Longitudinal changes in body composition and energy balance in lean women with normal and abnormal glucose tolerance during pregnancy.

Autor:	Catalano, Patrick M., Roman-Drago, Noreen M., Amini, Saeid B., Sims, Ethan A. H., Catalano, P M, Roman-Drago, N M, Amini, S B, Sims, E A
Předmět:	PREGNANCY complications GLUCOSE tolerance tests BODY composition CALORIMETRY CARBOHYDRATE metabolism CLINICAL trials COMPARATIVE studies ENERGY metabolism GESTATIONAL age INSULIN resistance LONGITUDINAL method RESEARCH methodology MEDICAL cooperation REFERENCE values REGRESSION analysis RESEARCH RESEARCH funding EVALUATION research BODY mass index RANDOMIZED controlled trials GLUCOSE intolerance GLUCOSE clamp technique
Zdroj:	American Journal of Obstetrics & Gynecology; Jul98, Vol. 179 Issue 1, p156-165, 10p, 4 Charts, 2 Graphs
Abstrakt:	Objective: The objective of this study was to evaluate the longitudinal changes in energy expenditure and body composition in relationship to alterations in carbohydrate metabolism in women with normal and abnormal glucose metabolism. We hypothesized that women with decreased insulin sensitivity before conception would have less fat accretion and smaller increases in energy expenditure.Study Design: Six women with normal glucose tolerance and 10 women with abnormal glucose tolerance were evaluated before conception, and in early (12 to 14 weeks) and late (34 to 36 weeks) gestation. Body composition was estimated by hydrodensitometry, resting energy expenditure, and glucose and fat metabolism by indirect calorimetry, endogenous glucose production by infusion of [6-6 2H2] glucose, and insulin sensitivity using a hyperinsulinemic-euglycemic clamp (40 mU/m2/min).Results: There was a smaller increase in fat mass (1.3 kg [P = .04]) in early pregnancy in women with abnormal glucose tolerance before pregnancy. Indirect calorimetry measured gestational age-related increases in basal oxygen utilization, with or without correction for fat-free mass (VO2, P = .002), resting energy expenditure (expressed in kilocalories, P = .0001), and carbohydrate oxidation (P = .0003). The insulin-mediated elevation in VO2 increased in later gestation VO2 (P = .005), as did resting energy expenditure (P = .0001) and fat oxidation (P = 0.0001). However, there was a decrease in respiratory quotient (P = .0001), carbohydrate oxidation (P = .002), and nonoxidative carbohydrate metabolism (P = .0001) with advancing gestation during insulin infusion. In early pregnancy, changes in fat mass correlated inversely with changes in insulin sensitivity (r= -0.52, P = .04) and changes in basal VO2 correlated inversely with decreases in basal endogenous glucose production (r = -0.74, P = .01).Conclusion: In early gestation, the changes in maternal fat mass and basal oxygen consumption are inversely related to the changes in insulin sensitivity. This response in lean women with decreased insulin sensitivity before conception may have survival value by providing a larger amount of available substrate to meet fetoplacental needs during gestation. [ABSTRACT FROM AUTHOR]
Databáze:	Supplemental Index
Externí odkaz:	Zobrazit plný text záznamu Full Text from ScienceDirect