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.
Study Goal
The researchers aimed to compare the effects of a higher-complex carbohydrate/lower-fat (CHOICE) diet versus a conventional low-carbohydrate/higher-fat (LC/CONV) diet on maternal insulin resistance, adipose tissue lipolysis, and infant adiposity in women with gestational diabetes mellitus (GDM).
Results Summary
The CHOICE diet improved maternal insulin resistance and reduced adipose tissue lipolysis and proinflammatory gene expression compared to the LC/CONV diet. Infant adiposity also trended lower with the CHOICE diet.
Population
Overweight/obese women with diet-controlled GDM.
Effective Dosage
CHOICE diet (60% carbohydrate/25% fat/15% protein) and LC/CONV diet (40% carbohydrate/45% fat/15% protein).
Duration
Approximately 7 weeks.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
higher-complex carbohydrate/lower-fat (CHOICE) diet | decrease | fasting glucose | diet-controlled overweight/obese women with GDM | P = 0.03 | decreased | #1 |
higher-complex carbohydrate/lower-fat (CHOICE) diet | decrease | free fatty acids | diet-controlled overweight/obese women with GDM | P = 0.06 | decreased | #2 |
low-carbohydrate/higher-fat (LC/CONV) diet | increase | fasting glucose | diet-controlled overweight/obese women with GDM | P = 0.03 | increased | #3 |
higher-complex carbohydrate/lower-fat (CHOICE) diet | increase | insulin suppression of AT lipolysis | diet-controlled overweight/obese women with GDM | 56 vs. 31%, P = 0.005 | improved | #4 |
higher-complex carbohydrate/lower-fat (CHOICE) diet | increase | insulin resistance | diet-controlled overweight/obese women with GDM | - | improved | #5 |
higher-complex carbohydrate/lower-fat (CHOICE) diet | decrease | AT expression of multiple proinflammatory genes | diet-controlled overweight/obese women with GDM | P < 0.01 | lower | #6 |
higher-complex carbohydrate/lower-fat (CHOICE) diet | decrease | infant adiposity | - | 10.1 ± 1.4 vs. 12.6 ± 2% | trended lower | #7 |
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.