Uncovering the Role of Dietary Fat and Protein in Glycemic Physiology in Pregnancy and in Gestational Diabetes

项目摘要/摘要 妊娠期糖尿病(GDM)是一种发病率不断上升的疾病，其一线治疗方法是饮食疗法，但 这些患者的最佳饮食尚不清楚。指南的重点是妊娠期糖尿病患者的碳水化合物限制， 一些证据表明，母亲和胎儿的结局有所改善，但人们担心，低碳水化合物 饮食可能会对胎儿产生不利的后果。评估不同营养大量营养素的研究， 特别是蛋白质和脂肪，在怀孕和妊娠期糖尿病是缺乏的。拟议研究项目的目标 是为了了解饮食中脂肪和蛋白质对怀孕和怀孕期间胰岛素生理和血糖的影响 GDM，目的是为受GDM影响的妇女寻找最佳饮食。申请者将利用数据 从一项对妊娠期糖代谢的前瞻性纵向观察研究中 膳食蛋白质和脂肪暴露对孕妇胰岛素生理的影响申请者还将 介入交叉试验评价蛋白质和脂肪对妊娠期糖尿病妇女血糖的急性影响 两种碳水化合物含量相同、蛋白质含量不同的等卡路里早餐的随机试验 脂肪含量(高蛋白/低脂肪、低蛋白/高脂肪)。该项目的目标是： 1.明确孕妇膳食脂肪和蛋白质与胰岛素生理的关系。第一 假说是，与低脂肪饮食相比，高脂肪饮食会导致胰岛素敏感性降低； 第二个假设是，高蛋白饮食会导致胰岛素分泌增加(调整后的 胰岛素敏感性)，而不是蛋白质含量低的饮食。 2.前瞻性测试脂肪和蛋白质对女性餐后血糖反应的急性影响 GDM。假设高蛋白/低脂肪膳食会导致餐后血糖峰值降低。 比高脂肪/低蛋白质膳食的摄入量要高。 这些研究的结果将确定蛋白质和脂肪对胰岛素生理和血糖的影响 因此有可能为妊娠期糖尿病的临床饮食建议提供信息。 培训计划包括Ellen Seely博士(赞助商)和Camille Powe博士(医学博士)的专门指导 (共同发起人)，每个人都提供根据申请者的需求和目标量身定做的专业知识。此外，申请者将 通过哈佛促进会完成生物统计学、营养学和临床研究的正式培训 马萨诸塞州哈佛大学公共卫生学院临床/转化科学中心 综合医院临床研究部和国立卫生研究院行为与健康办公室 社会科学研究。这些活动将为申请者提供对职业生涯至关重要的工具 妊娠期糖尿病营养和生活方式领域的独立临床研究员。

PROJECT SUMMARY/ABSTRACT The first-line treatment of gestational diabetes (GDM), a disease rising in prevalence, is dietary therapy, yet the optimal diet for these patients is unknown. Guidelines have focused on carbohydrate restriction in GDM, with some evidence suggesting improved maternal and fetal outcomes, yet there is concern that low carbohydrate diets may have adverse fetal consequences. Research evaluating different nutritional macronutrients, specifically protein and fat, in pregnancy and GDM is lacking. The objectives of the proposed research projects are to understand the impact of dietary fat and protein on insulin physiology and glycemia in pregnancy and in GDM with the goal of discovering the optimal diet for women affected by GDM. The applicant will utilize data from a prospective longitudinal observational study of glucose metabolism in pregnancy to investigate the effects of dietary protein and fat exposure on insulin physiology in pregnant women. The applicant will also evaluate the acute effects of protein and fat on glycemia in women with GDM in an interventional cross-over randomized trial of two isocaloric breakfast meals with identical carbohydrate content and varying protein and fat content (high protein/low fat, low protein/high fat). The aims of this project are: 1. Define the relationship of dietary fat and protein with insulin physiology in pregnant women. The first hypothesis is that diets high in fat will lead to reduced insulin sensitivity as compared to diets low in fat; the second hypothesis is that diets high in protein will lead to increased insulin secretion (adjusted for insulin sensitivity) as compared to diets low in protein. 2. Prospectively test the acute effect of fat and protein on post-prandial glycemic response in women with GDM. The hypothesis is that the high protein/low fat meal will lead to lower peak post prandial glucose levels than the high fat/low protein meal. The results of these studies will determine the impact of protein and fat on insulin physiology and glycemia in pregnant women and in GDM and thus have the potential to inform clinical dietary recommendations in GDM. The training plan includes dedicated mentorship by Dr. Ellen Seely MD (sponsor) and Dr. Camille Powe MD (co-sponsor), each offering expertise tailored to the applicant’s needs and goals. Additionally, the applicant will complete formal training in biostatistics, nutrition and clinical research through the Harvard Catalyst Clinical/Translational Science Center, the Harvard T.H. Chan School of Public Health, the Massachusetts General Hospital Division of Clinical Research, and the National Institutes of Health Office of Behavioral and Social Sciences Research. These activities will provide the applicant with the tools critical for a career as an independent clinical researcher in the field of nutritional and lifestyle approaches to GDM.