Women With Gestational Diabetes Mellitus Randomized to a Higher-Complex Carbohydrate/Low-Fat Diet Manifest Lower Adipose Tissue Insulin Resistance, Inflammation, Glucose, and Free Fatty Acids: A Pilot Study
Teri L Hernandez, Rachael E Van Pelt, Molly A Anderson, Melanie S Reece, Regina M Reynolds, Becky A de la Houssaye, Margaret Heerwagen, William T Donahoo, Linda J Daniels, Catherine Chartier-Logan, Rachel C Janssen, Jacob E Friedman, Linda A Barbour, Teri L Hernandez, Rachael E Van Pelt, Molly A Anderson, Melanie S Reece, Regina M Reynolds, Becky A de la Houssaye, Margaret Heerwagen, William T Donahoo, Linda J Daniels, Catherine Chartier-Logan, Rachel C Janssen, Jacob E Friedman, Linda A Barbour
Abstract
Objective: Diet therapy in gestational diabetes mellitus (GDM) has focused on carbohydrate restriction but is poorly substantiated. In this pilot randomized clinical trial, we challenged the conventional low-carbohydrate/higher-fat (LC/CONV) diet, hypothesizing that a higher-complex carbohydrate/lower-fat (CHOICE) diet would improve maternal insulin resistance (IR), adipose tissue (AT) lipolysis, and infant adiposity.
Research design and methods: At 31 weeks, 12 diet-controlled overweight/obese women with GDM were randomized to an isocaloric LC/CONV (40% carbohydrate/45% fat/15% protein; n = 6) or CHOICE (60%/25%/15%; n = 6) diet. All meals were provided. AT was biopsied at 37 weeks.
Results: After ∼7 weeks, fasting glucose (P = 0.03) and free fatty acids (P = 0.06) decreased on CHOICE, whereas fasting glucose increased on LC/CONV (P = 0.03). Insulin suppression of AT lipolysis was improved on CHOICE versus LC/CONV (56 vs. 31%, P = 0.005), consistent with improved IR. AT expression of multiple proinflammatory genes was lower on CHOICE (P < 0.01). Infant adiposity trended lower with CHOICE (10.1 ± 1.4 vs. 12.6 ± 2%, respectively).
Conclusions: A CHOICE diet may improve maternal IR and infant adiposity, challenging recommendations for a LC/CONV diet.
Trial registration: ClinicalTrials.gov NCT01719029.
© 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
Source: PubMed