Exercise training improves in vivo endothelial repair capacity of early endothelial progenitor cells in subjects with metabolic syndrome.

BACKGROUND: Endothelial dysfunction and injury are considered to contribute considerably to the development and progression of atherosclerosis. It has been suggested that intense exercise training can increase the number and angiogenic properties of early endothelial progenitor cells (EPCs). However, whether exercise training stimulates the capacity of early EPCs to promote repair of endothelial damage and potential underlying mechanisms remain to be determined. The present study was designed to evaluate the effects of moderate exercise training on in vivo endothelial repair capacity of early EPCs, and their nitric oxide and superoxide production as characterized by electron spin resonance spectroscopy analysis in subjects with metabolic syndrome. METHODS AND RESULTS: Twenty-four subjects with metabolic syndrome were randomized to an 8 weeks exercise training or a control group. Superoxide production and nitric oxide (NO) availability of early EPCs were characterized by using electron spin resonance (ESR) spectroscopy analysis. In vivo endothelial repair capacity of EPCs was examined by transplantation into nude mice with defined carotid endothelial injury. Endothelium-dependent, flow-mediated vasodilation was analysed using high-resolution ultrasound. Importantly, exercise training resulted in a substantially improved in vivo endothelial repair capacity of early EPCs (24.0 vs 12.7%; p < 0.05) and improved endothelium-dependent vasodilation. Nitric oxide production of EPCs was substantially increased after exercise training, but not in the control group. Moreover, exercise training reduced superoxide production of EPCs, which was not observed in the control group. CONCLUSIONS: The present study suggests for the first time that moderate exercise training increases nitric oxide production of early endothelial progenitor cells and reduces their superoxide production. Importantly, this is associated with a marked beneficial effect on the in vivo endothelial repair capacity of early EPCs in subjects with metabolic syndrome.

Longitudinal analysis of changes in energy intake and macronutrient composition during pregnancy and 6 weeks post-partum.

PURPOSE: This prospective study was carried out in order to investigate changes in nutritional intake during pregnancy with regard to caloric intake and macronutrient composition in normal-weight pregnant women. METHODS: Using food scales, 32 healthy pregnant women estimated their food intake over a period of 2 days at gestational week 16, 22, 30, 36 and, in addition, 6 weeks after delivery. The recorded food logs were analyzed with respect to caloric intake and macronutrient composition. RESULTS: The women's age was averaged 29.6 ± 4.5 years, and the mean pre-pregnancy BMI was 22.4 ± 2.5 kg/m². Mean weight gain was 16.5 ± 4.5 kg. On average, birth took place during the 40th week of gestation, with the babies having a mean birth weight of 3,515 ± 406 g. Caloric intake during the gestation period and post-partum showed no statistically significant changes and added up 9,237 ± 1,876 kJ/day during the 16th week of gestation, 9,496 ± 2,437 kJ/day during the 22nd, 9,073 ± 1,863 kJ/day during the 30th, 9,525 ± 2,135 kJ/day during the 36th week and 8,445 ± 2,160 kJ/day 6 weeks after delivery. No significant changes were observed in the composition of macronutrients during the pregnancy. The daily composition of macronutrients was as follows: carbohydrates 281 ± 57 g/day (51.7%), fat 86 ± 16 g/day (35.8%) and protein 75 ± 13 g/day (13.9%). However, we observed a decrease in carbohydrate intake of 239 ± 72 g/day (48%) after birth. CONCLUSIONS: Healthy pregnant women showed no significant changes in their caloric intake or nutritional profiles. Performed with an accurate measurement, this prospective study shows that healthy pregnant require neither increased caloric intake nor a change in macronutrient composition.

Adiponectin during pregnancy: correlation with fat metabolism, but not with carbohydrate metabolism.

BACKGROUND: Several studies show an association of adiponectin deficiency with obesity, insulin resistance and dysfunctional fat metabolism. This study investigates to what extent the correlations described occurs in pregnant women. METHOD: Metabolism parameters and adiponectin serum levels were measured in 32 pregnant women at various times during their pregnancies and during the first six postpartum weeks. RESULTS: In this random group of pregnant subjects no correlation was found between adiponectin and insulin, C-peptides, blood sugar levels or BMI. No correlation was found between adiponectin and carbohydrate metabolism. The adiponectin levels of the pregnant women correlated negatively with triglyceride levels during the various stages of pregnancy; in the 36th week of gestation and at 6 weeks after the birth a positive correlation with HDL cholesterol was observed. The decrease in adiponectin concentration in pregnancy must therefore be more closely connected with changes in fat metabolism than with an increase in insulin resistance or weight gain during the pregnancy. The decrease in adiponectin does not correlate with an increase in body fat, BMI or weight; however, it does correlate with metabolism. The mechanisms of the regulation, which causes adiponectin levels to fall, is still unknown.

Longitudinal changes in the continuous glucose profile measured by the CGMS in healthy pregnant women and determination of cut-off values.

OBJECTIVE: This longitudinal study performed continuous evaluation of daily blood glucose level profiles in healthy normal-weight pregnant patients during various gestational age and determined normal levels. STUDY DESIGN: Thirty-two healthy normal-weight pregnant women received a continuous glucose monitoring system (CGMS) device for periods of 72h in the 16th, 22nd, 30th and 36th weeks of gestational age and at 6 weeks after delivery. All observations took place in the outpatient clinic of the Charité hospital. The daily blood glucose level profiles obtained with the CGMS provided pre- and postprandial blood glucose levels and a mean glucose value for a 24-h period. Caloric intake was determined using detailed food logs. Additionally, a fetal biometry and an measurement of maternal weight were performed at each visit. The correlation was tested using Spearman's test. RESULTS: The average age of the study subjects was 29.6+/-4.5. Average pre-pregnancy BMI was 22.4+/-2.5kg/m(2). The births occurred on average in the 40th week of pregnancy. Average caloric intake was 2223+/-356kcal. No significant changes in caloric intake were observed during the course of the study. The blood glucose levels showed a significant rise throughout the course of the pregnancy, going from 4.84+/-0.4mmol/l (87.2+/-7.2mg/dl) during the 30th week of pregnancy to 5.22+/-0.5mmol/l (94.0+/-9.0mg/dl) during the 36th week (p=0.002). Postpartum levels were 5.20+/-0.5mmol/l (93.7+/-9.0mg/dl) (p=0.51). Fasting blood glucose levels did not change during the course of the pregnancy. A noticeable aspect were the significantly increased fasting postpartum levels with 5.02+/-0.6mmol/l (90.4+/-10.8mg/dl) (p=0.00). Analysis of the postprandial glucose levels confirmed a rise from 5.30+/-0.6mmol/l (95.5+/-10.8mg/dl) in the 16th week to 6.14+/-0.7mmol/l (110.6+/-12.6mg/dl) in the fourth study phase (36th week), and a decrease after the birth to 5.59+/-0.6mmol/l (100.7+/-10.8mg/dl). These measurements were adapted to the gestational age. CONCLUSION: Continuous measured glucose levels rose during the pregnancy in healthy pregnant women in spite of normal pre-pregnancy metabolism and unchanged carbohydrate intake during gestation. These results suggest the necessity of gestational-age-dependent cut-off values.

Accuracy and influence of ascorbic acid on glucose-test with urine dip sticks in prenatal care.

OBJECTIVE: In Germany, urine analysis with dip sticks are used for screening of gestational diabetes. Our goal was to find the cut-off levels of glucose dip sticks and evaluate the influence of ascorbic acid on the result. STUDY DESIGN: We took urine samples of 152 pregnant patients between 01/2004 and 10/2004. The glucose content of the urine was analyzed using several dip sticks (Combur10 Roche, Multistix 8SG Bayer, Diabur5000 Roche and by the hexokinase method. The ascorbic acid concentration of the specimen was determined. RESULTS: Glycosuria test dip sticks have a good sensitivity and specificity of the expected positive/negative-reaction compared with the hexokinase method but showed a significant reduction of the color reaction at high concentrations of ascorbic acid. CONCLUSION: High ascorbic acid concentrations cause a reduction in the color reaction of urine dip sticks. False-negative test stick measurements can appear in patients with low glycosuria. The rate of glycosuria shows high individual differences and dependent on the concentration of vitamin C. We conclude that dip sticks are not useful in prenatal management.