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. 2017 Feb;60(2):306-313.
doi: 10.1007/s00125-016-4143-9. Epub 2016 Nov 5.

Liver triacylglycerol content and gestational diabetes: effects of moderate energy restriction

Kenneth Hodson  1   2   3 , Chiara Dalla Man  4 , Fiona E Smith  5   6 , Alison Barnes  7 , Catherine McParlin  5   8 , Claudio Cobelli  4 , Stephen C Robson  5   8 , Vera Araújo-Soares  7 , Roy Taylor  5   8   6
Affiliations

Liver triacylglycerol content and gestational diabetes: effects of moderate energy restriction

Kenneth Hodson et al. Diabetologia. 2017 Feb.

Abstract

Aims/hypothesis: Women with a history of gestational diabetes mellitus (GDM) have raised liver triacylglycerol. Restriction of energy intake in type 2 diabetes can normalise glucose control and liver triacylglycerol concentration but it is not known whether similar benefits could be achieved in GDM. The aim of this work was to examine liver triacylglycerol accumulation in women with GDM and the effect of modest energy restriction.

Methods: Sixteen women with GDM followed a 4 week diet (5 MJ [1200 kcal]/day). Liver triacylglycerol, before and after diet and postpartum, was measured by magnetic resonance. Insulin secretion and sensitivity were assessed before and after diet. Twenty-six women who underwent standard antenatal care for GDM (matched for age, BMI, parity and ethnicity) were used as a comparator group.

Results: Fourteen women, who completed the study, achieved a weight loss of 1.6 ± 1.7 kg over the 4 week dietary period. Mean weight change was -0.4 kg/week in the study group vs +0.3 kg/week in the comparator group (p = 0.002). Liver triacylglycerol level was normal but decreased following diet (3.7% [interquartile range, IQR 1.2-6.1%] vs 1.8% [IQR 0.7-3.1%], p = 0.004). There was no change in insulin sensitivity or production. Insulin was required in six comparator women vs none in the study group (eight vs two required metformin). Blood glucose control was similar for both groups. The hypo-energetic diet was well accepted.

Conclusions/interpretation: Liver triacylglycerol in women with GDM was not elevated, unlike observations in non-pregnant women with a history of GDM. A 4 week hypo-energetic diet resulted in weight loss, reduced liver triacylglycerol and minimised pharmacotherapy. The underlying pathophysiology of glucose metabolism appeared unchanged.

Keywords: Gestational diabetes; Insulin resistance; Intrahepatic lipid; Magnetic resonance spectroscopy; Pregnancy.

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Conflict of interest statement

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Contribution statement

KH, RT, SCR and VA-S designed the study. KH recruited and studied the participants and drafted the paper. CDM and CC designed the standardised meal test protocol and analysed the meal test data. FES developed the magnetic resonance protocol and acquired and analysed the MRI data. SCR developed the study protocol. CM and VA-S developed, administered and analysed the semi-structured interview. AB developed and administered the dietary intervention and supporting resources and provided training for KH to do the same. All authors reviewed and approved the final paper. RT was the principal investigator and supervisor of the study, developed the study protocol and provided clinical support to research participants and is the guarantor of this work.

Figures

Fig. 1
Fig. 1
Percentage liver triacylglycerol before and after dietary intervention (n = 13) and postpartum (n = 7). Circles show individual values; bars show the median. p = 0.004 before vs after intervention
Fig. 2
Fig. 2
Plasma cholesterol and triacylglycerol lipoproteins in women with GDM before (light grey bars) and after (dark grey bars) dietary intervention (n = 14) and postpartum (black bars) (n = 7). Data are means ± SD. *p < 0.05 before diet vs postpartum
See this image and copyright information in PMC

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