Metabolismo energético en mujeres con diabetes mellitus pregestacional : estudio longitudinal durante el embarazo

La gestació normal es caracteritza per canvis i adaptacions en la funció de la cèl • lula beta, la despesa energètica basal (DEB) i en la composició corporal per afavorir la major disponibilitat de glucosa per al fetus. Les gestants amb diabetis mellitus tipus 1 (DM1) poden presentar diferències en el DEB, en la utilització de nutrients i en l'antropometria materna al llarg de l'embaràs. Avaluem el paper del DEB en 3 ocasions mitjançant calorimetria indirecta al llarg de la gestació en gestants controls i amb DM1. Durant les avaluacions també es van realitzar determinacions de paràmetres bioquímics, avaluacions antropomètriques de la mare i aplicació d'enquestes dietètiques i d'activitat física. A més a més es van recollir dades de les exploracions ecogràfiques realitzades per la valoració del creixement fetal i en les primeres 48 hores després del part es va realitzar una avaluació antropomètrica neonatal per determinar la composició corporal del nadó. El grau d'adipositat matern va ser determinant del GEB amb independència de la presència de DM1 durant la gestació. Diversos factors materns com el enguany de pes, els nivells de glucosa i de triglicèrids materns es van associar al grau d'adipositat neonatal en ambdós grups d'estudi. La ingesta referida va ser infraestimada en ambdós grups de gestants. El grup DM1 va mostrar major adherència a la dieta mediterrània que la resta de la població.La gestación normal se caracteriza por cambios y adaptaciones en la función de la célula beta, el gasto energético basal (GEB) y en la composición corporal para favorecer la mayor disponibilidad de glucosa para el feto. Las gestantes con diabetes mellitus tipo 1 (DM1) pueden presentar diferencias en el GEB, en la utilización de nutrientes y en la antropometría materna a lo largo del embarazo. Evaluamos el papel del GEB en 3 ocasiones mediante calorimetría indirecta a lo largo de la gestación en gestantes controles y con DM1. Durante las evaluaciones también se realizaron determinaciones de parámetros bioquímicos, evaluaciones antropométricas de la madre y aplicación de encuestas dietéticas y de actividad física. Además se recogieron datos de las exploraciones ecográficas realizadas para valoración del crecimiento fetal y en las primeras 48 horas tras el parto se realizó una evaluación antropométrica neonatal para determinar la composición corporal del recién nacido. El grado de adiposidad materno fue determinante del GEB con independencia de la presencia de DM1 durante la gestación. Diversos factores maternos como la ganancia de peso, los niveles de glucosa y de triglicéridos maternos se asociaron al grado de adiposidad neonatal en ambos grupos de estudio. La ingesta referida fue infraestimada en ambos grupos de gestantes. El grupo DM1 mostró mayor adherencia a la dieta mediterránea que el resto de la población.Normal pregnancy is characterized by changes and adaptations in the function of the beta cell, resting energy expenditure (REE) and body composition for promoting the increased availability of glucose to the fetus. Pregnant women with type 1 diabetes mellitus may differ in the REE in nutrient utilization and maternal anthropometry during pregnancy. We evaluated the role of the REE on 3 moments by indirect calorimetry throughout gestation in control pregnant and DM1 pregnant. During evaluations we also made biochemical parameters, anthropometric assessments of mother and application of dietary and physical activity surveys. Further details ultrasound examinations were collected for evaluation of fetal growth and in the first 48 hours after birth we made neonatal anthropometric assessment to determine the body composition of the newborn. The adiposity maternal was an associate direct factor for REE independently of the presence of DM1 during gestation. Various factors such as maternal weight gain, glucose levels and triglycerides were associated with maternal level of neonatal adiposity in both study groups. The reported energy intake was underestimated in both groups of pregnant women. The DM1 group showed greater adherence to the Mediterranean diet than the rest of population

Mis casos clínicos de especialidades odontológicas

Libro que muestra la atención de casos clínicos particulares referente a las diferentes especialidades odontológicasLibro que muestra la atención de casos clínicos particulares referente a las diferentes especialidades odontológicasUniversidad Autónoma de Campeche Universidad Autónoma del Estado de Hidalgo Universidad Autónoma del Estado de Méxic

Zinc-α2-glycoprotein is unrelated to gestational diabetes: anthropometric and metabolic determinants in pregnant women and their offspring.

CONTEXT: Zinc-α2-Glycoprotein (ZAG) is an adipokine with lipolytic action and is positively associated with adiponectin in adipose tissue. We hypothesize that ZAG may be related with hydrocarbonate metabolism disturbances observed in gestational diabetes mellitus (GDM). OBJECTIVE: The aim of this study was to analyze serum ZAG concentration and its relationship with carbohydrate metabolism in pregnant women and its influence on fetal growth. DESIGN: 207 pregnant women (130 with normal glucose tolerance (NGT) and 77 with GDM) recruited in the early third trimester and their offspring were studied. Cord blood was obtained at delivery and neonatal anthropometry was assessed in the first 48 hours. ZAG was determined in maternal serum and cord blood. RESULTS: ZAG concentration was lower in cord blood than in maternal serum, but similar concentration was observed in NGT and GDM pregnant women. Also similar levels were found between offspring of NGT and GDM women. In the bivariate analysis, maternal ZAG (mZAG) was positively correlated with adiponectin and HDL cholesterol, and negatively correlated with insulin and triglyceride concentrations, and HOMA index. On the other hand, cord blood ZAG (cbZAG) was positively correlated with fat-free mass, birth weight and gestational age at delivery. After adjusting for confounding variables, gestational age at delivery and HDL cholesterol emerged as the sole determinants of cord blood ZAG and maternal ZAG concentrations, respectively. CONCLUSION: mZAG was not associated with glucose metabolism during pregnancy. ZAG concentration was lower in cord blood compared with maternal serum. cbZAG was independently correlated with gestational age at delivery, suggesting a role during the accelerated fetal growth during latter pregnancy

Serum activin A and follistatin levels in gestational diabetes and the association of the Activin A-Follistatin system with anthropometric parameters in offspring.

CONTEXT: The Activin A-Follistatin system has emerged as an important regulator of lipid and glucose metabolism with possible repercussions on fetal growth. OBJECTIVE: To analyze circulating activin A, follistatin and follistatin-like-3 (FSTL3) levels and their relationship with glucose metabolism in pregnant women and their influence on fetal growth and neonatal adiposity. DESIGN AND METHODS: A prospective cohort was studied comprising 207 pregnant women, 129 with normal glucose tolerance (NGT) and 78 with gestational diabetes mellitus (GDM) and their offspring. Activin A, follistatin and FSTL3 levels were measured in maternal serum collected in the early third trimester of pregnancy. Serial fetal ultrasounds were performed during the third trimester to evaluate fetal growth. Neonatal anthropometry was measured to assess neonatal adiposity. RESULTS: Serum follistatin levels were significantly lower in GDM than in NGT pregnant women (8.21±2.32 ng/mL vs 9.22±3.41, P = 0.012) whereas serum FSTL3 and activin A levels were comparable between the two groups. Serum follistatin concentrations were negatively correlated with HOMA-IR and positively with ultrasound growth parameters such as fractional thigh volume estimation in the middle of the third trimester and percent fat mass at birth. Also, in the stepwise multiple linear regression analysis serum follistatin levels were negatively associated with HOMA-IR (β = -0.199, P = 0.008) and the diagnosis of gestational diabetes (β = -0.138, P = 0.049). Likewise, fractional thigh volume estimation in the middle of third trimester and percent fat mass at birth were positively determined by serum follistatin levels (β = 0.214, P = 0.005 and β = 0.231, P = 0.002, respectively). CONCLUSIONS: Circulating follistatin levels are reduced in GDM compared with NGT pregnant women and they are positively associated with fetal growth and neonatal adiposity. These data suggest a role of the Activin-Follistatin system in maternal and fetal metabolism during pregnancy

Clinical and metabolic characteristics of the population studied.

<p>Value data are presented as mean ± SD or median (25–75th percentile) for nonnormally distributed.</p><p>variables. mAdiponectin: maternal adiponectin, cbAdiponectin: cord blood adiponectin, SBP: systolic.</p><p>blood pressure, DBP: diastolic blood pressure.</p

Correlation between serum cbZAG levels and anthropometric variables: birth weight (A) and fat-free mass (FFM) (B).

<p>Correlation between serum cbZAG levels and anthropometric variables: birth weight (A) and fat-free mass (FFM) (B).</p

Correlation between serum mZAG levels and HDL cholesterol levels (A), triglyceride levels (B), Insulin logarithm (Lg Insulin) (C) and HOMA-IR logarithm (Lg HOMA-IR) (D).

<p>Correlation between serum mZAG levels and HDL cholesterol levels (A), triglyceride levels (B), Insulin logarithm (Lg Insulin) (C) and HOMA-IR logarithm (Lg HOMA-IR) (D).</p

Stepwise multiple linear regression models of activin A, follistatin and FSTL3.

<p>* Model 1: Covariates considered for selection: maternal age, diagnosis of GDM, LogHOMA-IR, LogPre-pregnancy BMI, BMI gain, and triglycerides.</p><p>**Model 2: Covariates considered for selection: The same as in model 1, follistatin and FSTL3.</p><p><i>r²</i>: corrected R².</p

Clinical, metabolic and ultrasound characteristics of the population studied.

<p>Value data are presented as mean ± SD or median (25^th–75^th percentile) for non-normally distributed variables. SBP: systolic blood pressure, DBP: diastolic blood pressure, FWE: fetal weight estimation, FTVE: fractional thigh volume estimation SDS: standard deviation score.</p

Stepwise multiple linear regression models of anthropometrical and ultrasound variables.

<p>Covariates considered for selection: LogActivin A, follistatin, FSTL3, maternal age, diagnosis of GDM, LogHOMA-IR, LogPre-pregnancy BMI, BMI gain and triglycerides. BW: birth weight, SDS: standard deviation score, PFM: percent fat mass, FTVE₃₅: Fractional thigh volume estimation calculated at approximately 35 weeks' gestation, FWE₃₅: fetal weight estimation calculated at approximately 35 weeks' gestation, <i>r²</i>: corrected R².</p