正常体重或超重/肥胖哺乳期母亲中循环瘦素对能量代谢无影响：病例对照母乳与超重/肥胖和母亲饮食的关系研究（BLOOM）。
No effect of circulating leptin on energy metabolism in normal weight or overweight/obese lactating mothers: The case-control Breastmilk and the Link to Overweight/Obesity and Maternal diet (BLOOM) study.
机构信息
Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), Nowoursynowska St. 159c, 02-776 Warsaw, Poland.
Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), Nowoursynowska St. 159c, 02-776 Warsaw, Poland.
出版信息
Clin Nutr ESPEN. 2024 Oct;63:878-886. doi: 10.1016/j.clnesp.2024.08.025. Epub 2024 Aug 30.
BACKGROUND & AIMS: Pregnancy and lactation are associated with metabolic changes, including alterations in energy metabolism, which are closely linked to body mass and composition due to hormonal status. Therefore, the objective of this study was to investigate the energy metabolism in exclusively or predominantly breastfeeding mothers with normal weight (NW) and overweight/obesity (OW/OB) and evaluate its associations with fasting serum leptin.
METHODS
This cross-sectional BLOOM study was conducted among 39 mothers (n = 19 NW, n = 20 OW/OB) in 15.5 ± 1.2 weeks of lactation. The leptin was analyzed in a blood sample using an enzyme-linked immunosorbent assay, body composition was analyzed by dual-energy X-ray absorptiometry, and resting metabolic rate (RMR) was measured by indirect calorimetry method.
RESULTS
The average RMR for all groups was 1747.5 ± 281.9 kcal/d, with a statistically significant difference between groups (1932.7 ± 222.6 vs. 1550.5 ± 190.6, p < 0.001, respectively in the OW/OB and NW group). The OW/OB mothers had higher oxygen uptake (VO2) and exhaled carbon dioxide (VCO2), but not respiratory quotient (RQ), carbohydrate (CHO%) and lipid oxidation (FAT%). When analyzing correlations stratified by BMI category, we found that serum leptin was correlated with CHO% negatively, and with FAT% positively in the NW but not in OW/OB mothers. Additionally, serum leptin was a significant predictor of RMR, VCO2, VO2, CHO%, and RMR/kg of total body weight. However, after adjusting for confounders, the observed associations were no longer statistically significant (RMR: β = 0.113, 95% CI -0.354-0.319; VO2: β = 0.141, 95% CI -0.462-0.744; VCO2: β = 0.238, 95% CI -0.411-0.888; CHO%: β = -0.146, 95% CI -0.151-0.444; RMR/kg of total body weight: β = -0.294, 95% CI -0.831-0.244).
CONCLUSIONS
Our results did not support the hypothesis that leptin plays a role in regulating energy homeostasis during lactation.
背景与目的
妊娠和哺乳与代谢变化有关，包括能量代谢的改变，这与激素状态下的体重和组成密切相关。因此，本研究的目的是研究体重正常（NW）和超重/肥胖（OW/OB）的纯母乳喂养或主要母乳喂养母亲的能量代谢，并评估其与空腹血清瘦素的关系。
方法
本横断面 BLOOM 研究纳入了 39 名母亲（n=19 名 NW，n=20 名 OW/OB），处于哺乳期 15.5±1.2 周。采用酶联免疫吸附试验分析血样中的瘦素，采用双能 X 射线吸收法分析身体成分，采用间接测热法测量静息代谢率（RMR）。
结果
所有组的平均 RMR 为 1747.5±281.9 kcal/d，组间存在统计学差异（OW/OB 组和 NW 组分别为 1932.7±222.6 和 1550.5±190.6，p<0.001）。OW/OB 母亲的耗氧量（VO2）和呼出二氧化碳（VCO2）较高，但呼吸商（RQ）、碳水化合物（CHO%）和脂肪氧化（FAT%）没有差异。对 BMI 分类进行分层分析后发现，NW 组血清瘦素与 CHO%呈负相关，与 FAT%呈正相关，但在 OW/OB 组中则没有。此外，血清瘦素是 RMR、VCO2、VO2、CHO%和 RMR/kg 总体重的显著预测因子。然而，在调整混杂因素后，观察到的关联不再具有统计学意义（RMR：β=0.113，95%CI-0.354-0.319；VO2：β=0.141，95%CI-0.462-0.744；VCO2：β=0.238，95%CI-0.411-0.888；CHO%：β=-0.146，95%CI-0.151-0.444；RMR/kg 总体重：β=-0.294，95%CI-0.831-0.244）。
结论
本研究结果不支持瘦素在哺乳期调节能量平衡中发挥作用的假设。
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