Prior lactation reduces future diabetic risk through sustained postweaning effects on insulin sensitivity
Prior lactation reduces future diabetic risk through sustained postweaning effects on insulin sensitivity
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DOI：
10.1152/ajpendo.00403.2016
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发表时间：
2017-03-01
影响因子：
5.1
通讯作者：
Retnakaran, Ravi
中科院分区：
文献类型：
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作者：
Bajaj, Harpreet;Ye, Chang;Retnakaran, Ravi
建议母乳喂养 >= 12 个月，以获得最佳婴儿营养，但也可能对产妇有益。事实上，哺乳期与母亲患糖尿病的长期风险较低有关，但哺乳期对断奶后葡萄糖耐量产生持续影响的机制仍不清楚。在这种情况下，我们假设哺乳可能会随着时间的推移改变胰岛素敏感性和/或胰腺β细胞功能的自然史，从而对断奶后的葡萄糖耐量产生有益的影响。因此，在这项研究中，我们评估了 330 名妊娠期糖耐量全面的女性队列中哺乳期 [= 12 个月（n = 120）] 与产后前 3 年胰岛素敏感性/抵抗、β 细胞功能和血糖轨迹之间的关系，这些妇女在产后 3 个月、1 年和 3 年接受了一系列代谢特征分析，包括口服葡萄糖耐量测试。母乳喂养 >= 12 个月的女性产后 3 年血糖异常（糖尿病前期/糖尿病）患病率低于母乳喂养 = 12 个月的女性，独立预测产后 3 年发生前驱糖尿病/糖尿病的可能性较低（OR = 0.37，95% CI 0.18-0.78，P = 0.009）。值得注意的是，与哺乳期 = 0.37 相比，哺乳期 >= 12 个月预计胰岛素敏感性/抵抗性 (P < 0.0001)、空腹血糖 (P < 0.0001) 和 2 小时血糖 (P = 0.011) 3 年期间的恶化程度较小。因此，坚持当前的母乳喂养建议可以通过断奶后对胰岛素敏感性/抵抗性的持续影响而不是对β细胞功能的影响来降低未来患糖尿病的风险。
Breastfeeding for >= 12 mo is recommended for optimal infant nutrition but may hold maternal benefits as well. Indeed, lactation has been associated with lower long-term risk of diabetes in the mother, but the mechanism by which it imparts sustained postweaning effects on glucose tolerance remains unclear. In this context, we postulated that lactation could potentially induce postweaning beneficial effects on glucose tolerance by modifying the natural history of insulin sensitivity and/or pancreatic beta-cell function over time. Thus, in this study, we evaluated the relationships between duration of lactation [= 12 mo (n = 120)] and trajectories of insulin sensitivity/ resistance, beta-cell function, and glycemia over the first 3 yr postpartum in a cohort of 330 women comprising the full spectrum of glucose tolerance in pregnancy, who underwent serial metabolic characterization, including oral glucose tolerance tests, at 3 mo, 1 yr, and 3 yr postpartum. The prevalence of dysglycemia (pre-diabetes/diabetes) at 3 yr postpartum was lower in women who breastfed for >= 12 mo (12.5%) than in those who breastfed for = 12 mo independently predicted a lower likelihood of prediabetes/diabetes at 3 yr postpartum (OR = 0.37, 95% CI 0.18-0.78, P = 0.009). Notably, lactation for >= 12 mo predicted lesser worsening of insulin sensitivity/resistance (P < 0.0001), fasting glucose (P < 0.0001), and 2-h glucose (P = 0.011) over 3 yr compared with lactation = 0.37). It has thus emerged that adherence to current breastfeeding recommendations reduces future diabetic risk through sustained postweaning effects on insulin sensitivity/resistance but not beta-cell function.