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Higher Serum Bilirubin Levels in Response to Higher Carbohydrate Intake During Early Pregnancy and Lower Gestational Diabetes Mellitus Occurrence in Overweight and Obese Gravidae.

ABSTRACT: Background and Aim: Serum bilirubin levels are recently shown to be a novel protector of gestational diabetes mellitus (GDM), yet whether they could be affected by carbohydrate quality is unclear. We aimed to examine the associations between dietary carbohydrate parameters and serum bilirubin levels during early pregnancy, with further exploration on a potential mediating role of serum bilirubin levels on carbohydrate parameters-GDM pathways. Methods: 260 healthy but overweight or obese gravidae (BMI ≥24 kg/m²) derived from a historical cohort in two hospitals in China were included. The associations between carbohydrate parameters (total carbohydrate intake, glycemic index GI, fiber intake, glycemic load GL) and serum bilirubin levels (total bilirubin, TB and direct bilirubin, DB) and GDM were evaluated by multivariable regression analysis. Generalized structural equation modeling was then applied to perform adjusted mediation analysis. Results: Increased serum bilirubin levels (mmol/L) and decreased GDM occurrence were observed following dietary carbohydrate intake (%E) and GL (g/1,000 kcal) in highest tertile compared to the lowest tertile [carbohydrate: TB: β = 0.926 (95%CI: 0.069, 1.782), DB: β = 0.554 (95%CI: 0.192, 0.916);GL:TB: β = 1.170 (95%CI: 0.339, 2.001); DB: β = 0.369 (95%CI: 0.016, 0.700); carbohydrate: adjusted OR = 0.43 (95%CI:0.19-0.99); GL: adjusted OR = 0.36 (95%CI:0.16, 0.84)]. The mediating effect of carbohydrate intake and GL on GDM through bilirubin levels was evaluated as modest (carbohydrate: 6.2% for TB, 1.3% for DB; GL: 8.7% for TB, 2.3% for DB). No association was observed regarding GI and fiber. Conclusions: Mildly elevated serum bilirubin levels appeared to be in response to higher energies consumed from carbohydrate during early pregnancy in healthy overweight or obese gravidae. However, the mediating effect of bilirubin levels on carbohydrate-GDM pathways is not evident. Larger investigation is further needed for solid evidence.

SUBMITTER: He W

PROVIDER: S-EPMC8435579 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe Dietary Approaches to Stop Hypertension (DASH) diet, a high-carbohydrate diet, is highly recommended based on its cardiovascular risk benefits, yet adherence remains persistently low. How subjective impressions of this diet contribute to adherence has not been thoroughly explored. The OmniCarb trial, which compared DASH-style diets varying in glycemic index (GI) and carbohydrate amount, surveyed subjective impressions of such diets.ObjectivesWe examined the effects of GI and carbohydrate amount on qualitative aspects of diet acceptability through secondary outcomes in the OmniCarb trial.MethodsOmniCarb was a randomized, crossover trial of 4 DASH-style diets varying by GI (≥65 compared with ≤45) and carbohydrate amount (40% compared with 58% kcal) in overweight or obese (BMI ≥25 kg/m2) adults (n = 163). Participants consumed each diet in random order over 5-wk periods, separated by 2-wk washouts. At baseline and the end of each feeding period, participants rated hunger, diet satisfaction, and gastrointestinal symptoms (diarrhea/loose stools, constipation, bloating, nausea, and heartburn).ResultsParticipant mean age was 52 y, with 52% women, 51% non-Hispanic black, and 56% obese (BMI ≥30). Compared with baseline, all intervention diets decreased heartburn, increased diarrhea/loose stools, and increased bloating, but did not significantly affect constipation or nausea. Compared with lower carbohydrate diets, higher carbohydrate diets increased hunger (RR: 1.16; 95% CI: 1.04, 1.30), increased diet satisfaction (RR: 1.10; 95% CI: 1.01, 1.20), and increased heartburn (RR: 1.49; 95% CI: 1.09, 2.04). Compared with lower GI diets, higher GI diets did not affect hunger (RR: 0.92; 95% CI: 0.83, 1.02), decreased diet satisfaction (RR: 0.83; 95% CI: 0.75, 0.92), and did not affect heartburn (RR: 0.89; 95% CI: 0.70, 1.13). There were no between-diet differences for diarrhea/loose stools, constipation, bloating, and nausea.ConclusionsAlthough a higher carbohydrate amount in DASH-style diets can increase diet satisfaction, it can also decrease satiety and increase heartburn in adults with overweight or obesity.This trial is registered at clinicaltrials.gov as NCT00608049.

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Higher Serum Bilirubin Levels in Response to Higher Carbohydrate Intake During Early Pregnancy and Lower Gestational Diabetes Mellitus Occurrence in Overweight and Obese Gravidae.

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