97-OR: Randomization to a Higher–Complex Carbohydrate vs. Conventional Diet in GDM Improves Glucose Tolerance and Results in Similar Cord Blood Insulin and Newborn Adiposity
Robust evidence for specific nutrition therapy for gestational diabetes (GDM) is lacking. Preliminary data suggested our CHOICE diet, higher in complex carbohydrate (60%) and lower in fat (25%) reduced fasting glucose (FBG), free fatty acids (FFA), and newborn adiposity (NB%fat). We tested the hypot...
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| creator | HERNANDEZ, TERI L. FARABI, SARAH S. ARBET, JARON HIRSCH, NICOLE DUNN, EMILY Z. HEISS, KRISTY P. CARLI, JAYNE MARTIN KREBS, NANCY F. POWELL, THERESA L. REYNOLDS, REGINA VAN PELT, RACHAEL E. FRIEDMAN, JACOB E. BARBOUR, LINDA (LYNN) A. |
| description | Robust evidence for specific nutrition therapy for gestational diabetes (GDM) is lacking. Preliminary data suggested our CHOICE diet, higher in complex carbohydrate (60%) and lower in fat (25%) reduced fasting glucose (FBG), free fatty acids (FFA), and newborn adiposity (NB%fat). We tested the hypothesis that 7-8 wks of CHOICE would improve insulin resistance, reduce FFA and NB%fat (2-wk PeaPod; 1° powered outcome) vs. a conventional low-carbohydrate (40%), higher fat (45%) diet (LC/CONV). After diagnosis (∼28-30 wks), 59 BMI-matched diet-controlled GDM women (mean±SD; BMI 32±5) were randomized to a eucaloric CHOICE or LC/CONV diet (7.2±1 wks; ALL MEALS PROVIDED). At baseline, a 2-hr 75g OGTT (with insulins) was performed and diet initiated. On day-4, a breakfast meal was given (30% of total calories) with fasting and hourly blood drawn x5 (gluc, insulin, FFA, triglycerides[TG]) for area-under-the curve (AUC). Measures were repeated at 36-37 wks. Of 59, 13 met exclusions (4 diet failures, 2/group). By ANCOVA (n=23/group), total and weight gain during diet were similar (CHOICE 1.9 vs. LC/CONV 1.8 kg) as was delivery wk (39.2 vs. 39.3 wks). At 37 wks, the meal gluc (p=0.001) and insulin AUCs (p=0.013) were lower for LC/CONV, though fasting gluc/insulin were similar. TG increased similarly. The FFA AUC decreased from 30-37 wks on CHOICE but rose on LC/CONV (p=0.016), and was lower for CHOICE at 37 wks (p=0.009). By the 37-wk OGTT, FBG decreased within both groups (CHOICE -7.2, LC/CONV -3.5 mg/dL, both p |
| doi_str_mv | 10.2337/db20-97-OR |
| format | Article |
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Preliminary data suggested our CHOICE diet, higher in complex carbohydrate (60%) and lower in fat (25%) reduced fasting glucose (FBG), free fatty acids (FFA), and newborn adiposity (NB%fat). We tested the hypothesis that 7-8 wks of CHOICE would improve insulin resistance, reduce FFA and NB%fat (2-wk PeaPod; 1° powered outcome) vs. a conventional low-carbohydrate (40%), higher fat (45%) diet (LC/CONV). After diagnosis (∼28-30 wks), 59 BMI-matched diet-controlled GDM women (mean±SD; BMI 32±5) were randomized to a eucaloric CHOICE or LC/CONV diet (7.2±1 wks; ALL MEALS PROVIDED). At baseline, a 2-hr 75g OGTT (with insulins) was performed and diet initiated. On day-4, a breakfast meal was given (30% of total calories) with fasting and hourly blood drawn x5 (gluc, insulin, FFA, triglycerides[TG]) for area-under-the curve (AUC). Measures were repeated at 36-37 wks. Of 59, 13 met exclusions (4 diet failures, 2/group). By ANCOVA (n=23/group), total and weight gain during diet were similar (CHOICE 1.9 vs. LC/CONV 1.8 kg) as was delivery wk (39.2 vs. 39.3 wks). At 37 wks, the meal gluc (p=0.001) and insulin AUCs (p=0.013) were lower for LC/CONV, though fasting gluc/insulin were similar. TG increased similarly. The FFA AUC decreased from 30-37 wks on CHOICE but rose on LC/CONV (p=0.016), and was lower for CHOICE at 37 wks (p=0.009). By the 37-wk OGTT, FBG decreased within both groups (CHOICE -7.2, LC/CONV -3.5 mg/dL, both p<0.01) but CHOICE led to improved (p=0.001) and lower gluc AUC (p<0.05)(similar insulin AUCs). Birthweight (3293 vs. 3303 g), anthropometrics, NB%fat (10.8±4 vs. 10.3±4%), and cord blood gluc, C-peptide, FFA and TG were similar. This RCT shows that complex carbohydrate can be liberalized by 20% above conventional recommendations and may improve gluc tolerance and similarly normalize fetal growth, expanding nutrition options in GDM.</description><identifier>ISSN: 0012-1797</identifier><identifier>EISSN: 1939-327X</identifier><identifier>DOI: 10.2337/db20-97-OR</identifier><language>eng</language><publisher>New York: American Diabetes Association</publisher><subject>Adipose tissue ; Birth weight ; Calories ; Carbohydrates ; Cord blood ; Diabetes mellitus ; Fasting ; Fatty acids ; Fetuses ; Gestational diabetes ; Glucose tolerance ; Insulin ; Insulin resistance ; Low carbohydrate diet ; Low fat diet ; Newborn babies ; Nutrition ; Nutrition therapy ; Triglycerides</subject><ispartof>Diabetes (New York, N.Y.), 2020-06, Vol.69 (Supplement_1)</ispartof><rights>Copyright American Diabetes Association Jun 1, 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c1049-522449a27dc7ea9f1cdeddc3518546c6b604f9dc342b2f30184f588666e1aa843</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids></links><search><creatorcontrib>HERNANDEZ, TERI L.</creatorcontrib><creatorcontrib>FARABI, SARAH S.</creatorcontrib><creatorcontrib>ARBET, JARON</creatorcontrib><creatorcontrib>HIRSCH, NICOLE</creatorcontrib><creatorcontrib>DUNN, EMILY Z.</creatorcontrib><creatorcontrib>HEISS, KRISTY P.</creatorcontrib><creatorcontrib>CARLI, JAYNE MARTIN</creatorcontrib><creatorcontrib>KREBS, NANCY F.</creatorcontrib><creatorcontrib>POWELL, THERESA L.</creatorcontrib><creatorcontrib>REYNOLDS, REGINA</creatorcontrib><creatorcontrib>VAN PELT, RACHAEL E.</creatorcontrib><creatorcontrib>FRIEDMAN, JACOB E.</creatorcontrib><creatorcontrib>BARBOUR, LINDA (LYNN) A.</creatorcontrib><title>97-OR: Randomization to a Higher–Complex Carbohydrate vs. Conventional Diet in GDM Improves Glucose Tolerance and Results in Similar Cord Blood Insulin and Newborn Adiposity</title><title>Diabetes (New York, N.Y.)</title><description>Robust evidence for specific nutrition therapy for gestational diabetes (GDM) is lacking. Preliminary data suggested our CHOICE diet, higher in complex carbohydrate (60%) and lower in fat (25%) reduced fasting glucose (FBG), free fatty acids (FFA), and newborn adiposity (NB%fat). We tested the hypothesis that 7-8 wks of CHOICE would improve insulin resistance, reduce FFA and NB%fat (2-wk PeaPod; 1° powered outcome) vs. a conventional low-carbohydrate (40%), higher fat (45%) diet (LC/CONV). After diagnosis (∼28-30 wks), 59 BMI-matched diet-controlled GDM women (mean±SD; BMI 32±5) were randomized to a eucaloric CHOICE or LC/CONV diet (7.2±1 wks; ALL MEALS PROVIDED). At baseline, a 2-hr 75g OGTT (with insulins) was performed and diet initiated. On day-4, a breakfast meal was given (30% of total calories) with fasting and hourly blood drawn x5 (gluc, insulin, FFA, triglycerides[TG]) for area-under-the curve (AUC). Measures were repeated at 36-37 wks. Of 59, 13 met exclusions (4 diet failures, 2/group). By ANCOVA (n=23/group), total and weight gain during diet were similar (CHOICE 1.9 vs. LC/CONV 1.8 kg) as was delivery wk (39.2 vs. 39.3 wks). At 37 wks, the meal gluc (p=0.001) and insulin AUCs (p=0.013) were lower for LC/CONV, though fasting gluc/insulin were similar. TG increased similarly. The FFA AUC decreased from 30-37 wks on CHOICE but rose on LC/CONV (p=0.016), and was lower for CHOICE at 37 wks (p=0.009). By the 37-wk OGTT, FBG decreased within both groups (CHOICE -7.2, LC/CONV -3.5 mg/dL, both p<0.01) but CHOICE led to improved (p=0.001) and lower gluc AUC (p<0.05)(similar insulin AUCs). Birthweight (3293 vs. 3303 g), anthropometrics, NB%fat (10.8±4 vs. 10.3±4%), and cord blood gluc, C-peptide, FFA and TG were similar. This RCT shows that complex carbohydrate can be liberalized by 20% above conventional recommendations and may improve gluc tolerance and similarly normalize fetal growth, expanding nutrition options in GDM.</description><subject>Adipose tissue</subject><subject>Birth weight</subject><subject>Calories</subject><subject>Carbohydrates</subject><subject>Cord blood</subject><subject>Diabetes mellitus</subject><subject>Fasting</subject><subject>Fatty acids</subject><subject>Fetuses</subject><subject>Gestational diabetes</subject><subject>Glucose tolerance</subject><subject>Insulin</subject><subject>Insulin resistance</subject><subject>Low carbohydrate diet</subject><subject>Low fat diet</subject><subject>Newborn babies</subject><subject>Nutrition</subject><subject>Nutrition therapy</subject><subject>Triglycerides</subject><issn>0012-1797</issn><issn>1939-327X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNotkU1u2zAQhYkgBeqk3fQEA2QXQClJUT_MzlUax0BSA04KZCdQ4iimIYkuKbtxV71DD9I75SSh4mAWA8x88wYPj5AvjF7wOM6-6orTSGbRYnlEJkzGMop59nhMJpQyHrFMZh_JifdrSmkaakL-v8GXsFS9tp35owZjexgsKLgxTyt0L3__FbbbtPgMhXKVXe21UwPCzl9AYfsd9uOFauHK4ACmh9nVHcy7jbM79DBrt7X1CA-2Raf6GiH8gSX6bTv4kb43nWmVC1JOw7fWWg3zPmzDaiR_4O_Kuh6m2mysN8P-E_nQqNbj5_d-Sn5ef38obqLbxWxeTG-jmlEho4RzIaTima4zVLJhtUat6zhheSLSOq1SKhoZBoJXvIkpy0WT5HmapsiUykV8Ss4OusHIry36oVzbrQs-fckFkyLhTMhAnR-o2lnvHTblxplOuX3JaDkGUo6BlDIrF8v4FblTgGY</recordid><startdate>20200601</startdate><enddate>20200601</enddate><creator>HERNANDEZ, TERI L.</creator><creator>FARABI, SARAH S.</creator><creator>ARBET, JARON</creator><creator>HIRSCH, NICOLE</creator><creator>DUNN, EMILY Z.</creator><creator>HEISS, KRISTY P.</creator><creator>CARLI, JAYNE MARTIN</creator><creator>KREBS, NANCY F.</creator><creator>POWELL, THERESA L.</creator><creator>REYNOLDS, REGINA</creator><creator>VAN PELT, RACHAEL E.</creator><creator>FRIEDMAN, JACOB E.</creator><creator>BARBOUR, LINDA (LYNN) A.</creator><general>American Diabetes Association</general><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope></search><sort><creationdate>20200601</creationdate><title>97-OR: Randomization to a Higher–Complex Carbohydrate vs. Conventional Diet in GDM Improves Glucose Tolerance and Results in Similar Cord Blood Insulin and Newborn Adiposity</title><author>HERNANDEZ, TERI L. ; FARABI, SARAH S. ; ARBET, JARON ; HIRSCH, NICOLE ; DUNN, EMILY Z. ; HEISS, KRISTY P. ; CARLI, JAYNE MARTIN ; KREBS, NANCY F. ; POWELL, THERESA L. ; REYNOLDS, REGINA ; VAN PELT, RACHAEL E. ; FRIEDMAN, JACOB E. ; BARBOUR, LINDA (LYNN) A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1049-522449a27dc7ea9f1cdeddc3518546c6b604f9dc342b2f30184f588666e1aa843</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adipose tissue</topic><topic>Birth weight</topic><topic>Calories</topic><topic>Carbohydrates</topic><topic>Cord blood</topic><topic>Diabetes mellitus</topic><topic>Fasting</topic><topic>Fatty acids</topic><topic>Fetuses</topic><topic>Gestational diabetes</topic><topic>Glucose tolerance</topic><topic>Insulin</topic><topic>Insulin resistance</topic><topic>Low carbohydrate diet</topic><topic>Low fat diet</topic><topic>Newborn babies</topic><topic>Nutrition</topic><topic>Nutrition therapy</topic><topic>Triglycerides</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>HERNANDEZ, TERI L.</creatorcontrib><creatorcontrib>FARABI, SARAH S.</creatorcontrib><creatorcontrib>ARBET, JARON</creatorcontrib><creatorcontrib>HIRSCH, NICOLE</creatorcontrib><creatorcontrib>DUNN, EMILY Z.</creatorcontrib><creatorcontrib>HEISS, KRISTY P.</creatorcontrib><creatorcontrib>CARLI, JAYNE MARTIN</creatorcontrib><creatorcontrib>KREBS, NANCY F.</creatorcontrib><creatorcontrib>POWELL, THERESA L.</creatorcontrib><creatorcontrib>REYNOLDS, REGINA</creatorcontrib><creatorcontrib>VAN PELT, RACHAEL E.</creatorcontrib><creatorcontrib>FRIEDMAN, JACOB E.</creatorcontrib><creatorcontrib>BARBOUR, LINDA (LYNN) A.</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><jtitle>Diabetes (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>HERNANDEZ, TERI L.</au><au>FARABI, SARAH S.</au><au>ARBET, JARON</au><au>HIRSCH, NICOLE</au><au>DUNN, EMILY Z.</au><au>HEISS, KRISTY P.</au><au>CARLI, JAYNE MARTIN</au><au>KREBS, NANCY F.</au><au>POWELL, THERESA L.</au><au>REYNOLDS, REGINA</au><au>VAN PELT, RACHAEL E.</au><au>FRIEDMAN, JACOB E.</au><au>BARBOUR, LINDA (LYNN) A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>97-OR: Randomization to a Higher–Complex Carbohydrate vs. Conventional Diet in GDM Improves Glucose Tolerance and Results in Similar Cord Blood Insulin and Newborn Adiposity</atitle><jtitle>Diabetes (New York, N.Y.)</jtitle><date>2020-06-01</date><risdate>2020</risdate><volume>69</volume><issue>Supplement_1</issue><issn>0012-1797</issn><eissn>1939-327X</eissn><abstract>Robust evidence for specific nutrition therapy for gestational diabetes (GDM) is lacking. Preliminary data suggested our CHOICE diet, higher in complex carbohydrate (60%) and lower in fat (25%) reduced fasting glucose (FBG), free fatty acids (FFA), and newborn adiposity (NB%fat). We tested the hypothesis that 7-8 wks of CHOICE would improve insulin resistance, reduce FFA and NB%fat (2-wk PeaPod; 1° powered outcome) vs. a conventional low-carbohydrate (40%), higher fat (45%) diet (LC/CONV). After diagnosis (∼28-30 wks), 59 BMI-matched diet-controlled GDM women (mean±SD; BMI 32±5) were randomized to a eucaloric CHOICE or LC/CONV diet (7.2±1 wks; ALL MEALS PROVIDED). At baseline, a 2-hr 75g OGTT (with insulins) was performed and diet initiated. On day-4, a breakfast meal was given (30% of total calories) with fasting and hourly blood drawn x5 (gluc, insulin, FFA, triglycerides[TG]) for area-under-the curve (AUC). Measures were repeated at 36-37 wks. Of 59, 13 met exclusions (4 diet failures, 2/group). By ANCOVA (n=23/group), total and weight gain during diet were similar (CHOICE 1.9 vs. LC/CONV 1.8 kg) as was delivery wk (39.2 vs. 39.3 wks). At 37 wks, the meal gluc (p=0.001) and insulin AUCs (p=0.013) were lower for LC/CONV, though fasting gluc/insulin were similar. TG increased similarly. The FFA AUC decreased from 30-37 wks on CHOICE but rose on LC/CONV (p=0.016), and was lower for CHOICE at 37 wks (p=0.009). By the 37-wk OGTT, FBG decreased within both groups (CHOICE -7.2, LC/CONV -3.5 mg/dL, both p<0.01) but CHOICE led to improved (p=0.001) and lower gluc AUC (p<0.05)(similar insulin AUCs). Birthweight (3293 vs. 3303 g), anthropometrics, NB%fat (10.8±4 vs. 10.3±4%), and cord blood gluc, C-peptide, FFA and TG were similar. This RCT shows that complex carbohydrate can be liberalized by 20% above conventional recommendations and may improve gluc tolerance and similarly normalize fetal growth, expanding nutrition options in GDM.</abstract><cop>New York</cop><pub>American Diabetes Association</pub><doi>10.2337/db20-97-OR</doi></addata></record> |
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| source | Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Adipose tissue Birth weight Calories Carbohydrates Cord blood Diabetes mellitus Fasting Fatty acids Fetuses Gestational diabetes Glucose tolerance Insulin Insulin resistance Low carbohydrate diet Low fat diet Newborn babies Nutrition Nutrition therapy Triglycerides |
| title | 97-OR: Randomization to a Higher–Complex Carbohydrate vs. Conventional Diet in GDM Improves Glucose Tolerance and Results in Similar Cord Blood Insulin and Newborn Adiposity |
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