Nutritional Lifestyle Intervention in Obese Pregnant Women, Including Lower Carbohydrate Intake, Is Associated With Increased Maternal Free Fatty Acids, 3-β-Hydroxybutyrate, and Fasting Glucose Concentrations: A Secondary Factorial Analysis of the European Multicenter, Randomized Controlled DALI Lifestyle Intervention Trial
In our randomized controlled trial, we investigated the impact of healthy eating (HE) aiming for restricted gestational weight gain (GWG) and physical activity (PA) interventions on maternal and neonatal lipid metabolism. Obese pregnant women ( = 436) were included before 20 weeks' gestation an...
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| Veröffentlicht in: | Diabetes care 2019-08, Vol.42 (8), p.1380-1389 |
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| creator | Harreiter, Jürgen Simmons, David Desoye, Gernot Corcoy, Rosa Adelantado, Juan M Devlieger, Roland Galjaard, Sander Damm, Peter Mathiesen, Elisabeth R Jensen, Dorte M Andersen, Lise Lotte T Dunne, Fidelma Lapolla, Annunziata Dalfra, Maria G Bertolotto, Alessandra Wender-Ozegowska, Ewa Zawiejska, Agnieszka Mantaj, Urszula Hill, David Jelsma, Judith G M Snoek, Frank J Leutner, Michael Lackinger, Christian Worda, Christof Bancher-Todesca, Dagmar Scharnagl, Hubert van Poppel, Mireille N M Kautzky-Willer, Alexandra |
| description | In our randomized controlled trial, we investigated the impact of healthy eating (HE) aiming for restricted gestational weight gain (GWG) and physical activity (PA) interventions on maternal and neonatal lipid metabolism.
Obese pregnant women (
= 436) were included before 20 weeks' gestation and underwent glucose testing (oral glucose tolerance test) and lipid profiling at baseline and 24-28 and 35-37 gestational weeks after an at least 10-h overnight fast. This secondary analysis had a factorial design with comparison of HE (
= 221) versus no HE (
= 215) and PA (
= 218) versus no PA (
= 218). Maternal changes in triglycerides (TG), LDL cholesterol, HDL cholesterol, free fatty acids (FFAs), and leptin from baseline to end of pregnancy and neonatal outcomes were analyzed using general linear models with adjustment for relevant parameters.
At 24-28 weeks' gestation, FFAs (mean ± SD, 0.60 ± 0.19 vs. 0.55 ± 0.17 mmol/L,
< 0.01) were increased after adjustment for FFA at baseline, maternal age, BMI at time of examination, gestational week, insulin resistance, self-reported food intake, self-reported physical activity, and maternal smoking, and GWG was lower (3.3 ± 2.6 vs. 4.3 ± 2.8 kg,
< 0.001, adjusted mean differences -1.0 [95% CI -1.5; -0.5]) in HE versus no HE. Fasting glucose levels (4.7 ± 0.4 vs. 4.6 ± 0.4 mmol/L,
< 0.05) and 3-β-hydroxybutyrate (3BHB) (0.082 ± 0.065 vs. 0.068 ± 0.067 mmol/L,
< 0.05) were higher in HE. Significant negative associations between carbohydrate intake and FFA, 3BHB, and fasting glucose at 24-28 weeks' gestation were observed. No differences between groups were found in oral glucose tolerance test or leptin or TG levels at any time. Furthermore, in PA versus no PA, no similar changes were found. In cord blood, elevated FFA levels were found in HE after full adjustment (0.34 ± 0.22 vs. 0.29 ± 0.16 mmol/L,
= 0.01).
HE intervention was associated with reduced GWG, higher FFAs, higher 3BHB, and higher fasting glucose at 24-28 weeks of gestation, suggesting induction of lipolysis. Increased FFA was negatively associated with carbohydrate intake and was also observed in cord blood. These findings support the hypothesis that maternal antenatal dietary restriction including carbohydrates is associated with increased FFA mobilization. |
| doi_str_mv | 10.2337/dc19-0418 |
| format | Article |
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Obese pregnant women (
= 436) were included before 20 weeks' gestation and underwent glucose testing (oral glucose tolerance test) and lipid profiling at baseline and 24-28 and 35-37 gestational weeks after an at least 10-h overnight fast. This secondary analysis had a factorial design with comparison of HE (
= 221) versus no HE (
= 215) and PA (
= 218) versus no PA (
= 218). Maternal changes in triglycerides (TG), LDL cholesterol, HDL cholesterol, free fatty acids (FFAs), and leptin from baseline to end of pregnancy and neonatal outcomes were analyzed using general linear models with adjustment for relevant parameters.
At 24-28 weeks' gestation, FFAs (mean ± SD, 0.60 ± 0.19 vs. 0.55 ± 0.17 mmol/L,
< 0.01) were increased after adjustment for FFA at baseline, maternal age, BMI at time of examination, gestational week, insulin resistance, self-reported food intake, self-reported physical activity, and maternal smoking, and GWG was lower (3.3 ± 2.6 vs. 4.3 ± 2.8 kg,
< 0.001, adjusted mean differences -1.0 [95% CI -1.5; -0.5]) in HE versus no HE. Fasting glucose levels (4.7 ± 0.4 vs. 4.6 ± 0.4 mmol/L,
< 0.05) and 3-β-hydroxybutyrate (3BHB) (0.082 ± 0.065 vs. 0.068 ± 0.067 mmol/L,
< 0.05) were higher in HE. Significant negative associations between carbohydrate intake and FFA, 3BHB, and fasting glucose at 24-28 weeks' gestation were observed. No differences between groups were found in oral glucose tolerance test or leptin or TG levels at any time. Furthermore, in PA versus no PA, no similar changes were found. In cord blood, elevated FFA levels were found in HE after full adjustment (0.34 ± 0.22 vs. 0.29 ± 0.16 mmol/L,
= 0.01).
HE intervention was associated with reduced GWG, higher FFAs, higher 3BHB, and higher fasting glucose at 24-28 weeks of gestation, suggesting induction of lipolysis. Increased FFA was negatively associated with carbohydrate intake and was also observed in cord blood. These findings support the hypothesis that maternal antenatal dietary restriction including carbohydrates is associated with increased FFA mobilization.</description><identifier>ISSN: 0149-5992</identifier><identifier>EISSN: 1935-5548</identifier><identifier>DOI: 10.2337/dc19-0418</identifier><identifier>PMID: 31182492</identifier><language>eng</language><publisher>United States: American Diabetes Association</publisher><subject>3-Hydroxybutyric Acid - blood ; Adult ; Blood ; Blood Glucose - analysis ; Body weight gain ; Carbohydrates ; Cholesterol ; Cholesterol, HDL - blood ; Cholesterol, LDL - blood ; Cord blood ; Diet ; Diet, Healthy - methods ; Dietary Carbohydrates - pharmacology ; Dietary restrictions ; Europe ; Exercise - physiology ; Factor Analysis, Statistical ; Factorial analysis ; Factorial design ; Fasting ; Fatty acids ; Fatty Acids, Nonesterified - blood ; Female ; Food intake ; Gestation ; Gestational Weight Gain ; Glucose ; Glucose tolerance ; Glucose Tolerance Test ; High density lipoprotein ; Humans ; Hydroxybutyrates ; Insulin ; Insulin Resistance ; Intervention ; Laboratory testing ; Leptin ; Leptin - blood ; Life Style ; Linear Models ; Lipid metabolism ; Lipids ; Lipolysis ; Low density lipoprotein ; Neonates ; Obesity ; Obesity - blood ; Obesity - therapy ; Physical activity ; Pregnancy ; Pregnancy Complications - blood ; Pregnancy Complications - therapy ; Prenatal Care - methods ; Randomization ; Research design ; Secondary analysis ; Smoking ; Treatment Outcome ; Triglycerides ; Triglycerides - blood ; Weight Gain ; Womens health</subject><ispartof>Diabetes care, 2019-08, Vol.42 (8), p.1380-1389</ispartof><rights>2019 by the American Diabetes Association.</rights><rights>Copyright American Diabetes Association Aug 1, 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c278t-510cddc922353e2ada68e983933d262bee6316297a89bf94823b259da2afa3cb3</citedby><cites>FETCH-LOGICAL-c278t-510cddc922353e2ada68e983933d262bee6316297a89bf94823b259da2afa3cb3</cites><orcidid>0000-0001-5055-6814 ; 0000-0002-5715-3230 ; 0000-0002-3520-4105</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31182492$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Harreiter, Jürgen</creatorcontrib><creatorcontrib>Simmons, David</creatorcontrib><creatorcontrib>Desoye, Gernot</creatorcontrib><creatorcontrib>Corcoy, Rosa</creatorcontrib><creatorcontrib>Adelantado, Juan M</creatorcontrib><creatorcontrib>Devlieger, Roland</creatorcontrib><creatorcontrib>Galjaard, Sander</creatorcontrib><creatorcontrib>Damm, Peter</creatorcontrib><creatorcontrib>Mathiesen, Elisabeth R</creatorcontrib><creatorcontrib>Jensen, Dorte M</creatorcontrib><creatorcontrib>Andersen, Lise Lotte T</creatorcontrib><creatorcontrib>Dunne, Fidelma</creatorcontrib><creatorcontrib>Lapolla, Annunziata</creatorcontrib><creatorcontrib>Dalfra, Maria G</creatorcontrib><creatorcontrib>Bertolotto, Alessandra</creatorcontrib><creatorcontrib>Wender-Ozegowska, Ewa</creatorcontrib><creatorcontrib>Zawiejska, Agnieszka</creatorcontrib><creatorcontrib>Mantaj, Urszula</creatorcontrib><creatorcontrib>Hill, David</creatorcontrib><creatorcontrib>Jelsma, Judith G M</creatorcontrib><creatorcontrib>Snoek, Frank J</creatorcontrib><creatorcontrib>Leutner, Michael</creatorcontrib><creatorcontrib>Lackinger, Christian</creatorcontrib><creatorcontrib>Worda, Christof</creatorcontrib><creatorcontrib>Bancher-Todesca, Dagmar</creatorcontrib><creatorcontrib>Scharnagl, Hubert</creatorcontrib><creatorcontrib>van Poppel, Mireille N M</creatorcontrib><creatorcontrib>Kautzky-Willer, Alexandra</creatorcontrib><title>Nutritional Lifestyle Intervention in Obese Pregnant Women, Including Lower Carbohydrate Intake, Is Associated With Increased Maternal Free Fatty Acids, 3-β-Hydroxybutyrate, and Fasting Glucose Concentrations: A Secondary Factorial Analysis of the European Multicenter, Randomized Controlled DALI Lifestyle Intervention Trial</title><title>Diabetes care</title><addtitle>Diabetes Care</addtitle><description>In our randomized controlled trial, we investigated the impact of healthy eating (HE) aiming for restricted gestational weight gain (GWG) and physical activity (PA) interventions on maternal and neonatal lipid metabolism.
Obese pregnant women (
= 436) were included before 20 weeks' gestation and underwent glucose testing (oral glucose tolerance test) and lipid profiling at baseline and 24-28 and 35-37 gestational weeks after an at least 10-h overnight fast. This secondary analysis had a factorial design with comparison of HE (
= 221) versus no HE (
= 215) and PA (
= 218) versus no PA (
= 218). Maternal changes in triglycerides (TG), LDL cholesterol, HDL cholesterol, free fatty acids (FFAs), and leptin from baseline to end of pregnancy and neonatal outcomes were analyzed using general linear models with adjustment for relevant parameters.
At 24-28 weeks' gestation, FFAs (mean ± SD, 0.60 ± 0.19 vs. 0.55 ± 0.17 mmol/L,
< 0.01) were increased after adjustment for FFA at baseline, maternal age, BMI at time of examination, gestational week, insulin resistance, self-reported food intake, self-reported physical activity, and maternal smoking, and GWG was lower (3.3 ± 2.6 vs. 4.3 ± 2.8 kg,
< 0.001, adjusted mean differences -1.0 [95% CI -1.5; -0.5]) in HE versus no HE. Fasting glucose levels (4.7 ± 0.4 vs. 4.6 ± 0.4 mmol/L,
< 0.05) and 3-β-hydroxybutyrate (3BHB) (0.082 ± 0.065 vs. 0.068 ± 0.067 mmol/L,
< 0.05) were higher in HE. Significant negative associations between carbohydrate intake and FFA, 3BHB, and fasting glucose at 24-28 weeks' gestation were observed. No differences between groups were found in oral glucose tolerance test or leptin or TG levels at any time. Furthermore, in PA versus no PA, no similar changes were found. In cord blood, elevated FFA levels were found in HE after full adjustment (0.34 ± 0.22 vs. 0.29 ± 0.16 mmol/L,
= 0.01).
HE intervention was associated with reduced GWG, higher FFAs, higher 3BHB, and higher fasting glucose at 24-28 weeks of gestation, suggesting induction of lipolysis. Increased FFA was negatively associated with carbohydrate intake and was also observed in cord blood. These findings support the hypothesis that maternal antenatal dietary restriction including carbohydrates is associated with increased FFA mobilization.</description><subject>3-Hydroxybutyric Acid - blood</subject><subject>Adult</subject><subject>Blood</subject><subject>Blood Glucose - analysis</subject><subject>Body weight gain</subject><subject>Carbohydrates</subject><subject>Cholesterol</subject><subject>Cholesterol, HDL - blood</subject><subject>Cholesterol, LDL - blood</subject><subject>Cord blood</subject><subject>Diet</subject><subject>Diet, Healthy - methods</subject><subject>Dietary Carbohydrates - pharmacology</subject><subject>Dietary restrictions</subject><subject>Europe</subject><subject>Exercise - physiology</subject><subject>Factor Analysis, Statistical</subject><subject>Factorial analysis</subject><subject>Factorial design</subject><subject>Fasting</subject><subject>Fatty acids</subject><subject>Fatty Acids, Nonesterified - blood</subject><subject>Female</subject><subject>Food intake</subject><subject>Gestation</subject><subject>Gestational Weight Gain</subject><subject>Glucose</subject><subject>Glucose tolerance</subject><subject>Glucose Tolerance Test</subject><subject>High density lipoprotein</subject><subject>Humans</subject><subject>Hydroxybutyrates</subject><subject>Insulin</subject><subject>Insulin Resistance</subject><subject>Intervention</subject><subject>Laboratory testing</subject><subject>Leptin</subject><subject>Leptin - blood</subject><subject>Life Style</subject><subject>Linear Models</subject><subject>Lipid metabolism</subject><subject>Lipids</subject><subject>Lipolysis</subject><subject>Low density lipoprotein</subject><subject>Neonates</subject><subject>Obesity</subject><subject>Obesity - blood</subject><subject>Obesity - therapy</subject><subject>Physical activity</subject><subject>Pregnancy</subject><subject>Pregnancy Complications - blood</subject><subject>Pregnancy Complications - therapy</subject><subject>Prenatal Care - methods</subject><subject>Randomization</subject><subject>Research design</subject><subject>Secondary analysis</subject><subject>Smoking</subject><subject>Treatment Outcome</subject><subject>Triglycerides</subject><subject>Triglycerides - blood</subject><subject>Weight Gain</subject><subject>Womens health</subject><issn>0149-5992</issn><issn>1935-5548</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1ksFu1DAQhgMC0aVw4AWQJS4gbSCxk12bW7R025W2FEFRj5FjT1qXrL3YDhAeiwfhmRjTwgGJk-3x5___NZ4se1IWLyljy1dalSIvqpLfzWalYHVe1xW_l82KshJ5LQQ9yB6GcF0URVVx_iA7YGXJaSXo7M767Ri9icZZOZCt6SHEaQCysRH8F7DpghhLzjoIQN55uLTSRnLhdmDnSKlh1MZekq37Cp6spO_c1aS9jL8l5CdAKJAmBKcMFjW5MPEqvfMgAx5PseiT9doDkLWMcSKNMjrMCct__shPUMx9m7oxTkl0TqTViIWYTI-HUTmMtXJWYVQEMG14TRryAZSzWvoJWRWdN-jQoM0UTCCuJ_EKyNHo3R6kJafjEE0SAD8n79HA7cx3zIay0bthwO2bZrv5X3fOk_qj7H4vhwCPb9fD7OP66Hx1km_PjjerZpsruuQxr8tCaa0EpaxmQKWWCw6CM8GYpgvaASxYuaBiKbnoelFxyjpaCy2p7CVTHTvMnt_o7r37PGKcdmeCgmGQFtwYWsoq_OSa1wLRZ_-g125MvUaKLlnJxaJgSL24oZR3IXjo2703O-xcWxZtGq42DVebhgvZp7eKY7cD_Zf8M03sF7FO0Mg</recordid><startdate>201908</startdate><enddate>201908</enddate><creator>Harreiter, Jürgen</creator><creator>Simmons, David</creator><creator>Desoye, Gernot</creator><creator>Corcoy, Rosa</creator><creator>Adelantado, Juan M</creator><creator>Devlieger, Roland</creator><creator>Galjaard, Sander</creator><creator>Damm, Peter</creator><creator>Mathiesen, Elisabeth R</creator><creator>Jensen, Dorte M</creator><creator>Andersen, Lise Lotte T</creator><creator>Dunne, Fidelma</creator><creator>Lapolla, Annunziata</creator><creator>Dalfra, Maria G</creator><creator>Bertolotto, Alessandra</creator><creator>Wender-Ozegowska, Ewa</creator><creator>Zawiejska, Agnieszka</creator><creator>Mantaj, Urszula</creator><creator>Hill, David</creator><creator>Jelsma, Judith G M</creator><creator>Snoek, Frank J</creator><creator>Leutner, Michael</creator><creator>Lackinger, Christian</creator><creator>Worda, Christof</creator><creator>Bancher-Todesca, Dagmar</creator><creator>Scharnagl, Hubert</creator><creator>van Poppel, Mireille N M</creator><creator>Kautzky-Willer, Alexandra</creator><general>American Diabetes Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5055-6814</orcidid><orcidid>https://orcid.org/0000-0002-5715-3230</orcidid><orcidid>https://orcid.org/0000-0002-3520-4105</orcidid></search><sort><creationdate>201908</creationdate><title>Nutritional Lifestyle Intervention in Obese Pregnant Women, Including Lower Carbohydrate Intake, Is Associated With Increased Maternal Free Fatty Acids, 3-β-Hydroxybutyrate, and Fasting Glucose Concentrations: A Secondary Factorial Analysis of the European Multicenter, Randomized Controlled DALI Lifestyle Intervention Trial</title><author>Harreiter, Jürgen ; Simmons, David ; Desoye, Gernot ; Corcoy, Rosa ; Adelantado, Juan M ; Devlieger, Roland ; Galjaard, Sander ; Damm, Peter ; Mathiesen, Elisabeth R ; Jensen, Dorte M ; Andersen, Lise Lotte T ; Dunne, Fidelma ; Lapolla, Annunziata ; Dalfra, Maria G ; Bertolotto, Alessandra ; Wender-Ozegowska, Ewa ; Zawiejska, Agnieszka ; Mantaj, Urszula ; Hill, David ; Jelsma, Judith G M ; Snoek, Frank J ; Leutner, Michael ; Lackinger, Christian ; Worda, Christof ; Bancher-Todesca, Dagmar ; Scharnagl, Hubert ; van Poppel, Mireille N M ; Kautzky-Willer, Alexandra</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c278t-510cddc922353e2ada68e983933d262bee6316297a89bf94823b259da2afa3cb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>3-Hydroxybutyric Acid - blood</topic><topic>Adult</topic><topic>Blood</topic><topic>Blood Glucose - analysis</topic><topic>Body weight gain</topic><topic>Carbohydrates</topic><topic>Cholesterol</topic><topic>Cholesterol, HDL - blood</topic><topic>Cholesterol, LDL - blood</topic><topic>Cord blood</topic><topic>Diet</topic><topic>Diet, Healthy - methods</topic><topic>Dietary Carbohydrates - pharmacology</topic><topic>Dietary restrictions</topic><topic>Europe</topic><topic>Exercise - physiology</topic><topic>Factor Analysis, Statistical</topic><topic>Factorial analysis</topic><topic>Factorial design</topic><topic>Fasting</topic><topic>Fatty acids</topic><topic>Fatty Acids, Nonesterified - blood</topic><topic>Female</topic><topic>Food intake</topic><topic>Gestation</topic><topic>Gestational Weight Gain</topic><topic>Glucose</topic><topic>Glucose tolerance</topic><topic>Glucose Tolerance Test</topic><topic>High density lipoprotein</topic><topic>Humans</topic><topic>Hydroxybutyrates</topic><topic>Insulin</topic><topic>Insulin Resistance</topic><topic>Intervention</topic><topic>Laboratory testing</topic><topic>Leptin</topic><topic>Leptin - blood</topic><topic>Life Style</topic><topic>Linear Models</topic><topic>Lipid metabolism</topic><topic>Lipids</topic><topic>Lipolysis</topic><topic>Low density lipoprotein</topic><topic>Neonates</topic><topic>Obesity</topic><topic>Obesity - blood</topic><topic>Obesity - therapy</topic><topic>Physical activity</topic><topic>Pregnancy</topic><topic>Pregnancy Complications - blood</topic><topic>Pregnancy Complications - therapy</topic><topic>Prenatal Care - methods</topic><topic>Randomization</topic><topic>Research design</topic><topic>Secondary analysis</topic><topic>Smoking</topic><topic>Treatment Outcome</topic><topic>Triglycerides</topic><topic>Triglycerides - blood</topic><topic>Weight Gain</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Harreiter, Jürgen</creatorcontrib><creatorcontrib>Simmons, David</creatorcontrib><creatorcontrib>Desoye, Gernot</creatorcontrib><creatorcontrib>Corcoy, Rosa</creatorcontrib><creatorcontrib>Adelantado, Juan M</creatorcontrib><creatorcontrib>Devlieger, Roland</creatorcontrib><creatorcontrib>Galjaard, Sander</creatorcontrib><creatorcontrib>Damm, Peter</creatorcontrib><creatorcontrib>Mathiesen, Elisabeth R</creatorcontrib><creatorcontrib>Jensen, Dorte M</creatorcontrib><creatorcontrib>Andersen, Lise Lotte T</creatorcontrib><creatorcontrib>Dunne, Fidelma</creatorcontrib><creatorcontrib>Lapolla, Annunziata</creatorcontrib><creatorcontrib>Dalfra, Maria G</creatorcontrib><creatorcontrib>Bertolotto, Alessandra</creatorcontrib><creatorcontrib>Wender-Ozegowska, Ewa</creatorcontrib><creatorcontrib>Zawiejska, Agnieszka</creatorcontrib><creatorcontrib>Mantaj, Urszula</creatorcontrib><creatorcontrib>Hill, David</creatorcontrib><creatorcontrib>Jelsma, Judith G M</creatorcontrib><creatorcontrib>Snoek, Frank J</creatorcontrib><creatorcontrib>Leutner, Michael</creatorcontrib><creatorcontrib>Lackinger, Christian</creatorcontrib><creatorcontrib>Worda, Christof</creatorcontrib><creatorcontrib>Bancher-Todesca, Dagmar</creatorcontrib><creatorcontrib>Scharnagl, Hubert</creatorcontrib><creatorcontrib>van Poppel, Mireille N M</creatorcontrib><creatorcontrib>Kautzky-Willer, Alexandra</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Diabetes care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Harreiter, Jürgen</au><au>Simmons, David</au><au>Desoye, Gernot</au><au>Corcoy, Rosa</au><au>Adelantado, Juan M</au><au>Devlieger, Roland</au><au>Galjaard, Sander</au><au>Damm, Peter</au><au>Mathiesen, Elisabeth R</au><au>Jensen, Dorte M</au><au>Andersen, Lise Lotte T</au><au>Dunne, Fidelma</au><au>Lapolla, Annunziata</au><au>Dalfra, Maria G</au><au>Bertolotto, Alessandra</au><au>Wender-Ozegowska, Ewa</au><au>Zawiejska, Agnieszka</au><au>Mantaj, Urszula</au><au>Hill, David</au><au>Jelsma, Judith G M</au><au>Snoek, Frank J</au><au>Leutner, Michael</au><au>Lackinger, Christian</au><au>Worda, Christof</au><au>Bancher-Todesca, Dagmar</au><au>Scharnagl, Hubert</au><au>van Poppel, Mireille N M</au><au>Kautzky-Willer, Alexandra</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Nutritional Lifestyle Intervention in Obese Pregnant Women, Including Lower Carbohydrate Intake, Is Associated With Increased Maternal Free Fatty Acids, 3-β-Hydroxybutyrate, and Fasting Glucose Concentrations: A Secondary Factorial Analysis of the European Multicenter, Randomized Controlled DALI Lifestyle Intervention Trial</atitle><jtitle>Diabetes care</jtitle><addtitle>Diabetes Care</addtitle><date>2019-08</date><risdate>2019</risdate><volume>42</volume><issue>8</issue><spage>1380</spage><epage>1389</epage><pages>1380-1389</pages><issn>0149-5992</issn><eissn>1935-5548</eissn><abstract>In our randomized controlled trial, we investigated the impact of healthy eating (HE) aiming for restricted gestational weight gain (GWG) and physical activity (PA) interventions on maternal and neonatal lipid metabolism.
Obese pregnant women (
= 436) were included before 20 weeks' gestation and underwent glucose testing (oral glucose tolerance test) and lipid profiling at baseline and 24-28 and 35-37 gestational weeks after an at least 10-h overnight fast. This secondary analysis had a factorial design with comparison of HE (
= 221) versus no HE (
= 215) and PA (
= 218) versus no PA (
= 218). Maternal changes in triglycerides (TG), LDL cholesterol, HDL cholesterol, free fatty acids (FFAs), and leptin from baseline to end of pregnancy and neonatal outcomes were analyzed using general linear models with adjustment for relevant parameters.
At 24-28 weeks' gestation, FFAs (mean ± SD, 0.60 ± 0.19 vs. 0.55 ± 0.17 mmol/L,
< 0.01) were increased after adjustment for FFA at baseline, maternal age, BMI at time of examination, gestational week, insulin resistance, self-reported food intake, self-reported physical activity, and maternal smoking, and GWG was lower (3.3 ± 2.6 vs. 4.3 ± 2.8 kg,
< 0.001, adjusted mean differences -1.0 [95% CI -1.5; -0.5]) in HE versus no HE. Fasting glucose levels (4.7 ± 0.4 vs. 4.6 ± 0.4 mmol/L,
< 0.05) and 3-β-hydroxybutyrate (3BHB) (0.082 ± 0.065 vs. 0.068 ± 0.067 mmol/L,
< 0.05) were higher in HE. Significant negative associations between carbohydrate intake and FFA, 3BHB, and fasting glucose at 24-28 weeks' gestation were observed. No differences between groups were found in oral glucose tolerance test or leptin or TG levels at any time. Furthermore, in PA versus no PA, no similar changes were found. In cord blood, elevated FFA levels were found in HE after full adjustment (0.34 ± 0.22 vs. 0.29 ± 0.16 mmol/L,
= 0.01).
HE intervention was associated with reduced GWG, higher FFAs, higher 3BHB, and higher fasting glucose at 24-28 weeks of gestation, suggesting induction of lipolysis. Increased FFA was negatively associated with carbohydrate intake and was also observed in cord blood. These findings support the hypothesis that maternal antenatal dietary restriction including carbohydrates is associated with increased FFA mobilization.</abstract><cop>United States</cop><pub>American Diabetes Association</pub><pmid>31182492</pmid><doi>10.2337/dc19-0418</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-5055-6814</orcidid><orcidid>https://orcid.org/0000-0002-5715-3230</orcidid><orcidid>https://orcid.org/0000-0002-3520-4105</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0149-5992 |
| ispartof | Diabetes care, 2019-08, Vol.42 (8), p.1380-1389 |
| issn | 0149-5992 1935-5548 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2340045859 |
| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | 3-Hydroxybutyric Acid - blood Adult Blood Blood Glucose - analysis Body weight gain Carbohydrates Cholesterol Cholesterol, HDL - blood Cholesterol, LDL - blood Cord blood Diet Diet, Healthy - methods Dietary Carbohydrates - pharmacology Dietary restrictions Europe Exercise - physiology Factor Analysis, Statistical Factorial analysis Factorial design Fasting Fatty acids Fatty Acids, Nonesterified - blood Female Food intake Gestation Gestational Weight Gain Glucose Glucose tolerance Glucose Tolerance Test High density lipoprotein Humans Hydroxybutyrates Insulin Insulin Resistance Intervention Laboratory testing Leptin Leptin - blood Life Style Linear Models Lipid metabolism Lipids Lipolysis Low density lipoprotein Neonates Obesity Obesity - blood Obesity - therapy Physical activity Pregnancy Pregnancy Complications - blood Pregnancy Complications - therapy Prenatal Care - methods Randomization Research design Secondary analysis Smoking Treatment Outcome Triglycerides Triglycerides - blood Weight Gain Womens health |
| title | Nutritional Lifestyle Intervention in Obese Pregnant Women, Including Lower Carbohydrate Intake, Is Associated With Increased Maternal Free Fatty Acids, 3-β-Hydroxybutyrate, and Fasting Glucose Concentrations: A Secondary Factorial Analysis of the European Multicenter, Randomized Controlled DALI Lifestyle Intervention Trial |
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