Role of Macronutrient Diet Composition on Maternal and Infant Metabolic Outcomes

常量营养素饮食成分对母婴代谢结果的作用

• 批准号: 7877696
• 负责人: LINDA Anne BARBOUR
• 金额: $ 22.97万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-20 至 2012-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7877696
• 关键词: 1-Phosphatidylinositol 3-Kinase; Address; Adipose tissue; Affect; Air; American; Animals; Apolipoproteins B; Area Under Curve; Attenuated; Biological Markers; Biopsy; Birth Weight; Body Composition; C-reactive protein; CCL2 gene; Carbohydrates; Cause of Death; Child; Childhood; Cholesterol; Complex; Consensus; Consumption; Cross-Over Studies; Crossover Design; Data; Development; Diabetes Mellitus; Diagnosis; Diet; Diet therapy; Dietary Fats; Dietary Intervention; Educational workshop; Environment; Epidemic; Erythrocytes; Exposure to; Fat-Restricted Diet; Fatty Liver; Fatty acid glycerol esters; Fetal Growth; Fetal Macrosomia; Fetus; Future; Gene Proteins; Gestational Diabetes; Gluconeogenesis; Glucose; Glucose Intolerance; Goals; Growth; Guidelines; Health; Hour; Human; Hyperglycemia; Hyperlipidemia; Hypertriglyceridemia; IL8 gene; In Vitro; Incidence; Infant; Inflammation; Inflammatory; Insulin; Insulin Resistance; Intake; Interleukin-6; International; Intervention; Isoproterenol; LDL Cholesterol Lipoproteins; Leptin; Life; Lipid Peroxidation; Lipids; Lipolysis; Lipoprotein (a); Lipoproteins; Long-Term Effects; Low-Density Lipoproteins; Macronutrients Nutrition; Measures; Medical; Membrane; Metabolic; Metabolism; Mothers; Neonatal; Newborn Infant; Non-Insulin-Dependent Diabetes Mellitus; Nonesterified Fatty Acids; Nutrient; Obesity; Outcome; Overweight; Phosphatidylinositols; Phosphotransferases; Physiological; Pilot Projects; Plasma; Plethysmography; Pregnancy; Pregnant Women; Prevalence; Proteins; Proxy; Randomized; Randomized Controlled Trials; Recommendation; Research Personnel; Risk; Risk Factors; Risk Marker; Role; Safety; System; Testing; Triglycerides; Woman; adipokines; adiponectin; adverse outcome; apolipoprotein B-100; atherogenesis; base; cholesterol biosynthesis; clinical Diagnosis; cytokine; design; diabetes risk; disorder risk; fetal; fetal programming; glucose monitor; high risk; human data; impaired glucose tolerance; in utero; infant monitoring; inflammatory marker; lipoprotein lipase; neonate; nonhuman primate; novel diagnostics; nutrition; obesity in children; offspring; oxidized low density lipoprotein; particle; prevent; programs; protein expression; public health relevance; randomized trial; resistin; saturated fat; treatment as usual

DESCRIPTION (provided by applicant): Despite the doubling in the prevalence of gestational diabetes mellitus (GDM) over the last 10 years, dietary management guidelines remain ambiguous due to the paucity of randomized controlled trials. New diagnostic criteria recently developed for the diagnosis of GDM are expected to increase the prevalence to 10-15% of all pregnant women. There is growing recognition that GDM has long-term implications on maternal risk for diabetes and that the intrauterine GDM environment is an independent risk factor for childhood obesity and impaired glucose tolerance. Yet, how diet can be used to modify fetal fuel and attenuate this risk remains unknown in humans. Fundamental to the management of GDM is dietary intervention, yet the historic practice of advising a low-carbohydrate (CHO), higher-fat diet has not been sufficiently tested. Both animal and non- human primate data support a fetal programming influence that maternal high-fat diets may promote insulin resistance, glucose intolerance, and hepatic steatosis in the offspring. Recent human data suggest that high maternal triglycerides (TG) and free fatty acids (FFA), variables sensitive to dietary manipulation, are independent risk factors for fetal macrosomia and adiposity. As a result, consensus groups have abandoned any specific diet recommendations for women with GDM. Despite the pivotal role of diet therapy in the treatment of GDM, no randomized trials have directly compared glycemic and lipoprotein profiles of the conventional higher-fat diet with any other diet. To address this critical need, the aims of this randomized cross-over trial are to study the effects of a high complex carbohydrate/low-fat diet (HC/LF; 60% CHO, 25% fat, 15% protein) compared to the usual care, low-CHO/higher fat diet (LC/HF; 40% CHO, 45% fat, and 15% protein) in GDM women on: 1) 72-hour glycemic profiles using a continuous glucose monitoring system within subjects; 2) postprandial lipemia by measuring serial plasma TG and FFA over a 5-hour, post-breakfast meal period within subjects; and 3) maternal lipoproteins, inflammatory profiles, and in-vitro adipose tissue lipolysis after 6-8 weeks of diet therapy between subjects. We will also measure neonatal adiposity by air displacement plethysmography and newborn markers of lipid peroxidation, inflammation, and dietary fat intake in the babies born to mothers with GDM. This pilot study will directly test which GDM diet is most effective in limiting maternal hyperglycemia and hyperlipidemia in a randomized controlled fashion, potentially optimizing fetal substrate availability and fetal growth. Our goal is to determine which diet intervention might favorably impact a cycle that could otherwise perpetuate future diabetes, obesity, and CVD in both mother and offspring. PUBLIC HEALTH RELEVANCE: A better understanding of the optimal diet for women with gestational diabetes is fundamental to the management of this rapidly growing problem in pregnancy. Careful comparison studies of the current low- carbohydrate, higher-fat diet versus a diet higher in complex carbohydrate but lower in fat is critical in order to determine which diet results in a more favorable maternal 24-hour glucose, lipid, and inflammatory profile, all of which directly affect optimal fetal growth and may influence the future health of the offspring.

描述（由申请人提供）：尽管妊娠糖尿病（GDM）在过去10年中的患病率增加了一倍，但由于随机对照试验的匮乏，饮食管理指南仍然模棱两可。最近为GDM诊断而开发的新诊断标准有望将患病率提高到所有孕妇的10-15％。人们越来越认识到，GDM对糖尿病的产妇风险具有长期影响，并且宫内GDM环境是儿童肥胖症的独立危险因素和葡萄糖耐受性受损。但是，如何使用饮食来改变胎儿燃料并衰减这种风险在人类中仍然未知。 GDM管理的基础是饮食干预，但是建议低碳水化合物（CHO）的历史实践尚未得到充分的测试。动物和非人类灵长类动物数据都支持胎儿编程的影响，即母体高脂饮食可能促进后代的胰岛素耐药性，葡萄糖不耐症和肝脂肪变性。最近的人类数据表明，对饮食操纵敏感的变量，高母体甘油三酸酯（TG）和游离脂肪酸（FFA）是胎儿大糖类和肥胖的独立危险因素。结果，共识小组放弃了针对GDM女性的任何特定饮食建议。尽管饮食疗法在GDM治疗中的关键作用，但尚无随机试验直接将常规高脂饮食的血糖和脂蛋白谱与任何其他饮食进行比较。 To address this critical need, the aims of this randomized cross-over trial are to study the effects of a high complex carbohydrate/low-fat diet (HC/LF; 60% CHO, 25% fat, 15% protein) compared to the usual care, low-CHO/higher fat diet (LC/HF; 40% CHO, 45% fat, and 15% protein) in GDM women on: 1) 72-hour glycemic profiles using a continuous受试者内的葡萄糖监测系统； 2）餐后脂肪血症通过在受试者的5小时内早餐时期测量串行等离子体TG和FFA； 3）受试者之间的饮食治疗6-8周后，母体脂蛋白，炎症谱和体外脂肪组织脂解。我们还将通过空气位移和脂质过氧化，炎症和饮食脂肪摄入的新生儿标记物测量新生儿肥胖，而GDM的母亲出生的婴儿中的饮食脂肪摄入量。这项初步研究将直接测试哪种GDM饮食最有效地以随机控制的方式限制孕妇高血糖和高脂血症，并可能优化胎儿底物的可用性和胎儿生长。我们的目标是确定哪种饮食干预可能会对母亲和后代的未来糖尿病，肥胖和CVD的循环产生有益的影响。 公共卫生相关性：对妊娠糖尿病女性的最佳饮食有更好的了解是管理这种迅速增长的怀孕问题的基础。对当前低碳水化合物，高脂饮食与复杂碳水化合物中饮食更高但脂肪较高的仔细比较研究至关重要，这对于确定哪种饮食会导致更有利的母体24小时葡萄糖，脂质和炎症性，所有饮食都直接影响最佳胎儿生长并可能影响后代的未来健康状况。