Effect of Physical Activity and/or Healthy Eating on GDM Risk: The DALI Lifestyle Study. Preterm birth and later insulin resistance: effects of birth weight and postnatal growth in a population based longitudinal study from birth into adult life Effects of probiotic supplements on insulin resistance in gestational diabetes mellitus: A double‐blind randomized controlled trial The effect of weight management interventions that include a diet component on weight‐related outcomes in pregnant and postpartum women: a systematic review protocol Pre-teen insulin resistance predicts weight gain, impaired fasting glucose, and type 2 diabetes at age 18-19 y: a 10-y prospective study of black and white girls. A randomized controlled clinical trial investigating the effect of DASH diet on insulin resistance, inflammation, and oxidative stress in gestational diabetes. Metformin during pregnancy reduces insulin, insulin resistance, insulin secretion, weight, testosterone and development of gestational diabetes: prospective longitudinal assessment of women with polycystic ovary syndrome from preconception throughout pregnancy. Is there a value for probiotic supplements in gestational diabetes mellitus? A randomized clinical trial Insulin receptor substrate 1 gene variation modifies insulin resistance response to weight-loss diets in a 2-year randomized trial: the Preventing Overweight Using Novel Dietary Strategies (POUNDS LOST) trial. Identification of those most likely to benefit from a low-glycaemic index dietary intervention in pregnancy. Weight-loss diets modify glucose-dependent insulinotropic polypeptide receptor rs2287019 genotype effects on changes in body weight, fasting glucose, and insulin resistance: the Preventing Overweight Using Novel Dietary Strategies trial. Effects of a Multispecies Probiotic Mixture on Glycemic Control and Inflammatory Status in Women with Gestational Diabetes: A Randomized Controlled Clinical Trial Gestational Diabetes Mellitus (GDM): Comparative Evaluation of Two Treatment Regimens, Diet Versus Insulin and Diet Does grape seed oil improve inflammation and insulin resistance in overweight or obese women? Prevention of Gestational Diabetes Effect of Vitamin K Supplementation on Insulin Resistance in Older Men and Women Effect of daily consumption of probiotic yoghurt on insulin resistance in pregnant women: a randomized controlled trial Red meat, dairy, and insulin sensitivity: a randomized crossover intervention study. Decreased Insulin Requirement and Improved Control of Diabetes in Pregnant Women Given a High-Carbohydrate, High-Fiber, Low-Fat Diet The effect of different doses of vitamin D supplementation on insulin resistance during pregnancy Low level of Nesfatin-1 is associated with gestational diabetes mellitus A MUFA-Rich Diet Improves Posprandial Glucose, Lipid and GLP-1 Responses in Insulin-Resistant Subjects Healthy Moms, a randomized trial to promote and evaluate weight maintenance among obese pregnant women: study design and rationale.
Context Lifestyle approaches for preventing gestational diabetes mellitus ( GDM ) have produced mixed results . Objective The aim of the present study was to compare the effectiveness of 3 lifestyle interventions [ healthy eating ( HE ) , physical activity ( PA ) , and both HE and PA ( HE+PA ) ] with usual care ( UC ) in reducing GDM risk . Design The present study was a multicenter r and omized controlled trial conducted from 2012 to 2014 [ the DALI ( vitamin D and lifestyle intervention for GDM prevention ) lifestyle study ] . Setting The study occurred at antenatal clinics across 11 centers in 9 European countries . Patients Consecutive pregnant women at < 20 weeks of gestation with a body mass index ( BMI ) of ≥29 kg/m2 and without GDM using the International Association of Diabetes and Pregnancy Study Group criteria ( n = 436 ) . For the intervention , women were r and omized , stratified by site , to UC , HE , PA , or HE+PA . The women received 5 face-to-face and ≤4 telephone coaching sessions using the principles of motivational interviewing . A gestational weight gain ( GWG ) < 5 kg was targeted . The coaches received st and ardized training and an intervention toolkit tailored to their culture and language . Main Outcome Measures The endpoints were the GWG at 35 to 37 weeks and the fasting glucose and insulin sensitivity [ homeostasis model assessment insulin resistance ( HOMA-IR ) ] at 24 to 28 weeks . Results We r and omized 108 women to HE+PA , 113 to HE , 110 to PA , and 105 to UC . In the HE+PA group , but not HE or PA alone , women achieved substantially less GWG than did the controls ( UC ) by 35 to 37 weeks ( -2.02 ; 95 % confidence interval , -3.58 to -0.46 kg ) . Despite this reduction , no improvements were seen in fasting or postload glucose levels , insulin concentrations , or HOMA-IR . The birthweights and large and small for gestational age rates were similar . Conclusions The combined HE+PA intervention was able to limit GWG but did not reduce fasting glycemia . Thus , lifestyle changes alone are unlikely to prevent GDM among women with a BMI of ≥29 kg/m2 Aims /hypothesisAn increased risk of type 2 diabetes mellitus is associated with low birthweight after full-term gestation , including amplification of this risk by weight gain during infancy and adult body composition . Premature birth is also associated with insulin resistance , but studies conducted so far have not provided follow-up into adulthood . We studied the effects of ( 1 ) lower birthweight ( as st and ard deviation score [ SDS ] ) and infancy weight gain on insulin resistance in 19-year-olds born before 32 weeks of gestation , and ( 2 ) the interaction between lower birthweight SDS and infancy weight gain , as well as between lower birthweight and adult body composition , on insulin resistance . Methods This was a prospect i ve follow-up study in 346 subjects from the Project on Preterm and Small-for-gestational-age infants cohort , in whom fasting glucose , insulin and C-peptide levels were measured at 19 years . Insulin resistance was calculated with homeostatic modelling ( homeostatic model assessment for insulin resistance index [ HOMA-IR ] ) . Results Birthweight SDS was unrelated to the outcomes . Rapid infancy weight gain until 3 months post-term was weakly associated with higher insulin level ( p=0.05 ) . Adult fatness was positively associated with insulin and C-peptide levels and HOMA-IR ( all p<0.001 ) . On these parameters , there was a statistical interaction between birthweight SDS and adult fat mass ( p=0.002 to 0.03 ) . Conclusions /interpretationIn subjects born very preterm , rapid infancy weight gain until 3 months predicted higher insulin levels at 19 years , but the association was weak . Adult obesity strongly predicted higher insulin and C-peptide levels as well as HOMA-IR . The effect of adult fat mass on these parameters was dependent on its interaction with birthweight SDS Abstract Aims / Introduction To evaluate the effect of probiotic supplements on insulin resistance in pregnant women with diet‐controlled gestational diabetes mellitus . Material s and Methods A r and omized , double‐blind , placebo‐controlled trial was carried out between June 2016 and February 2017 . Pregnant women with diet‐controlled gestational diabetes mellitus were enrolled in the study at 24–28 weeks‐of‐gestation and r and omized to receive either probiotic supplements containing Bifidobacterium and Lactobacillus or a placebo daily for four consecutive weeks . Primary outcomes were mean differences in insulin resistance ( homeostatic model assessment for insulin resistance ) , fasting insulin and fasting plasma glucose between the two groups . Secondary outcomes were changes in maternal weight after the intervention . Results Data from 28 patients in the probiotic group and 29 in the placebo group were analyzed . The changes in metabolic parameters after r and omization showed significant improvement in glucose metabolism in the probiotic group compared with the placebo group , including fasting plasma glucose ( 0.68 ± 5.88 vs 4.620 ± 7.78 mg/dL , mean difference −3.94 mg/dL , 95 % confidence interval −7.62 , −0.27 , P = 0.034 ) , fasting plasma insulin ( 1.11 ± 1.71 vs 3.77 ± 1.70 mIU/L , mean difference −2.67 mIU/L , 95 % confidence interval −3.57 , −1.76 , P = 0.001 ) and homeostatic model assessment for insulin resistance ( 0.25 ± 0.37 vs 0.89 ± 0.46 , mean difference −0.63 , 95 % confidence interval −0.86 , −0.41 , P = 0.001 ) . Weight gain during r and omization was similar between the two groups . Conclusions Four weeks of probiotic supplements  in women with diet‐controlled gestational diabetes in the late second and early third trimester lowered fasting glucose and increased insulin sensitivity  . Probiotic supplements may be considered as an adjunct treatment for glycemic control in these patients Review question / objective What are the effects of weight management interventions that include a diet component on weight‐related outcomes in pregnant and postpartum women ? The primary objective of this systematic review is to evaluate the effectiveness of weight management interventions which include a diet component and are aim ed at limiting gestational weight gain and postpartum weight retention in women . The second objective of this systematic review is to investigate included intervention components with respect to effect on weight‐related outcomes . This may include , but is not limited to : length of intervention , use of face‐to‐face counselling , group or individual consultations , use of other interventions components including exercise , use of goals and use of support tools like food diaries , coaching , including email or text message support . Background Around half of all women of reproductive age are either overweight or obese,1,2,3 with women aged 25‐34 years having a greater risk of substantial weight gain compared with men of all ages.1,4 Excessive gestational weight gain ( GWG ) and postpartum weight retention ( PPWR ) may play a significant role in long term obesity . Having one child doubles the five‐ and 10‐year obesity incidence for women , with many women who gain excessive weight during pregnancy remaining obese permanently.5 Excessive GWG and /or PPWR can also significantly contribute to short‐ and long‐term adverse health outcomes for mother , baby and future pregnancies.6,7 Maternal obesity increases the risk of pregnancy related complications such as pre‐eclampsia , gestational diabetes mellitus , stillbirth and the rate of caesarean section.8 Childhood obesity is a further long term complication of maternal obesity for offspring , which may persist in to adulthood.9 Excess GWG is also a risk factor for PPWR both in the short and long‐term.10,11 Nehring et al. conducted a meta‐ analysis with over 65,000 women showing that , compared to women who gained weight within recommendations during pregnancy , women with GWG above Institute of Medicine weight gain recommendations , 12 retained an additional 3.1 kg and 4.7 kg after three and greater than or equal to 15 years postpartum , respectively.13 The health risk associated with PPWR is highlighted in a study of 151,025 Swedish women followed between 1992 and 2001.The study identified the risk of adverse pregnancy outcomes for those who gained three or more units of Body Mass Index ( kg/m2 ) between consecutive pregnancies ( an average of two years ) was much higher compared with women whose BMI changed from ‐1.0 and 0.9 units.14 Long‐term chronic disease risk may also be affected by PPWR as weight retention at the end of the first year post‐partum has been found to be a predictor of maternal overweight 15 years later.15With around 14‐20 % of women retaining 5 kg or more 12 months postpartum,16,5 the risk of developing conditions like diabetes , metabolic syndrome and cardiovascular disease may be increased.17 It becomes evident that interventions which aim to support attainment of healthy weight both in the antenatal and postpartum periods are key health priorities for women during this life stage . Lifestyle factors of overweight , having poor diet quality , and not undertaking enough moderate‐to‐vigorous physical activity are amongst the top five predictors of mortality in women.18 Additionally it is noted that , for many women , pregnancy and the postpartum period are associated with a reduction in physical activity.19 It is known that a combination of poor dietary choices , an increase in sedentary time and reduction in physical activity are all contributors to the development of overweight and obesity . With this in mind , current research has focused on lifestyle interventions to limit GWG and PPWR . Thangaratinam et al. review ed 44 r and omized controlled trials ( 7278 women ) where interventions including diet , physical activity or both were evaluated for their influence on maternal weight during  pregnancy.20 Results indicate that all were significantly effective in reducing GWG compared with the control group . More specifically , dietary interventions were the most effective in reducing weight gain , with a mean weight loss of ‐3.84 kg compared with ‐0.72 kg and ‐1.06 kg for physical activity and the mixed ( diet plus physical activity ) approach , respectively.20 This finding is supported by Hill and colleagues ' recent systematic review of theory based interventions to limit GWG.21 Included studies in this review reported an underpinning theory base and were classified as adopting a dietary , physical activity or mixed approach . Hill et al. concluded that studies which included a diet intervention were significantly more effective at limiting GWG.21 In 2011 Tanentsapf et al. review ed the effect of dietary interventions alone for reducing GWG in normal weight , overweight and obese pregnant women.22 This review analysed 13 r and omized controlled trials and quasi‐r and omized controlled trials with a dietary intervention to prevent excessive GWG in women . The review concluded that dietary interventions during pregnancy were effective in reducing GWG with an effect of ‐1.92 kg ( n=1434 ) compared with the control group.22 Tanentsapf et al. identified that trials differed in the conduct of the interventions with various diet and non‐diet related components utilised . Dietary approaches were highly variable with some trials focusing only on calorie restriction and others included additional target macronutrient distribution for intake . Some trials further provided feedback based on maternal weight gain guidelines .12 Interventions also varied in delivery method with a variety of modes used , including face‐to‐face , individual or group consultations and /or written correspondence . The frequency of communication , despite the type or mix , also changed from trial to trial with additional methods via telephone , posted material s , feedback or food diaries utilised . The inclusion of physical activity in addition to diet intervention was also common . Whilst the recent review by Tanentsapf et al.22 identified that dietary interventions are effective in reducing GWG , the review did not investigate the impact that different intervention components , delivery methods or dietary counselling approaches had on gestational weight management . It remains unclear as to which intervention components optimize GWG in women . The impact of lifestyle interventions has also been investigated in the postpartum period . The recent systematic review from van der Pligt et al. reported seven of 11 studies review ed were successful in limiting PPWR.23 As with studies aim ed at limiting GWG , interventions included in van der Pligt et al. 's review differed greatly in their conduct . Six of these seven studies included both dietary and physical activity components for the intervention , with the final successful study including a diet only intervention . Five of the successful studies recruited overweight or obese women only . Intervention time varied considerably in successful studies with some running for as little at ten days , and others up to six months . Bertz et al. demonstrated that their 12‐week behavior modification intervention which targeted diet alone or diet and exercise , including two individual sessions with a dietitian and physical therapist , provision of scales for weight self‐monitoring and bi‐weekly text messages was successful in achieving significant weight loss following the intervention , and sustained at one year.24 The diet intervention and the diet and exercise intervention  yielded significant weight loss compared to the control . Following 12 weeks a reduction of ‐8.3 + /‐ 4.2 kg for diet intervention and ‐6.9 + /‐ 3.0 kg for diet and exercise was observed . Additionally after one year , the diet intervention showed ‐10.2 + /‐ 5.7 kg reduction and ‐7.3 + /‐ 6.3 kg for the diet and exercise intervention (p<0.001).24 Colleran et al. also found significant weight change results by implementing a 16‐week intervention which consisted of weekly individual sessions with a dietitian regarding calorie restriction , two additional home visits regarding exercise , weekly food diary completion and email support.25 The intervention group had greater weight loss compared to the control group ( ‐5.8 kg + /‐ 3.5 kg vs ‐1.6 kg + /‐ 5.4 kg ) . It can be seen that various methods have been utilized in investigating the impact of diet and physical activity interventions on PPWR . The review by van der Pligt et al.23 highlights the impact successful lifestyle interventions can have on postpartum weight change . However , this review did not investigate the different intervention strategies utilized . It remains unclear as to the optimal setting , delivery method , diet strategy , contact frequency or intervention length to limit PPWR . Previous systematic review s for both GWG and PPWR have focused on the effectiveness of lifestyle interventions as a whole for weight management in pregnant and postpartum women.20,23 And despite Tanentsapf et al. 's focus on dietary interventions for GWG,22 much is still unknown about the effectiveness of differing diet interventions over the antenatal and postpartum period . Specifically , the impact of differing diet intervention strategies on maternal weight gain is not known . Firstly , this systematic review will focus on whether  weight management interventions which include a dietary component  are effective in pregnant and postpartum women . In addition to this , this review will investigate the different intervention strategies utilized and their effectiveness in maternal weight management . A search of systematic review protocol data bases has shown that there is no current review underway for this topic BACKGROUND Identifying early pre-teen predictors of  adolescent weight gain and the development of impaired fasting glucose ( IFG ) and type 2 diabetes ( T2DM ) at age 18 - 19 y could provide avenues for prevention . OBJECTIVE We evaluated possible pre-teen predictors for development of IFG , T2DM , and changes in body mass index at age 18 - 19 y in black and white girls . DESIGN In a prospect i ve cohort study , body habitus and fasting insulin and glucose were measured at ages 9 - 10 and 18 - 19 y , and multiple 3-d diet records were collected . Factors predicting 10-y change in body mass index and development of IFG and T2DM together were assessed . RESULTS In multivariate analyses , 10-y change in homeostatic model assessment of insulin resistance ( HOMA-IR ) and the age 9 - 10 y HOMA-IR x percentage of calories from fat interaction were positive predictors of 10-y changes in body mass index . At age 18 - 19 y , there were 5 incident cases of T2DM , 37 cases of IFG , and 597 noncases . Age 9 - 10 y IFG and HOMA-IR ( or insulin ) , 10-y change in HOMA-IR ( or insulin ) , and the age 9 - 10 y insulin x total caloric intake interaction predicted IFG and T2DM at age 18 - 19 y. CONCLUSIONS Pre-teen IFG , insulin resistance ( and insulin ) , and rapidly increasing insulin resistance during adolescence identifies girls who are at greater risk of future IFG and T2DM . In addition , insulin resistance , interacting with high-fat diets , identifies girls who are at risk of greater weight gain . These findings could open avenues to primary prevention of obesity , IFG , and T2DM in children OBJECTIVE To our knowledge , no reports are available indicating the effects of the dietary approaches to stop hypertension ( DASH ) eating plan on insulin resistance , inflammation , and oxidative stress among pregnant women with gestational diabetes mellitus ( GDM ) . This study was design ed to investigate the effects of the DASH diet on insulin resistance , serum high-sensitivity C-reactive protein ( hs-CRP ) and biomarkers of oxidative stress among pregnant women with GDM . METHODS This r and omized controlled clinical trial was performed with 32 pregnant women diagnosed with GDM at 24 to 28 wk gestation . Participants were r and omly assigned to consume either the control ( n = 16 ) or DASH diet ( n = 16 ) for 4 wk . The DASH diet was rich in fruits , vegetables , whole grains , and low-fat dairy products and was low in saturated fats , total fats , cholesterol , refined grains , and sweets , with a total of 2400 mg/d of sodium . The control diet contained 40 % to 55 % of its energy as carbohydrates , 10 % to 20 % as proteins , and 25 % to 30 % as total fats . Fasting blood sample s were taken at baseline and after 4 wk of intervention to measure fasting plasma glucose ( FPG ) , serum insulin , and hs-CRP , homeostasis model of assessment -insulin resistance ( HOMA-IR ) , plasma total antioxidant capacity ( TAC ) , and total glutathione levels ( GSH ) . RESULTS Consumption of the DASH diet compared with the control diet result ed in decreased FPG ( -7.62 versus 3.68 mg/dL ; P = 0.02 ) , serum insulin levels ( -2.62 versus 4.32 μIU/mL , P = 0.03 ) , and HOMA-IR score ( -0.8 versus 1.1 ; P = 0.03 ) . Increased concentrations of plasma TAC ( 45.2 versus -159.2 mmol/L ; P < 0.0001 ) and GSH ( 108.1 versus -150.9 μmol/L ; P < 0.0001 ) also were seen in the DASH group compared with control group . We failed to find a significant difference in mean changes of serum hs-CRP levels between the two diets . Within-group comparisons revealed significant reductions in plasma TAC and GSH levels in the control diet , while a significant increase in these biomarkers in the DASH diet . CONCLUSION Consumption of the DASH diet in pregnant women with GDM had beneficial effects on FPG , serum insulin levels , HOMA-IR score , plasma TAC , and total GSH levels . The effects of this dietary pattern on pregnancy outcomes need to be investigated in future studies BACKGROUND In a prospect i ve observational study of 42 pregnancies in 39 Caucasian women ( age 30 + /- 4 years ) with polycystic ovary syndrome ( PCOS ) , we examined effects of metformin on maternal insulin , insulin resistance ( IR ) , insulin secretion ( IS ) , weight gain , development of gestational diabetes ( GD ) , testosterone and plasminogen activator inhibitor activity . We assessed the hypothesis that diet-metformin ( MET ) lessens the physiological gestational increase in IR and reduces gestational weight gain , thus reducing GD . METHODS Preconception , in an out-patient clinical research centre , MET 1.5 ( eight pregnancies ) to 2.55 g/day ( 34 pregnancies ) was started . Women with body mass index < 25 or > or=25 kg/m(2 ) were given a 2000 or 1500 calorie/day , high-protein ( 26 % of calories ) , low-carbohydrate ( 44 % ) diet . Calorie restrictions were dropped after conception . RESULTS On MET , GD developed in three out of 42 pregnancies ( 7.1 % ) . Median entry weight ( 94.5 kg ) fell to 82.7 on MET at the last preconception visit ( P = 0.0001 ) , fell further to 81.6 during the first trimester , was 83.6 in the second trimester , and 89.1 kg in the third trimester . Median weight gain during pregnancy was 3.5 kg . The median percentage reduction in serum insulin was 40 % on MET at the last preconception visit ; insulin did not increase in the first or second trimesters ( P > 0.05 ) , and rose 10 % in the third trimester . The median percentage reduction in HOMA IR was 46 % on MET at the last preconception visit ; IR did not increase ( P > 0.05 ) in the first , second or third trimesters . HOMA insulin secretion fell 45 % on MET at the last preconception visit , did not increase in the first trimester , rose 24 % in the second trimester , and rose 109 % in the third trimester . Testosterone fell 30 % on MET at the last preconception visit ( P = 0.01 ) and then rose 74 , 61 and 95 % during trimesters 1 , 2 and 3 ; median testosterone during the third trimester did not differ from pre-treatment levels . CONCLUSIONS By reducing preconception weight , insulin , IR , insulin secretion and testosterone , and by maintaining these insulin-sensitizing effects throughout pregnancy , MET-diet reduces the likelihood of developing GD , and prevents and rogen excess for the fetus Background Although several studies have found probiotics encouraging in prevention of gestational diabetes mellitus ( GDM ) , the evidence for the use of probiotics in diagnosed GDM is largely limited . The aim of this study was to assess the effect of a probiotic supplement capsule containing four bacterial strains on glucose metabolism indices and weight changes in women with newly diagnosed GDM . Methods Sixty-four pregnant women with GDM were enrolled into a double-blind placebo-controlled r and omized clinical trial . They were r and omly assigned to receive either a probiotic or placebo capsule along with dietary advice for eight consecutive weeks . The trend of weight gain along with glucose metabolism indices was assayed . Results During the first 6 weeks of the study , the weight gain trend was similar between the groups . However , in the last 2 weeks of the study , the weight gain in the probiotic group was significantly lower than in the placebo group ( p < 0.05 ) . Fasting blood sugar ( FBS ) decreased in both intervention ( from 103.7 to 88.4 mg/dl ) and control ( from 100.9 to 93.6 mg/dl ) groups significantly , and the decrease in the probiotic group was significantly higher than in the placebo group ( p < 0.05 ) . Insulin resistance index in the probiotic group had 6.74 % reduction over the study period ( p < 0.05 ) . In the placebo group , however , there was an increase in insulin resistance index ( 6.45 % ) , but the observed change in insulin resistance was not statistically significant . Insulin sensitivity index was increased in both groups . The post-intervention insulin sensitivity index in the probiotic group was not significantly different from placebo when adjusted for the baseline levels . Conclusions The probiotic supplement appeared to affect glucose metabolism and weight gain among pregnant women with GDM . This needs to be confirmed in other setting s before a therapeutic value could be approved BACKGROUND Common genetic variants in the insulin receptor substrate 1 ( IRS1 ) gene have been recently associated with insulin resistance and hyperinsulinemia . We examined whether the best-associated variant modifies the long-term changes in insulin resistance and body weight in response to weight-loss diets in Preventing Overweight Using Novel Dietary Strategies ( POUNDS LOST ) trial . METHODS AND RESULTS We genotyped IRS1 rs2943641 in 738 overweight adults ( 61 % were women ) who were r and omly assigned to 1 of 4 diets varying in macronutrient contents for 2 years . We assessed the progress in fasting insulin , homeostasis model assessment of insulin resistance ( HOMA-IR ) and weight loss by genotypes . At 6 months , participants with the risk-conferring CC genotype had greater decreases in insulin ( P=0.009 ) , HOMA-IR ( P=0.015 ) , and weight loss ( P=0.018 ) than those without this genotype in the highest-carbohydrate diet group whereas an opposite genotype effect on changes in insulin and HOMA-IR ( P≤0.05 ) was observed in participants assigned to the lowest-carbohydrate diet group . No significant differences were observed across genotypes in the other 2 diet groups . The tests for genotype by intervention interactions were all significant ( P<0.05 ) . At 2 years , the genotype effect on changes in insulin and HOMA-IR remained significant in the highest-carbohydrate diet group ( P<0.05 ) . The highest carbohydrate diet led to a greater improvement of insulin and HOMA-IR ( P for genotype-time interaction ≤0.009 ) in participants with the CC genotype than those without this genotype across 2-year intervention . CONCLUSIONS Individuals with the IRS1 rs2943641 CC genotype might obtain more benefits in weight loss and improvement of insulin resistance than those without this genotype by choosing a high-carbohydrate and low-fat diet . CLINICAL TRIAL REGISTRATION http : www . clinical trials.gov . Unique identifier : NCT00072995 The present study is a secondary analysis of the ROLO study , a r and omised control trial of a low-glycaemic index ( GI ) diet in pregnancy to prevent the recurrence of fetal macrosomia . The objectives of the present study were to identify which women are most likely to respond to a low-GI dietary intervention in pregnancy with respect to three outcome measures : birth weight ; maternal glucose intolerance ; gestational weight gain ( GWG ) . In early pregnancy , 372 women had their mid-upper arm circumference recorded and BMI calculated . Concentrations of glucose , insulin and leptin were measured in early pregnancy and at 28 weeks . At delivery , infant birth weight was recorded and fetal glucose , C-peptide and leptin concentrations were measured in the cord blood . Women who benefited in terms of infant birth weight were shorter , with a lower education level . Those who maintained weight gain within the GWG guidelines were less overweight in both their first and second pregnancies , with no difference being observed in maternal height . Women who at 28 weeks of gestation developed glucose intolerance , despite the low-GI diet , had a higher BMI and higher glucose concentrations in early pregnancy with more insulin resistance . They also had significantly higher-interval pregnancy weight gain . For each analysis , women who responded to the intervention had lower leptin concentrations in early pregnancy than those who did not . These findings suggest that the maternal metabolic environment in early pregnancy is important in determining later risks of excessive weight gain and metabolic disturbance , whereas birth weight is mediated more by genetic factors . It highlights key areas , which warrant further interrogation before future pregnancy intervention studies , in particular , maternal education level and inter-pregnancy weight gain BACKGROUND Glucose-dependent insulinotropic polypeptide [ also known as gastric inhibitory polypeptide ( GIP ) ] and its receptor ( GIPR ) may link overnutrition to obesity , insulin resistance , and type 2 diabetes . A GIPR variant rs2287019 was recently associated with obesity and glucose metabolism . OBJECTIVE We aim ed to examine whether weight-loss diets that vary in fat content may modify the effect of this variant on changes in body weight , fasting glucose , and insulin resistance in the Preventing Overweight Using Novel Dietary Strategies ( POUNDS LOST ) trial . DESIGN We genotyped the GIPR rs2287019 in 737 overweight adults who were r and omly assigned to 1 of 4 weight-loss diets that varied in macronutrient contents for 2 y. We assessed the percentage changes in body weight , fasting glucose , and insulin resistance ( HOMA-IR ) across genotypes by the low-fat and high-fat diets . RESULTS At 6 mo of diet intervention , the T allele of rs2287019 was associated with greater weight loss ( β ± SE : -1.05 ± 0.56 % ; P = 0.06 ) and greater decreases in fasting glucose ( β ± SE : -2.33 ± 0.86 % ; P = 0.006 ) , fasting insulin ( β ± SE : -8.76 ± 4.13 % ; P = 0.03 ) , and HOMA-IR ( β ± SE : -10.52 ± 4.39 % ; P = 0.01 ) in participants who were assigned to low-fat diets , whereas there was no significant genotype effect on changes in these traits in the group assigned to the high-fat diet ( all P > 0.44 ; P-interaction = 0.08 , 0.04 , 0.10 , and 0.07 , respectively ) . After correction for multiple tests ( significant P = 0.008 ) , the genotype effect on changes in fasting glucose remained significant . Sensitivity analysis in white participants showed that the interactions were more evident on changes in insulin and HOMA-IR ( P-interaction < 0.008 ) . CONCLUSION The T allele of GIPR rs2287019 is associated with greater improvement of glucose homeostasis in individuals who choose a low-fat , high-carbohydrate , and high-fiber diet . The POUNDS LOST trial was registered at clinical trials.gov as NCT00072995 Objective . This trial aims to examine the effects of a Probiotic Mixture ( VSL#3 ) on glycemic status and inflammatory markers , in women with GDM . Material s and Methods . Over a period of 8 weeks , 82 women with gestational diabetes were r and omly assigned to either an intervention group ( n = 41 ) which were given VSL#3 capsule or to a control group which were given placebo capsule ( n = 41 ) . Fasting plasma glucose , homeostatic model assessment of insulin resistance , glycosylated hemoglobin , high-sensitivity C-reactive protein , tumor necrosis factor-α , interleukin-6 , Interferon gamma , and interleukin-10 were measured before and after the intervention . Results . After 8 wk of supplementation FPG , HbA1c , HOMA-IR , and insulin levels remained unchanged in the probiotic and placebo groups . The comparison between the two groups showed no significant differences with FPG and HbA1c , but there were significant differences in insulin levels and HOMA-IR ( 16.6 ± 5.9 ; 3.7 ± 1.5 , resp . ) . Unlike the levels of IFN-g ( 19.21 ± 16.6 ) , there was a significant decrease in levels of IL-6 ( 3.81 ± 0.7 ) , TNF-α ( 3.10 ± 1.1 ) , and hs-CRP ( 4927.4 ± 924.6 ) . No significant increase was observed in IL-10 ( 3.11 ± 5.7 ) in the intervention group as compared with the control group . Conclusions . In women with GDM , supplementation with probiotics ( VSL#3 ) may help to modulate some inflammatory markers and may have benefits on glycemic control Two-hundred and two pregnant women with impaired glucose tolerance were r and omized to treatment with diet or diet and insulin by stratified selection . Self-monitoring of blood glucose was performed six times a day , 3 days/wk . Dietary treatment was considered inappropriate if fasting and postpr and ial blood glucose values exceeded 7 and 9 mmol/L , respectively , in which case insulin therapy was instituted . Insulin doses were adjusted according to blood glucose values , aim ing at fasting and postpr and ial values below 5 and 6.5 mmol/L , respectively . There were no perinatal deaths . The two treatment regimens disclosed no differences regarding achieved degree of maternal blood glucose control , hemoglobin A1c at delivery , obstetric or neonatal complications , infant 's size at birth including skinfold thickness , or C-peptide concentration in cord serum . Routine treatment of pregnant women with mild carbohydrate intolerance with insulin seems unnecessary . However , 15 patients ( 14 % ) in the diet group needed insulin to achieve acceptable blood glucose control , underlining the importance of monitoring blood glucose to detect those who are at risk of developing overt diabetes Abstract Grape seed oil ( GSO ) is reported to improve oxidative stress and lipid profile . However , the ameliorating effect of GSO on inflammation and insulin resistance has not being noticed so far . We aim ed to examine the effects of GSO consumption on inflammation and insulin resistance in overweight or obese females . The subjects ( n = 44 ) were r and omly assigned into intervention group as “ GSO ” ( consuming 15 % of energy from GSO ) and control group as sunflower oil “ SFO ” ( consuming 15 % of energy from SFO ) through a weight loss diet for 8 weeks . Anthropometric measurements , dietary recall and fasting serum glucose , insulin , high sensitive C-reactive protein ( hs-CRP ) and tumor necrosis factor-alpha ( TNF-α ) were assessed before and after the intervention . Homeostatic model assessment of insulin resistance ( HOMA-IR ) scores , hs-CRP and TNF-α decreased in the GSO group . The hs-CRP was lower in GSO than the SFO group ( p < 0.03 ) . GSO consumption seems to improve inflammatory condition and insulin resistance in overweight/obese women OBJECTIVE To examine the feasibility of an individualized exercise program to prevent  gestational diabetes mellitus ( GDM ) in obese pregnant women . RESEARCH DESIGN AND METHODS The study was a pilot r and omized controlled trial with obese pregnant women ( intervention group , individualized exercise program [ n = 25 ] ; control group , usual care [ n = 25 ] ) . Average weekly energy expenditure ( MET hours per week and kilocalories per week ) of exercise-specific activity was assessed during pregnancy using the Pregnancy Physical Activity Question naire . Fasting glucose and insulin and homeostasis model assessment of insulin resistance ( HOMA-IR ) were assessed at baseline and 20 , 28 , and 36 weeks ' gestation . RESULTS Of the women in the intervention group , 16 of 22 ( 73 % ) achieved more than 900 kcal/week of exercise-based activity  at 28 weeks compared with 8 of 19 women in the control group ( 42 % ) , P = 0.047 . However , insulin resistance ( HOMA-IR ) did not differ between the groups . CONCLUSION This intervention was feasible and prompted a modest increase in physical activity . However , we are not confident that this intervention would be sufficient to prevent GDM OBJECTIVE —Vitamin K has a potentially beneficial role in insulin resistance , but evidence is limited in humans . We tested the hypothesis that vitamin K supplementation for 36 months will improve insulin resistance in older men and women . RESEARCH DESIGN AND METHODS —This was an ancillary study of a 36-month , r and omized , double-blind , controlled trial design ed to assess the impact of supplementation with 500 μg/day phylloquinone on bone loss . Study participants were older nondiabetic men and women ( n = 355 ; aged 60–80 years ; 60 % women ) . The primary outcome of this study was insulin resistance as measured by homeostasis model assessment ( HOMA-IR ) at 36 months . Fasting plasma insulin and glucose were examined as the secondary outcomes . RESULTS —The effect of 36-month vitamin K supplementation  on HOMA-IR differed by sex ( sex × treatment interaction P = 0.02 ) . HOMA-IR was statistically significantly lower at the 36-month visit among men in the supplement group versus the men in the control group ( P = 0.01 ) after adjustment for baseline HOMA-IR , BMI , and body weight change . There were no statistically significant differences in outcome measures between intervention groups in women . CONCLUSIONS —Vitamin K supplementation for 36 months at doses attainable in the diet may reduce progression of insulin resistance in older men Background / objectives : Owing to excess body weight and increased secretion of inflammatory cytokines primarily during the third trimester , pregnancy is associated with elevated insulin resistance . To our knowledge , no report is available indicating the effects of probiotic yoghurt consumption on serum insulin levels in pregnant women . This study was design ed to determine the effects of daily consumption of probiotic yoghurt on insulin resistance and serum insulin levels of Iranian pregnant women . Subjects/ methods : In this r and omized controlled clinical trial , 70 primigravida pregnant women with singleton pregnancy at their third trimester were participated . We r and omly assigned participants to consume 200 g per day of conventional ( n=33 ) or the probiotic group ( n=37 ) for 9 weeks . The probiotic yoghurt was a commercially available product prepared with the starter cultures of Streptococcus thermophilus and Lactobacillus bulgaricus , enriched with probiotic culture of two strains of lactobacilli ( Lactobacillus acidophilus LA5 ) and bifidobacteria ( Bifidobacterium animalis BB12 ) with a total of min 1 × 107 colony-forming units . Fasting blood sample s were taken at baseline and after 9-week intervention to measure fasting plasma glucose and serum insulin levels . Homeostatic model assessment of insulin resistance ( HOMA-IR ) was used to calculate insulin resistance score . Results : Although consumption of probiotic yogurt for 9 weeks did not affect serum insulin levels and HOMA-IR score , significant differences were found comparing changes in these variables between probiotic and conventional yogurts ( changes from baseline in serum insulin levels : + 1.2±1.2 vs + 5.0±1.1 μIU/ml , respectively , P=0.02 ; and in HOMA-IR score : −0.2±0.3 vs 0.7±0.2 , respectively , P=0.01 ) . Conclusions : It is concluded that in contrast to conventional yogurt , daily consumption of probiotic yogurt for 9 weeks maintains serum insulin levels and might help pregnant women prevent developing insulin resistance BACKGROUND Epidemiologic studies have linked high consumption of red and processed meat with risk of developing type 2 diabetes , whereas high dairy consumption has been associated with decreased risk , but interventions have been limited . OBJECTIVE We compared the effects on insulin sensitivity of consuming a diet high in lean red meat with minimal dairy , a diet high in primarily low-fat dairy ( from milk , yogurt , or custard ) with no red meat , and a control diet that contained neither red meat nor dairy . DESIGN A r and omized crossover study was undertaken with 47 overweight and obese men and women divided into 2 groups as follows : those with normal glucose tolerance and those with impaired fasting glucose or impaired glucose tolerance . Participants followed the 3 weight-stable dietary interventions for 4 wk with  glucose , insulin , and C-peptide  measured by using oral-glucose-tolerance tests at the end of each diet . RESULTS Fasting insulin was significantly higher after the dairy diet than after the red meat diet ( P < 0.01 ) with no change in fasting glucose result ing in a decrease in insulin sensitivity after the high-dairy diet ( P < 0.05 ) as assessed by homeostasis model assessment of insulin resistance ( HOMA-IR ) . A significant interaction between diet and sex was observed such that , in women alone , HOMA-IR was significantly lower after the red meat diet than after the dairy diet ( 1.33 ± 0.8 compared with 1.71 ± 0.8 , respectively ; P < 0.01 ) . Insulin sensitivity calculated by using the Matsuda method was 14.7 % lower in women after the dairy diet than after the red meat diet ( P < 0.01 ) with no difference between diets in men . C-peptide was not different between diets . CONCLUSION In contrast to some epidemiologic findings , these results suggest that high consumption of dairy reduces insulin sensitivity compared with a diet high in lean red meat in overweight and obese subjects , some of whom had glucose intolerance . This trial was registered at the Australian New Zeal and Clinical Trials Registry as ACTRN12613000441718 Five quantitative measures of diabetic control [ HbA1c determinations , mean 24-h plasma glucose values , mean amplitude of glycemic excursions ( MAGE ) , mean 24-h urinary loss of glucose , and daily exogenous insulin requirement ] were compared in 20 pregnant women who were r and omly assigned to either a high-carbohydrate , high-fiber diet ( HCF ) that was low in fat or to a control diet commonly prescribed for pregnancy . Eleven women followed the HCF diet and nine subjects , the control diet , from baseline entry into the study until delivery . Dietary compliance was excellent , with 78 % of the women in each group rated good or acceptable . HbA1c values were similar in both groups at baseline ( HCF : 11.0 ± 0.5 % versus control : 10.2 ± 0.6 % ) , with no different predelivery values ( 8.6 ± 0.4 % ) . Mean 24-h plasma glucose levels improved in patients on both diets , with lower values noted in the HCF group at predelivery . MAGE values and st and ard deviations did not differ significantly in the two groups . Glycosuria decreased markedly in both dietary groups , but differences between groups were not significant . Improved control of diabetes on the HCF diet was achieved with significantly lower increments in insulin dose during gestation ( HCF baseline : 32 ± 8 U/24 h to 66 ± 10 U/24 h versus control baseline : 27 ± 9 U/24 h to 108 ± 12 U/24 h , P < 0.03 ) . Outcome of pregnancy did not differ in the two groups of patients , but women on the HCF diet gained less weight than those on the control diet ( 26 ± 3 lb versus 35 ± 5 lb , P < 0.05 ) . Mean newborn gestational age was similar in the two groups ( HCF : 37.2 ± 0.7 wk versus control : 36.5 ± 0.7 wk ) . Mean birth weight in infants of HCF mothers ± was 3809 ± 248 g versus 3313 ± 278 g in infants of control mothers ( P < 0.05 ) . We conclude that although marked improvement of diabetic control occurred on both regimens , patients on the HCF diet achieved better control of diabetes with significantly lower increments in exogenous insulin Abstract Low serum vitamin D levels are correlated with insulin resistance during pregnancy . We have assessed the effects of different doses of vitamin D on insulin resistance during pregnancy . A r and omized clinical trial was done on 120 women with a gestational age of less than 12 weeks . The women were divided into three groups r and omly . Group A received 200 IU vitamin D daily , group B 50 000 IU vitamin D monthly and group C 50 000 IU vitamin D every 2 weeks from 12 weeks of pregnancy until delivery . The serum levels of fasting blood sugar ( FBS ) , insulin , calcium and 25-hydroxyvitamin D were measured before and after intervention . We used the homeostatic model assessment of insulin resistance ( HOMA-IR ) as a surrogate measure of insulin resistance . The mean ± st and ard deviation of serum 25-hydroxyvitamin D increased in group C from 7.3 ± 5.9 to 34.1 ± 11.5 ng/ml and in group B it increased from 7.3 ± 5.3 to 27.23 ± 10.7 ng/ml , but the level of vitamin D in group A increased from 8.3 ± 7.8 to 17.7 ± 9.3 ng/ml ( p < 0.001 ) . The mean differences of insulin and HOMA-IR before and after intervention in groups A and C were significant ( p = 0.01 , p = 0.02 ) . This study has shown that supplementation of pregnant women with 50 000 IU vitamin D every 2 weeks improved insulin resistance significantly Abstract Introduction : Gestational diabetes mellitus ( GDM ) occurs in ∼10–25 % of pregnancies . Nesfatin-1 , plays a role in carbohydrate metabolism by inhibiting glucagon secretion , besides has a glucose-dependent insulinotropic effect . Explanation of the GDM pathogenesis is important due to preventing gestational complications . We aim ed to investigate relationship between GDM and Nesfatin-1 . Material and methods : Seventy-nine pregnant subjects were r and omly allocated to either GDM group ( GDG , n = 38 ) or control group ( CG , n = 41 ) . For GDM diagnosis , 50 and 100 g oral glucose tolerance test ( OGTT ) were used . Nesfatin-1 , insulin and other parameters were measured for all subjects . The homeostasis model assessment -insulin resistance ( HOMA-IR ) was calculated . Results : Nesfatin-1 was found lower and insulin was found higher in GDG than CG . Negative correlation has been founded between Nesfatin-1 with weight , BMI , fasting glucose , serum glucose level at first hour of the 50 g OGTT and HOMA-IR . Conclusion : In this study , patients with GDM had lower Nesfatin-1 levels than without GDM . Therefore , when the Nesfatin-1 effects on the GDM pathogenesis is clear , it may be contributed to diagnosis and treatment of the GDM Objective : To study the effects of three weight-maintenance diets with different macronutrient composition on carbohydrate , lipid metabolism , insulin and incretin levels in insulin-resistant subjects . Methods : A prospect i ve study was performed in eleven ( 7 W , 4 M ) offspring of obese and type 2 diabetes patients . Subjects had a BMI > 25 Kg/m2 , waist circumference ( men/women ) > 102/88 , HBA1c < 6.5 % and were regarded as insulin-resistant after an OGTT ( Matsuda ISIm < 4 ) . They were r and omly divided into three groups and underwent three dietary periods each of 28 days in a crossover design : a ) diet high in saturated fat ( SAT ) , b ) diet rich in monounsaturated fat ( MUFA ; Mediterranean diet ) and c ) diet rich in carbohydrate ( CHO ) . Results : Body weight and resting energy expenditure did not changed during the three dietary periods . Fasting serum glucose concentrations fell during MUFA-rich and CHO-rich diets compared with high-SAT diets ( 5.02 ± 0.1 , 5.03 ± 0.1 , 5.50 ± 0.2 mmol/L , respectively . Anova < 0.05 ) . The MUFA-rich diet improved insulin sensitivity , as indicated by lower homeostasis model analysis -insulin resistance ( HOMA-ir ) , compared with CHO-rich and high-SAT diets ( 2.32 ± 0.3 , 2.52 ± 0.4 , 2.72 ± 0.4 , respectively , Anova < 0.01 ) . After a MUFA-rich and high-SAT breakfasts ( 443 kcal ) the postpr and ial integrated area under curve ( AUC ) of glucose and insulin were lowered compared with isocaloric CHO-rich breakfast ( 7.8 ± 1.3 , 5.84 ± 1.2 , 11.9 ± 2.7 mmol · 180 min/L , Anova < 0.05 ; and 1004 ± 147 , 1253 ± 140 , 2667 ± 329 pmol · 180 min/L , Anova < 0.01 , respectively ) ; while the integrated glucagon-like peptide-1 response increased with MUFA and SAT breakfasts compared with isocaloric CHO-rich meals ( 4.22 ± 0.7 , 4.34 ± 1.1 , 1.85 ± 1.1 , respectively , Anova < 0.05 ) . Fasting and postpr and ial HDL cholesterol concentrations rose with MUFA-rich diets , and the AUCs of triacylglycerol fell with the CHO-rich diet . Similarly fasting proinsulin ( PI ) concentration fell , while stimulated ratio PI/I was not changed by MUFA-rich diet . Conclusions : Weight maintenance with a MUFA-rich diet improves HOMA-ir and fasting proinsulin levels in insulin-resistant subjects . Ingestion of a virgin olive oil-based breakfast decreased postpr and ial glucose and insulin concentrations , and increased HDL-C and GLP-1 concentrations as compared with CHO-rich diet BACKGROUND Obesity and excessive weight gain during pregnancy are associated with adverse pregnancy outcomes . Observational studies suggest that minimal or no gestational weight gain ( GWG ) may minimize the risk of adverse pregnancy outcomes for obese women . OBJECTIVE This report describes the design of Healthy Moms , a r and omized trial testing a weekly , group-based , weight management intervention design ed to help limit GWG to 3 % of weight ( measured at the time of r and omization ) among obese pregnant women ( BMI ≥30 kg/m(2 ) ) . Participants are r and omized at 10 - 20 weeks gestation to either the intervention or a single dietary advice control condition . PRIMARY OUTCOMES The study is powered for the primary outcome of total GWG , yielding a target sample size of 160 women . Additional secondary outcomes include weight change between r and omization and one-year postpartum and proportion of infants with birth weight>90th percentile for gestational age . Statistical analyses will be based on intention-to-treat . METHODS Following r and omization , all participants receive a 45-minute dietary consultation . They are encouraged to follow the Dietary Approaches to Stop Hypertension diet without sodium restriction . Intervention group participants receive an individualized calorie intake goal , a second individual counseling session and attend weekly group meetings until they give birth . Research staff assesses all participants at 34-weeks gestation and at 2-weeks and one-year postpartum with their infants . SUMMARY The Healthy Moms study is testing weight management techniques that have been used with non-pregnant adults . We aim to help obese women limit GWG to improve their long-term health and the health of their offspring
In general , when given alongside gestational weight gain advice , fasting glucose improved in most diets compared to diets that gave gestational weight gain advice only .
However , fasting glucose increased in high unsaturated or monounsaturated fatty acids diets .
In the absence of gestational weight gain advice , fasting glucose improved in DASH-style diets compared to st and ard of care .
Although most were non-significant , similar trends were observed for these same diets for the other glycemic outcomes .
/INTERPRETATION Alongside with gestational weight gain advice , most diets , with the exception of a high unsaturated or a high monounsaturated fatty acid diet , demonstrated a fasting glucose improvement compared with gestational weight gain advice only .
When gestational weight gain advice was not given , the DASH-style diet appeared optimal on fasting glucose .
However , a small number of trials were identified and most dietary comparisons were underpowered to detect differences in glycemic outcomes .
AIMS Evidence to support dietary modifications to improve glycemia during pregnancy is limited , and the benefits of diet beyond limiting gestational weight gain is unclear .
Therefore , a systematic review and network meta- analysis of r and omized trials was conducted to compare the effects of various common diets , stratified by the addition of gestational weight gain advice , on fasting glucose and insulin , hemoglobin A1c ( HbA1c ) , and homeostatic model assessment for insulin resistance ( HOMA-IR ) in pregnant women .