Impact of lifestyle intervention for obese women during pregnancy on maternal metabolic and inflammatory markers
Impact of lifestyle intervention for obese women during pregnancy on maternal metabolic and inflammatory markers
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DOI：
10.1038/ijo.2017.9
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发表时间：
2017-04-01
影响因子：
4.9
通讯作者：
Norgaard, K.
中科院分区：
文献类型：
--
作者：
Renault, K. M.;Carlsen, E. M.;Norgaard, K.
背景：肥胖母亲的子女患肥胖症及相关的短期和长期疾病的风险增加。其原因是多因素的，部分原因可能是不利的宫内环境。目的：评价生活方式干预对肥胖孕妇代谢和炎症指标的影响，这是一项随机对照试验。方法：在TOP研究中，425名体重指数<30 kg/m(2)的受试者被随机分为饮食建议和体力活动计步器(PA+D)、计步器(PA)体力活动(C)两组。在完成这项研究的389名参与者中，有376人有可用的血液样本。分别于18~20周和28~30周测定血清胰岛素、C-肽、血脂、瘦素、高敏C反应蛋白(HsCRP)和可溶性尿激酶型纤溶酶原激活物受体(SuPAR)，同时进行2小时口服糖耐量试验。结果：各干预组孕28~30周超敏C反应蛋白中位数(PA+D组8.3 mg/L，P=0.03；PA组8.8 mg/L，P=0.02)均低于对照组(11.5 mg/L)。与不顺从的妇女相比，每天达到11000步的目标导致hsCRP降低21%。报告高碳水化合物摄入量的妇女在妊娠晚期的hsCRP浓度比报告最低摄入量的妇女高约30%。干预组与对照组在妊娠28~30周的血脂及代谢指标无明显差异。结论：生活方式干预可降低孕期炎症标志物hsCRP水平。这种影响可能部分是通过更多的体力活动，部分是通过碳水化合物摄入量和血糖负荷的变化来实现的。
BACKGROUND: Offspring of obese mothers have increased risk of developing obesity and related short- and long-term disease. The cause is multifactorial and may partly be explained by the unfavorable intrauterine environment. Intervention during pregnancy leading to a healthier lifestyle among obese may alter this.OBJECTIVE: To assess the effect of lifestyle intervention on markers of maternal metabolism and inflammation in ` the TOP (Treatment of Obese Pregnant Women) study', a randomized controlled trial.METHODS: In the TOP-study 425 participants with body mass index >= 30 kg/m(2) were randomized to intervention with dietary advices and physical activity assessed by pedometer (PA+ D), physical activity assessed by pedometer (PA) or control (C). Of 389 participants completing the study 376 had available blood samples. Serum was analyzed for insulin, c-peptide, lipid profile, leptin, high-sensitivity CRP (hsCRP) and Soluble urokinase Plasminogen Activator Receptor (suPAR), in week 18-20 and 28-30, and simultaneously a 2-h oral glucose-tolerance-test was performed. Diet was assessed in gestational week 11-14 and 36-37 using a validated 360-item Food Frequency Questionnaire.RESULTS: Median levels of hsCRP in gestational week 28-30 were lower in each of the intervention groups (8.3 mg/l in PA+ D group, P = 0.03; and 8.8 mg/l in PA group, P = 0.02) versus the control group (11.5 mg/l). Obtaining 11 000 steps per day as aimed for resulted in a 21% lower hsCRP compared to non-compliant women. Women reporting high carbohydrate intake had around 30% higher hsCRP concentrations in late gestation than women reporting the lowest intake. There were no differences in lipid profile or any of the metabolic markers in gestational week 28-30 when comparing the intervention and control groups.CONCLUSIONS: Lifestyle intervention in obese women can reduce hsCRP representing a marker of inflammation during pregnancy. The effect may partly be mediated by more physical activity and partly by changes in intake of carbohydrates and the glycaemic load.