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Abstract
CONTEXT Gestational diabetes is commonly linked to development of type 2 diabetes mellitus (T2DM). There is a need to characterize metabolic changes associated with gestational diabetes in order to find novel biomarkers for T2DM. OBJECTIVE To find potential pathophysiological mechanisms and markers for progression from gestational diabetes mellitus to T2DM by studying the metabolic transition from pregnancy to postpartum. DESIGN The metabolic transition profile from pregnancy to postpartum was characterized in 56 women by mass spectrometry-based metabolomics; 11 women had gestational diabetes mellitus, 24 had normal glucose tolerance, and 21 were normoglycaemic but at increased risk for gestational diabetes mellitus. Fasting serum samples collected during trimester 3 (gestational week 32±0.6) and postpartum (10.5±0.4months) were compared in diagnosis-specific multivariate models (orthogonal partial least squares analysis). Clinical measurements (e.g., insulin, glucose, lipid levels) were compared and models of insulin sensitivity and resistance were calculated for the same time period. RESULTS Women with gestational diabetes had significantly increased postpartum levels of the branched-chain amino acids (BCAAs) leucine, isoleucine, and valine, and their circulating lipids did not return to normal levels after pregnancy. The increase in BCAAs occurred postpartum since the BCAAs did not differ during pregnancy, as compared to normoglycemic women. CONCLUSIONS Postpartum levels of specific BCAAs, notably valine, are related to gestational diabetes during pregnancy.
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Affiliation(s)
- Elin Chorell
- Department of Public Health and Clinical Medicine, Umeå University.
| | | | | | - Kerstin Berntorp
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - Jatta Puhkala
- UKK Institute for Health Promotion Research, Tampere, Finland,; National Institute for Health and Welfare, Helsinki, Finland
| | - Riitta Luoto
- UKK Institute for Health Promotion Research, Tampere, Finland,; National Institute for Health and Welfare, Helsinki, Finland
| | - Tommy Olsson
- Department of Public Health and Clinical Medicine, Umeå University
| | - Agneta Holmäng
- Institute of Neuroscience and Physiology, University of Gothenburg
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Abstract
BACKGROUND Risk for developing metabolic syndrome (MeS) after delivery is high among women with gestational diabetes mellitus (GDM), but little is known about development of MeS among women with risk factors for GDM during pregnancy. In the present study, we studied the prevalence of MeS 7 years postpartum among women with GDM risk factors during pregnancy, women with early GDM diagnosis and women without GDM risk factors. We also analysed the early pregnancy risk factors associated with MeS. METHODS A Finnish cluster randomised controlled GDM prevention trial was conducted in 2007-2009. The prevalence of MeS according to International Diabetes Federation criteria was determined in the follow-up study 7 years after original trial. Eligible participants (n=289) in 4 study groups (intervention (n=83) and usual care (n=87) with GDM risk factors; early GDM (n=51), and healthy control without GDM risk factors (n=68)) were evaluated for MeS. Binary logistic regression models were used to analyse risk factors associated with MeS. RESULTS 7 years postpartum, the MeS prevalence was 14% (95% CI 8% to 25%) in the intervention group; 15% (CI 8% to 25%) in the usual care group; 50% (CI 35% to 65%) in the early GDM group and 7% (CI 2% to 18%) in the healthy control group. OR for MeS in women with GDM risk factors did not differ from the healthy control group. Body mass index (BMI)-adjusted OR for MeS was 9.18 (CI 1.82 to 46.20) in the early GDM group compared with the healthy control group. Increased prepregnancy BMI was associated with MeS (OR, 1.17, CI 1.08 to 1.28, adjusted for group). CONCLUSIONS Increased prepregnancy BMI and early GDM diagnosis were the strongest risk factors for developing MeS 7 years postpartum. Overweight and obese women and especially those with early GDM should be monitored and counselled for cardiometabolic risk factors after delivery.
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Affiliation(s)
- Jatta Puhkala
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Jani Raitanen
- UKK Institute for Health Promotion Research, Tampere, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Päivi Kolu
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Pipsa Tuominen
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Pauliina Husu
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Riitta Luoto
- UKK Institute for Health Promotion Research, Tampere, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
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Puhkala J, Kukkonen-Harjula K, Aittasalo M, Mansikkamäki K, Partinen M, Hublin C, Kärmeniemi P, Sallinen M, Olkkonen S, Tokola K, Ojala A, Nygård CH, Fogelholm M. Lifestyle counseling in overweight truck and bus drivers - Effects on dietary patterns and physical activity. Prev Med Rep 2016; 4:435-40. [PMID: 27583202 PMCID: PMC4995529 DOI: 10.1016/j.pmedr.2016.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED We studied dietary patterns, physical activity (PA), and monthly goal setting in a weight reduction intervention in long-distance professional drivers. The study was conducted in Finland in 2009-2012. Male drivers with waist circumference > 100 cm were randomized to a lifestyle counseling (LIFE, N = 55) and a reference (REF, N = 58) group. During 12 months, LIFE participated in 6 face-to-face and 7 telephone counseling sessions on diet and PA. Dietary patterns were assessed using an index combining food diary and counselor interview, and PA with the number of daily steps using a pedometer. Monthly lifestyle goals, perceived facilitators and barriers, and adverse effects of PA in the LIFE participants were monitored using counselors' log books. Forty-seven (85%) LIFE participants completed the 12-month program. After 12 months, the mean dietary index score improved by 12% (p = 0.002, N = 24), and the number of daily steps increased by 1811 steps (median; p = 0.01, N = 22). The most frequent dietary goals dealt with meal frequency, plate model, and intake of vegetables, fruits, and berries. The most common PA mode was walking. Typical facilitators to reach monthly lifestyle goals were support from family and friends and ailment prevention; typical barriers were working schedules and ailments. Adverse effects, most commonly musculoskeletal pain, occurred among 83% of the LIFE participants. Positive changes in lifestyle habits were observed during counseling. Monthly lifestyle counseling combining face-to-face and phone contacts seemed appropriate to long-distance drivers. Barriers for reaching lifestyle changes, and adverse effects of PA were common and need to be addressed when planning counseling. TRIAL REGISTRATION Clinical Trials NCT00893646.
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Affiliation(s)
- Jatta Puhkala
- UKK Institute for Health Promotion Research, Tampere, Finland
- Corresponding author at: UKK Institute for Health Promotion Research, P.O. Box 30, FI-33501 Tampere, Finland.UKK Institute for Health Promotion ResearchP.O. Box 30TampereFI-33501Finland
| | | | - Minna Aittasalo
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Kirsi Mansikkamäki
- UKK Institute for Health Promotion Research, Tampere, Finland
- Tampere University of Applied Sciences, Tampere, Finland
| | - Markku Partinen
- Vitalmed Sleep Clinic and Research Centre, Helsinki, Finland
| | | | - Paula Kärmeniemi
- Rehabilitation, South Karelia, Social and Health Care District, Lappeenranta, Finland
| | - Mikael Sallinen
- Finnish Institute of Occupational Health, Helsinki, Finland
- Agora Center, University of Jyväskylä, Jyväskylä, Finland
| | - Seppo Olkkonen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Kari Tokola
- UKK Institute for Health Promotion Research, Tampere, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Anna Ojala
- UKK Institute for Health Promotion Research, Tampere, Finland
| | | | - Mikael Fogelholm
- Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
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Puhkala J, Kukkonen-Harjula K, Mansikkamäki K, Aittasalo M, Hublin C, Kärmeniemi P, Olkkonen S, Partinen M, Sallinen M, Tokola K, Fogelholm M. Lifestyle counseling to reduce body weight and cardiometabolic risk factors among truck and bus drivers – a randomized controlled trial. Scand J Work Environ Health 2014; 41:54-64. [DOI: 10.5271/sjweh.3463] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Puhkala J, Luoto R, Ahotupa M, Raitanen J, Vasankari T. Postpartum weight retention is associated with elevated ratio of oxidized LDL lipids to HDL-cholesterol. Lipids 2014; 48:1227-35. [PMID: 24122103 DOI: 10.1007/s11745-013-3852-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 09/13/2013] [Indexed: 10/26/2022]
Abstract
Oxidized LDL lipids (ox-LDL) are associated with lifestyle diseases such as cardiovascular diseases, metabolic syndrome and type 2 diabetes. The present study investigated how postpartum weight retention effects on ox-LDL and serum lipids. The study is a nested comparative research of a cluster-randomized controlled trial, NELLI (lifestyle and counselling during pregnancy). During early pregnancy (8-12 weeks) and 1 year postpartum, 141 women participated in measurements for determining of plasma lipids: total cholesterol (T-C), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), triacylglycerols (TAG) and ox-LDL. Subjects were stratified into tertiles (weight loss, unaltered weight and weight gain groups) based on their weight change from baseline to follow-up. Ox-LDL was determined by baseline level of conjugated dienes in LDL lipids. Among the group of weight gainers, concentration of TAG reduced less (-0.14 vs. -0.33, p = 0.002), HDL-C reduced more (-0.31 vs. -0.16, p = 0.003) and ox-LDL/HDL-C ratio increased (3.0 vs. -0.2, p = 0.003) when compared to group of weight loss. Both T-C and LDL-C elevated more (0.14 vs. -0.21, p = 0.008; 0.31 vs. 0.07, p = 0.015) and TAG and ox-LDL reduced less (-0.33 vs. 0.20, p = 0.033; -3.33 vs. -0.68, p = 0.026) in unaltered weight group compared to weight loss group. The women who gained weight developed higher TAG and ox-LDL/HDL-C ratio as compared to those who lost weight. Postpartum weight retention of 3.4 kg or more is associated with atherogenic lipid profile.
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Kinnunen TI, Puhkala J, Raitanen J, Ahonen S, Aittasalo M, Virtanen SM, Luoto R. Effects of dietary counselling on food habits and dietary intake of Finnish pregnant women at increased risk for gestational diabetes - a secondary analysis of a cluster-randomized controlled trial. Matern Child Nutr 2012; 10:184-97. [PMID: 22735030 DOI: 10.1111/j.1740-8709.2012.00426.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The incidence of gestational diabetes mellitus (GDM) is increasing and GDM might be prevented by improving diet. Few interventions have assessed the effects of dietary counselling on dietary intake of pregnant women. This study examined the effects of dietary counselling on food habits and dietary intake of Finnish pregnant women as secondary outcomes of a trial primarily aiming at preventing GDM. A cluster-randomized controlled trial was conducted in 14 municipalities in Finland, including 399 pregnant women at increased risk for developing GDM. The intervention consisted of dietary counselling focusing on dietary fat, fibre and saccharose intake at four routine maternity clinic visits. Usual counselling practices were continued in the usual care municipalities. A validated 181-item food frequency questionnaire was used to assess changes in diet from baseline to 26-28 and 36-37 weeks gestation. The data were analysed using multilevel mixed-effects linear regression models. By 36-37 weeks gestation, the intervention had beneficial effects on total intake of vegetables, fruits and berries (coefficient for between-group difference in change 61.6 g day(-1), 95% confidence interval 25.7-97.6), the proportions of high-fibre bread of all bread (7.2% units, 2.5-11.9), low-fat cheeses of all cheeses (10.7% units, 2.6-18.9) and vegetable fats of all dietary fats (6.1% -units, 2.0-10.3), and the intake of saturated fatty acids (-0.67 energy-%-units, -1.16 to -0.19), polyunsaturated fatty acids (0.38 energy-%-units, 0.18-0.58), linoleic acid (764 mg day(-1), 173-1354) and fibre (2.07 g day(-1) , 0.39-3.75). The intervention improved diet towards the recommendations in pregnant women at increased risk for GDM suggesting the counselling methods could be implemented in maternity care.
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Affiliation(s)
- Tarja I Kinnunen
- School of Health Sciences, University of Tampere, Tampere, Finland The UKK Institute for Health Promotion Research, Tampere, Finland The National Institute for Health and Welfare, The Unit of Nutrition, Helsinki, Finland Science Center of Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland The National Institute for Health and Welfare, The Unit of Sexual and Reproductive Health, Helsinki, Finland
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