Gar C, Rottenkolber M, Grallert H, Banning F, Freibothe I, Sacco V, Wichmann C, Reif S, Potzel A, Dauber V, Schendell C, Sommer N N, Wolfarth B, Seissler J, Lechner A, Ferrari U
Diabetes Research Group, Medizinische Klinik IV, Klinikum der Universitaet Muenchen, Munich, Germany.
CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany.
PLoS One. 2017 Jun 13;12(6):e0179128. doi: 10.1371/journal.pone.0179128. eCollection 2017.
AIMS/HYPOTHESIS: Low physical fitness (PF) is a risk factor for type 2 diabetes mellitus (T2D). Women with a history of gestational diabetes (GDM) are at risk for T2D at a young age, but the role of PF in this population is not clear. PF has also been found to correlate inversely with plasma leptin in previous studies. Here, we examine whether women who had GDM have lower PF than women after a normoglycemic pregnancy and, second, whether PF is associated with plasma leptin, independently of body fat mass.
Cross-sectional analysis of 236 participants in the PPSDiab Study (cohort study of women 3-16 months after delivery, 152 after gestational diabetes (pGDM), 84 after normoglycemic pregnancy (control subjects); consecutively recruited 2011-16); medical history, physical examination with bioelectrical impedance analysis (BIA), whole body magnetic resonance imaging (MRI) (n = 154), 5-point oral glucose tolerance test, cardiopulmonary exercise testing, clinical chemistry including fasting plasma leptin; statistical analysis with Mann-Whitney U and t -test, Spearman correlation coefficient, multiple linear regression.
Women pGDM had lower maximally achieved oxygen uptake (VO2peak/kg: 25.7(21.3-29.9) vs. 30.0(26.6-34.1)ml/min/kg; total VO2peak: 1733(1552-2005) vs. 1970(1767-2238)ml/min; p<0.0001 for both), and maximum workload (122.5(105.5-136.5) vs. 141.0(128.5-159.5)W; p<0.0001). Fasting plasma leptin correlated inversely with PF (VO2peak/kg ρ = -0.72 p<0.0001; VO2peak ρ = -0.16 p = 0.015; max. load ρ = -0.35 p<0.0001). These associations remained significant with adjustment for body mass index, or for body fat mass (BIA and MRI).
CONCLUSIONS/INTERPRETATION: Women with a recent history of GDM were less fit than control subjects. Low PF may therefore contribute to the risk for T2D after GDM. This should be tested in intervention studies. Low PF also associated with increased leptin levels-independently of body fat. PF may therefore influence leptin levels and signaling. This hypothesis requires further investigation.
目的/假设：低身体素质（PF）是2型糖尿病（T2D）的一个危险因素。有妊娠期糖尿病（GDM）病史的女性在年轻时有患T2D的风险，但PF在该人群中的作用尚不清楚。在先前的研究中还发现PF与血浆瘦素呈负相关。在此，我们研究有GDM病史的女性的PF是否低于血糖正常妊娠后的女性，其次，PF是否与血浆瘦素相关，且独立于体脂量。
对PPSDiab研究中的236名参与者进行横断面分析（该队列研究对象为产后3 - 16个月的女性，152名有妊娠期糖尿病（pGDM），84名血糖正常妊娠后（对照对象）；于2011 - 16年连续招募）；收集病史，通过生物电阻抗分析（BIA）进行体格检查，全身磁共振成像（MRI）（n = 154），5点口服葡萄糖耐量试验，心肺运动试验，临床化学检测包括空腹血浆瘦素；采用曼 - 惠特尼U检验和t检验、斯皮尔曼相关系数、多元线性回归进行统计分析。
pGDM女性的最大摄氧量较低（峰值摄氧量/体重：25.7(21.3 - 29.9) vs. 30.0(26.6 - 34.1)ml/min/kg；总峰值摄氧量：1733(1552 - 2005) vs. 1970(1767 - 2238)ml/min；两者p均<0.0001），且最大工作量较低（122.5(105.5 - 136.5) vs. 141.0(128.5 - 159.5)W；p<0.0001）。空腹血浆瘦素与PF呈负相关（峰值摄氧量/体重ρ = -0.72，p<0.0001；峰值摄氧量ρ = -0.16，p = 0.015；最大负荷ρ = -0.35，p<0.0001）。在调整体重指数或体脂量（BIA和MRI）后，这些关联仍然显著。
结论/解读：近期有GDM病史的女性身体素质不如对照对象。因此，低PF可能导致GDM后患T2D的风险增加。这应在干预研究中进行验证。低PF还与瘦素水平升高相关——独立于体脂。因此，PF可能影响瘦素水平和信号传导。这一假设需要进一步研究。
