádiz, Spain.
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12
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Insulin Resistance in Pregnancy: Implications for Mother and Offspring. CONTEMPORARY ENDOCRINOLOGY 2020. [DOI: 10.1007/978-3-030-25057-7_5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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13
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Abstract
PURPOSE OF REVIEW To review the latest evidence for dietary interventions for treatment of gestational diabetes (GDM). RECENT FINDINGS High-quality systematic reviews demonstrate no major advantages between the low-carbohydrate or calorie-restricted diets. However, the low glycemic index (GI) diet, characterized by intake of high-quality, complex carbohydrates, demonstrated lower insulin use and reduced risk of macrosomia in multiple reviews. Recent evidence suggests the Mediterranean diet is safe in pregnancy, though trials are needed to determine its efficacy over conventional dietary advice. Currently, there are insufficient data to support the safety of the ketogenic diet for the treatment of GDM. The low GI diet may improve maternal and neonatal outcomes in GDM. The liberalized carbohydrate intake is less restrictive, culturally adaptable, and may improve long-term maternal adherence. Further research is needed to establish the optimal, most sustainable, and most acceptable medical nutrition therapy for management of women with GDM.
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Affiliation(s)
- Amita Mahajan
- Department of Medicine - Division of Endocrinology and Metabolism, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Lois E Donovan
- Department of Medicine - Division of Endocrinology and Metabolism, Department of Obstetrics and Gynecology, and Alberta Children's Hospital Research Institute Calgary, Cumming School of Medicine - University of Calgary, Calgary, Canada
| | - Rachelle Vallee
- Diabetes in Pregnancy Clinic, Alberta Health Services, Calgary, Canada
| | - Jennifer M Yamamoto
- Department of Medicine - Division of Endocrinology and Metabolism, Department of Obstetrics and Gynecology, and Alberta Children's Hospital Research Institute Calgary, Cumming School of Medicine - University of Calgary, Calgary, Canada.
- Cumming School of Medicine, Richmond Road Diagnostic and Treatment Centre, University of Calgary, 1820 Richmond Road SW, Calgary, AB, T2T 5C7, Canada.
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14
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Farabi SS, Hernandez TL. Low-Carbohydrate Diets for Gestational Diabetes. Nutrients 2019; 11:nu11081737. [PMID: 31357598 PMCID: PMC6723585 DOI: 10.3390/nu11081737] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/12/2019] [Accepted: 07/23/2019] [Indexed: 02/07/2023] Open
Abstract
Nutrition therapy provides the foundation for treatment of gestational diabetes (GDM), and has historically been based on restricting carbohydrate (CHO) intake. In this paper, randomized controlled trials (RCTs) are reviewed to assess the effects of both low- and higher CHO nutrition approaches in GDM. The prevailing pattern across the evidence underscores that although CHO restriction improves glycemia at least in the short-term, similar outcomes could be achievable using less restrictive approaches that may not exacerbate IR. The quality of existing studies is limited, in part due to dietary non-adherence and confounding effects of treatment with insulin or oral medication. Recent evidence suggests that modified nutritional manipulation in GDM from usual intake, including but not limited to CHO restriction, improves maternal glucose and lowers infant birthweight. This creates a platform for future studies to further clarify the impact of multiple nutritional patterns in GDM on both maternal and infant outcomes.
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Affiliation(s)
- Sarah S Farabi
- Goldfarb School of Nursing, Office of Nursing Research, Barnes-Jewish College, St. Louis, MO 63110, USA
- Department of Medicine, Division of Nutritional Science, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Teri L Hernandez
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA.
- College of Nursing, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA.
- Department of Research, Innovation, and Professional Practice, Children's Hospital Colorado, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA.
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15
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Barbour LA. Metabolic Culprits in Obese Pregnancies and Gestational Diabetes Mellitus: Big Babies, Big Twists, Big Picture : The 2018 Norbert Freinkel Award Lecture. Diabetes Care 2019; 42:718-726. [PMID: 31010942 PMCID: PMC6489109 DOI: 10.2337/dci18-0048] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pregnancy has been equated to a "stress test" in which placental hormones and growth factors expose a mother's predisposition toward metabolic disease, unleashing her previously occult insulin resistance (IR), mild β-cell dysfunction, and glucose and lipid surplus due to the formidable forces of pregnancy-induced IR. Although pregnancy-induced IR is intended to assure adequate nutrition to the fetus and placenta, in mothers with obesity, metabolic syndrome, or those who develop gestational diabetes mellitus, this overnutrition to the fetus carries a lifetime risk for increased metabolic disease. Norbert Freinkel, nearly 40 years ago, coined this excess intrauterine nutrient exposure and subsequent offspring developmental risk "fuel-mediated teratogenesis," not limited to only excess maternal glucose. Our attempts to better elucidate the causes and mechanisms behind this double-edged IR of pregnancy, to metabolically characterize the intrauterine environment that results in changes in newborn body composition and later childhood obesity risk, and to examine potential therapeutic approaches that might target maternal metabolism are the focus of this article. Rapidly advancing technologies in genomics, proteomics, and metabolomics offer us innovative approaches to interrogate these metabolic processes in the mother, her microbiome, the placenta, and her offspring that contribute to a phenotype at risk for future metabolic disease. If we are successful in our efforts, the researcher, endocrinologist, obstetrician, and health care provider fortunate enough to care for pregnant women have the unique opportunity to positively impact health outcomes not only in the short term but in the long run, not just in one life but in two-and possibly, for the next generation.
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Affiliation(s)
- Linda A Barbour
- Divisions of Endocrinology, Metabolism and Diabetes and Maternal Fetal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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16
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Viswanathan V, Krishnan D, Kalra S, Chawla R, Tiwaskar M, Saboo B, Baruah M, Chowdhury S, Makkar BM, Jaggi S. Insights on Medical Nutrition Therapy for Type 2 Diabetes Mellitus: An Indian Perspective. Adv Ther 2019; 36:520-547. [PMID: 30729455 PMCID: PMC6824451 DOI: 10.1007/s12325-019-0872-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Indexed: 02/07/2023]
Abstract
It is critical to integrate medical nutrition therapy (MNT) provided by a registered dietician (RD) into primary care of type 2 diabetes mellitus (T2DM). This is necessary to achieve the goals of improving overall metabolic measures beyond calorie restriction and weight loss. Misconceptions about nutrition in T2DM add to the challenges of executing MNT in a culturally sensitive population. The current review provides insights into MNT for the prevention and management of T2DM in India, based on both evidence and experience. It revisits historical Indian studies and provides information on appropriate dietary intake of carbohydrates (60-70%), proteins (~ 20%) and fats (10%) that will be acceptable and beneficial in an Indian T2DM population. It discusses nuances of types of carbohydrates and fats and explains associations of increased dietary fiber intake, balanced intake of low and high glycemic index foods and substitution of saturated fats with plant-based polyunsaturated fats in improving outcomes of T2DM and attenuating risk factors. The article also deliberates upon special patient populations with comorbid conditions and diseases and the necessary adjustments needed in their nutritional care. It outlines a step-wise approach to MNT involving a careful interplay of nutrition assessment, diagnosis, individualization and patient counseling. Overall, the success of MNT relies on providing accurate, acceptable and appropriate dietary choices for continued patient adherence. Collaborative efforts from diabetologists, endocrinologists, internists and RDs are required to prioritize and implement MNT in diabetes practice in India.Funding: Signutra Inc.
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Affiliation(s)
- Vijay Viswanathan
- M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre (WHO Collaborating Centre for Research, Education and Training in Diabetes), Chennai, Tamil Nadu, India
| | | | - Sanjay Kalra
- Bharti Research Institute of Diabetes & Endocrinology (BRIDE), Karnal, Haryana, India.
| | | | | | - Banshi Saboo
- Dia Care-Diabetes and Hormone Centre, Ahmedabad, Gujarat, India
| | | | - Subhankar Chowdhury
- Institute of Postgraduate Medical Education and Research/SSKM Hospital, Kolkata, India
| | - B M Makkar
- Diabetes and Obesity Center, New Delhi, India
| | - Shalini Jaggi
- Dr. Mohan's Diabetes Specialties Centre, New Delhi, India
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17
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Hernandez TL, Mande A, Barbour LA. Nutrition therapy within and beyond gestational diabetes. Diabetes Res Clin Pract 2018; 145:39-50. [PMID: 29679625 PMCID: PMC6195478 DOI: 10.1016/j.diabres.2018.04.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/03/2018] [Indexed: 02/08/2023]
Abstract
With the global rising prevalence of gestational diabetes (GDM), an adaptable, economical approach to nutrition therapy that effectively controls maternal glycemia while promoting normal fetal growth will have far-reaching implications. The conventional focus has been to rigidly limit all types of carbohydrate. While controlling glucose, this approach fosters maternal anxiety and is a primary barrier to adherence. Many mothers substitute fat for carbohydrate, which may unintentionally enhance lipolysis, promote elevated free fatty acids (FFA), and worsen maternal insulin resistance (IR). Nutrition that worsens IR may facilitate nutrient shunting across the placenta, promoting excess fetal fat accretion. Evidence suggests that liberalizing higher quality, nutrient-dense carbohydrates results in controlled fasting/postprandial glucose, lower FFA, improved insulin action, vascular benefits, and may reduce excess infant adiposity. Thus, a less carbohydrate-restricted approach may improve maternal adherence when combined with higher quality carbohydrates, lower fat, appropriate caloric intake, and ethnically acceptable foods. Such a diet can be culturally sensitive, socioeconomically attentive, minimize further weight gain in GDM, with potential relevance for pregnancies complicated by overweight/obesity. Future research is needed to better understand the effect of macronutrient composition on the placenta and gut microbiome, the benefits/risks of nonnutritive sweeteners, and whether precision-nutrition is beneficial in pregnancy.
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Affiliation(s)
- Teri L Hernandez
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States; College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States.
| | - Archana Mande
- Colorado Clinical and Translational Science Institute, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - Linda A Barbour
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States; Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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18
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Assaf-Balut C, Garcia de la Torre N, Durán A, Fuentes M, Bordiú E, del Valle L, Valerio J, Familiar C, Jiménez I, Herraiz MA, Izquierdo N, Torrejón MJ, Runkle I, de Miguel MP, Moraga I, Montañez MC, Barabash A, Cuesta M, Rubio MA, Calle-Pascual AL. Medical nutrition therapy for gestational diabetes mellitus based on Mediterranean Diet principles: a subanalysis of the St Carlos GDM Prevention Study. BMJ Open Diabetes Res Care 2018; 6:e000550. [PMID: 30397489 PMCID: PMC6202993 DOI: 10.1136/bmjdrc-2018-000550] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/23/2018] [Accepted: 08/13/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To assess whether Mediterranean Diet (MedDiet)-based medical nutrition therapy facilitates near-normoglycemia in women with gestational diabetes mellitus (GDMw) and observe the effects on adverse pregnancy outcomes. RESEARCH DESIGN AND METHODS This is a secondary analysis of the St Carlos GDM Prevention Study, conducted between January and December 2015 in Hospital Clínico San Carlos (Madrid, Spain). One thousand consecutive women with normoglycemia were included before 12 gestational weeks (GWs), with 874 included in the final analysis. Of these, 177 women were diagnosed with gestational diabetes mellitus (GDM) and 697 had normal glucose tolerance. All GDMw received MedDiet-based medical nutrition therapy with a recommended daily extra virgin olive oil intake ≥40 mL and a daily handful of nuts. The primary goal was comparison of hemoglobin A1c (HbA1c) levels at 36-38 GWs in GDMw and women with normal glucose tolerance (NGTw). RESULTS GDMw as compared with NGTw had higher HbA1c levels at 24-28 GWs (5.1%±0.3% (32±0.9 mmol/mol) vs 4.9%±0.3% (30±0.9 mmol/mol), p=0.001). At 36-38 GWs values were similar between the groups. Similarly, fasting serum insulin and homeostatic model assessment insulin resitance (HOMA-IR) were higher in GDMw at 24-28 GWs (p=0.001) but became similar at 36-38 GWs. 26.6% of GDMw required insulin for glycemic control. GDMw compared with NGTw had higher rates of insufficient weight gain (39.5% vs 22.0%, p=0.001), small for gestational age (6.8% vs 2.6%, p=0.009), and neonatal intensive care unit admission (5.6% vs 1.7%, p=0.006). The rates of macrosomia, large for gestational age, pregnancy-induced hypertensive disorders, prematurity and cesarean sections were comparable with NGTw. CONCLUSIONS Using a MedDiet-based medical nutrition therapy as part of GDM management is associated with achievement of near-normoglycemia, subsequently making most pregnancy outcomes similar to those of NGTw.
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Affiliation(s)
- Carla Assaf-Balut
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Nuria Garcia de la Torre
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Alejandra Durán
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Fuentes
- Preventive Medicine Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Elena Bordiú
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Laura del Valle
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Johanna Valerio
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Cristina Familiar
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Inés Jiménez
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Miguel Angel Herraiz
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- Gynecology and Obstetrics Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Nuria Izquierdo
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- Gynecology and Obstetrics Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Maria José Torrejón
- Clinical Laboratory Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Isabelle Runkle
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Maria Paz de Miguel
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Inmaculada Moraga
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Maria Carmen Montañez
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ana Barabash
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Martín Cuesta
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Miguel A Rubio
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Alfonso Luis Calle-Pascual
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
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Kintiraki E, Goulis DG. Gestational diabetes mellitus: Multi-disciplinary treatment approaches. Metabolism 2018; 86:91-101. [PMID: 29627447 DOI: 10.1016/j.metabol.2018.03.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 03/25/2018] [Accepted: 03/27/2018] [Indexed: 02/08/2023]
Abstract
Gestational diabetes mellitus (GDM) is the most common metabolic disease of pregnancy, associated with several perinatal complications. Adequate glycemic control has been proved to decrease risk of GDM-related complications. Several studies have shown the beneficial effect of exercise and medical nutrition treatment on glycemic and weight control in GDM-affected women. Moreover, pharmacological agents, such as insulin and specific oral anti-diabetic agents can be prescribed safely during pregnancy, decreasing maternal blood glucose and, thus, perinatal adverse outcomes. Multi-disciplinary treatment approaches that include both lifestyle modifications (medical nutritional therapy and daily physical exercise) and pharmacological treatment, in cases of failure of the former, constitute the most effective approach. Insulin is the gold standard pharmacological agent for GDM treatment. Metformin and glyburide are two oral anti-diabetic agents that could serve as alternative, although not equal in terms of effectiveness and safety, treatment for GDM. As studies on short-term safety of metformin are reassuring, in some countries it is considered as first-line treatment for GDM management. More studies are needed to investigate the long-term effects on offspring. As safety issues have been raised on the use of glyburide during pregnancy, it must be used only when benefits surpass possible risks.
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Affiliation(s)
- Evangelia Kintiraki
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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20
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Hernandez TL, Brand-Miller JC. Nutrition Therapy in Gestational Diabetes Mellitus: Time to Move Forward. Diabetes Care 2018; 41:1343-1345. [PMID: 29934477 PMCID: PMC6014541 DOI: 10.2337/dci18-0014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Teri L Hernandez
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jennie C Brand-Miller
- Charles Perkins Centre and School of Life and Environmental Sciences, University of Sydney, Sydney, Australia
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Barbour LA, Hernandez TL. Maternal Non-glycemic Contributors to Fetal Growth in Obesity and Gestational Diabetes: Spotlight on Lipids. Curr Diab Rep 2018; 18:37. [PMID: 29744612 DOI: 10.1007/s11892-018-1008-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Excess fetal growth is increasingly recognized as a risk factor for childhood obesity, and mounting evidence supports that maternal glucose is not the only driver. This review focuses on the role of clinically applicable maternal non-glycemic contributors to excess fetal growth, particularly lipids, in addition to amino acids (AA), insulin resistance, inflammation, maternal nutrition, and gestational weight gain (GWG) in obesity and gestational diabetes mellitus (GDM). RECENT FINDINGS Lipids, specifically triglycerides and free fatty acids, appear to be strong contributors to excess fetal fat accretion and adiposity at birth, particularly in obese pregnancies, which account for the largest number of large-for-gestational-age infants. Maternal pre-pregnancy body mass index (BMI), GWG, insulin resistance, inflammation, and glucose, lipid, and AA concentrations have both independent and interacting effects on fetal growth, operating both early and late in pregnancy. All are sensitive to maternal nutrition. Early vs. later gestational exposure to excess maternal fuels in fasting and postprandial conditions may differentially impact fetoplacental outcomes. Compelling evidence suggests that targeting interventions early in pregnancy beyond glucose may be critical to improve fetal growth patterns.
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Affiliation(s)
- Linda A Barbour
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, 12801 E 17th Ave, Room 7103; Mail Stop 8106, Aurora, CO, 80045, USA.
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
| | - Teri L Hernandez
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, 12801 E 17th Ave, Room 7103; Mail Stop 8106, Aurora, CO, 80045, USA
- College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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22
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Joseph M, Das Gupta R, Shetty S, Ramachandran R, Antony G, Mathews J, Benjamin S, Anoop S, Rani JV, Thomas N. How Adequate are Macro- and Micronutrient Intake in Pregnant Women with Diabetes Mellitus? A Study from South India. J Obstet Gynaecol India 2017; 68:400-407. [PMID: 30224846 DOI: 10.1007/s13224-017-1069-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/26/2017] [Indexed: 11/26/2022] Open
Abstract
Background Diabetes is the most common condition in pregnancy with a worldwide prevalence of 16.9%. Aim To determine the adequacy of the nutrient intake of pregnant women with diabetes mellitus. Methods This is a cross-sectional study of 85 pregnant women who met the diagnostic inclusion criteria for diabetes mellitus (gestational and pre-gestational diabetes mellitus) and who were being managed at the outpatient clinic of a tertiary care teaching hospital. Their demography, clinical characteristics (from updated medical records), anthropometric measures (using standard procedures), nutrient intake and meal pattern (obtained using 24 h recall, food frequency and their log diaries) were collected. Results The mean age of the group was 29.9 + 4.5 years, 54% were in the second trimester of pregnancy with a mean glycosylated haemoglobin level of 6.3 + 1.4%. The mean BMI indicated that 47% of them were in the obese grade 1 category. Insulin was used in one-third of the population. The overall macronutrient and micronutrient intakes of the population were below the recommended daily allowances for Indians (60-70% of RDA). There was a deficit in the intake of calories, fibre, proteins, iron, calcium, carotene, folic acid, thiamine, riboflavin and niacin. Between the two groups, the pre-GDM women had a significantly better nutrient intake and this could be attributed to a greater exposure to nutrition counselling that they have received during the earlier part of their diabetes care. Conclusion The gestational period should be viewed as a window of opportunity to modify dietary patterns and introduce healthy lifestyle practices for the woman and her family.
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Affiliation(s)
- Mini Joseph
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Riddhi Das Gupta
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Sahana Shetty
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Roshna Ramachandran
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Geethu Antony
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Jiji Mathews
- 2Department of Gynaecology and Obstetrics, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Santhosh Benjamin
- 2Department of Gynaecology and Obstetrics, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Shajith Anoop
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Jansi Vimala Rani
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Nihal Thomas
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
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Kizirian NV, Goletzke J, Brodie S, Atkinson FS, Markovic TP, Ross GP, Buyken A, Brand-Miller JC. Lower glycemic load meals reduce diurnal glycemic oscillations in women with risk factors for gestational diabetes. BMJ Open Diabetes Res Care 2017; 5:e000351. [PMID: 28405345 PMCID: PMC5372136 DOI: 10.1136/bmjdrc-2016-000351] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/15/2017] [Accepted: 03/09/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Maternal glycemia plays a key role in fetal growth. We hypothesized that lower glycemic load (GL) meals (lower glycemic index, modestly lower carbohydrate) would substantially reduce day-long glucose variability in women at risk of gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS A crossover study of 17 women (mean±SD age 34.8±4 years; gestational weeks 29.3±1.3; body mass index 23.8±4.7 kg/m2) who consumed a low GL or a high GL diet in random order, 1-day each, over 2 consecutive days. Diets were energy-matched and fiber-matched with 5 meals per 24 hours. All food was provided. Continuous glucose monitoring was used to assess diurnal glycemia. RESULTS Maternal glucose levels were 51% lower on the low GL day with lower incremental area under the curve (iAUC±SEM 549±109 vs 1120±198 mmol/L min, p=0.015). Glycemic variability was significantly lower on the low GL day, as demonstrated by a lower average SD (0.7±0.1 vs 0.9±0.1, p<0.001) and lower mean amplitude of glycemic excursions (2.1±0.2 vs 2.7±0.2 mmol/L, p<0.001). CONCLUSIONS A lower GL meal plan in pregnancy acutely halves day-long maternal glucose levels and reduces glucose variability, providing further evidence to support the utility of a low GL diet in pregnancy.
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Affiliation(s)
- Nathalie V Kizirian
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Janina Goletzke
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
- IEL-Nutritional Epidemiology, University of Bonn, DONALD Study, Dortmund, Germany
| | - Shannon Brodie
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia
| | - Fiona S Atkinson
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Tania P Markovic
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Glynis P Ross
- Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Anette Buyken
- IEL-Nutritional Epidemiology, University of Bonn, DONALD Study, Dortmund, Germany
| | - Jennie C Brand-Miller
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia
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