title: A higher-complex carbohydrate diet in gestational diabetes mellitus achieves glucose targets and lowers postprandial lipids: a randomized crossover study.
abstract: OBJECTIVE
  The conventional diet approach to gestational diabetes mellitus (GDM) advocates carbohydrate restriction, resulting in higher fat (HF), also a substrate for fetal fat accretion and associated with maternal insulin resistance. Consequently, there is no consensus about the ideal GDM diet. We hypothesized that, compared with a conventional, lower-carbohydrate/HF diet (40% carbohydrate/45% fat/15% protein), consumption of a higher-complex carbohydrate (HCC)/lower-fat (LF) Choosing Healthy Options in Carbohydrate Energy (CHOICE) diet (60/25/15%) would result in 24-h glucose area under the curve (AUC) profiles within therapeutic targets and lower postprandial lipids.
  
  
  METHODS
  Using a randomized, crossover design, we provided 16 GDM women (BMI 34 ± 1 kg/m2) with two 3-day isocaloric diets at 31 ± 0.5 weeks (washout between diets) and performed continuous glucose monitoring. On day 4 of each diet, we determined postprandial (5 h) glucose, insulin, triglycerides (TGs), and free fatty acids (FFAs) following a controlled breakfast meal.
  
  
  RESULTS
  There were no between-diet differences for fasting or mean nocturnal glucose, but 24-h AUC was slightly higher (∼6%) on the HCC/LF CHOICE diet (P = 0.02). The continuous glucose monitoring system (CGMS) revealed modestly higher 1- and 2-h postprandial glucose on CHOICE (1 h, 115 ± 2 vs. 107 ± 3 mg/dL, P ≤ 0.01; 2 h, 106 ± 3 vs. 97 ± 3 mg/dL, P = 0.001) but well below current targets. After breakfast, 5-h glucose and insulin AUCs were slightly higher (P < 0.05), TG AUC was no different, but the FFA AUC was significantly lower (∼19%; P ≤ 0.01) on the CHOICE diet.
  
  
  CONCLUSIONS
  This highly controlled study randomizing isocaloric diets and using a CGMS is the first to show that liberalizing complex carbohydrates and reducing fat still achieved glycemia below current treatment targets and lower postprandial FFAs. This diet strategy may have important implications for preventing macrosomia.
authors.affiliation: Corresponding author: Teri L. Hernandez, teri.hernandez@ucdenver.edu.
authors.forename: Teri L
authors.initials: TL
authors.lastname: Hernandez
authors.forename: Rachael E
authors.initials: RE
authors.lastname: Van Pelt
authors.forename: Molly A
authors.initials: MA
authors.lastname: Anderson
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Daniels
authors.forename: Nancy A
authors.initials: NA
authors.lastname: West
authors.forename: William T
authors.initials: WT
authors.lastname: Donahoo
authors.forename: Jacob E
authors.initials: JE
authors.lastname: Friedman
authors.forename: Linda A
authors.initials: LA
authors.lastname: Barbour
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D018592:Cross-Over Studies; D016640:Diabetes, Gestational / Q000097:blood / Q000178:diet therapy* / Q000503:physiopathology; D004040:Dietary Carbohydrates / Q000627:therapeutic use*; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D008055:Lipids / Q000097:blood*; D009043:Motor Activity / Q000502:physiology; D010349:Patient Compliance; D019518:Postprandial Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000178:diet therapy* / Q000503:physiopathology; D011446:Prospective Studies; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D005230:Fatty Acids, Nonesterified; D007328:Insulin; D008055:Lipids; D014280:Triglycerides