1. x8 1.5hr weekly sessions with HT
Women’s Health Academic Centre
Improvements to biomarkers associated with the metabolic syndrome in obese pregnant: results from the UK Pregnancies Better Eating and Activity Trial (UPBEAT) pilot
R Maitland1, A Briley2, P Seed1, N Sattar3, S Barr1 and L Poston1 on behalf of the UPBEAT trial consortium
4. Results
1. Background
Total sample
n=117
Intervention n=57
Control
n=58
Women with GDM n=29
Women with NGT n=77
Incomplete OGTT data n=11
The UPBEAT pilot study reported significant macronutrient dietary changes in the intervention arm (reduction in saturated fat intake and glycaemic load) in obese pregnant (OP) women at 28 weeks’ (Poston et a 2013)
Comparable intervention studies of OP women have thus far not reported consistent reductions in biomarkers associated with insulin resistance and GDM (Vinter, 2014)
Data is presented for 16 biomarkers, measured in the UPBEAT pilot study which reflect a range of inflammatory pathways, adipose tissue function, hepatic fat accumulation and vascular dysfunction (Savvidou 2010, Ferreira 2011 & Lacroix 2013)
BMI 36.0[4.76]kg/m2, age 30.8[5.4]yr, 61.5% Caucasian and 34.2% Black
At weeks’ (post intervention)
No differences observed between the two arms
At weeks’ significant reductions in the intervention arm for:
Cholesterol (5.93mmol/l [1.28] v 6.63 [1.21], ratio 0.94 [0.89 to 0.99], p=0.03
6% reduction [95% CI -11 to -1%]
LDL (2.90mmol/l [1.58] v 3.65 [1.33], ratio 0.89 [0.81 to 0.98], p=0.02
11% reduction [95%CI to -2.15]
Visfatin (4.89ng/l [1.38] v 5.15 [1.52], ratio 0.85 [ ], p=0.02
2. Aim
To examine the effect of a complex lifestyle intervention in OP women on a panel of 16 biomarkers associated with the development of GDM a)
UPBEAT is a multi centre RCT of a complex intervention of physical activity and dietary change designed to improve glucose tolerance in obese women (BMI≥30kg/m2)
Primary outcome GDM (IADPSG 2010 guidelines)
3. Methods
1st
Maternal demography, history & dietary recall
2nd
1 wk later Randomisation, blood/urine sample, dietary recall, anthropometry
3rd
Post intervention All OGTT, blood/urine collection, dietary recall, anthropometry
4th
1 wk later Dietary recall & food questionnaire
5th
Dietary recall & lifestyle questionnaire, blood/urine sample
6th
1 wk later Dietary recall, food questionnaire, anthropometry
Intervention
x8 1.5hr weekly sessions with HT
Pedometer & log book
exercise DVD
participant handbook
SMART goals
Dietary exchanges
Low GI/GL diet, <free sugar & SFA b)
Figure 1. Flow of participants through UPBEAT
Figure 2. The UPBEAT intervention c)
Insulin (mU/l)
Fructosamine (umol/l)
Cholesterol (mmol/l)
ALT (U/L)
Triglycerides (mmol/l)
AST (U/L)
HDL (mmol/l)
Ferritin (ng/ml)
LDL (mmol/l)
Adiponectin (μg/ml)
VLDL (mmol/l)
tPA (ng/ml)
Cholesterol:HDL
IL-6 (pg/ml)
LDL:HDL
Leptin (pg/ml)
CRP (mg/l)
Visfatin (ng/ml)
117 OP subjects randomised to an 8 week intervention at 3 UK centres
Blood samples were obtained at randomisation, weeks’ [fasted, post 75g OGTT] & weeks’
Control subjects followed standard antenatal care
Treatment effects were estimated using multiple regression, with adjustment for baseline measurements
Data are presented as geometric mean (SD) and ratio of GM (95% CI)
Figure 4. Longitudinal changes in plasma concentration of a) cholesterol b) LDL and c) visfatin by randomisation. Error bars represent geometric mean±SEM on the log scale
Figure 3. Panel of biomarkers measured
5. Summary
In this pilot study of 117 obese pregnant women, these results suggest lifestyle interventions in high-risk women may reduce metabolic risk.
Validation will be undertaken in the whole trial cohort (n=1555 women), due to report shortly.
Funded by an NIHR programme RP-PG
Chief Scientist Office Scotland