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1.
Metabolism ; 72: 27-36, 2017 07.
Article in English | MEDLINE | ID: mdl-28641781

ABSTRACT

CONTEXT: Gestational diabetes is commonly linked to development of type 2 diabetes mellitus (T2DM). There is a need to characterize metabolic changes associated with gestational diabetes in order to find novel biomarkers for T2DM. OBJECTIVE: To find potential pathophysiological mechanisms and markers for progression from gestational diabetes mellitus to T2DM by studying the metabolic transition from pregnancy to postpartum. DESIGN: The metabolic transition profile from pregnancy to postpartum was characterized in 56 women by mass spectrometry-based metabolomics; 11 women had gestational diabetes mellitus, 24 had normal glucose tolerance, and 21 were normoglycaemic but at increased risk for gestational diabetes mellitus. Fasting serum samples collected during trimester 3 (gestational week 32±0.6) and postpartum (10.5±0.4months) were compared in diagnosis-specific multivariate models (orthogonal partial least squares analysis). Clinical measurements (e.g., insulin, glucose, lipid levels) were compared and models of insulin sensitivity and resistance were calculated for the same time period. RESULTS: Women with gestational diabetes had significantly increased postpartum levels of the branched-chain amino acids (BCAAs) leucine, isoleucine, and valine, and their circulating lipids did not return to normal levels after pregnancy. The increase in BCAAs occurred postpartum since the BCAAs did not differ during pregnancy, as compared to normoglycemic women. CONCLUSIONS: Postpartum levels of specific BCAAs, notably valine, are related to gestational diabetes during pregnancy.


Subject(s)
Amino Acids, Branched-Chain/blood , Diabetes, Gestational/blood , Metabolomics/methods , Postpartum Period/blood , Adult , Biomarkers/blood , Blood Glucose/metabolism , Female , Humans , Mass Spectrometry , Pregnancy/blood , Young Adult
2.
BMJ Open ; 7(3): e014565, 2017 03 15.
Article in English | MEDLINE | ID: mdl-28298369

ABSTRACT

BACKGROUND: Risk for developing metabolic syndrome (MeS) after delivery is high among women with gestational diabetes mellitus (GDM), but little is known about development of MeS among women with risk factors for GDM during pregnancy. In the present study, we studied the prevalence of MeS 7 years postpartum among women with GDM risk factors during pregnancy, women with early GDM diagnosis and women without GDM risk factors. We also analysed the early pregnancy risk factors associated with MeS. METHODS: A Finnish cluster randomised controlled GDM prevention trial was conducted in 2007-2009. The prevalence of MeS according to International Diabetes Federation criteria was determined in the follow-up study 7 years after original trial. Eligible participants (n=289) in 4 study groups (intervention (n=83) and usual care (n=87) with GDM risk factors; early GDM (n=51), and healthy control without GDM risk factors (n=68)) were evaluated for MeS. Binary logistic regression models were used to analyse risk factors associated with MeS. RESULTS: 7 years postpartum, the MeS prevalence was 14% (95% CI 8% to 25%) in the intervention group; 15% (CI 8% to 25%) in the usual care group; 50% (CI 35% to 65%) in the early GDM group and 7% (CI 2% to 18%) in the healthy control group. OR for MeS in women with GDM risk factors did not differ from the healthy control group. Body mass index (BMI)-adjusted OR for MeS was 9.18 (CI 1.82 to 46.20) in the early GDM group compared with the healthy control group. Increased prepregnancy BMI was associated with MeS (OR, 1.17, CI 1.08 to 1.28, adjusted for group). CONCLUSIONS: Increased prepregnancy BMI and early GDM diagnosis were the strongest risk factors for developing MeS 7 years postpartum. Overweight and obese women and especially those with early GDM should be monitored and counselled for cardiometabolic risk factors after delivery.


Subject(s)
Body Mass Index , Diabetes, Gestational/prevention & control , Metabolic Syndrome/etiology , Obesity/complications , Adult , Female , Finland/epidemiology , Follow-Up Studies , Humans , Logistic Models , Overweight/complications , Postpartum Period , Pregnancy , Prevalence , Risk Factors
3.
PLoS One ; 11(12): e0167759, 2016.
Article in English | MEDLINE | ID: mdl-27936083

ABSTRACT

There is a link between the pregnancy and its long-term influence on health and susceptibility to future chronic disease both in mother and offspring. The objective was to determine whether individual counseling on physical activity and diet and weight gain at five antenatal visits can prevent type 2 diabetes mellitus (T2DM) and overweight or improve glycemic parameters, among all at-risk-mothers and their children. Another objective was to evaluate whether gestational lifestyle intervention was cost-effective as measured with mother's sickness absence and quality-adjusted life years (QALY). This study was a seven-year follow-up study for women, who were enrolled to the antenatal cluster-randomized controlled trial (RCT). Analysis of the outcome included all women whose outcome was available, in addition with subgroup analysis including women adherent to all lifestyle aims. A total of 173 women with their children participated to the study, representing 43% (173/399) of the women who finished the original RCT. Main outcome measures were: T2DM based on medication use or fasting blood glucose or oral glucose tolerance test (OGTT), body mass index (BMI), glycosylated hemoglobin (HbA1c). None of the women were diagnosed to have T2DM. HbA1c or fasting blood glucose differences were not found among mothers or children. Differences in BMI were non-significant among mothers (Intervention 27.3, Usual care 28.1 kg/m2, p = 0.33) and children (I 21.3 vs U 22.5 kg/m2, p = 0.07). Children's BMI was significantly lower among adherent group (I 20.5 vs U 22.5, p = 0.04). The mean total cost per person was 30.6% lower in the intervention group than in the usual care group (I €2,944 vs. U €4,243; p = 0.74). Intervention was cost-effective in terms of sickness absence but not in QALY gained i.e. if society is willing to pay additional €100 per one avoided sickness absence day; there is a 90% probability of the intervention arm to be cost-effective. Long-term effectiveness of antenatal lifestyle counseling was not shown, in spite of possible effect on children's BMI. Cost-effectiveness of the intervention in terms of sickness absence may have larger societal impact.


Subject(s)
Counseling , Diabetes Mellitus, Type 2/prevention & control , Diabetes, Gestational/prevention & control , Life Style , Maternal Health Services , Adult , Body Mass Index , Child , Cost-Benefit Analysis , Counseling/economics , Diabetes Mellitus, Type 2/economics , Diabetes Mellitus, Type 2/epidemiology , Diabetes, Gestational/economics , Diabetes, Gestational/epidemiology , Diet , Female , Follow-Up Studies , Health Care Costs , Humans , Maternal Health Services/economics , Pregnancy , Prenatal Care/economics , Quality-Adjusted Life Years , Weight Gain
4.
Prev Med Rep ; 4: 435-40, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27583202

ABSTRACT

UNLABELLED: We studied dietary patterns, physical activity (PA), and monthly goal setting in a weight reduction intervention in long-distance professional drivers. The study was conducted in Finland in 2009-2012. Male drivers with waist circumference > 100 cm were randomized to a lifestyle counseling (LIFE, N = 55) and a reference (REF, N = 58) group. During 12 months, LIFE participated in 6 face-to-face and 7 telephone counseling sessions on diet and PA. Dietary patterns were assessed using an index combining food diary and counselor interview, and PA with the number of daily steps using a pedometer. Monthly lifestyle goals, perceived facilitators and barriers, and adverse effects of PA in the LIFE participants were monitored using counselors' log books. Forty-seven (85%) LIFE participants completed the 12-month program. After 12 months, the mean dietary index score improved by 12% (p = 0.002, N = 24), and the number of daily steps increased by 1811 steps (median; p = 0.01, N = 22). The most frequent dietary goals dealt with meal frequency, plate model, and intake of vegetables, fruits, and berries. The most common PA mode was walking. Typical facilitators to reach monthly lifestyle goals were support from family and friends and ailment prevention; typical barriers were working schedules and ailments. Adverse effects, most commonly musculoskeletal pain, occurred among 83% of the LIFE participants. Positive changes in lifestyle habits were observed during counseling. Monthly lifestyle counseling combining face-to-face and phone contacts seemed appropriate to long-distance drivers. Barriers for reaching lifestyle changes, and adverse effects of PA were common and need to be addressed when planning counseling. TRIAL REGISTRATION: Clinical Trials NCT00893646.

5.
Scand J Work Environ Health ; 41(1): 54-64, 2015 Jan.
Article in English | MEDLINE | ID: mdl-25310464

ABSTRACT

OBJECTIVES: We conducted a randomized trial among overweight long-distance drivers to study the effects of structured lifestyle counseling on body weight and cardiometabolic risk factors. METHODS: Men with waist circumference >100 cm were randomized into a lifestyle counseling (LIFE, N=55) and a reference (REF, N=58) group. The LIFE group participated in monthly counseling on nutrition, physical activity, and sleep for 12 months aiming at 10% weight loss. After 12 months, the REF group participated in 3-month counseling. Assessments took place at 0, 12, and 24 months. Between-group differences in changes were analyzed by generalized linear modeling. Metabolic risk (Z score) was calculated from components of metabolic syndrome. RESULTS: The mean body weight change after 12 months was -3.4 kg in LIFE (N=47) and 0.7 kg in REF (N=48) [net difference -4.0 kg, 95% confidence interval (95% CI) -1.9- -6.2]. Six men in LIFE reduced body weight by ≥10%. Changes in waist circumference were -4.7 cm in LIFE and -0.1 cm in REF (net -4.7 cm, 95% CI -6.6- -2.7). Metabolic risk decreased more in the LIFE than REF group (net -1.2 points, 95% CI -0.6- -2.0). After 24 months follow-up, there were no between-group differences in changes in body weight (net -0.5 kg, 95% CI -3.8-2.9) or metabolic risk score (net 0.1 points; 95% CI -0.8-1.0) compared to baseline. CONCLUSIONS: Weight reduction and decreases in cardiometabolic risk factors were clinically meaningful after 12 months of counseling.


Subject(s)
Automobile Driving , Cardiovascular Diseases/epidemiology , Counseling , Diet, Reducing , Metabolic Syndrome/epidemiology , Overweight/therapy , Adult , Cardiovascular Diseases/prevention & control , Exercise/physiology , Feeding Behavior/physiology , Health Behavior , Humans , Male , Metabolic Syndrome/prevention & control , Middle Aged , Risk Factors , Risk Reduction Behavior , Weight Loss
6.
Matern Child Nutr ; 10(2): 184-97, 2014 Apr.
Article in English | MEDLINE | ID: mdl-22735030

ABSTRACT

The incidence of gestational diabetes mellitus (GDM) is increasing and GDM might be prevented by improving diet. Few interventions have assessed the effects of dietary counselling on dietary intake of pregnant women. This study examined the effects of dietary counselling on food habits and dietary intake of Finnish pregnant women as secondary outcomes of a trial primarily aiming at preventing GDM. A cluster-randomized controlled trial was conducted in 14 municipalities in Finland, including 399 pregnant women at increased risk for developing GDM. The intervention consisted of dietary counselling focusing on dietary fat, fibre and saccharose intake at four routine maternity clinic visits. Usual counselling practices were continued in the usual care municipalities. A validated 181-item food frequency questionnaire was used to assess changes in diet from baseline to 26-28 and 36-37 weeks gestation. The data were analysed using multilevel mixed-effects linear regression models. By 36-37 weeks gestation, the intervention had beneficial effects on total intake of vegetables, fruits and berries (coefficient for between-group difference in change 61.6 g day(-1), 95% confidence interval 25.7-97.6), the proportions of high-fibre bread of all bread (7.2% units, 2.5-11.9), low-fat cheeses of all cheeses (10.7% units, 2.6-18.9) and vegetable fats of all dietary fats (6.1% -units, 2.0-10.3), and the intake of saturated fatty acids (-0.67 energy-%-units, -1.16 to -0.19), polyunsaturated fatty acids (0.38 energy-%-units, 0.18-0.58), linoleic acid (764 mg day(-1), 173-1354) and fibre (2.07 g day(-1) , 0.39-3.75). The intervention improved diet towards the recommendations in pregnant women at increased risk for GDM suggesting the counselling methods could be implemented in maternity care.


Subject(s)
Diabetes, Gestational/prevention & control , Feeding Behavior , Adult , Counseling , Diet , Dietary Fats/administration & dosage , Dietary Fiber/administration & dosage , Dietary Sucrose/administration & dosage , Female , Finland , Fruit , Health Education , Humans , Linear Models , Pregnancy , Surveys and Questionnaires , Vegetables , Young Adult
7.
Lipids ; 48(12): 1227-35, 2013 Dec.
Article in English | MEDLINE | ID: mdl-24122103

ABSTRACT

Oxidized LDL lipids (ox-LDL) are associated with lifestyle diseases such as cardiovascular diseases, metabolic syndrome and type 2 diabetes. The present study investigated how postpartum weight retention effects on ox-LDL and serum lipids. The study is a nested comparative research of a cluster-randomized controlled trial, NELLI (lifestyle and counselling during pregnancy). During early pregnancy (8-12 weeks) and 1 year postpartum, 141 women participated in measurements for determining of plasma lipids: total cholesterol (T-C), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), triacylglycerols (TAG) and ox-LDL. Subjects were stratified into tertiles (weight loss, unaltered weight and weight gain groups) based on their weight change from baseline to follow-up. Ox-LDL was determined by baseline level of conjugated dienes in LDL lipids. Among the group of weight gainers, concentration of TAG reduced less (-0.14 vs. -0.33, p = 0.002), HDL-C reduced more (-0.31 vs. -0.16, p = 0.003) and ox-LDL/HDL-C ratio increased (3.0 vs. -0.2, p = 0.003) when compared to group of weight loss. Both T-C and LDL-C elevated more (0.14 vs. -0.21, p = 0.008; 0.31 vs. 0.07, p = 0.015) and TAG and ox-LDL reduced less (-0.33 vs. 0.20, p = 0.033; -3.33 vs. -0.68, p = 0.026) in unaltered weight group compared to weight loss group. The women who gained weight developed higher TAG and ox-LDL/HDL-C ratio as compared to those who lost weight. Postpartum weight retention of 3.4 kg or more is associated with atherogenic lipid profile.


Subject(s)
Body Weight/physiology , Cholesterol, HDL/blood , Lipoproteins, LDL/blood , Postpartum Period/physiology , Adult , Cholesterol, LDL/blood , Female , Humans , Pregnancy , Triglycerides/blood , Weight Loss
8.
J Pregnancy ; 2013: 139049, 2013.
Article in English | MEDLINE | ID: mdl-23577256

ABSTRACT

BACKGROUND: Women with a history of gestational diabetes mellitus (GDM) are at increased risk for metabolic syndrome (MeS) after delivery. We studied the prevalence of MeS at one year postpartum among Finnish women who in early pregnancy were at increased risk of developing GDM. METHODS: This follow-up study is a part of a GDM prevention trial. At one year postpartum, 150 women (mean age 33.1 years, BMI 27.2 kg/m(2)) were evaluated for MeS. RESULTS: The prevalence of MeS was 18% according tothe International Diabetes Federation (IDF) criteria and 16% according toNational Cholestrol Education Program (NCEP) criteria. Of MeS components, 74% of participants had an increased waist circumference (≥80 cm). Twenty-seven percent had elevated fasting plasma glucose (≥5.6 mmol/L), and 29% had reduced HDL cholesterol (≤1.3 mmol/L). The odds ratio for the occurrence of MeS at one year postpartum was 3.0 (95% CI 1.0-9.2) in those who were overweight before pregnancy compared to normal weight women. CONCLUSIONS: Nearly one-fifth of the women with an increased risk of GDM in early pregnancy fulfilled the criteria of MeS at one year postpartum. The most important factor associated with MeS was prepregnancy overweight. Weight management before and during pregnancy is important for preventing MeS after delivery.


Subject(s)
Diabetes, Gestational/epidemiology , Metabolic Syndrome/epidemiology , Adult , Blood Glucose/metabolism , Cholesterol, HDL/metabolism , Diabetes, Gestational/blood , Diabetes, Gestational/etiology , Female , Finland/epidemiology , Humans , Metabolic Syndrome/blood , Metabolic Syndrome/etiology , Overweight/epidemiology , Pregnancy , Prevalence , Regression Analysis , Risk Factors
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