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



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.



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.



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.
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. kenneth.hodson@ncl.ac.uk.|Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. kenneth.hodson@ncl.ac.uk.|Newcastle Magnetic Resonance Centre, Newcastle University Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK. kenneth.hodson@ncl.ac.uk.
Kenneth
K
Hodson
Department of Information Engineering, University of Padova, Padova, Italy.
Chiara
C
Dalla Man
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.|Newcastle Magnetic Resonance Centre, Newcastle University Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
Fiona E
FE
Smith
Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
Alison
A
Barnes
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.|Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
Catherine
C
McParlin
Department of Information Engineering, University of Padova, Padova, Italy.
Claudio
C
Cobelli
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.|Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
Stephen C
SC
Robson
Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
Vera
V
Araújo-Soares
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.|Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.|Newcastle Magnetic Resonance Centre, Newcastle University Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
Roy
R
Taylor
D016640:Diabetes, Gestational / Q000378:metabolism*; D002149:Energy Intake / Q000502:physiology; D005260:Female; D006801:Humans; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance / Q000502:physiology; D008099:Liver / Q000378:metabolism*; D011247:Pregnancy; D014280:Triglycerides / Q000378:metabolism*
D007328:Insulin; D014280:Triglycerides
Gestational diabetes; Insulin resistance; Intrahepatic lipid; Magnetic resonance spectroscopy; Pregnancy