Nutrition therapy within and beyond gestational diabetes.
Nutrition therapy within and beyond gestational diabetes.
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DOI：
10.1016/j.diabres.2018.04.004
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发表时间：
2018-11
影响因子：
5.1
通讯作者：
Barbour LA
中科院分区：
文献类型：
--
作者：
Hernandez TL;Mande A;Barbour LA
随着全球妊娠糖尿病 (GDM) 患病率的上升，一种适应性强、经济的营养治疗方法能够有效控制孕妇血糖，同时促进胎儿正常生长，将产生深远的影响。传统的焦点是严格限制所有类型的碳水化合物。在控制血糖的同时，这种方法会加剧产妇的焦虑，并且是依从性的主要障碍。许多母亲用脂肪代替碳水化合物，这可能会无意中增强脂肪分解，促进游离脂肪酸 (FFA) 升高，并恶化母亲的胰岛素抵抗 (IR)。导致IR恶化的营养可能会促进营养物质在胎盘中的分流，从而促进胎儿脂肪堆积过多。有证据表明，自由摄入更高质量、营养丰富的碳水化合物可以控制空腹/餐后血糖、降低 FFA、改善胰岛素作用、对血管有益，并可能减少婴儿过度肥胖。因此，当与更高质量的碳水化合物、更低的脂肪、适当的热量摄入和种族上可接受的食物相结合时，减少碳水化合物限制的方法可以提高母亲的依从性。这样的饮食可以具有文化敏感性、社会经济关注度，最大限度地减少 GDM 中体重的进一步增加，并与因超重/肥胖而并发的妊娠具有潜在相关性。未来的研究需要更好地了解常量营养素成分对胎盘和肠道微生物组的影响、非营养性甜味剂的益处/风险，以及精准营养是否对怀孕有益。
With the global rising prevalence of gestational diabetes (GDM), an adaptable, economical approach to nutrition therapy that effectively controls maternal glycemia while promoting normal fetal growth will have far-reaching implications. The conventional focus has been to rigidly limit all types of carbohydrate. While controlling glucose, this approach fosters maternal anxiety and is a primary barrier to adherence. Many mothers substitute fat for carbohydrate, which may unintentionally enhance lipolysis, promote elevated free fatty acids (FFA), and worsen maternal insulin resistance (IR). Nutrition that worsens IR may facilitate nutrient shunting across the placenta, promoting excess fetal fat accretion. Evidence suggests that liberalizing higher quality, nutrient-dense carbohydrates results in controlled fasting/postprandial glucose, lower FFA, improved insulin action, vascular benefits, and may reduce excess infant adiposity. Thus, a less carbohydrate-restricted approach may improve maternal adherence when combined with higher quality carbohydrates, lower fat, appropriate caloric intake, and ethnically acceptable foods. Such a diet can be culturally sensitive, socioeconomically attentive, minimize further weight gain in GDM, with potential relevance for pregnancies complicated by overweight/obesity. Future research is needed to better understand the effect of macronutrient composition on the placenta and gut microbiome, the benefits/risks of nonnutritive sweeteners, and whether precisionnutrition is beneficial in pregnancy.
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影响因子：
7.1
作者：
de Carvalho, Claudia M.;de Paula, Tatiana P.;Azevedo, Mirela J.
通讯作者：
Azevedo, Mirela J.
DOI：
10.1016/j.numecd.2015.05.005
发表时间：
2015-09-01
影响因子：
3.9
作者：
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通讯作者：
Poli, A.
影响因子：
3.5
作者：
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通讯作者：
Del Prato, S
影响因子：
1.5
作者：
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通讯作者：
Thornburg, Kent L.
DOI：
10.1080/713606657
发表时间：
2003-10-01
期刊：
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
影响因子：
--
作者：
Chen, R;Yogev, Y;Phillip, M
通讯作者：
Phillip, M