不同遗传风险的妊娠期糖尿病患者接受产后饮食和生活方式综合干预的效果评价研究

Effects of postpartum diet and lifestyle intervention on women with gestational diabetes mellitus having different genetic risk scores

目的探讨不同遗传风险的妊娠期糖尿病(GDM)患者产后接受饮食和生活方式综合干预的效果。方法于2009年8月至2013年9月选取“天津市GDM女性产后生活方式干预研究”中曾经诊断为GDM但产后尚未发展为糖尿病的患者,收集患者干预前空腹血糖(FPG)、餐后2 h血糖(2hPG)、总胆固醇(TC)、体重、腰围、膳食纤维摄入量>20 g/d情况、业余健身运动>30 min/d情况等指标,收集患者身高和体重并计算体重指数(BMI)。对患者进行饮食和生活方式的综合干预,于干预后1年再次收集相关指标,计算各指标(包括2hPG、TC、体重、体重改变百分比、BMI、腰围和体脂率等)的改变值。检测可能与产后2型糖尿病(T2DM)发病相关的11个单核苷酸多态性(SNP)。综合所有11个目标SNP的风险等位基因数量之和,得到个体综合遗传风险得分(GRS),根据GRS中位数,将患者分为低遗传风险组(GRS<10.00)和高遗传风险组(GRS≥10.00)。分别在低、高遗传风险分层内,根据干预措施将患者分为生活方式干预组和对照组。采用t检验或χ²检验分别对低、高遗传风险患者中干预组和对照组的相关指标进行比较。结果共675例患者纳入研究。其中,低遗传风险患者292例(干预组和对照组分别为142例和150例),高遗传风险患者383例(干预组和对照组分别为188例和195例)。在低遗传风险GDM患者中,与对照组相比,干预组膳食纤维摄入量>20 g/d的达标率更高(P=0.037);血糖异常率更低(P=0.012);2hPG改变和TC改变更优,差异均有统计学意义(P<0.05)。在高遗传风险GDM患者中,与对照组相比,干预组的业余健身运动>30 min/d达标率更高(P=0.003);空腹胰岛素改变更优(P=0.038);干预组的体重改变、体重改变百分比、BMI改变、腰围改变和体脂率改变幅度更大,两组间差异均有统计学意义(P<0.05)。结论产后饮食和生活方式综合干预对不同遗传风险的GDM患者均相对有效。低遗传风险GDM患者接受综合干预后膳食纤维摄入增多,餐后血糖和血脂改善更明显,血糖异常率更低。高遗传风险GDM患者接受综合干预后体重改变、体重改变百分比、BMI改变、腰围改变和体脂率改变幅度更大,减重效果更为明显,胰岛素改善效果更为明显。

Objective To evaluate the effects of postpartum diet and lifestyle intervention on gestational diabetes(GDM)women with different genetic risk scores(GRS).Methods Based on an established randomized controlled trial(RCT)evaluating the effects of a postpartum diet and lifestyle intervention between August 2009 and September 2013,women with previous GDM and non-diabetes postpartum were recruited.Information at baseline and follow-up survey after 1-year intervention were collected,including fasting blood glucose(FPG),2-hour blood glucose(2hPG),total cholesterol(TC),body fat,waist circumference,dietary fiber intake>20 g/d,and exercise>30 min/d and other indicators.The height and body weight were recorded,and the body mass index(BMI)was calculated.After 1-year intervention,percentage reduction in initial weight,and changes in 2hPG,TC,weight,BMI,waist circumference and body fat percentage were calculated.We detected 11 postpartum type 2 diabetes mellitus(T2DM)-related single nucleotide polymorphisms(SNP)which were previously validated,and calculated the individual′s comprehensive GRS.Patients were divided into low genetic risk group(GRS<10.00)and high genetic risk group(GRS≥10.00)according to the median of GRS.In the low and high genetic risk groups,patients were divided into lifestyle intervention group and control group respectively.The t test orχ2 test were used to compare the indicators between the intervention and control group.Results A total of 675 patients were enrolled in the study,including 292 patients with low genetic risk(142 in the intervention group and 150 in the control group),and 383 patients with high genetic risk(188 in the intervention group and 195 in the control group),respectively.Among patients with low genetic risk,compared with control group,patients in the intervention group had a higher rate of dietary fiber intake>20 g/d(P=0.037),a lower rate of abnormal blood glucose(P=0.012),and better changed 2hPG and TC(both P<0.05).Among patients with high genetic risk,compared with control group,patients in the intervention group had a higher rate of exercise>30 min/d(P=0.003),better changed fasting insulin(P=0.038),and the changes in weight,percentage in weight change BMI,waist circumference and body fat percentage were larger(all P<0.05).Conclusions The postpartum diet and lifestyle intervention were relatively effective for GDM patients with different genetic risks.GDM patients with low genetic risk had increased dietary fiber intake,improved blood glucose and lipid levels,and lower risk of abnormal blood glucose.GDM patients with high genetic risk had larger changes in weight,BMI,waist circumference and body fat percentage,and better insulin improvement after comprehensive intervention.