Using Resistance Training in Women with Gestational Diabetes Mellitus to Improve Glucose Regulation

Gestational diabetes mellitus (GDM) poses a significant threat to the short- and long-term health of the mother and baby. Pharmacological treatments for GDM do not fully correct the underlying problem of the disease; however, non-pharmacological treatments such as exercise are increasingly recognized as foundational to glycemic management in other populations with disordered glucose regulation, such as non-gravid women with type II diabetes mellitus (T2DM). Much of the research regarding the impact of exercise on glycemic control in T2DM leverages aerobic training as the primary modality; yet research has demonstrated the effectiveness of resistance training on improving glycemic control in T2DM. This chapter will review the rationale for resistance training in the management of GDM using evidence from individuals with T2DM; then the chapter will review available studies on the effectiveness of resistance training on glucose control in women with GDM

The Health Impact of Nighttime Eating: Old and New Perspectives

Nighttime eating, particularly before bed, has received considerable attention. Limiting and/or avoiding food before nighttime sleep has been proposed as both a weight loss strategy and approach to improve health and body composition. Indeed, negative outcomes have been demonstrated in response to large mixed meals in populations that consume a majority of their daily food intake during the night. However, data is beginning to mount to suggest that negative outcomes may not be consistent when the food choice is small, nutrient-dense, low energy foods and/or single macronutrients rather than large mixed-meals. From this perspective, it appears that a bedtime supply of nutrients can promote positive physiological changes in healthy populations. In addition, when nighttime feeding is combined with exercise training, any adverse effects appear to be eliminated in obese populations. Lastly, in Type I diabetics and those with glycogen storage disease, eating before bed is essential for survival. Nevertheless, nighttime consumption of small (~150 kcals) single nutrients or mixed-meals does not appear to be harmful and may be beneficial for muscle protein synthesis and cardiometabolic health. Future research is warranted to elucidate potential applications of nighttime feeding alone and in combination with exercise in various populations of health and disease

Visual Representation of Body Shape in African-American and European American Women: Clinical Considerations

Background Body mass index (BMI) has been used widely among clinicians to assess obesity in their patients due to its ease and availability. However, BMI has some diagnostic limitations and other measures related to health risks; in particular, body shape may be of greater relevance to health outcomes. Objective The objective of this study was to illustrate the importance of body shape assessments above and beyond BMI and its relationship to health risk among a sample of African-American and European American women. Methods African-American and European American women aged 19–78 years ( n = 552) in Birmingham, Alabama, were recruited and stratified by menopausal status (ie, pre- or postmenopausal). Pictorial body shapes were derived from digital photographs, while body fat distribution defined by android-gynoid ratio (AGR) and body composition were obtained from dual-energy X-ray absorptiometry. Results Images of BMI and age-matched women illustrate variability in fat distribution. Among both menopausal status groups, more than 50% of women had a pear body shape (AGR < 1). An apple body shape was associated with higher odds of having diabetes (unadjusted odds ratio [OR]: 4.1, 95% confidence interval [CI]: 1.9–9.3), hypertension (unadjusted OR: 3.1, 95% CI: 2.0–4.7), and high cholesterol (unadjusted OR: 3.0, 95% CI: 1.8–5.1). Conclusion Use of visual cues alongside traditional methods of weight status assessment may help to facilitate weight management conversations between physicians and female patients. However, next steps should include the validation of visual assessments of body shape in women for use by physicians

The Effect of Casein Protein Prior to Sleep on Fat Metabolism in Obese Men

We have previously shown that ingesting protein at night before sleep is either beneficialor non-detrimental to metabolism, health, and body composition in obese women. However, theovernight protein-induced lipolytic actions and mechanism for improved metabolism and bodycomposition have not been fully established. Therefore, in a crossover design, twelve obese men(age, 27.0 ˘ 2.2 years) were randomly assigned to ingest (within 30 min of sleep) casein protein(CAS, 120 kcal) or a non-nutritive placebo (PLA) before going to sleep. Markers of fat metabolism(lipolysis, substrate utilization, growth hormone), insulin, glucose, resting energy expenditure (REE),and appetite (questionnaire and ghrelin) were measured. During sleep and the next morning,interstitial glycerol from the subcutaneous abdominal adipose tissue (SCAAT) was measured usingmicrodialysis. There were no differences in SCAAT glycerol (overnight: CAS, 177.4 ˘ 26.7; PLA,183.8 ˘ 20.2 µmol/L; morning: CAS, 171.6 ˘ 19.1; PLA, 161.5 ˘ 18.6 µmol/L), substrate utilization,REE, or any blood markers between CAS and PLA. Desire to eat was greater for CAS comparedto baseline (p = 0.03), but not different from PLA (baseline: 39 ˘ 6, CAS: 62 ˘ 8, PLA: 55 ˘ 5 mm).CAS consumption before sleep did not affect fat or glucose metabolism, REE, or suppress appetitein hyperinsulemic obese men. CAS may be consumed before sleep without impeding overnight ormorning fat metabolism in young, obese men