title: Women With Gestational Diabetes Mellitus Randomized to a Higher-Complex Carbohydrate/Low-Fat Diet Manifest Lower Adipose Tissue Insulin Resistance, Inflammation, Glucose, and Free Fatty Acids: A Pilot Study.
abstract: OBJECTIVE
  Diet therapy in gestational diabetes mellitus (GDM) has focused on carbohydrate restriction but is poorly substantiated. In this pilot randomized clinical trial, we challenged the conventional low-carbohydrate/higher-fat (LC/CONV) diet, hypothesizing that a higher-complex carbohydrate/lower-fat (CHOICE) diet would improve maternal insulin resistance (IR), adipose tissue (AT) lipolysis, and infant adiposity.
  
  
  METHODS
  At 31 weeks, 12 diet-controlled overweight/obese women with GDM were randomized to an isocaloric LC/CONV (40% carbohydrate/45% fat/15% protein; n = 6) or CHOICE (60%/25%/15%; n = 6) diet. All meals were provided. AT was biopsied at 37 weeks.
  
  
  RESULTS
  After ∼7 weeks, fasting glucose (P = 0.03) and free fatty acids (P = 0.06) decreased on CHOICE, whereas fasting glucose increased on LC/CONV (P = 0.03). Insulin suppression of AT lipolysis was improved on CHOICE versus LC/CONV (56 vs. 31%, P = 0.005), consistent with improved IR. AT expression of multiple proinflammatory genes was lower on CHOICE (P < 0.01). Infant adiposity trended lower with CHOICE (10.1 ± 1.4 vs. 12.6 ± 2%, respectively).
  
  
  CONCLUSIONS
  A CHOICE diet may improve maternal IR and infant adiposity, challenging recommendations for a LC/CONV diet.
authors.affiliation: Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, CO Center for Women's Health Research, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO teri.hernandez@ucdenver.edu.
authors.forename: Teri L
authors.initials: TL
authors.lastname: Hernandez
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO.
authors.forename: Rachael E
authors.initials: RE
authors.lastname: Van Pelt
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO.
authors.forename: Molly A
authors.initials: MA
authors.lastname: Anderson
authors.affiliation: Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO.
authors.forename: Melanie S
authors.initials: MS
authors.lastname: Reece
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO.
authors.forename: Regina M
authors.initials: RM
authors.lastname: Reynolds
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO.
authors.forename: Becky A
authors.initials: BA
authors.lastname: de la Houssaye
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO.
authors.forename: Margaret
authors.initials: M
authors.lastname: Heerwagen
authors.affiliation: Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO Kaiser Permanente Colorado, Denver, CO.
authors.forename: William T
authors.initials: WT
authors.lastname: Donahoo
authors.affiliation: Kaiser Permanente Colorado, Denver, CO.
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Daniels
authors.affiliation: Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO.
authors.forename: Catherine
authors.initials: C
authors.lastname: Chartier-Logan
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO.
authors.forename: Rachel C
authors.initials: RC
authors.lastname: Janssen
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO.
authors.forename: Jacob E
authors.initials: JE
authors.lastname: Friedman
authors.affiliation: Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO.
authors.forename: Linda A
authors.initials: LA
authors.lastname: Barbour
mesh_terms: D000273:Adipose Tissue / Q000378:metabolism; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D016640:Diabetes, Gestational / Q000178:diet therapy*; D003927:Diet, Diabetic; D018752:Diet, Fat-Restricted; D005215:Fasting; D005230:Fatty Acids, Nonesterified / Q000378:metabolism; D005260:Female; D038321:Glycemic Index; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000453:epidemiology*; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance; D009765:Obesity / Q000178:diet therapy / Q000378:metabolism; D050177:Overweight / Q000178:diet therapy; D010865:Pilot Projects; D011247:Pregnancy; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D005230:Fatty Acids, Nonesterified; D007328:Insulin