The associations of ferritin, serum lipid and plasma glucose levels across pregnancy in women with gestational diabetes mellitus and newborn birth weight.

BACKGROUND: Women with gestational diabetes mellitus (GDM) are at greater risk of abnormal birth weight. Since the level of biochemical indicators could often affect the intrauterine growth and development of the fetus, it is of great practical significance to understand the changes of biochemical levels across pregnancy in women with GDM and to find out the indicators that play an important role in predicting birth weight. METHODS: The data source of this study was from the Xi'an Longitudinal Mother-Child Cohort study (XAMC), in which women with GDM with normal and high pre-pregnancy body mass index (BMI) and their newborns between January 1st and March 31st in 2018 were included. The data of ferritin, serum lipid profile and fasting plasma glucose (FPG) of mothers in the three trimesters of pregnancy, as well as birth weight of newborns were all collected from medical records. Multiple linear regression and multivariate logistic regression analyses were used to explore the association of the biochemical indexes and birth weight. A P value < 0.05 was considered statistically significant. RESULTS: A total of 782 mother-infant pairs were finally included and divided into normal weight group (NG) (n = 530, 67.8%) and overweight/obesity group (OG) (n = 252, 32.2%) according to maternal pre-pregnancy BMI. The level of ferritin in both NG and OG decreased during pregnancy (P for trend < 0.001 for all), whereas the levels of total cholesterol (TC), high density cholesterol (HDL-C), low density cholesterol (LDL-C) and triglycerides (TG) all showed an upward trend (P for trend < 0.05 for all). The levels of FPG in the two groups remained in a relatively stable during the whole pregnancy even though it was higher in OG during the 2nd and 3rd trimesters, whilst HbAlc levels in NG women increased (P for trend = 0.043) during pregnancy. Meanwhile, the risk of macrosomia and large-for-gestational-age (LGA) increased with the increase of FPG level (P for trend < 0.05). Multivariate logistic regression analyses results showed that only FPG level in the 3rd trimester was correlated with birth weight, with birth weight increased by 44.9 g for each SD increase in FPG level. CONCLUSION: Maternal FPG in the 3rd trimester is an independent predictor of newborn birth weight, and a higher level of that is associated with an increased risk of macrosomia and LGA.

What is an appropriate gestational weight gain for women with gestational diabetes mellitus: based on the adverse pregnancy outcomes of over 12 thousand participants?

BACKGROUND: Evidence showed possible benefits of a less gestational weight gain (GWG) than the US Institute of Medicine (IOM) recommendation in gestational diabetes mellitus (GDM) pregnancy. Here, we aimed to explore an appropriate GWG range in GDM women according to adverse pregnancy outcomes. METHODS: We enrolled all the singleton GDM pregnant women (n = 14,213) from January 2015 to December 2018 in Xi'an, Northwest China. According to the pre-pregnancy body mass index (BMI), they were classified into the Underweight (< 18.5 kg/m2), Normal weight (18.5-24.9 kg/m2), Overweight (25.0-29.9 kg/m2) and Obesity (≥ 30.0 kg/m2) group, respectively. Logistic regression analysis was used to calculate the odds ratio (OR) and 95% confidence intervals (95% CI). The appropriate ranges of GWG were determined based on a significant protective association (OR < 1). RESULTS: Totally, 12,712 participants were finally recruited. There were 1180 (9.3%), 9134 (71.9%), 2097 (16.5%), and 301 (2.4%) patients in the Underweight, Normal weight, Overweight, and Obesity groups, respectively. Adverse outcomes increased with the elevation of pre-pregnancy BMI. Among them, the risk of cesarean section was the highest, followed by large for gestational age (LGA), small for gestational age (SGA), preeclampsia, and gestational hypertension. Through the analysis of the risk of adverse outcomes in continuous GWG categories in each group, an ideal GWG range obtained in this study was as follows: 10-15.9 kg, 8-11.9 kg, 6-7.9 kg, and -5-3.9 kg for the Underweight, Normal weight, Overweight and Obesity group, respectively. Furthermore, the ranges in this study were more protective for adverse outcomes than those from IOM. CONCLUSIONS: Based on the adverse pregnancy outcomes of over 12 thousand participants, our findings showed a more stringent GWG range for GDM women than the IOM criteria recommendation.

Late-Pregnancy Dysglycemia After Negative Testing for Gestational Diabetes and Risk of the Large-for-Gestational-Age Newborns: A Nest Case-Control Study Based on the Xi'an Longitudinal Mother-Child Cohort Study.

Background: The implications of gestational diabetes mellitus (GDM) on the short- and long-term health outcomes of both mother and child have been extensively studied. However, studies related to negative Oral Glucose Tolerance Test (OGTT) results in the second trimester but dysglycemia in late pregnancy on maternal and infant pregnancy outcomes are rare. Methods: We conducted a nest case-control study within the Xi'an Longitudinal Mother-Child Cohort study (XAMC) to investigate the risk of adverse pregnancy outcomes in mothers and children with maternal negative mid-pregnancy OGTT results but high glycated hemoglobin (HbA1c) levels (≥5.7%) in late pregnancy. All target women who delivered from January 1st, 2017 to December 31st, 2018 in Northwest Women's and Children's Hospital in Xi'an were enrolled as the case group (HbA1c ≥ 5.7%). Others with HbA1c < 5.7% but without GDM were selected as the control group (HbA1c < 5.7%) by matching with the same delivery period. The logistic regression models were used to find out the risk factors of adverse pregnancy outcomes in the target population. Results: A total of 2,116 and 1,907 women were finally enrolled in the case and control groups, respectively. Compared to the control group, more newborns with macrosomia (9.2% vs 4.1%, P < 0.001) and large for gestational age (LGA) (23.7% vs. 13.5%, P < 0.001), but less small for gestational age (SGA) (4.4% vs. 6.1%, P = 0.017) were found in the case group. The differences in other outcomes were not statistically significant. The multiple logistic regression analysis showed that gestational age, fetal length, prenatal HbA1c, and total cholesterol (TG) were independent risk factors for newborns with large-for-gestational-age (LGA). The case group had a 2.516-fold (95% CI, 1.692-3.739) risk of delivering LGA newborns compared to the control group. Conclusion: The glycemic management during the late pregnancy of non-GDM women should be given special consideration to reduce the risk of overweight offspring at birth.

Enteral combined with parenteral nutrition improves clinical outcomes in patients with traumatic brain injury.

Objective: To investigate the effect of nutritional support on nutritional status and clinical outcomes of patients with traumatic brain injury (TBI).Methods: Sixty-one patients with TBI from the intensive care unit and neurosurgery of Xianyang Central Hospital from 2017 to 2019 were retrospectively included. General and clinical data of the study subjects were collected. The control group (n = 28) received parenteral nutrition alone, and the observation group (n = 33) received parenteral nutrition combined with enteral nutrition. The general conditions and biochemical indicators of both groups of patients were divided into two groups of ≤8 and ≥9 for stratified analysis to compare the nutritional support status and infection complications during hospitalization Occurrence, ICU length of stay, total length of stay, total cost of stay, and prognostic indicators of the patients were analyzed and compared.Results: There were no significant differences in biochemical indicators between both groups of patients when they were discharged. Among patients with GCS ≤8 points, the incidence of lung infection in the observer was significantly higher than that in the control group (P < 0.001), but the incidence of intracranial infection, stress ulcers, and diarrhea was not statistically different from that in the control group (P = 0.739). No significant differences were observed in hospitalization time and hospitalization costs between both groups (P = 0.306 and P = 0.079, respectively). The observation group was significantly better than the control group in GSC score and long-term quality of life score (P = 0.042 and P = 0.025, respectively). When GCS was ≥ 9 points, there was no statistical difference in the incidence of lung infections and intracranial infections between both groups of patients (P = 0.800 and P = 0.127, respectively). The observation group was significantly higher than the control group in terms of length of hospital stay, nasal feeding time and hospitalization costs (P < 0.001, P < 0.001 and P = 0.006, respectively). The observation group was significantly better than the control group in GSC score and long-term quality of life score (P = 0.001 and P = 0.015, respectively). There was no significant difference in the incidence of pulmonary infection and intracranial infection between both groups of patients (P = 0.800 and P = 0.127, respectively).Conclusion: Enteral nutrition combined with parenteral nutrition intervention has a positive effect on the clinical prognosis of TBI patients.

Prevalence and Determinants of Anemia among Children in Zanzibar, Tanzania: Analysis of Cross-Sectional Population Representative Surveys.

The aim of this study was to assess the prevalence of anemia and its determinants among children aged 6-59 months in Zanzibar, Tanzania, from 2005 to 2015. We used secondary data from the Tanzania Demographic and Health Surveys from three different periods: 2005, 2010, and 2015. A sample of 3502 child-mother pairs from three survey datasets was used to analyze the overall prevalence of anemia and reveal its determinants. Hierarchical logistic regression was used to demonstrate the prevalence odds ratio of factors, both from the mothers and children, for anemia prevalence. The study indicated a significant decrease in anemia prevalence from 76.1% in 2005 to 65.4% in 2015 (p < 0.001). Hierarchical logistic regression between variables and anemia showed a significant association (p = 0.02) with households that improperly disposed of stool, children with minimum dietary diversity (p = 0.041), children in low age quartiles (p = < 0.001), and underweight children (p = 0.025). Maternal, household characteristics, and child factors were associated with childhood anemia in Zanzibar, Tanzania. Despite the significant decrease of anemia in Zanzibar, the overall prevalence rate is still a significant public health concern. Designing and strengthening comprehensive interventions to address anemia in the general population and different categories should be given special consideration.

Effects of Oral Vitamin C Supplementation on Liver Health and Associated Parameters in Patients With Non-Alcoholic Fatty Liver Disease: A Randomized Clinical Trial.

Non-alcoholic fatty liver disease (NAFLD) is now recognized as the most prevalent hepatic disorder worldwide, and an unhealthy lifestyle is the leading risk factor for its occurrence. Vitamin C (VC) has been suggested to protect NAFLD, whereas evidence from randomized controlled trials (RCTs) is sparse. In this study, we aimed to investigate the potential benefits of VC supplementation daily on liver health and associated parameters in patients with NAFLD. In this double-blind, RCT, 84 patients with NAFLD, aged 18-60 years old, were assigned to 12 weeks of oral treatment with either low (250 mg/day, n = 26), medium (1,000 mg/day, n = 30), or high (2,000 mg/day, n = 28) doses of VC supplements. After the intervention, the Medium group had a more significant decrease in aspartate aminotransferase [Medium, -5.00 (-10.25, -1.75) vs. High, -2.50 (-7.75, 0.00), P = 0.02] and alanine aminotransferase [Medium, -8.00 (-18.00, -1.75) vs. High, -3.50 (-13.75, 4.25), P = 0.05; Medium vs. Low, -3.00 (-9.00, 5.50), P = 0.031]. The levels of other indicators of liver health, such as gamma-glutamyl transferase, alkaline phosphatase, total bilirubin, and direct bilirubin were decreased after the intervention but comparable among the three groups and so did the parameters of glucose metabolism, such as fasting insulin, fasting glucose, and homeostasis model assessment for insulin resistance. The plasma level of VC in patients and total adiponectin and high molecular weight (HMW) adiponectin levels were also elevated but not in a dose-dependent manner. Meanwhile, analysis of fecal microbiota composition showed an increase in the alpha diversity (Abundance-based Coverage Estimator (ACE), Shannon, chao1, and Simpson) both in the Low and the Medium groups. A total of 12 weeks of VC supplementation, especially 1,000 mg/day, improved liver health and glucose metabolism in patients with NAFLD. The elevated plasma levels of VC, total and HMW adiponectin, and the improvement of intestinal microbiota may have made some contributions.

The Xi'an longitudinal mother-child cohort study: design, study population and methods.

The large-scale Xi'an longitudinal mother-child cohort study has started to enroll pregnant women who attended Northwest Women's and Children's Hospital (NWCH) for antenatal care in early pregnancy (less than 20 weeks' gestation) from January 2013 and the enrollment will be ended in January 2023. We aimed to investigate the role of external factors (i.e., diet and environment) and internal (i.e., biological, genetic and epigenetic) on the short- and long-term outcomes of mothers and children up to at least 12 years. Mothers completed all routine prenatal care during pregnancy and four times of follow-up at 42 days, 3, 6 and 12 years after delivery, respectively. For children, birth information were obtained from routine medical records and the follow-up information were obtained from child health care clinics of NWCH at age 42 days, 6, 12 and 24 months, then by interviewing mothers every two years until 12 years old. A range of data (including biological, demographic, birth outcomes/birth defects and nutritional factors from both maternal and off-spring) were collected by both interviews and laboratory tests. By June 30th 2019, a total of 114,946 mothers and 124,454 live births had been recruited.

Dietary Vitamin C Intake Is Associated With Improved Liver Function and Glucose Metabolism in Chinese Adults.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is one of the most prevalent chronic liver diseases worldwide. Dietary vitamin C intake might play an important role in reducing the risk of NAFLD. This study assesses the relationship between dietary vitamin C intake and diagnostic biomarkers of NAFLD. METHODS: The data from the 2009 China Health and Nutrition Survey (CHNS), nine provinces across four diverse regions (Northeast, East Coast, Central, and West) were included in the study. The dietary vitamin C intake of participants was calculated based on 3-day 24-h diet questionnaires at the individual level. The associations of dietary vitamin C intake and the biochemical indicators of liver function and glucose/lipid metabolism were determined. RESULTS: A total of 8,307 participants were included in the final analysis. The mean dietary vitamin C intake for the overall, male and female subjects was 79.8 ± 58.6, 81.6 ± 55.3, and 78.2 ± 61.2 mg/day, respectively. The prevalence of inadequate dietary vitamin C intake for the overall, male and female subjects was 24.4, 26.5, and 22.6%, respectively. Intake of vitamin C was associated with both lower concentrations of plasma ferritin and hemoglobin A1c (HbA1c). Higher dietary vitamin C intake was associated with higher albumin, even further adjusted for body mass index (BMI), residence, and smoking status. No improvement in lipid metabolism was found. CONCLUSION: This study demonstrated that higher dietary vitamin C intake is a benefit for improving glucose metabolism and liver function in which reducing ferritin, a biomarker of iron accumulation, may be involved.

Numbers and Mortality Risk of Hypertensive Patients with or without Elevated Body Mass Index in China.

Objective: Our study aimed to estimate the number of hypertension patients with or without elevated body mass index (BMI), and assess their mortality risk. Methods: We used data from the China Health and Retirement Longitudinal Study (CHARLS) to estimate the population of hypertensive patients with or without elevated BMI. The mortality risk of hypertension with elevated BMI was estimated by using the China Health and Nutrition Survey (CHNS) data. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals (CI). Results: In total, 23.02% of adults, representing 117.74 (95% CI: 108.79, 126.69) million, had both high BMI and hypertension. Among them, 38.53 (95% CI: 35.50, 41.56) million were recommended to initiate antihypertensive medication but did not take it. Moreover, there were 38.40 (95% CI: 35.50, 41.56) million hypertensive patients with elevated BMI who did not achieve the goal of blood pressure control. All-cause mortality and premature death mortality, especially for the elderly, were significantly and positively associated with the severity of the hypertensive condition (p for trend = 0.001). Conclusion: In China, there were a huge number of patients with hypertension and elevated BMI, and the treatment and control rates for them were low. The more severe the degree of hypertension, the higher risk of all-cause death and premature death in these patients.

Comparing the efficacy and safety of insulin detemir versus neutral protamine hagedorn insulin in treatment of diabetes during pregnancy: a randomized, controlled study.

OBJECTIVE: To compare the efficacy and safety of insulin detemir (IDet) versus neutral protamine Hagedorn (NPH) insulin used in pregnant women with diabetes. RESEARCH DESIGN AND METHODS: A randomized study was conducted in diabetic pregnant women (n=240) (including 132 with pregestational diabetes and 108 with gestational diabetes). All patients were randomly divided into two groups: IDet group (n=120) treated with IDet plus short acting insulin Novolin-R before three meals (RRR-IDet plan), and NPH group treated with NPH plus Novolin-R before three meals (RRR-NPH plan). Patients were enrolled during 12-28 gestation weeks and followed up until delivery. RESULTS: Basal characteristics, such as age, enrollment gestational weeks, average HbA1c, fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) were similar between two groups. After 1 week of treatment, the FPG of IDet group were significantly lower than NPH group (p<0.05) and the time required to reach the targeted blood glucose level was significantly shorter (p<0.001). After 3 months of treatment, the HbA1c level in the two groups was normalized but there was no significant difference in HbA1c level. Maternal and neonatal outcomes were comparable between the two therapeutic approaches; however, the incidence of hypoglycemia in IDet group was remarkably lower than that of NPH group (p<0.05). The adverse drug reactions were rare and similar between the two groups. CONCLUSIONS: For the treatment of gestational diabetes, both RRR-IDet plan and RRR-NPH plan were reported to control blood glucose effectively. Compared with NPH, IDet could control blood glucose and reached the targets faster and more effectively, thus reducing the number of insulin injections and the incidence of hypoglycemia in pregnant women without increasing adverse birth outcomes. Therefore, for pregnant women with gestational diabetes, who require insulin therapy, IDet would be an ideal basal insulin being worthy of promotion in clinical settings.

DHA Protects Against Hepatic Steatosis by Activating Sirt1 in a High Fat Diet-Induced Nonalcoholic Fatty Liver Disease Mouse Model.

AIM: Docosahexaenoic acid (DHA; C22; n-3) shows beneficial effects on Non-alcoholic fatty liver disease (NAFLD). Deacetylase Sirtuin1 (Sirt1) was reported to increase energy metabolism and decrease lipogenesis. Here, we investigated whether DHA plays a role in protecting against hepatic steatosis via Sirt1. MAIN METHODS: Both in vivo and in vitro hepatic steatosis models were used: diet-induced obesity (DIO) model (middle-aged C57BL/6 mice fed a high-fat diet (HFD)) and palmitic acid (PA)-induced lipid accumulation cell model (HepG2 cells). KEY FINDINGS: In DIO mice, treatment with DHA (gavage supplementation) for 8 weeks not only inhibited the lipid accumulation, but also increased fatty acids (FA) oxidation and induced triglyceride export in liver. These changes were accompanied by attenuation of inflammation. Moreover, DHA reversed the HFD-induced reduction of Sirt1 in liver. Interestingly, the beneficial effects of DHA were reversed by lentivirus-mediated Sirt1 knockdown, accompanied with increased expression of markers of lipogenesis, inflammation and reduced FA oxidation. In HepG2 cells, DHA prevented the accumulation of PA-induced lipid droplets, the decrease of FA oxidation and the reduction of Sirt1 level. Inhibition of Sirt1 by sirtinol partially reversed the beneficial effects of DHA on PA-treated cells. SIGNIFICANCE: DHA alleviated hepatic steatosis and reduced inflammation of liver in obese middle-aged mice by mechanisms involving Sirt1 activation.

Ascorbic acid attenuates cell stress by activating the fibroblast growth factor 21/fibroblast growth factor receptor 2/adiponectin pathway in HepG2 cells.

Increasing prevalence of obesity­induced non­alcoholic fatty liver disease (NAFLD) and non­alcoholic steatohepatitis (NASH) has been reported. Ascorbic acid (AA), also known as vitamin C, an excellent antioxidant, has been shown to exert beneficial effects on NAFLD; however, the underlying mechanisms are yet to be fully elucidated. In the present study, the role of AA on cell stress in tumor necrosis factor α (TNFα)­treated HepG2 cells was investigated. Our findings revealed that exposure to AA effectively ameliorated TNFα­induced cell stresses, including hypoxia, inflammation and endoplasmic reticulum (ER) stress by reducing the expression of Hif1α and its target genes (glucose transporter 1), pro­inflammatory genes (monocyte chemoattractant 1) and ER stress­related genes (glucose­regulated protein, 78 kDa). AA also decreased the protein level of HIF1α. Additionally, AA significantly increased the secretion of total adiponectin and high molecular weight (HMW) adiponectin. Mechanistically, AA was determined to increase the expression of fibroblast growth factor 21 (FGF21) and its receptor, fibroblast growth factor receptor 2 (FGFR2). Knockdown of FGFR2 not only decreased the levels of total adiponectin and HMW adiponectin, but almost abolished the beneficial effects of AA in ameliorating cell stress. Collectively, the findings of our study demonstrated that AA may attenuate hepatocyte stress induced by TNFα via activation of the FGF21/FGFR2/adiponectin pathway. This could a novel mechanism of action of AA, and its potential for the treatment of NAFLD/NASH.