The effect of intermittent energy restriction on weight loss and diabetes risk markers in women with a history of gestational diabetes: a 12-month randomized control trial

2021 ◽  
Author(s):  
Kristy L Gray ◽  
Peter M Clifton ◽  
Jennifer B Keogh
Keyword(s):  
Weight Loss ◽  
Gestational Diabetes ◽  
Serum Insulin ◽  
Dropout Rate ◽  
Energy Restriction ◽  
Diabetes Risk ◽  
Oral Glucose ◽  
Risk Markers ◽  
Overweight Women ◽  
The Mean

ABSTRACT Background Weight loss after gestational diabetes (GDM) can prevent or delay the onset of type 2 diabetes. Intermittent energy restriction (IER) may offer an alternative to continuous energy restriction (CER) for weight loss. Objectives We compared the effects of IER (2 days per week) to daily CER over 12 mo on weight loss and diabetes risk markers in overweight women with previous GDM. Methods Overweight females (n = 121) ≥18 y were randomized 1:1 to either IER [2-d 500 kcal (2100 kJ); n = 61] or CER [1500 kcal (6000 kJ); n = 60] in this 12-mo noninferiority trial. Results The trial was completed by 62 participants with a median age of 39.6 y [Quartile (Q) 1 to Quartile 3, 34.9 to 43.9 y] with a median BMI of 32.6 kg/m2 (Q1 to Q3, 28.5 to 37.9 kg/m2) at a median of 2.9 y after GDM (Q1 to Q3, 2.1 to 6.4 y; 49% attrition; IER n = 29; CER n = 30; P = 0.8). The mean ± SD weight loss was significant over time (P < 0.001) but not by diet group (IER −4.8 ± 5.0 kg; CER −3.2 ± 5.0; P = 0.2). The mean between-group difference was −1.6 kg (95% CI: −4.2 to 1.0 kg; P = 0.2). There were no significant between-group differences in change in HbA1c, fasting plasma glucose, fasting serum insulin, HOMA-IR or 2-h oral glucose tolerance at 12 mo (p>0.05). The trial was registered at https://www.anzctr.org.au/ (ACTRN12617001476325). Conclusions IER produces comparable weight loss to CER over 12 mo in overweight women with previous GDM. The high dropout rate in this study is a limitation in the interpretation of these results. Larger studies are needed to confirm noninferiority of IER compared to CER.

scholarly journals 24-h severe energy restriction impairs postprandial glycaemic control in young, lean males

2018 ◽  
Vol 120 (10) ◽  
pp. 1107-1116 ◽  
Author(s):  
David J. Clayton ◽  
Jack Biddle ◽  
Tyler Maher ◽  
Mark P. Funnell ◽  
Jack A. Sargeant ◽  
...  
Keyword(s):  
Weight Loss ◽  
Insulin Sensitivity ◽  
Glycaemic Control ◽  
Dietary Intervention ◽  
Serum Insulin ◽  
Serum Glucose ◽  
Energy Restriction ◽  
Fibroblast Growth Factor 21 ◽  
Oral Glucose ◽  
Model Assessment

AbstractIntermittent energy restriction (IER) involves short periods of severe energy restriction interspersed with periods of adequate energy intake, and can induce weight loss. Insulin sensitivity is impaired by short-term, complete energy restriction, but the effects of IER are not well known. In randomised order, fourteen lean men (age: 25 (sd 4) years; BMI: 24 (sd 2) kg/m2; body fat: 17 (4) %) consumed 24-h diets providing 100 % (10 441 (sd 812) kJ; energy balance (EB)) or 25 % (2622 (sd 204) kJ; energy restriction (ER)) of estimated energy requirements, followed by an oral glucose tolerance test (OGTT; 75 g of glucose drink) after fasting overnight. Plasma/serum glucose, insulin, NEFA, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP) and fibroblast growth factor 21 (FGF21) were assessed before and after (0 h) each 24-h dietary intervention, and throughout the 2-h OGTT. Homoeostatic model assessment of insulin resistance (HOMA2-IR) assessed the fasted response and incremental AUC (iAUC) or total AUC (tAUC) were calculated during the OGTT. At 0 h, HOMA2-IR was 23 % lower after ER compared with EB (P<0·05). During the OGTT, serum glucose iAUC (P<0·001), serum insulin iAUC (P<0·05) and plasma NEFA tAUC (P<0·01) were greater during ER, but GLP-1 (P=0·161), GIP (P=0·473) and FGF21 (P=0·497) tAUC were similar between trials. These results demonstrate that severe energy restriction acutely impairs postprandial glycaemic control in lean men, despite reducing HOMA2-IR. Chronic intervention studies are required to elucidate the long-term effects of IER on indices of insulin sensitivity, particularly in the absence of weight loss.

scholarly journals Breastfeeding Duration and Development of Dysglycemia in Women Who Had Gestational Diabetes Mellitus: Evidence from the GUSTO Cohort Study

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 408
Author(s):  
Sumali S. Hewage ◽  
Xin Yu Hazel Koh ◽  
Shu E. Soh ◽  
Wei Wei Pang ◽  
Doris Fok ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Tolerance Test ◽  
Diabetes Risk ◽  
Breastfeeding Duration ◽  
Oral Glucose ◽  
Inverse Association ◽  
Index Pregnancy

(1) Background: Breastfeeding has been shown to support glucose homeostasis in women after a pregnancy complicated by gestational diabetes mellitus (GDM) and is potentially effective at reducing long-term diabetes risk. (2) Methods: Data from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study were analyzed to understand the influence of breastfeeding duration on long-term dysglycemia (prediabetes and diabetes) risk in women who had GDM in the index pregnancy. GDM and dysglycemia four to seven years postpartum were determined by the oral glucose tolerance test (OGTT). A Poisson regression model with a robust error variance was used to estimate incidence rate ratios (IRRs) for dysglycemia four to seven years post-delivery according to groupings of the duration of any breastfeeding (<1, ≥1 to <6, and ≥6 months). (3) Results: Women who had GDM during the index pregnancy and complete breastfeeding information and OGTT four to seven years postpartum were included in this study (n = 116). Fifty-one women (44%) had postpartum dysglycemia. Unadjusted IRRs showed an inverse association between dysglycemia risk and ≥1 month to <6 months (IRR 0.91; 95% confidence interval [CI] 0.57, 1.43; p = 0.68) and ≥6 months (IRR 0.50; 95% CI 0.27, 0.91; p = 0.02) breastfeeding compared to <1 month of any breastfeeding. After adjusting for key confounders, the IRR for the ≥6 months group remained significant (IRR 0.42; 95% CI 0.22, 0.80; p = 0.008). (4) Conclusions: Our results suggest that any breastfeeding of six months or longer may reduce long-term dysglycemia risk in women with a history of GDM in an Asian setting. Breastfeeding has benefits for mothers beyond weight loss, particularly for those with GDM.

scholarly journals Maternal obesity influences birth weight more than gestational diabetes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eman M Alfadhli
Keyword(s):  
Birth Weight ◽  
Gestational Diabetes ◽  
Pregnancy Outcomes ◽  
Maternal Obesity ◽  
Reference Group ◽  
Adverse Pregnancy Outcomes ◽  
Antenatal Visit ◽  
Oral Glucose ◽  
The Mean ◽  
Adverse Pregnancy

Abstract Background Maternal obesity and gestational diabetes (GDM) are commonly encountered during pregnancy. Both conditions are independently associated with unfavorable pregnancy consequences. The objective of this study was to compare the effects of obesity and GDM on birth weight, macrosomia, and other adverse pregnancy outcomes. Methods This cohort study involved 531 women with a singleton pregnancy attending the Maternity and Children’s Hospital, Medina, Saudi Arabia, between June 2014 and June 2015. Participants underwent a 75-g oral glucose tolerance test between 24 and 28 weeks. The International Association of Diabetes and Pregnancy Study Groups criteria were used for GDM diagnosis. BMI was assessed at the first antenatal visit, and obesity was defined as a BMI ≥30.0 kg/m2. All women were followed up until delivery. Women were divided into 4 groups: non-GDM nonobese (reference group), GDM nonobese, obese non-GDM, and obese GDM. Clinical characteristics and adverse pregnancy outcomes were compared. Results The mean age and BMI of the participants were 30.5 years and 29.3 kg/m2, respectively. GDM was diagnosed in 50.2% of the participants, and obesity was diagnosed in 47.8% of the participants. Obese women with GDM were the oldest and heaviest among all women. The mean birth weight increased in order among the four groups; it was highest in the infants in the obese GDM group, followed by those in the obese non-GDM, GDM nonobese and reference groups. Obesity and GDM alone or in combination were associated with higher rates of macrosomia and cesarean deliveries than the reference group. Neonatal intensive care unit (NICU) admission was higher in infants in the GDM nonobese and obese GDM groups. The frequency of low Apgar score was significantly higher in infants in the obese GDM group than in infants in the reference group. Conclusions Maternal obesity seems to influence birth weight more than GDM, while GDM is associated with a greater risk of admission to the NICU. The combination of both conditions is associated with the greatest risk of adverse pregnancy outcomes.

Abstract MP052: Neither Insulin Secretion nor Genotype Pattern Modify 12-Month Weight Loss Effects of Healthy Low-Fat vs. Healthy Low-Carbohydrate Diets Among Adults with Obesity

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Christopher D Gardner ◽  
Michelle Hauser ◽  
Liana Del Gobbo ◽  
John Trepanowski ◽  
Joseph Rigdon ◽  
...  
Keyword(s):  
Weight Loss ◽  
Insulin Secretion ◽  
Energy Restriction ◽  
Risk Indicators ◽  
Oral Glucose ◽  
Multilocus Genotype ◽  
Low Fat ◽  
Data Set ◽  
Low Carbohydrate ◽  
Glucose Dynamics

Background: Dietary modification remains an essential component of successful weight loss strategies. No one dietary strategy has been determined to be superior to others for the general population. Studies that contrast reducing dietary fat vs. carbohydrate report consistently high within-group variability in dietary adherence and weight loss. Previous research by our group and others suggest that insulin-glucose dynamics or genotype patterns may modify diet effects. Objective: To determine if within-group weight loss variability on a Healthy Low-Fat (HLF) vs. a Healthy Low Carbohydrate (HLC) diet can be attributed to underlying factors such as insulin-glucose dynamics (i.e., insulin resistance and secretion) or genotype pattern. We hypothesized the above factors would be effect modifiers of HLF and HLC diets on 12-month weight loss. Methods: Generally healthy, non-diabetic adults, 18-50 years, BMI 28-40 kg/m 2 , were randomized to HLF or HLC with no specific prescribed energy restriction for 12 months (n=609). Health educators delivered the intervention in 22 1-hr group classes. Data were collected at 0, 3, 6, & 12 months. Dietary intake was assessed by three 24-hour recalls/time point. Clinical data includes: 75-g glucose oral glucose tolerance tests (insulin concentration at 30 minutes [Ins-30], a measure of insulin secretion), genotyping (3-SNP multilocus genotype: Low-Fat Genotype vs. Low-Carb Genotype, UK Biobank Axiom® array), body composition (DXA), resting energy expenditure (indirect calorimetry), epigenetics, proteomics, subcutaneous adipose tissue, microbiota, and standard CVD risk indicators. Results: At 12 months participants collectively lost 6,559 lbs. Retention was 79%, with equal dropout between arms. Range of weight change in both diet arms was ~80 lbs (-60 to +20 lbs). Macronutrient distribution at 12 months was 48% vs. 30% carbohydrate, 29% vs. 45% fat, and 21% vs. 23% protein for HLF and HLC, respectively. Both groups reported achieving and maintaining an average ~500 kcal deficit relative to baseline. Weight loss was similar for HLF vs. HLC: -12.1 ± 1.1 lbs vs. -13.8 ± 1.0 lbs, mean ± SEM. Neither Ins-30 (p for interaction = 0.84) nor genotype pattern (p for interaction = 0.20) modified the effect of diet on 12-month weight loss. Conclusions: Despite substantial weight loss, high within-group variability, and strong dietary differentiation between groups, neither baseline Ins-30 nor genotype pattern modified the effect of diet on 12-month weight loss. Focus on a healthy diet in both diet arms is novel in the context of many previous Low-Fat vs. Low-Carb studies and may have diminished expected effect modification. The extensive data set collected will be used to explore this and other potential explanatory factors.

scholarly journals Significant seasonal variations in the rate of women diagnosed with gestational diabetes: A observational single centre study of 28,128 women

2021 ◽  
Author(s):  
Matthew Cauldwell ◽  
Yolande VanDerI'isle ◽  
Ingrid Watt-Coote ◽  
Philip Steer
Keyword(s):  
Gestational Diabetes ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Test Design ◽  
Single Centre ◽  
June July August ◽  
Single Centre Study ◽  
The Mean ◽  
June July

Objective To test the hypothesis that there is seasonal variation in the rates of gestational diabetes (GDM) diagnosed using a 2 hour oral glucose tolerance test. Design Monthly assessment of the percentage of women screened from 1st April 2016 to the 31st December 2020 who were diagnosed as having gestational diabetes Setting London Teaching Hospital Population 28,128 women receiving antenatal care between April 1st 2016 and 31 December 2020. Methods Retrospective study of prospectively collected data. Main Outcome Measures Proportion of women screened diagnosed as having gestational diabetes. Results The mean (SD) percentage of women diagnosed with GDM was 14.78 (2.24) in summer (June, July, August) compared with 11.23 (1.62) in winter (p < 0.001), 12.13 (1.94) in spring (p = 0.002), and 11.88 (2.67) in autumn (p = 0.003). There was a highly significant positive correlation of the percentage testing positive for GDM with the mean maximum monthly temperature (R2 = 0.248, p < 0.001). There was a statistically significant 33.8% increase in the proportion of GDM diagnoses from June 2020 onwards, possibly related to a reduction in exercise secondary to the Covid-19 pandemic. Conclusions There is a 23.3% higher rate of GDM diagnoses in the warmer summer months. There has been a 33.8% rise in GDM diagnoses associated with the Covid-19 pandemic.

scholarly journals Women's Barriers to Weight Loss, Knowledge of Future Diabetes Risk and Opinions of Diet Strategies Following Gestational Diabetes: An Online Survey (OR08-01-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Kristy Gray ◽  
Maya Grebenshchikova ◽  
Sharleen O'Reilly ◽  
Lois McKellar ◽  
Peter Clifton ◽  
...  
Keyword(s):  
Weight Loss ◽  
Gestational Diabetes ◽  
Online Survey ◽  
South Australia ◽  
Theoretical Domains Framework ◽  
Energy Restriction ◽  
The Internet ◽  
Cross Sectional ◽  
Family Responsibilities ◽  
Expert Review

Abstract Objectives Weight loss after gestational diabetes (GDM) significantly reduces the risk of developing type 2 diabetes (T2DM) however weight loss is not easily achieved or maintained. The purpose of this survey was to examine knowledge of future risk of T2DM after GDM, barriers to weight loss and to identify diet strategies that these women feel might work for them. Opinions of intermittent energy restriction (IER) were of particular interest. Methods Australian women aged ≥18 years who ever had GDM were invited to participate in this cross-sectional online survey. The survey was developed by a dietitian using the Theoretical Domains Framework and underwent expert review (n = 6) and piloted (n = 20) prior to the final survey being run. Results There were 429 partial and 328 complete responses (age 37.2 ± 7.2 years, n = 429, years post GDM 4.9 ± 6.3 years, n = 428, BMI 30.9 ± 7.3 kg/m2n = 394). Overweight (n = 110) or obese (n = 200) responders mostly knew they were overweight and three-quarters thought they were either high (n = 144, 33.6%) or moderate risk (n = 176, 41.1%) for developing T2DM. Most women reported they knew what sorts of food to eat to lose weight (n = 332, 86.7%), that their families would support them (n = 320, 87%) and they were motivated to lose weight (n = 213, 58.4%). The most common barriers were family responsibilities taking priority (n = 240, 63%) and finding it hard to deal with hunger (n = 206, 55.8%). Weight loss programs by a dietitian were popular as individual appointments (n = 242, 65.1%) or an online program (n = 200, 53.5%). Nearly three-quarters of responders had or would use the internet to seek weight loss information (n = 308, 71.8%). Exercising was the most tried method of weight loss (n = 234, 71.1%). Most women had heard of IER (the “5:2 diet”) (n = 284, 73%) but only 34 had tried the diet. Of the women who hadn't heard of the 5:2 diet, 51.5% (n = 52) answered that it sounded like a good option and 15.8% (n = 16) didn't think the diet would suit them. Conclusions Despite most women reporting knowledge of their risk of T2DM, motivation to lose weight and family support, family responsibilities can make weight loss efforts difficult for mothers. Exercising, the 5:2 diet and use of the internet is an appealing option for some women however individual circumstances should be taken into consideration. Funding Sources The University of South Australia.

scholarly journals DNA Methylation Pattern in Overweight Women under an Energy-Restricted Diet Supplemented with Fish Oil

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Cátia Lira do Amaral ◽  
Fermín I. Milagro ◽  
Rui Curi ◽  
J. Alfredo Martínez
Keyword(s):  
Gene Expression ◽  
Dna Methylation ◽  
Weight Loss ◽  
Fish Oil ◽  
Mononuclear Cells ◽  
Energy Restriction ◽  
Dietary Factors ◽  
Epigenetic Mechanisms ◽  
Overweight Women ◽  
Fish Oil Supplementation

Dietary factors modulate gene expression and are able to alter epigenetic signatures in peripheral blood mononuclear cells (PBMC). However, there are limited studies about the effects of omega-3 polyunsaturated fatty acids (n-3 PUFA) on the epigenetic mechanisms that regulate gene expression. This research investigates the effects ofn-3-rich fish oil supplementation on DNA methylation profile of several genes whose expression has been reported to be downregulated byn-3 PUFA in PBMC:CD36,FFAR3,CD14,PDK4, andFADS1. Young overweight women were supplemented with fish oil or control in a randomized 8-week intervention trial following a balanced diet with 30% energy restriction. Fatty acid receptorCD36decreased DNA methylation at CpG +477 due to energy restriction. Hypocaloric diet-induced weight loss also reduced the methylation percentages of CpG sites located inCD14,PDK4, andFADS1. The methylation patterns of these genes were only slightly affected by the fish oil supplementation, being the most relevant to the attenuation of the weight loss-induced decrease inCD36methylation after adjusting by baseline body weight. These results suggest that then-3 PUFA-induced changes in the expression of these genes in PBMC are not mediated by DNA methylation, although other epigenetic mechanisms cannot be discarded.

scholarly journals The effect of intermittent energy and carbohydrate restrictionv. daily energy restriction on weight loss and metabolic disease risk markers in overweight women

2013 ◽  
Vol 110 (8) ◽  
pp. 1534-1547 ◽  
Author(s):  
Michelle Harvie ◽  
Claire Wright ◽  
Mary Pegington ◽  
Debbie McMullan ◽  
Ellen Mitchell ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Weight Loss ◽  
Insulin Sensitivity ◽  
Body Fat ◽  
Disease Risk ◽  
Phase 1 ◽  
Weight Maintenance ◽  
Energy Restriction ◽  
Overweight Women ◽  
Daily Energy

Intermittent energy restriction may result in greater improvements in insulin sensitivity and weight control than daily energy restriction (DER). We tested two intermittent energy and carbohydrate restriction (IECR) regimens, including one which allowedad libitumprotein and fat (IECR+PF). Overweight women (n115) aged 20 and 69 years with a family history of breast cancer were randomised to an overall 25 % energy restriction, either as an IECR (2500–2717 kJ/d, < 40 g carbohydrate/d for 2 d/week) or a 25 % DER (approximately 6000 kJ/d for 7 d/week) or an IECR+PF for a 3-month weight-loss period and 1 month of weight maintenance (IECR or IECR+PF for 1 d/week). Insulin resistance reduced with the IECR diets (mean − 0·34 (95 % CI − 0·66, − 0·02) units) and the IECR+PF diet (mean − 0·38 (95 % CI − 0·75, − 0·01) units). Reductions with the IECR diets were significantly greater compared with the DER diet (mean 0·2 (95 % CI − 0·19, 0·66) μU/unit,P= 0·02). Both IECR groups had greater reductions in body fat compared with the DER group (IECR: mean − 3·7 (95 % CI − 2·5, − 4·9) kg,P= 0·007; IECR+PF: mean − 3·7 (95 % CI − 2·8, − 4·7) kg,P= 0·019; DER: mean − 2·0 (95 % CI − 1·0, 3·0) kg). During the weight maintenance phase, 1 d of IECR or IECR+PF per week maintained the reductions in insulin resistance and weight. In the short term, IECR is superior to DER with respect to improved insulin sensitivity and body fat reduction. Longer-term studies into the safety and effectiveness of IECR diets are warranted.

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