Randomization to a Provided Higher-Complex-Carbohydrate Versus Conventional Diet in Gestational Diabetes Mellitus Results in Similar Newborn Adiposity.

IF 14.8 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Diabetes Care Pub Date : 2023-11-01 DOI:10.2337/dc23-0617
Teri L Hernandez, Sarah S Farabi, Bailey K Fosdick, Nicole Hirsch, Emily Z Dunn, Kristy Rolloff, John P Corbett, Elizabeth Haugen, Tyson Marden, Janine Higgins, Jacob E Friedman, Linda A Barbour
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Abstract

Objective: Nutrition therapy for gestational diabetes mellitus (GDM) has conventionally focused on carbohydrate restriction. In a randomized controlled trial (RCT), we tested the hypothesis that a diet (all meals provided) with liberalized complex carbohydrate (60%) and lower fat (25%) (CHOICE diet) could improve maternal insulin resistance and 24-h glycemia, resulting in reduced newborn adiposity (NB%fat; powered outcome) versus a conventional lower-carbohydrate (40%) and higher-fat (45%) (LC/CONV) diet.

Research design and methods: After diagnosis (at ∼28-30 weeks' gestation), 59 women with diet-controlled GDM (mean ± SEM; BMI 32 ± 1 kg/m2) were randomized to a provided LC/CONV or CHOICE diet (BMI-matched calories) through delivery. At 30-31 and 36-37 weeks of gestation, a 2-h, 75-g oral glucose tolerance test (OGTT) was performed and a continuous glucose monitor (CGM) was worn for 72 h. Cord blood samples were collected at delivery. NB%fat was measured by air displacement plethysmography (13.4 ± 0.4 days).

Results: There were 23 women per group (LC/CONV [214 g/day carbohydrate] and CHOICE [316 g/day carbohydrate]). For LC/CONV and CHOICE, respectively (mean ± SEM), NB%fat (10.1 ± 1 vs. 10.5 ± 1), birth weight (3,303 ± 98 vs. 3,293 ± 81 g), and cord C-peptide levels were not different. Weight gain, physical activity, and gestational age at delivery were similar. At 36-37 weeks of gestation, CGM fasting (86 ± 3 vs. 90 ± 3 mg/dL), 1-h postprandial (119 ± 3 vs. 117 ± 3 mg/dL), 2-h postprandial (106 ± 3 vs. 108 ± 3 mg/dL), percent time in range (%TIR; 92 ± 1 vs. 91 ± 1), and 24-h glucose area under the curve values were similar between diets. The %time >120 mg/dL was statistically higher (8%) in CHOICE, as was the nocturnal glucose AUC; however, nocturnal %TIR (63-100 mg/dL) was not different. There were no between-group differences in OGTT glucose and insulin levels at 36-37 weeks of gestation.

Conclusions: A ∼100 g/day difference in carbohydrate intake did not result in between-group differences in NB%fat, cord C-peptide level, maternal 24-h glycemia, %TIR, or insulin resistance indices in diet-controlled GDM.

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妊娠期糖尿病患者随机选择复合碳水化合物含量较高的饮食与常规饮食相比,会导致类似的新生儿肥胖。
目的:妊娠期糖尿病(GDM)的营养治疗通常侧重于碳水化合物限制。在一项随机对照试验(RCT)中,我们检验了一种假设,即与传统的低碳水化合物(40%)高脂肪(45%)(LC/CONV)饮食相比,含有自由化复合碳水化合物(60%)和低脂肪(25%)(CHOICE饮食)的饮食(所有膳食)可以改善母体胰岛素抵抗和24小时血糖,从而降低新生儿肥胖(NB%脂肪;有力的结果)。研究设计和方法:诊断后(妊娠28-30周),59名饮食控制型GDM(平均值±SEM;BMI 32±1 kg/m2)的女性在分娩时随机接受LC/CONV或CHOICE饮食(BMI匹配热量)。在妊娠30-31周和36-37周,进行2小时、75-g的口服葡萄糖耐量试验(OGTT),并佩戴连续血糖监测仪(CGM)72小时。分娩时采集脐带血样本。结果:每组有23名女性(LC/CONV[214g/天碳水化合物]和CHOICE[316g/天碳水化合物)。对于LC/CONV和CHOICE(平均值±SEM),NB%脂肪(10.1±1 vs.10.5±1)、出生体重(3303±98 vs.3293±81 g)和脐带C肽水平分别没有差异。分娩时体重增加、体力活动和胎龄相似。在妊娠36-37周时,CGM禁食(86±3 vs.90±3 mg/dL)、餐后1小时(119±3 vs.117±3 mg/d L)、饭后2小时(106±3 vs.108±3 mg/dL),范围内时间百分比(%TIR;92±1 vs.91±1)和24小时葡萄糖曲线下面积值在饮食之间相似。CHOICE中>120 mg/dL的%时间在统计学上更高(8%),夜间葡萄糖AUC也是如此;夜间%TIR(63-100mg/dL)没有差异。在妊娠36-37周时,OGTT葡萄糖和胰岛素水平在组间没有差异。结论:碳水化合物摄入量的A~100g/天差异不会导致饮食控制的GDM中NB%脂肪、脐带C肽水平、母体24小时血糖、%TIR或胰岛素抵抗指数的组间差异。
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来源期刊
Diabetes Care
Diabetes Care 医学-内分泌学与代谢
CiteScore
27.80
自引率
4.90%
发文量
449
审稿时长
1 months
期刊介绍: The journal's overarching mission can be captured by the simple word "Care," reflecting its commitment to enhancing patient well-being. Diabetes Care aims to support better patient care by addressing the comprehensive needs of healthcare professionals dedicated to managing diabetes. Diabetes Care serves as a valuable resource for healthcare practitioners, aiming to advance knowledge, foster research, and improve diabetes management. The journal publishes original research across various categories, including Clinical Care, Education, Nutrition, Psychosocial Research, Epidemiology, Health Services Research, Emerging Treatments and Technologies, Pathophysiology, Complications, and Cardiovascular and Metabolic Risk. Additionally, Diabetes Care features ADA statements, consensus reports, review articles, letters to the editor, and health/medical news, appealing to a diverse audience of physicians, researchers, psychologists, educators, and other healthcare professionals.
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