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Dingena CF, Mahendra A, Holmes MJ, Clement NS, Scott EM, Zulyniak MA. Protocol for the INFORMED (Individualised Patient Care and Treatment for Maternal Diabetes) Study: a randomised controlled trial embedded within routine care. BMJ Open 2023; 13:e065388. [PMID: 36849210 PMCID: PMC9972421 DOI: 10.1136/bmjopen-2022-065388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
INTRODUCTION Diabetes in pregnancy presents a unique physiological challenge to manage glycaemia while maintaining adequate nourishment for the growing fetus. Women with diabetes who become pregnant are at greater risk of adverse maternal and newborn outcomes, compared with women without diabetes. Evidence suggests that control of (postprandial) glycaemia is key to manage maternal and offspring health but it is not yet clear (1) how diet and lifestyle moderate these shifts across the full duration of pregnancy or (2) what aspects of maternal and offspring health are associated with dysglycaemia. METHODS AND ANALYSIS To investigate these gaps, a cross-over randomised clinical trial has been embedded within routine clinical care. Seventy-six pregnant women in their first trimester with type 1 or type 2 diabetes (with or without medication) attending their routine antenatal appointments at National Health Service (NHS) Leeds Teaching Hospitals will be recruited. Following informed consent, data on women's health, glycaemia, pregnancy and delivery will be shared by the NHS with researchers. At each visit in the first (10-12 weeks), second (18-20 weeks) and third (28-34 weeks) trimester, participants will be asked for consent to: (1) lifestyle and diet questionnaires, (2) blood for research purposes and (3) analysis of urine collected at clinical visits. Additionally, participants will be asked to consume two blinded meals in duplicate in second and third trimester. Glycaemia will be assessed by continuous glucose monitoring as part of routine care. The primary outcome is the effect of experimental meals (high vs low protein) on postprandial glycaemia. Secondary outcomes include (1) the association between dysglycaemia and maternal and newborn health, and (2) the association between maternal metabolic profiles in early pregnancy with dysglycaemia in later pregnancy. ETHICS AND DISSEMINATION The Leeds East Research Ethics Committee and NHS (REC: 21/NE/0196) approved the study. Results will be published in peer-reviewed journals and disseminated to participants and the wider public. TRIAL REGISTRATION NUMBER ISRCTN57579163.
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Affiliation(s)
| | | | | | | | - Eleanor M Scott
- Division of Clinical and Population Sciences, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Modzelewski R, Stefanowicz-Rutkowska MM, Matuszewski W, Bandurska-Stankiewicz EM. Gestational Diabetes Mellitus—Recent Literature Review. J Clin Med 2022; 11:jcm11195736. [PMID: 36233604 PMCID: PMC9572242 DOI: 10.3390/jcm11195736] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/25/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM), which is defined as a state of hyperglycemia that is first recognized during pregnancy, is currently the most common medical complication in pregnancy. GDM affects approximately 15% of pregnancies worldwide, accounting for approximately 18 million births annually. Mothers with GDM are at risk of developing gestational hypertension, pre-eclampsia and termination of pregnancy via Caesarean section. In addition, GDM increases the risk of complications, including cardiovascular disease, obesity and impaired carbohydrate metabolism, leading to the development of type 2 diabetes (T2DM) in both the mother and infant. The increase in the incidence of GDM also leads to a significant economic burden and deserves greater attention and awareness. A deeper understanding of the risk factors and pathogenesis becomes a necessity, with particular emphasis on the influence of SARS-CoV-2 and diagnostics, as well as an effective treatment, which may reduce perinatal and metabolic complications. The primary treatments for GDM are diet and increased exercise. Insulin, glibenclamide and metformin can be used to intensify the treatment. This paper provides an overview of the latest reports on the epidemiology, pathogenesis, diagnosis and treatment of GDM based on the literature.
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Affiliation(s)
- Robert Modzelewski
- Endocrinology, Diabetology and Internal Medicine Clinic, Department of Internal Medicine, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland
| | | | - Wojciech Matuszewski
- Endocrinology, Diabetology and Internal Medicine Clinic, Department of Internal Medicine, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland
| | - Elżbieta Maria Bandurska-Stankiewicz
- Endocrinology, Diabetology and Internal Medicine Clinic, Department of Internal Medicine, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland
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Koch SAJ, Conrad J, Cade JE, Weinhold L, Alexy U, Nöthlings U. Validation of the web-based self-administered 24-h dietary recall myfood24-Germany: comparison with a weighed dietary record and biomarkers. Eur J Nutr 2021; 60:4069-4082. [PMID: 33974128 PMCID: PMC8437850 DOI: 10.1007/s00394-021-02547-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/22/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE We aimed to validate myfood24-Germany, a web-based 24-h dietary recall (24HDR), by comparing its performance with a weighed dietary record (WDR) and biomarkers. METHODS 97 adults (77% female) completed a 3-day WDR with a 24-h urine collection on day 3, followed by at least one 24HDR with myfood24-Germany (corresponding to day 3 of the WDR). Intake of energy and 32 nutrients assessed by myfood24-Germany and the WDR for the same day were compared (method comparison). Intakes of protein and potassium assessed by myfood24-Germany/WDR were compared with intake estimated from urinary biomarkers for protein and potassium (biomarker comparison). RESULTS In the method comparison, significant correlations were found for energy and all tested nutrients (range 0.45-0.87). There was no significant difference between both methods in the assessed mean energy and macronutrient intake. However, myfood24-Germany underestimated mean intake of 15 nutrients. In the biomarker comparison, protein intake reported by myfood24-Germany/WDR was on average 10%/8% lower than estimated by biomarker. There was no significant difference in mean potassium intake assessed by myfood24-Germany/WDR and biomarker. However, a shared bias in the assessment of potassium intake was observed for both instruments. Concordance correlation coefficients (pc) and weighted Kappa coefficients (κ) confirmed good agreement with the biomarker estimates for myfood24-Germany/WDR in case of protein (pc = 0.58/0.66, κ = 0.51/0.53) and moderate agreement in case of potassium (pc = 0.44/0.51; κ = 0.30/0.33). CONCLUSION Our results suggest that myfood24-Germany is of comparable validity to traditional dietary assessment methods.
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Affiliation(s)
- Stefanie A J Koch
- Nutritional Epidemiology, Department of Nutrition and Food Sciences, University of Bonn, Bonn, Germany.
| | - Johanna Conrad
- Nutritional Epidemiology, Department of Nutrition and Food Sciences, University of Bonn, Bonn, Germany.,Science Department, German Nutrition Society, Bonn, Germany
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Leonie Weinhold
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Bonn, Germany
| | - Ute Alexy
- Nutritional Epidemiology, Department of Nutrition and Food Sciences, University of Bonn, Bonn, Germany
| | - Ute Nöthlings
- Nutritional Epidemiology, Department of Nutrition and Food Sciences, University of Bonn, Bonn, Germany
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Machairiotis N, Vasilakaki S, Minns L, Malakasis A. Nutrients that modulate gestational diabetes mellitus: A systematic review of cohort studies Jan 2019-Jan 2020. Int J Clin Pract 2021; 75:e14033. [PMID: 33480127 DOI: 10.1111/ijcp.14033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 01/17/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The role of eating habits of pregnant women in the development and treatment of gestational diabetes mellitus (GDM) is well established. OBJECTIVES To estimate the contribution of specific nutrients and dietary patterns in the development or privation of GDM in pregnant women. DATA SOURCES A systematic review of cohort studies, published between January 2019 and January 2020, of English articles using PubMed, Scopus and Europe PMC databases. Search terms included diabetes, pregnancy, dietary, food, and nutrients. STUDY SELECTION Only cohort studies about the association between eating habits before and during pregnancy and the risk of GDM in English were included. The studies used dietary patterns, specific nutrients or records of food intake of the participants using a questionnaire. DATA EXTRACTION Two authors independently extracted data from articles-including dietary patterns, food intake, nutrients, number and demographic data of participants, data about pregnancies-using predefined criteria. RESULTS In total, 28 cohort studies were organised to examine the correlation between dietary patterns and the prevention of GDM. Studies were conducted in 13 countries and included 3 058 242 participants. Of those, 13 (46%) studies focused on the consumption of vitamins, probiotics, micronutrients, folate, vegetables and fruits. Moreover, seven (25%) studies focused on what is considered to be "unhealthy" eating habits, including prudent and Western dietary patterns. The mediterranean pattern was used in three (11%) studies. CONCLUSIONS Ongoing studies support advice to adhere to a healthy balanced diet, with the addition of folic acid and a multi-vitamin suitable for pregnancy. There is new evidence suggesting probiotics and cod-liver oil supplementation may improve glycaemic control and also the important consideration of the psychological influences of eating.
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Affiliation(s)
- Nikolaos Machairiotis
- Department of Obstetrics and Gynaecology, Accredited Endometriosis Centre, Northwick Park Hospital, London North West Healthcare NHS Trust, Harrow, London, UK
| | - Sofia Vasilakaki
- Pharmacy Department, University of Athens, Panepistimiopolis of Zographou, Athens, Greece
| | - Laura Minns
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Anastasios Malakasis
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
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Guo HP, Zhao A, Xue Y, Ma LK, Zhang YM, Wang PY. [Relationship between nutrients intake during pregnancy and the glycemic control effect in pregnant women with gestational diabetes mellitus]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021. [PMID: 34145846 DOI: 10.19723/j.issn.1671-167x.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To explore the relationship between nutrients intake during pregnancy and the glycemic control effect in pregnant women with gestational diabetes mellitus (GDM). METHODS Pregnant women for 25-35 gestational weeks who underwent prenatal examination and completed GDM diagnostic test in two third-class hospitals in Beijing from October 2015 to October 2017 were recruited to participate in the cohort study, and were investigated at enrollment, 2 weeks after enrollment, and delivery. The cross-sectional survey data 2 weeks after enrollment was used for this study. Among them, dietary survey used the 24 h dietary records to collect the food intake of the subjects for the past day, and the intake of energy, macronutrients and micronutrients, was calculated according to the Chinese Food Composition Table. Using the data of fasting blood glucose (FBG) collected by clinical information system and referring to the Chinese Guidelines for the Diagnosis and Treatment of Pregnancy Diabetes (2014), the GDM patients with FBG ≤5.3 mmol/L were divided into the well-control group, those with FBG >5.3 mmol/L were divided into poorly-control group, and pregnant women with normal glucose tolerance were consi-dered as the normal group. Binary Logistic regression was used to analyze the association between the nutrients intake and glycemic control effect in pregnant women with GDM. RESULTS A total of 227 pregnant women were enrolled, including 104 GDM patients and 123 normal pregnancy women. Among them, 76 subjects in the well-control group (73.1%, 76/104) and 28 subjects in the poorly-control group (26.9%, 28/104). Compared with the well-control group and the normal group, the protein intake and its energy ratio of the poorly-control group were significantly higher, while carbohydrate energy ratio was significantly lower. In terms of micronutrients, there was no significant difference between the well-control group and the poorly-control group. After adjusting for age, gestational age and physical activity level, with the well-control group as the control group, binary Logistic regression model showed that higher protein energy ratio was positively correlated with poorly glycemic control effect in pregnant women with GDM (OR=6.12, 95%CI: 1.44-25.98), while higher carbohydrate energy ratio was negatively correlated with poorly glycemic control (OR=0.54, 95%CI: 0.32-0.91). CONCLUSION Reduced protein intake and increased carbohydrate intake were associated with better glycemic control in pregnant women with GDM. It is suggested that GDM patients should adjust their dietary pattern further to achieve good glycemic control effect.
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Affiliation(s)
- H P Guo
- Department of Nutrition and Food Hygiene, Peking University School of Public Health, Beijing 100191, China
| | - A Zhao
- Vanke School of Public Health, Tsinghua University, Beijing 100091, China
| | - Y Xue
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China
| | - L K Ma
- Department of Obstetrics and Gynecology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Y M Zhang
- Department of Nutrition and Food Hygiene, Peking University School of Public Health, Beijing 100191, China
| | - P Y Wang
- Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
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Almoraie NM, Saqaan R, Alharthi R, Alamoudi A, Badh L, Shatwan IM. Snacking patterns throughout the life span: potential implications on health. Nutr Res 2021; 91:81-94. [PMID: 34144310 DOI: 10.1016/j.nutres.2021.05.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/02/2021] [Accepted: 05/11/2021] [Indexed: 12/16/2022]
Abstract
Eating outside the three main meals - in other words, snacking - is a part of the dietary pattern of individuals in all stages of life. The quality and pattern of snacking have an impact on health during the life span. Thus, the aim of this review was to evaluate various patterns and health outcomes of the snacking habits of different demographical groups, from children to the elderly, throughout their life span. We discuss the snacking pattern among children and adolescents, which is characterized by consuming high energy foods with low nutrient value, and which is associated with increased risk of obesity. During university years, study stress and lack of time were obstacles to a healthy dietary pattern involving nutritious snacks, although awareness of the importance of healthy snacks was higher in this group than among younger age groups. Employment status and skipping regular meals were important factors affecting snacking quality and patterns in adulthood. Unhealthy snacks, high in energy, sugar, and salt and low in nutrients, were demonstrated to have a negative impact on individuals' health, such as oral health, blood pressure, obesity, and diabetes. In conclusion, encouraging individuals to consume healthy snacks that are high in nutrients through education to help them plan for their snacks is important to enhance health and reduce disease risk.
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Affiliation(s)
- Noha M Almoraie
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Rula Saqaan
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Razan Alharthi
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amal Alamoudi
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Lujain Badh
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Israa M Shatwan
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah, Saudi Arabia
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