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Ramos-Levi A, Barabash A, Valerio J, García de la Torre N, Mendizabal L, Zulueta M, de Miguel MP, Diaz A, Duran A, Familiar C, Jimenez I, del Valle L, Melero V, Moraga I, Herraiz MA, Torrejon MJ, Arregi M, Simón L, Rubio MA, Calle-Pascual AL. Genetic variants for prediction of gestational diabetes mellitus and modulation of susceptibility by a nutritional intervention based on a Mediterranean diet. Front Endocrinol (Lausanne) 2022; 13:1036088. [PMID: 36313769 PMCID: PMC9612917 DOI: 10.3389/fendo.2022.1036088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
HYPOTHESIS Gestational diabetes mellitus (GDM) entails a complex underlying pathogenesis, with a specific genetic background and the effect of environmental factors. This study examines the link between a set of single nucleotide polymorphisms (SNPs) associated with diabetes and the development of GDM in pregnant women with different ethnicities, and evaluates its potential modulation with a clinical intervention based on a Mediterranean diet. METHODS 2418 women from our hospital-based cohort of pregnant women screened for GDM from January 2015 to November 2017 (the San Carlos Cohort, randomized controlled trial for the prevention of GDM ISRCTN84389045 and real-world study ISRCTN13389832) were assessed for evaluation. Diagnosis of GDM was made according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Genotyping was performed by IPLEX MassARRAY PCR using the Agena platform (Agena Bioscience, SanDiego, CA). 110 SNPs were selected for analysis based on selected literature references. Statistical analyses regarding patients' characteristics were performed in SPSS (Chicago, IL, USA) version 24.0. Genetic association tests were performed using PLINK v.1.9 and 2.0 software. Bioinformatics analysis, with mapping of SNPs was performed using STRING, version 11.5. RESULTS Quality controls retrieved a total 98 SNPs and 1573 samples, 272 (17.3%) with GDM and 1301 (82.7%) without GDM. 1104 (70.2%) were Caucasian (CAU) and 469 (29.8%) Hispanic (HIS). 415 (26.4%) were from the control group (CG), 418 (26.6%) from the nutritional intervention group (IG) and 740 (47.0%) from the real-world group (RW). 40 SNPs (40.8%) presented some kind of significant association with GDM in at least one of the genetic tests considered. The nutritional intervention presented a significant association with GDM, regardless of the variant considered. In CAU, variants rs4402960, rs7651090, IGF2BP2; rs1387153, rs10830963, MTNR1B; rs17676067, GLP2R; rs1371614, DPYSL5; rs5215, KCNJ1; and rs2293941, PDX1 were significantly associated with an increased risk of GDM, whilst rs780094, GCKR; rs7607980, COBLL1; rs3746750, SLC17A9; rs6048205, FOXA2; rs7041847, rs7034200, rs10814916, GLIS3; rs3783347, WARS; and rs1805087, MTR, were significantly associated with a decreased risk of GDM, In HIS, variants significantly associated with increased risk of GDM were rs9368222, CDKAL1; rs2302593, GIPR; rs10885122, ADRA2A; rs1387153, MTNR1B; rs737288, BACE2; rs1371614, DPYSL5; and rs2293941, PDX1, whilst rs340874, PROX1; rs2943634, IRS1; rs7041847, GLIS3; rs780094, GCKR; rs563694, G6PC2; and rs11605924, CRY2 were significantly associated with decreased risk for GDM. CONCLUSIONS We identify a core set of SNPs in their association with diabetes and GDM in a large cohort of patients from two main ethnicities from a single center. Identification of these genetic variants, even in the setting of a nutritional intervention, deems useful to design preventive and therapeutic strategies.
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Affiliation(s)
- Ana Ramos-Levi
- Endocrinology and Nutrition Department, Hospital Universitario de la Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ana Barabash
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Facultad de Medicina. Medicina II Department, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Johanna Valerio
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Nuria García de la Torre
- Endocrinology and Nutrition Department, Hospital Clínico Universitario 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
- *Correspondence: Alfonso L. Calle-Pascual, ; Nuria García de la Torre,
| | | | | | - Maria Paz de Miguel
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Facultad de Medicina. Medicina II Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Angel Diaz
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Facultad de Medicina. Medicina II Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Alejandra Duran
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Facultad de Medicina. Medicina II Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Cristina Familiar
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Inés Jimenez
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Laura del Valle
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Veronica Melero
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Inmaculada Moraga
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Miguel A. Herraiz
- Gynecology and Obstetrics Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - María José Torrejon
- Clinical Laboratory Department Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Maddi Arregi
- Patia Europe, Clinical Laboratory, San Sebastián, Spain
| | | | - Miguel A. Rubio
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Facultad de Medicina. Medicina II Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Alfonso L. Calle-Pascual
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Facultad de Medicina. Medicina II Department, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- *Correspondence: Alfonso L. Calle-Pascual, ; Nuria García de la Torre,
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Runkle I, de Miguel MP, Barabash A, Cuesta M, Diaz Á, Duran A, Familiar C, de la Torre NG, Herraiz MÁ, Izquierdo N, Diaz Á, Marcuello C, Matia P, Melero V, Montañez C, Moraga I, Perez-Ferre N, Perez N, Assaf-Balut C, Rubio MÁ, Ruiz-Sanchez JG, Sanabria C, Torrejon MJ, Valerio J, Del Valle L, Calle-Pascual A. Early Levothyroxine Treatment for Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy: The St Carlos Gestational and Thyroid Protocol. Front Endocrinol (Lausanne) 2021; 12:743057. [PMID: 34737722 PMCID: PMC8560890 DOI: 10.3389/fendo.2021.743057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED The optimal maternal levels of thyroid hormones (TH) during the first trimester of gestation have not been established, nor has the ideal moment to initiate levothyroxine treatment (LT) to improve the evolution of gestation and fetal development. Cut-off points for Thyroid-stimulating hormone (TSH) <2.5 µIU/mL and free thyroxine (FT4)>7.5 pg/mL have been recommended. There are no data on whether initiation of LT <9th Gestational Week (GW) can have a favourable impact. OBJECTIVE To define the TSH/FT4 percentiles corresponding with 2.5 µIU/mL and 7.5 pg/mL levels, respectively, at GW8 (Study 1), and evaluate the effects of protocol-based LT before GW9 on gestation evolution, in women with TSH ≥2.5 µIU/mL and/or FT4≤ 7.5 pg/mL (study 2). SUBJECTS 2768 consecutive pregnant women attending the first gestational visit from 2013-2014 and 3026 from 2015-2016 were eligible for Study I and 2 respectively. A final 2043 (study 1) and 2069 (study 2) women were assessed in these studies. RESULTS Study 1: The FT4 level of 7.5 pg/mL corresponds with the 17.9th percentile, a TSH level of 2.5 µIU/mL with the 75.8th. Women with TSH ≥2.5 µIU/mL had a history of fetal losses more frequently than those <2.5 (OR 2.33 (95%CI): 1.58-3.12), as did those with FT4 ≤7.5 pg/ml compared to those >7.5 (OR 4.81; 3.25-8.89). Study 2: A total of 1259 women had optimal TSH/FT4 levels (Group 1), 672 (32.4%, Group 2) had suboptimal TSH or T4l, and 138 (6.7%, Group 3) had suboptimal values of both. 393 (58.5%) in Group 2 and 88 (63.8%) in Group 3 started LT before GW9. Mean (SD) GW24 levels were TSH: 1.96 ± 1.22 µIU/mL and FT4: 7.07 ± 1.25 pg/mL. The highest FT4 value was 12.84 pg/mL. The adjusted risk for an adverse event if LT was started early was 0.71 (0.43-0.91) for Group 2 and 0.80 (0.66-0.94) for Group 3. CONCLUSIONS Early LT in women with suboptimum levels of TSH/FT4 (≥2.5µIU/mL/≤7.5 pg/ml) at or before GW9 is safe and improves gestation progression. These data support the recommendation to adopt these cut-off points for LT initiation, which should be started as early as possible.
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Affiliation(s)
- Isabelle Runkle
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Medicina II Department, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - María Paz de Miguel
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Medicina II Department, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana Barabash
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Medicina II Department, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Martin Cuesta
- Endocrinology and Nutrition Department, Hospital Clínico Universitario 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
| | - Ángel Diaz
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Medicina II Department, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Alejandra Duran
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Medicina II Department, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Cristina Familiar
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Nuria García de la Torre
- Endocrinology and Nutrition Department, Hospital Clínico Universitario 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 Ángel Herraiz
- Medicina II Department, 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
- Medicina II Department, 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
| | - Ángel Diaz
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Clara Marcuello
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Pilar Matia
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Medicina II Department, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Verónica Melero
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Carmen Montañez
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Inmaculada Moraga
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Natalia Perez-Ferre
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Noelia Perez
- Gynecology and Obstetrics Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Carla Assaf-Balut
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Medicina II Department, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Miguel Ángel Rubio
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Medicina II Department, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Jorge Gabriel Ruiz-Sanchez
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Concepción Sanabria
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - María José Torrejon
- Clinical Laboratory Department Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Johanna Valerio
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Laura Del Valle
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Alfonso Calle-Pascual
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Medicina II Department, 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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Melero V, García de la Torre N, Assaf-Balut C, Jiménez I, del Valle L, Durán A, Bordiú E, Valerio JJ, Herraiz MA, Izquierdo N, Torrejón MJ, Runkle I, Barabash A, Rubio MA, Calle-Pascual AL. Effect of a Mediterranean Diet-Based Nutritional Intervention on the Risk of Developing Gestational Diabetes Mellitus and Other Maternal-Fetal Adverse Events in Hispanic Women Residents in Spain. Nutrients 2020; 12:nu12113505. [PMID: 33202607 PMCID: PMC7696021 DOI: 10.3390/nu12113505] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is the most frequent morbidity found in pregnancy, and it increases the risk for several maternal-fetal complications. Hispanic women are considered at high risk. The St. Carlos GDM prevention study is a randomized controlled trial (RCT) conducted from 2016–2017. Normoglycemic women were randomized at 12–14 Gestation week (WG) to an intervention group (IG) receiving recommendations based on the MedDiet (supplemented with ExtraVirgin Olive Oil/pistachios), or to a control group (CG), recommended to limit fat intake. After RCT conclusion, IG recommendations were applied to a real-world group (RW) in routine clinical practice. The primary endpoint of the current study is an assessment of the GDM rate in Hispanic participants of the aforementioned studies: 132 RCT, 128 CT, 284 RW participants. The GDM rate was lower in IG: 19/128(14.8%), p = 0.021, and RW: 38/284(13.4%), p = 0.029) than in CG: 34/132(25.8%). Adjusted RR (95%CI) for GDM: 0.72 (0.50–0.97), p = 0.037 in IG and 0.77 (0.61–0.97), p = 0.008 in RW. Rates of urinary tract infections, emergency caesarean-sections and perineal trauma were also lower in IG and RW. Other adverse outcomes were lower in IG vs. CG. In conclusion, a MedDiet-based intervention reduces the rate of GDM and several adverse maternal-fetal outcomes in Hispanic women residing in Spain.
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Affiliation(s)
- Verónica Melero
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
| | - Nuria García de la Torre
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), E 28040 Madrid, Spain
| | - Carla Assaf-Balut
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
| | - Inés Jiménez
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
| | - Laura del Valle
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
| | - Alejandra Durán
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
- Medicina 2 Department, Facultad de Medicina, Universidad Complutense de Madrid, E 28040 Madrid, Spain; (M.A.H.); (N.I.)
| | - Elena Bordiú
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
- Medicina 2 Department, Facultad de Medicina, Universidad Complutense de Madrid, E 28040 Madrid, Spain; (M.A.H.); (N.I.)
| | - Johanna J. Valerio
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
- Medicina 2 Department, Facultad de Medicina, Universidad Complutense de Madrid, E 28040 Madrid, Spain; (M.A.H.); (N.I.)
| | - Miguel A Herraiz
- Medicina 2 Department, Facultad de Medicina, Universidad Complutense de Madrid, E 28040 Madrid, Spain; (M.A.H.); (N.I.)
- Gynecology and Obstetrics Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain
| | - Nuria Izquierdo
- Medicina 2 Department, Facultad de Medicina, Universidad Complutense de Madrid, E 28040 Madrid, Spain; (M.A.H.); (N.I.)
- Clinical Laboratory Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain;
| | - Maria José Torrejón
- Clinical Laboratory Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain;
| | - Isabelle Runkle
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
- Medicina 2 Department, Facultad de Medicina, Universidad Complutense de Madrid, E 28040 Madrid, Spain; (M.A.H.); (N.I.)
| | - Ana Barabash
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), E 28040 Madrid, Spain
| | - Miguel A Rubio
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
- Medicina 2 Department, Facultad de Medicina, Universidad Complutense de Madrid, E 28040 Madrid, Spain; (M.A.H.); (N.I.)
| | - Alfonso L Calle-Pascual
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), E 28040 Madrid, Spain
- Medicina 2 Department, Facultad de Medicina, Universidad Complutense de Madrid, E 28040 Madrid, Spain; (M.A.H.); (N.I.)
- Correspondence: ; Tel.: +34-91-330-3281; Fax: +34-91-330-3240
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Melero V, Assaf-Balut C, García de la Torre N, Jiménez I, Bordiú E, del Valle L, Valerio J, Familiar C, Durán A, Runkle I, de Miguel MP, Montañez C, Barabash A, Cuesta M, Herraiz MA, Izquierdo N, Rubio MA, Calle-Pascual AL. Benefits of Adhering to a Mediterranean Diet Supplemented with Extra Virgin Olive Oil and Pistachios in Pregnancy on the Health of Offspring at 2 Years of Age. Results of the San Carlos Gestational Diabetes Mellitus Prevention Study. J Clin Med 2020; 9:jcm9051454. [PMID: 32414066 PMCID: PMC7290358 DOI: 10.3390/jcm9051454] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022] Open
Abstract
The intrauterine environment may be related to the future development of chronic diseases in the offspring. The St. Carlos gestational diabetes mellitus (GDM) prevention study, is a randomized controlled trial that evaluated the influence of the early (before 12th gestational week) Mediterranean diet (MedDiet) on the onset of GDM and adverse gestational outcomes. Out of 874 women assessed after delivery (440 control group (CG)/434 intervention group (IG)), 703 children were followed (365/338; CG/IG), with the aim to assess whether the adherence to a MedDiet during pregnancy induces health benefits for the offspring during the first two years of life. Logistic regression analysis showed that the IG in children of mothers with pre-gestational body mass index (BMI) < 25 kg/m2 and normal glucose tolerance (NGT), was associated with a lower risk (RR(95% CI)) of suffering from severe events requiring hospitalization due to bronchiolitis/asthma (0.75(0.58–0.98) and 0.77(0.59–0.99), respectively) or other diseases that required either antibiotic (0.80(0.65–0.98) and 0.80(0.65–0.99), respectively), corticosteroid treatment (0.73(0.59–0.90) and 0.79(0.62–1.00) respectively) or both (all p < 0.05). A nutritional intervention based on the MedDiet during pregnancy is associated with a reduction in offspring’s hospital admissions, especially in women with pre-gestational BMI < 25 kg/m2 and NGT.
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Affiliation(s)
- Verónica Melero
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (C.A.-B.); (N.G.d.l.T.); (I.J.); (E.B.); (L.d.V.); (J.V.); (C.F.); (A.D.); (I.R.); (M.P.d.M.); (C.M.); (A.B.); (M.C.); (M.A.R.)
- Facultad de Medicina. Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.A.H.); (N.I.)
| | - Carla Assaf-Balut
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (C.A.-B.); (N.G.d.l.T.); (I.J.); (E.B.); (L.d.V.); (J.V.); (C.F.); (A.D.); (I.R.); (M.P.d.M.); (C.M.); (A.B.); (M.C.); (M.A.R.)
- Facultad de Medicina. Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.A.H.); (N.I.)
| | - Nuria García de la Torre
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (C.A.-B.); (N.G.d.l.T.); (I.J.); (E.B.); (L.d.V.); (J.V.); (C.F.); (A.D.); (I.R.); (M.P.d.M.); (C.M.); (A.B.); (M.C.); (M.A.R.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Inés Jiménez
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (C.A.-B.); (N.G.d.l.T.); (I.J.); (E.B.); (L.d.V.); (J.V.); (C.F.); (A.D.); (I.R.); (M.P.d.M.); (C.M.); (A.B.); (M.C.); (M.A.R.)
| | - Elena Bordiú
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (C.A.-B.); (N.G.d.l.T.); (I.J.); (E.B.); (L.d.V.); (J.V.); (C.F.); (A.D.); (I.R.); (M.P.d.M.); (C.M.); (A.B.); (M.C.); (M.A.R.)
- Facultad de Medicina. Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.A.H.); (N.I.)
| | - Laura del Valle
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (C.A.-B.); (N.G.d.l.T.); (I.J.); (E.B.); (L.d.V.); (J.V.); (C.F.); (A.D.); (I.R.); (M.P.d.M.); (C.M.); (A.B.); (M.C.); (M.A.R.)
| | - Johanna Valerio
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (C.A.-B.); (N.G.d.l.T.); (I.J.); (E.B.); (L.d.V.); (J.V.); (C.F.); (A.D.); (I.R.); (M.P.d.M.); (C.M.); (A.B.); (M.C.); (M.A.R.)
| | - Cristina Familiar
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (C.A.-B.); (N.G.d.l.T.); (I.J.); (E.B.); (L.d.V.); (J.V.); (C.F.); (A.D.); (I.R.); (M.P.d.M.); (C.M.); (A.B.); (M.C.); (M.A.R.)
| | - Alejandra Durán
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (C.A.-B.); (N.G.d.l.T.); (I.J.); (E.B.); (L.d.V.); (J.V.); (C.F.); (A.D.); (I.R.); (M.P.d.M.); (C.M.); (A.B.); (M.C.); (M.A.R.)
- Facultad de Medicina. Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.A.H.); (N.I.)
| | - Isabelle Runkle
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (C.A.-B.); (N.G.d.l.T.); (I.J.); (E.B.); (L.d.V.); (J.V.); (C.F.); (A.D.); (I.R.); (M.P.d.M.); (C.M.); (A.B.); (M.C.); (M.A.R.)
- Facultad de Medicina. Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.A.H.); (N.I.)
| | - María Paz de Miguel
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (C.A.-B.); (N.G.d.l.T.); (I.J.); (E.B.); (L.d.V.); (J.V.); (C.F.); (A.D.); (I.R.); (M.P.d.M.); (C.M.); (A.B.); (M.C.); (M.A.R.)
- Facultad de Medicina. Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.A.H.); (N.I.)
| | - Carmen Montañez
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (C.A.-B.); (N.G.d.l.T.); (I.J.); (E.B.); (L.d.V.); (J.V.); (C.F.); (A.D.); (I.R.); (M.P.d.M.); (C.M.); (A.B.); (M.C.); (M.A.R.)
| | - Ana Barabash
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (C.A.-B.); (N.G.d.l.T.); (I.J.); (E.B.); (L.d.V.); (J.V.); (C.F.); (A.D.); (I.R.); (M.P.d.M.); (C.M.); (A.B.); (M.C.); (M.A.R.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Martín Cuesta
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (C.A.-B.); (N.G.d.l.T.); (I.J.); (E.B.); (L.d.V.); (J.V.); (C.F.); (A.D.); (I.R.); (M.P.d.M.); (C.M.); (A.B.); (M.C.); (M.A.R.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Miguel A. Herraiz
- Facultad de Medicina. Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.A.H.); (N.I.)
- Gynecology and Obstetrics Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Nuria Izquierdo
- Facultad de Medicina. Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.A.H.); (N.I.)
- Gynecology and Obstetrics Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Miguel A. Rubio
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (C.A.-B.); (N.G.d.l.T.); (I.J.); (E.B.); (L.d.V.); (J.V.); (C.F.); (A.D.); (I.R.); (M.P.d.M.); (C.M.); (A.B.); (M.C.); (M.A.R.)
- Facultad de Medicina. Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.A.H.); (N.I.)
| | - Alfonso L. Calle-Pascual
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (C.A.-B.); (N.G.d.l.T.); (I.J.); (E.B.); (L.d.V.); (J.V.); (C.F.); (A.D.); (I.R.); (M.P.d.M.); (C.M.); (A.B.); (M.C.); (M.A.R.)
- Facultad de Medicina. Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.A.H.); (N.I.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
- Correspondence:
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Assaf-Balut C, García de la Torre N, Calle-Pascual AL, Calle-Pascual AL, Torre NGDL, Durán A, Jiménez I, Rubio MÁ, Herraíz MÁ, Izquierdo N, Pérez N, Garcia AS, Dominguez GC, Torrejón MJ, Cuadrado MÁ, Assaf-Balut C, Del Valle L, Bordiú E, Valerio J, Barabash A, Orta MS, Parayuelo MVSD, Muñoz LF, Calzada F. Detection, treatment and prevention programs for gestational diabetes mellitus: The St Carlos experience. ACTA ACUST UNITED AC 2019; 67:342-350. [PMID: 31519528 DOI: 10.1016/j.endinu.2019.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 01/15/2023]
Abstract
Gestational diabetes mellitus (GDM) increases the risk of adverse events in pregnancy and jeopardizes long-term health of the mother and offspring. There is currently no consensus as to what screening strategies improve the efficiency of GDM diagnosis. Which criteria should be used? Is the one-step or two-step procedure better? There is no agreement as to what the best dietary approach in the treatment of GDM is. In addition, different nutritional interventions have been studied in the prevention of GDM. The Mediterranean diet seems to be effective in preventing GDM and other maternofoetal outcomes. We review herein our experience using the one-step criteria for GDM screening; the treatment and prevention strategies used; and the overall impact of nutrition on maternofoetal health.
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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; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Nuria García 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
| | - Alfonso L Calle-Pascual
- 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; Departamento de Medicina II, Facultad de Medicina, Universidad Complutense de Madrid, Spain.
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6
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de la Torre NG, Assaf-Balut C, Jiménez Varas I, Del Valle L, Durán A, Fuentes M, Del Prado N, Bordiú E, Valerio JJ, Herraiz MA, Izquierdo N, Torrejón MJ, Cuadrado MA, de Miguel P, Familiar C, Runkle I, Barabash A, Rubio MA, Calle-Pascual AL. Effectiveness of Following Mediterranean Diet Recommendations in the Real World in the Incidence of Gestational Diabetes Mellitus (GDM) and Adverse Maternal-Foetal Outcomes: A Prospective, Universal, Interventional Study with a Single Group. The St Carlos Study. Nutrients 2019; 11:E1210. [PMID: 31141972 PMCID: PMC6627921 DOI: 10.3390/nu11061210] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/18/2019] [Accepted: 05/24/2019] [Indexed: 12/11/2022] Open
Abstract
We reported that a Mediterranean Diet (MedDiet), supplemented with extra-virgin olive oil (EVOO) and pistachios, reduces GDM incidence and several other adverse outcomes. In order to assess its translational effects in the real world we evaluated the effect of MedDiet from 1st gestational visit in GDM rate compared with control (CG) and intervention (IG) groups from the previously referred trial. As secondary objective we also compared adverse perinatal outcomes between normoglycemic and diabetic women. This trial is a prospective, clinic-based, interventional study with a single group. 1066 eligible normoglycaemic women before 12 gestational weeks were assessed. 932 women (32.4 ± 5.2 years old, pre-gestational BMI 22.5 ± 3.5 kg/m2) received a motivational lifestyle interview with emphasis on daily consumption of EVOO and nuts, were followed-up and analysed. Binary regression analyses were used to examine the risk for each pregnancy outcome, pregnancy-induced hypertension, preeclampsia, gestational weight gain (GWG), caesarean-section, perineal trauma, preterm delivery, small (SGA) and large for gestational age (LGA), and Neonatal Intensive Care Unit admissions. GDM was diagnosed in 13.9%. This rate was significantly lower than the CG: RR 0.81 (0.73-0.93), p < 0.001 and no different from the IG: RR 0.96 (0.85-1.07), p = 0.468. GWG was lower in diabetic women (10.88 ± 6.46 vs. 12.30 ± 5.42 Kg; p = 0.013). Excessive weight gain (EWG) was also lower in GDM [RR 0.91 (0.86-0.96); p < 0.001] without a significant increase of insufficient weight gain. LGA were also lower (1 (0.8%) vs. 31 (3.9%); p < 0.05)), and SGA were similar (5 (3.8%) vs. 30 (3.7%)). LGA were associated to EWG (RR 1.61 (1.35-1.91), p < 0.001). Differences in other maternal-foetal outcomes were not found. In conclusions an early MedDiet nutritional intervention reduces GDM incidence and maternal-foetal adverse outcomes and should be universally applied as 1st line therapy. GDM might not be consider as a high risk pregnancy any longer.
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Affiliation(s)
- Nuria García de la Torre
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28040 Madrid, Spain.
| | - Carla Assaf-Balut
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain.
| | - Inés Jiménez Varas
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
| | - Laura Del Valle
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
| | - Alejandra Durán
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain.
| | - Manuel Fuentes
- Preventive Medicine Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
| | - Náyade Del Prado
- Preventive Medicine Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
| | - Elena Bordiú
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain.
| | - Johanna Josefina Valerio
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain.
| | - Miguel A Herraiz
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain.
- Gynecology and Obstetrics Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
| | - Nuria Izquierdo
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain.
- Gynecology and Obstetrics Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
| | - Maria José Torrejón
- Clinical Laboratory Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
| | - Maria Angeles Cuadrado
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain.
- Clinical Laboratory Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
| | - Paz de Miguel
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain.
| | - Cristina Familiar
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
| | - Isabelle Runkle
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain.
| | - Ana Barabash
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28040 Madrid, Spain.
| | - Miguel A Rubio
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain.
| | - Alfonso L Calle-Pascual
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28040 Madrid, Spain.
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain.
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Assaf-Balut C, García de la Torre N, Duran A, Fuentes M, Bordiú E, Del Valle L, Familiar C, Valerio J, Jiménez I, Herraiz MA, Izquierdo N, Torrejon MJ, Cuadrado MÁ, Ortega I, Illana FJ, Runkle I, de Miguel P, Moraga I, Montañez C, Barabash A, Cuesta M, Rubio MA, Calle-Pascual AL. A Mediterranean Diet with an Enhanced Consumption of Extra Virgin Olive Oil and Pistachios Improves Pregnancy Outcomes in Women Without Gestational Diabetes Mellitus: A Sub-Analysis of the St. Carlos Gestational Diabetes Mellitus Prevention Study. Ann Nutr Metab 2018; 74:69-79. [PMID: 30554220 DOI: 10.1159/000495793] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/26/2018] [Indexed: 12/20/2022]
Abstract
AIMS The aim of the study was to evaluate the effect of a Mediterranean diet (MedDiet), enhanced with extra virgin olive oil (EVOO) and nuts, on a composite of adverse maternofoetal outcomes of women with normoglycemia during pregnancy. METHODS This was a sub-analysis of the St Carlos gestational diabetes mellitus Prevention Study. Only normoglycemic women were analysed (697). They were randomized (at 8-12th gestational weeks) to: standard-care control group (337), where fat consumption was limited to 30% of total caloric intake; or intervention group (360), where a MedDiet, enhanced with EVOO and pistachios (40-42% fats of total caloric intake) was recommended. The primary outcome was a composite of maternofoetal outcomes (CMFOs): at least having 1 event of emergency C-section, perineal trauma, pregnancy-induced hypertension and preeclampsia, prematurity, large-for-gestational-age and small-for gestational-age. RESULTS Crude relative risk showed that the intervention was associated with a significant reduction in the risk of CMFOs (0.48 [0.37-0.63]; p = 0.0001), with a number-needed-to-treat = 5. Risk of urinary tract infections, emergency C-sections, perineal trauma, large-for-gestational-age and small-for gestational age new-borns were also significantly reduced. CONCLUSION A MedDiet, enhanced with EVOO and nuts, was associated with a risk reduction of CMFOs in over 50% in normoglycemic pregnant women. Therefore, it might be a potentially adequate diet for pregnant women. TRIAL REGISTRATION Identifier ISRCTN84389045. The study was registered on September 27, 2013. Last edited on September 26, 2018.
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Affiliation(s)
- Carla Assaf-Balut
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario 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 García de la Torre
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario 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 Duran
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario 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
- Department of Preventive Medicine, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Elena Bordiú
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario 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
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Cristina Familiar
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Johanna Valerio
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Inés Jiménez
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Miguel A Herraiz
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.,Department of Gynecology and Obstetrics, 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.,Department of Gynecology and Obstetrics, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - María J Torrejon
- Department of Clinical Laboratory, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Maria Ángeles Cuadrado
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.,Department of Clinical Laboratory, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Isabel Ortega
- Department of Clinical Laboratory, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Francisco J Illana
- Department of Clinical Laboratory, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Isabelle Runkle
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Paz de Miguel
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario 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
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Carmen Montañez
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ana Barabash
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario 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
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario 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
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario 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 L Calle-Pascual
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario 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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8
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Assaf-Balut C, García de la Torre N, Durán A, Fuentes M, Bordiú E, del Valle L, Familiar C, Ortolá A, Jiménez I, Herraiz MA, Izquierdo N, Perez N, Torrejon MJ, Ortega MI, Illana FJ, Runkle I, de Miguel MP, Montañez C, Barabash A, Cuesta M, Rubio MA, Calle-Pascual AL. A Mediterranean diet with additional extra virgin olive oil and pistachios reduces the incidence of gestational diabetes mellitus (GDM): A randomized controlled trial: The St. Carlos GDM prevention study. PLoS One 2017; 12:e0185873. [PMID: 29049303 PMCID: PMC5648128 DOI: 10.1371/journal.pone.0185873] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/20/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) prevalence is increasing and becoming a major public health concern. Whether a Mediterranean diet can help prevent GDM in unselected pregnant women has yet to be studied. METHODS We conducted a prospective, randomized controlled trial to evaluate the incidence of GDM with two different dietary models. All consecutive normoglycemic (<92 mg/dL) pregnant women at 8-12 gestational weeks (GW) were assigned to Intervention Group (IG, n = 500): MedDiet supplemented with extra virgin olive oil (EVOO) and pistachios; or Control Group (CG, n = 500): standard diet with limited fat intake. Primary outcome was to assess the effect of the intervention on GDM incidence at 24-28 GW. Gestational weight gain (GWG), pregnancy-induced hypertension, caesarean section (CS), preterm delivery, perineal trauma, small and large for gestational age (SGA and LGA) and admissions to neonatal intensive care unit were also assessed. Analysis was by intention-to-treat. RESULTS A total of 874 women completed the study (440/434, CG/IG). According to nutritional questionnaires and biomarker analysis, women in the IG had a good adherence to the intervention. 177/874 women were diagnosed with GDM, 103/440 (23.4%) in CG and 74/434(17.1%) in IG, p = 0.012. The crude relative risk (RR) for GDM was 0.73 (95% CI: 0.56-0.95; p = 0.020) IG vs CG and persisted after adjusted multivariable analysis, 0.75(95% CI: 0.57-0.98; p = 0.039). IG had also significantly reduced rates of insulin-treated GDM, prematurity, GWG at 24-28 and 36-38 GW, emergency CS, perineal trauma, and SGA and LGA newborns (all p<0.05). CONCLUSIONS An early nutritional intervention with a supplemented MedDiet reduces the incidence of GDM and improves several maternal and neonatal outcomes.
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Affiliation(s)
- Carla Assaf-Balut
- Endocrinology and Nutrition Department, Hospital Clínico Universitario 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 García de la Torre
- Endocrinology and Nutrition Department, Hospital Clínico Universitario 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 Universitario 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 Universitario 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 Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Cristina Familiar
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ana Ortolá
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Inés Jiménez
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Miguel A. 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
| | - Noelia Perez
- Gynecology and Obstetrics Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - María J. Torrejon
- Clinical Laboratory Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - María I. Ortega
- Clinical Laboratory Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Francisco J. Illana
- 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 Universitario 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 P. de Miguel
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Carmen Montañez
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ana Barabash
- Endocrinology and Nutrition Department, Hospital Clínico Universitario 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 Universitario 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 Universitario 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 L. Calle-Pascual
- Endocrinology and Nutrition Department, Hospital Clínico Universitario 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
- * E-mail:
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9
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Assaf-Balut C, García de la Torre N, Rubio MA, Bordiú E, Calle-Pascual AL. Change in postpartum insulin resistance syndrome in women with prior GDM identified by Carpenter-Coustan and IADPSG criteria. ACTA ACUST UNITED AC 2017; 64:400-403. [PMID: 28968222 DOI: 10.1016/j.endinu.2017.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/24/2017] [Accepted: 04/29/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Carla Assaf-Balut
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Nuria García de la Torre
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain
| | - Miguel A Rubio
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Elena Bordiú
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Alfonso L Calle-Pascual
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain.
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10
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Assaf-Balut C, Familiar C, García de la Torre N, Rubio MA, Bordiú E, del Valle L, Lara M, Ruiz T, Ortolá A, Crespo I, Duran A, Herraiz MA, Izquierdo N, Perez N, Torrejon MJ, Runkle I, Montañez C, Calle-Pascual AL. Gestational diabetes mellitus treatment reduces obesity-induced adverse pregnancy and neonatal outcomes: the St. Carlos gestational study. BMJ Open Diabetes Res Care 2016; 4:e000314. [PMID: 28074143 PMCID: PMC5220275 DOI: 10.1136/bmjdrc-2016-000314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 09/23/2016] [Accepted: 10/19/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Obesity and gestational diabetes mellitus (GDM) increase the morbidity of the mother and newborn, which could increase further should they coexist. We aimed to determine the risk of adverse pregnancy and neonatal outcomes associated with excess weight (EW), and within this group identify potential differences between those with and without GDM. METHODS We carried out a post-hoc analysis of the St. Carlos Gestational Study which included 3312 pregnant women, arranged in 3 groups: normal-weight women (NWw) (2398/72.4%), overweight women (OWw) (649/19.6%) and obese women (OBw) (265/8%). OWw and OBw were grouped as EW women (EWw). We analyzed variables related to adverse pregnancy and neonatal outcomes. RESULTS The relative risk (95% CI) for GDM was 1.82 (1.47 to 2.25; p<0.0001) for OWw, and 3.26 (2.45 to 4.35; p<0.0001) in OBw. Univariate analysis showed associations of EW to higher rates of prematurity, birth weight >90th centile, newborns admitted to neonatal intensive care unit (NICU), instrumental delivery and cesarean delivery (all p<0.005). Multivariate analysis, adjusted for parity and ethnicity, showed that EW increased the risk of prematurity, admission to NICU, cesarean and instrumental delivery, especially in EWw without GDM. NWw with GDM had a significantly lower risk of admission to NICU and cesarean delivery, compared with NWw without GDM. CONCLUSIONS EW is detrimental for pregnancy and neonatal outcomes, and treatment of GDM contributes to lowering the risk in EWw and NWw. Applying the same lifestyle changes to all pregnant women, independent of their weight or GDM condition, could improve these outcomes.
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Affiliation(s)
- Carla Assaf-Balut
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Cristina Familiar
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Miguel A Rubio
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain
| | - Elena Bordiú
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain
| | - Laura del Valle
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Miriam Lara
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Teresa Ruiz
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Ana Ortolá
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Irene Crespo
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Alejandra Duran
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain
| | - Miguel A Herraiz
- Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain
- Gynecology and Obstetrics Department, Madrid, Spain
| | - Nuria Izquierdo
- Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain
- Gynecology and Obstetrics Department, Madrid, Spain
| | - Noelia Perez
- Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain
- Gynecology and Obstetrics Department, Madrid, Spain
| | - Maria J Torrejon
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
- Clinical Laboratory Department, Madrid, Spain
| | - Isabelle Runkle
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain
| | - Carmen Montañez
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Alfonso L Calle-Pascual
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain
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11
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García de la Torre N, Fernández-Durango R, Gómez R, Fuentes M, Roldán-Pallarés M, Donate J, Barabash A, Alonso B, Runkle I, Durán A, Rubio MA, Calle-Pascual AL. Expression of Angiogenic MicroRNAs in Endothelial Progenitor Cells From Type 1 Diabetic Patients With and Without Diabetic Retinopathy. Invest Ophthalmol Vis Sci 2015; 56:4090-8. [PMID: 26114486 DOI: 10.1167/iovs.15-16498] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE MicroRNA (miR) expression in endothelial progenitor cells (EPCs) in type 1 diabetes (DM1) and its relation with different stages of diabetic retinopathy (DR) have not been reported to date. Our aim was to analyze miR-222, miR-221, and miR-126 expression in EPCs from DM1 patients with and without DR. METHODS We included 41 patients with DR, 35 without DR, and 38 controls. Blood was collected for flow cytometry and EPC culture. Total RNA was extracted and purified and real-time quantitative PCR was performed for miR expression in cultured EPCs. Relative changes in miR expression were analyzed with the 2-ΔΔCT method. RESULTS Circulating EPCs were reduced and miR-126 expression was increased in DM1 compared to controls (0.030 [interquartile range [IQR], 0.020-0.050] vs. 0.060 [IQR, 0.030-0.110], P = 0.004; 1.740 [IQR, 0.890-4.120] vs. 0.990 [IQR, 0.487-3.015], P = 0.047 respectively) without differences between patients with and without DR. Patients with DR had higher expression of miR-221 than those without DR (1.405 [IQR, 0.820-2.867] vs. 0.915 [IQR, 0.507-1.292], P = 0.019) without differences among degrees of DR. Circulating EPCs were reduced in patients on statins (0.010 [IQR, 0.010-0.050] vs. 0.045 [IQR, 0.020-0.087], P = 0.008), and miR-221 expression increased in patients on angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blocker (ARB) II (1.430 [IQR, 1.160-2.705] vs. 1.000 [IQR, 0.520-1.330], P = 0.021) compared to those without treatment. MicroRNA-126 expression was associated with body mass index (BMI; ρ = -0.267, P = 0.026) and diastolic blood pressure (ρ = -0.267, P = 0.034). MicroRNA-221 was associated with triglyceride concentration (ρ = 0.296, P = 0.012). CONCLUSIONS Circulating EPCs were reduced and miR-126 expression was increased in DM1 compared to controls. Patients with DR had higher expression of miR-221 than those without DR. The identification of biomarkers of diabetic complications might be useful for monitoring disease progression and potential therapeutic targets.
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Affiliation(s)
- Nuria García de la Torre
- Department of Endocrinology Diabetes and Nutrition, Instituto de Investigación Sanitaria San Carlos (IdISSC) Hospital Clínico San Carlos, Madrid, Spain
| | - Raquel Fernández-Durango
- Research Unit, Department of Internal Medicine, IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | - Raquel Gómez
- Department of Endocrinology Diabetes and Nutrition, Instituto de Investigación Sanitaria San Carlos (IdISSC) Hospital Clínico San Carlos, Madrid, Spain
| | - Manuel Fuentes
- Department of Preventive Medicine, IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | - Manuela Roldán-Pallarés
- Department of Ophthalmology, IdISSC, Complutense University and Hospital Clinico San Carlos, Madrid, Spain
| | - Juan Donate
- Department of Ophthalmology, IdISSC, Complutense University and Hospital Clinico San Carlos, Madrid, Spain
| | - Ana Barabash
- Department of Endocrinology Diabetes and Nutrition, Instituto de Investigación Sanitaria San Carlos (IdISSC) Hospital Clínico San Carlos, Madrid, Spain
| | - Bárbara Alonso
- Department of Endocrinology Diabetes and Nutrition, Instituto de Investigación Sanitaria San Carlos (IdISSC) Hospital Clínico San Carlos, Madrid, Spain
| | - Isabelle Runkle
- Department of Endocrinology Diabetes and Nutrition, Instituto de Investigación Sanitaria San Carlos (IdISSC) Hospital Clínico San Carlos, Madrid, Spain
| | - Alejandra Durán
- Department of Endocrinology Diabetes and Nutrition, Instituto de Investigación Sanitaria San Carlos (IdISSC) Hospital Clínico San Carlos, Madrid, Spain
| | - Miguel Angel Rubio
- Department of Endocrinology Diabetes and Nutrition, Instituto de Investigación Sanitaria San Carlos (IdISSC) Hospital Clínico San Carlos, Madrid, Spain
| | - Alfonso L Calle-Pascual
- Department of Endocrinology Diabetes and Nutrition, Instituto de Investigación Sanitaria San Carlos (IdISSC) Hospital Clínico San Carlos, Madrid, Spain
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12
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Ruiz-Gracia T, Duran A, Fuentes M, Rubio MA, Runkle I, Carrera EF, Torrejón MJ, Bordiú E, Valle LD, García de la Torre N, Bedia AR, Montañez C, Familiar C, Calle-Pascual AL. Lifestyle patterns in early pregnancy linked to gestational diabetes mellitus diagnoses when using IADPSG criteria. The St Carlos gestational study. Clin Nutr 2015; 35:699-705. [PMID: 25998584 DOI: 10.1016/j.clnu.2015.04.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 01/27/2023]
Abstract
UNLABELLED Early-pregnancy lifestyle (EPL) could influence the development of gestational diabetes mellitus(GDM), depending on the diagnostic criteria used. OBJECTIVE We studied EPL in 1750 pregnant women using Carpenter-Coustan criteria(CCc), and in 1526 with the International Association of Diabetes and Pregnancy Study Groups criteria(IADPSGc). METHODS GDM risk factors were assessed in women between 24 and 28 weeks of gestational age during two consecutive years. A semiquantitative frequent-food-consumption questionnaire was used to evaluate lifestyle during pregnancy. Multiple logistic regression analysis was conducted to assess GDM risk with different lifestyle patterns. RESULTS Using IADPSGc, the GDM ORs (95%CI) for intake/week were: nuts >3 times: 0.59 (0.39-0.91; p < 0.015), refined cereals ≤1 serving: 0.72(0.58-0.89; p < 0.003), juices <4 servings: 0.77 (0.62-0.95; p < 0.017), cookies and pastries <4 servings: 0.71(0.57-0.89; p < 0.003) as compared to opposite habits. No significant nutritional patterns were found to be significant using CCc. The OR (95%CI) for GDM with none of the four risk patterns as compared to having three-four risk factors was 0.21(0.07-0.62; p < 0.005), remaining significant after stratification by BMI, age, obstetric events, parity and family history. The multiple logistic regression model including nutritional categories and pregestational BMI, age, obstetric history, parity, personal/family history, had an area under the curve(AUC) of the receiver operating curve(ROC) for the probability to predict GDM of 0.66 (CI 95%: 0.63-0.69; p < 0.001). CONCLUSION Our study is the first to identify four early-pregnancy nutritional patterns associated with the GDM when using IADPSGc. Adherence to a low-risk nutritional pattern from early pregnancy on could be an effective strategy for GDM prevention.
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Affiliation(s)
| | - Alejandra Duran
- Endocrinology and Nutrition Department, Spain; Facultad de Medicina, Departamento de Medicina, Universidad Complutense de Madrid, Spain
| | | | - Miguel A Rubio
- Endocrinology and Nutrition Department, Spain; Facultad de Medicina, Departamento de Medicina, Universidad Complutense de Madrid, Spain
| | - Isabelle Runkle
- Endocrinology and Nutrition Department, Spain; Facultad de Medicina, Departamento de Medicina, Universidad Complutense de Madrid, Spain
| | | | - María J Torrejón
- Clinical Laboratory Department, Hospital Clínico San Carlos-IdISSC, Madrid, Spain
| | - Elena Bordiú
- Endocrinology and Nutrition Department, Spain; Facultad de Medicina, Departamento de Medicina, Universidad Complutense de Madrid, Spain
| | | | | | - Ana R Bedia
- Clinical Laboratory Department, Hospital Clínico San Carlos-IdISSC, Madrid, Spain
| | | | | | - Alfonso L Calle-Pascual
- Endocrinology and Nutrition Department, Spain; Facultad de Medicina, Departamento de Medicina, Universidad Complutense de Madrid, Spain.
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13
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Durán A, Runkle I, Rubio MA, García de la Torre N, Calle-Pascual AL. Response to comment on Duran et al. Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women: the St. Carlos Gestational Diabetes Study. Diabetes Care 2014;37:2442-2450. Diabetes Care 2015; 38:e69-70. [PMID: 25805880 DOI: 10.2337/dc15-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Alejandra Durán
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain
| | - Isabelle Runkle
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain
| | - Miguel A Rubio
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain
| | - Nuria García de la Torre
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Alfonso L Calle-Pascual
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain
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14
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Duran A, Sáenz S, Torrejón MJ, Bordiú E, Del Valle L, Galindo M, Perez N, Herraiz MA, Izquierdo N, Rubio MA, Runkle I, Pérez-Ferre N, Cusihuallpa I, Jiménez S, García de la Torre N, Fernández MD, Montañez C, Familiar C, Calle-Pascual AL. Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women: the St. Carlos Gestational Diabetes Study. Diabetes Care 2014; 37:2442-50. [PMID: 24947793 DOI: 10.2337/dc14-0179] [Citation(s) in RCA: 222] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The use of the new International Association of the Diabetes and Pregnancy Study Groups criteria (IADPSGC) for the diagnosis of gestational diabetes mellitus (GDM) results in an increased prevalence of GDM. Whether their introduction improves pregnancy outcomes has yet to be established. We sought to evaluate the cost-effectiveness of one-step IADPSGC for screening and diagnosis of GDM compared with traditional two-step Carpenter-Coustan (CC) criteria. RESEARCH DESIGN AND METHODS GDM risk factors and pregnancy and newborn outcomes were prospectively assessed in 1,750 pregnant women from April 2011 to March 2012 using CC and in 1,526 pregnant women from April 2012 to March 2013 using IADPSGC between 24 and 28 weeks of gestation. Both groups received the same treatment and follow-up regimes. RESULTS The use of IADPSGC resulted in an important increase in GDM rate (35.5% vs. 10.6%) and an improvement in pregnancy outcomes, with a decrease in the rate of gestational hypertension (4.1 to 3.5%: -14.6%, P < 0.021), prematurity (6.4 to 5.7%: -10.9%, P < 0.039), cesarean section (25.4 to 19.7%: -23.9%, P < 0.002), small for gestational age (7.7 to 7.1%: -6.5%, P < 0.042), large for gestational age (4.6 to 3.7%: -20%, P < 0.004), Apgar 1-min score <7 (3.8 to 3.5%: -9%, P < 0.015), and admission to neonatal intensive care unit (8.2 to 6.2%: -24.4%, P < 0.001). Estimated cost savings was of €14,358.06 per 100 women evaluated using IADPSGC versus the group diagnosed using CC. CONCLUSIONS The application of the new IADPSGC was associated with a 3.5-fold increase in GDM prevalence in our study population, as well as significant improvements in pregnancy outcomes, and was cost-effective. Our results support their adoption.
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Affiliation(s)
- Alejandra Duran
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Sofía Sáenz
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain
| | - María J Torrejón
- Clinical Laboratory Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Elena Bordiú
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Laura Del Valle
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Mercedes Galindo
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Noelia Perez
- Gynecology and Obstetrician Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Miguel A Herraiz
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain Gynecology and Obstetrician Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Nuria Izquierdo
- Gynecology and Obstetrician Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Miguel A Rubio
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Isabelle Runkle
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Natalia Pérez-Ferre
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Idalia Cusihuallpa
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Sandra Jiménez
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain
| | | | - María D Fernández
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Carmen Montañez
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Cristina Familiar
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Alfonso L Calle-Pascual
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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15
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García de la Torre N, Durán A, Del Valle L, Fuentes M, Barca I, Martín P, Montañez C, Perez-Ferre N, Abad R, Sanz F, Galindo M, Rubio MA, Calle-Pascual AL. Early management of type 2 diabetes based on a SMBG strategy: the way to diabetes regression--the St Carlos study : a 3-year, prospective, randomized, clinic-based, interventional study with parallel groups. Acta Diabetol 2013; 50:607-14. [PMID: 23532298 DOI: 10.1007/s00592-013-0467-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 03/05/2013] [Indexed: 12/13/2022]
Abstract
The aims are to define the regression rate in newly diagnosed type 2 diabetes after lifestyle intervention and pharmacological therapy based on a SMBG (self-monitoring of blood glucose) strategy in routine practice as compared to standard HbA1c-based treatment and to assess whether a supervised exercise program has additional effects. St Carlos study is a 3-year, prospective, randomized, clinic-based, interventional study with three parallel groups. Hundred and ninety-five patients were randomized to the SMBG intervention group [I group; n = 130; Ia: SMBG (n = 65) and Ib: SMBG + supervised exercise (n = 65)] and to the HbA1c control group (C group) (n = 65). The primary outcome was to estimate the regression rate of type 2 diabetes (HbA1c <6 % on metformin treatment). After 3 years of follow-up, diabetes regression was achieved by 56 patients, 6 (9.2 %) from the C group, 21 (32.3 %) from the Ia group and 29 (44.6 %) from the Ib group. RR (95 % CI) for diabetes regression in the intervention group (Ia + Ib) was 4.5 (2.1-9); p < 0.001 and remained after stratification by gender, age and BMI. This difference was associated with healthier changes in lifestyle and greater weight loss. RR for a weight loss >4 kg was 3.6 (1.8-7); p < 0.001. This study shows that the use of SMBG in an educational program effectively increases the regression rate in newly diagnosed type 2 diabetic patients after 3 years of follow-up. These data suggest that SMBG-based programs should be extended to primary care settings where diabetic patients are usually attended.
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Affiliation(s)
- Nuria García de la Torre
- Endocrinology and Nutrition Department, Hospital Clinico San Carlos-IdISSC, Professor Martin Lagos s/n, 1ª Sur., 28040, Madrid, Spain,
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Lecumberri E, Krekshi W, Matía P, Hermida C, de la Torre NG, Cabrerizo L, Rubio MÁ. Effectiveness and safety of air-filled balloon Heliosphere BAG® in 82 consecutive obese patients. Obes Surg 2012; 21:1508-12. [PMID: 21221835 DOI: 10.1007/s11695-010-0314-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Intragastric balloon is a widely used technique to treat obesity that is considered to be more efficient than conservative treatment before bariatric surgery. To describe air-filled balloon (Heliosphere BAG®) effectiveness [absolute weight loss, body mass index (BMI) loss, percentage of body weight loss (BWL), percentage of excess weight loss (EWL)] and complications 6 months after its insertion. METHODS Eighty-four consecutive intragastric balloons were placed endoscopically. Individualized nutritional counseling was given. The follow-up was carried out in an endocrinology outpatient clinic. Due to the weight or height data missed in two cases, only 82 patients were included in this report, 63 women with a mean age 39 years (SD, 11.1); mean BMI, 39.1 kg/m(2) (SD, 5.8). The median follow-up was 182 days. RESULTS The mean weight loss and BMI loss were 14.5 kg (SD, 8.2); and 5.3 kg/m(2) (SD, 2.8), respectively (for difference, p < 0.001). The mean percentage of BWL was 13.4% (SD, 7.0). Of the sample, 70.4% achieved a percentage of BWL >10%. The percentage of EWL reached 33.2% (SD, 19.2). After adjusting by sex and initial BMI, absolute weight loss (p = 0.033), BMI loss (p = 0.034), percentage of BWL (p = 0.034), and percentage of EWL (p = 0.034) were inversely related to age. Absolute weight loss and BMI loss were greater in higher initial BMI, but the percentage of EWL was lower. Two spontaneous deflations occurred (3%), but only one surgical early removal (1.2%) was required. Nausea and vomiting developed in 7.4% of the patients during the first week. CONCLUSIONS Air-filled Heliosphere BAG® has been effective in achieving a relevant loss of body weight.
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Affiliation(s)
- Edurne Lecumberri
- Endocrinology and Nutrition Department, Fundación Jiménez Díaz-Capio, Avda. Reyes Católicos n 2, Madrid, Spain.
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García de la Torre N, Rubio MA, Bordiú E, Cabrerizo L, Aparicio E, Hernández C, Sánchez-Pernaute A, Díez-Valladares L, Torres AJ, Puente M, Charro AL. Effects of weight loss after bariatric surgery for morbid obesity on vascular endothelial growth factor-A, adipocytokines, and insulin. J Clin Endocrinol Metab 2008; 93:4276-81. [PMID: 18713823 DOI: 10.1210/jc.2007-1370] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Adipocytes regulate blood vessel formation, and in turn endothelial cells promote preadipocyte differentiation through the expression of proangiogenic factors, such as vascular endothelial growth factor (VEGF)-A. Some adipocytokines and hormones also have an effect on vascular development. OBJECTIVES Our objectives were to analyze the relationship between weight and circulating VEGF-A in morbidly obese subjects before and after bariatric surgery, and investigate the relationship between circulating VEGF-A and certain adipocytokines and hormones regulating adipocytes. METHODS A total of 45 morbidly obese women and nine lean females were included in the study. Patients underwent bariatric surgery: vertical banded gastroplasty (n=17), gastric bypass (n=17), and biliopancreatic diversion (n=11). Serum samples for VEGF-A, adiponectin, leptin, ghrelin, and insulin were obtained preoperatively and 9-12 months after surgery. RESULTS Obese patients showed significantly higher VEGF-A levels than controls (306.3+/-170.3 vs. 187.6+/-91.9 pg/ml; P=0.04), decreasing to 246.1+/-160.4 after surgery (P<0.001), with no differences among surgical procedures. In controls there was an inverse correlation between VEGF-A and ghrelin (r=-0.85; P<.01), but not in obese patients. Leptin and insulin concentrations were increased in obese patients, with a significant decrease shown after weight loss with surgery. Conversely, adiponectin concentrations were lower in obese patients, with a significant increase shown after weight loss with surgery. Ghrelin was higher in controls than obese patients, decreasing after gastric bypass and biliopancreatic diversion, but not after vertical banded gastroplasty. CONCLUSION Serum VEGF-A levels are significantly higher in obese patients than in lean controls, decreasing after weight loss with bariatric surgery, behaving similarly to other hormones related to adipose mass like leptin and insulin.
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Affiliation(s)
- Nuria García de la Torre
- Department of Endocrinology, Hospital Clínico Universitario San Carlos, Martín Lagos s/n, 28040 Madrid, Spain.
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