Modulation of in vivo insulin action by dietary protein during pregnancy

Enhanced glucose uptake into adipose tissue induced by early growth restriction augments excursions in plasma leptin response evoked by changes in insulin status

OBJECTIVE

The study used a rat model of moderate protein restriction exclusively during fetal and early neonatal life, which has been established to cause intrauterine early growth retardation, to investigate possible association between adipocyte glucose utilisation and leptin secretion in vivo.

DESIGN

These rats, termed early protein restricted, were transferred to a diet containing the standard amount of protein at weaning and remained on this diet til adulthood, at which time adipocyte glucose utilisation and leptin secretion was compared with that of age-matched controls. Insulin status was modulated by acute (2 h) insulin infusion at a constant rate (4.2 mU/min per kg) to elevate insulin to the high physiological range. Euglycaemia was maintained by variable glucose infusion.

MEASUREMENTS

Glucose utilisation was measured in vivo in conscious unrestrained rats using 2-deoxy[1-3H] glucose. Leptin concentrations (measured by radioimmunoassay) and whole-body glucose kinetics (measured using [3-3H] glucose) were studied in the postabsorptive state and after acute insulin stimulation.

RESULTS

Adipose-tissue glucose utilisation rates in vivo tended to be higher in the post-absorptive state and were consistently 1.8-3.0-fold higher after insulin stimulation in the early-protein-restricted group compared with the control group. Both the absolute increase in leptin concentration elicited by hyperinsulinaemia and the magnitude of the effect of insulin to elevate plasma leptin levels were greater in the early-protein-restricted group compared with the control group (by 2.2-fold and 1.6-fold, respectively). The effect of insulin to stimulate R(d) was much greater in the early-protein-restricted group (4.1-fold) than in the control group (2.2-fold) and the absolute increase in R(d) elicited by insulin was 43% higher in the early-protein-restricted group than in the control group.

CONCLUSIONS

It is concluded that poor early growth enhances the acute leptin response to changes in insulin status through programmed changes in adipocyte glucose handling.

Antecedent protein restriction and high-fat feeding interactively sensitise the leptin response to elevated insulin

Using a rat model of moderate (8 vs. 20% protein) isocaloric protein restriction initiated in early life (low protein, LP), we examined the possible basis for the association between impaired early growth and elevated leptin levels in later life in man by examining the acute leptin response to insulin and its relationship with glucose utilisation. We placed subsets of LP rats on a high-saturated-fat (HF) diet containing 20% protein for 4 weeks (LP-4HF) or 8 weeks (LP-8HF), making comparison with age-matched control (C) groups (C, C-4HF, C-8HF). At ambient insulin concentrations, LP was not associated with altered leptinaemia compared with C, despite a more active lipolytic programme as inferred from increased adipocyte sensitivity to norepinephrine. HF feeding led to insulin resistance with respect to whole-body glucose disposal (R(d)) (measured using [3-(3)H] glucose at steady state) in both LP and C in vivo and impaired suppression of agonist-stimulated lipolysis by insulin in LP but not C in vitro. Whereas insulin infusion for 2 h (while maintaining euglycaemia) only modestly increased plasma leptin levels in vivo in C, C-4HF, C-8HF and LP groups, the leptin response to insulin was greatly enhanced in the HF-fed LP groups. A close positive correlation (r = 0.96) existed between plasma leptin levels and R(d) in the C groups (viz. C, C-4HF, C-8HF) whereas a close inverse correlation (r = 0.95) existed between plasma leptin levels and insulin-stimulated R(d) in the LP groups (viz. LP, LP-4HF, LP-8HF). Glucose utilisation (estimated from 2-deoxy-D-[1-(3)H] glucose 6-phosphate accumulation) in vivo in two intra-abdominal and two superficial adipose-tissue depots was consistently higher in the LP group. After HF feeding, glucose utilisation by the superficial adipose-tissue depots was threefold higher in the LP than in the C group. We conclude that protein restriction from conception to adulthood followed by high-fat feeding sensitizes the acute leptin response to insulin, an adaptation associated with enhanced glucose utilisation by adipose tissue. This effect is observed despite impaired insulin sensitivity, both at the level of whole-body glucose disposal and adipocyte anti-lipolysis, and increased lipolytic activity (although the latter is not in itself sufficient to influence the leptin response). We propose that associations between a low birthweight and elevated leptin concentrations in later life may reflect long-term modulation of adipocyte glucose handling.

Moderate protein restriction during pregnancy modifies the regulation of triacylglycerol turnover and leads to dysregulation of insulin's anti-lipolytic action

Moderate protein restriction throughout pregnancy in the rat leads to relative hyperlipidaemia and blunted insulin responsiveness of lipid fuel supply, and impairs foetal growth. The present study examined the basis for these changes. Isocaloric 8% (vs 20%) protein diets were provided throughout pregnancy. Rats were sampled at 19-20 days of gestation. Protein restriction enhanced triacylglycerol (TAG) secretion rates (estimated using Triton WR 1339) 1.6-fold (P < 0.05) in the post-absorptive state. Insulin infusion (4.2 mU/kg per min) decreased plasma TAG concentrations by 33% (P < 0.05) and 48% (P < 0.05) in control (C) and protein-restricted (PR) pregnant groups, an effect associated with suppression of TAG secretion by 42% (P < 0.05) and 51% (P < 0.01) respectively, in the C and PR groups. Since TAG concentrations decline more rapidly, while TAG secretion is enhanced, TAG utilisation during hyperinsulinaemia is enhanced in the PR group. We evaluated whether these changes were associated with dysregulation of lipolysis using adipocytes from two abdominal depots (mesenteric and parametrial). Noradrenaline-stimulated glycerol release was enhanced in parametrial adipocytes (by 40%; P < 0.05) from PR pregnant rats. The anti-lipolytic action of insulin at low concentrations (< or = 15 microU/ml) was impaired by protein restriction (adipocytes from both depots). There was no evidence for altered intra-hepatic regulation of fatty acid (FA) disposal at the level of carnitine palmitoyltransferase. Our results demonstrate increased post-absorptive production of non-carbohydrate energy substrates (TAG and FA) as a consequence of mild protein restriction during pregnancy. These adaptations contribute to a homeostatic strategy to reduce the maternal requirement for gluconeogenesis from available amino acids, optimising the foetal protein supply. Protein restriction also enhances TAG turnover during hyperinsulinaemia. This effect is not a consequence of abnormal regulation of hepatic lipid metabolism by insulin.

Suboptimal protein nutrition in early life later influences insulin action in pregnant rats

First-generation rats received either 20% (standard) or 8% (suboptimal) protein nutrition during pregnancy and lactation. Suboptimal protein nutrition led to reduced body weights of the second-generation progeny at day 19 of gestation (10%, p < 0.001) and at weaning (33% reduction, p < 0.001). Control (born of 20% protein-fed dams) and experimental (born of 8% protein-fed dams) offspring received 20% protein diet after weaning and were studied on day 19 of gestation at 9 to 12 weeks after weaning. Basal glucose turnover was lower (29%, p < 0.05) and glucose utilization by fast-twitch muscle, adipose tissue and diaphragm significantly reduced in experimental offspring. Hyperinsulinaemia increased whole-body glucose disposal rate in both control (2.3-fold, p < 0.001) and experimental (3.2-fold, p < 0.001) offspring. Hyperinsulinaemia normalised the suppression of glucose utilization observed in diaphragm, heart and adipose tissue, but not in fast-twitch muscle, where rates remained 30-40% lower in the experimental offspring. Glucose tolerance and insulin secretion after i.v. glucose were unimpaired in the pregnant experimental offspring. A 27% reduction in basal glucose utilization, without impaired growth, was observed for the third-generation fetuses of the experimental offspring. The results demonstrate that growth retardation evoked by suboptimal protein nutrition during early life leads to decreased basal glucose turnover and glucose utilization by a range of maternal tissues and the fetus during a subsequent pregnancy. It is not, however, associated with any major permanent impairment of glucose-stimulated insulin secretion or insulin action during pregnancy.