Correlation between Body Mass Index and Central Adiposity with Pregnancy Complications in Pregnant Women

The Association Between Body Fat Index and Gestational Diabetes Mellitus: A Prospective Cohort Study

BACKGROUND

 Body mass index (BMI) has commonly been used to evaluate the risk of gestational diabetes mellitus (GDM), but BMI does not always represent body fat mass distribution. Body fat index (BFI), which includes the measurement of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT), has been suggested to be a better predictor for GDM than BMI.

OBJECTIVE

The objective of this study is to compare the risk of GDM among pregnant females with BFI of >0.5 and ≤0.5.

METHODS

Maternal abdominal subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) thickness were measured by ultrasonography before 14 weeks of gestation, and BFI was calculated (VAT×SAT/height). The study group was 160 females with BFI of >0.5, and the comparison group was 80 females with BFI of ≤0.5. All females received GDM screening during the first antenatal visit and at 24-28 weeks of gestation. The rate of GDM was compared between the two groups. The correlation between BFI and BMI and their diagnostic ability for GDM were evaluated. Logistic regression analysis was performed to determine the independent associated factors for GDM.

RESULTS

Females with BFI of >0.5 were significantly older (p=0.033) and had higher body mass index (BMI) (p<0.001) and were more likely to be overweight or obese (p<0.001). BFI correlated well with BMI (correlation coefficient of 0.736, p<0.001). GDM was significantly more common in females with BFI of >0.5 (24.4% versus 11.3%, p=0.017). The diagnostic ability for GDM between BFI and BMI was similar (areas under receiver operating characteristic {ROC} curves of 0.641 and 0.646, respectively). Significant independent risk factors for GDM were a BFI of >0.5 and a BMI of ≥25 kg/m² (adjusted odds ratio {OR}, 3.8; 95% confidence interval {CI}, 1.5-9.2), age of ≥30 years (adjusted OR, 2.8; 95% CI, 1.2-6.4), and family history of diabetes mellitus (DM) (adjusted OR, 4.0; 95% CI, 1.9-8.3).

CONCLUSION

Females with BFI of >0.5 were significantly more likely to have GDM. The diagnostic ability of BFI and BMI for GDM was comparable. Females with BFI of >0.5 and BMI of ≥25 kg/m² have an increased risk for GDM.

Association between maternal adiposity measures and infant health outcomes: A systematic review and meta-analysis

Maternal obesity increases risks of adverse fetal and infant outcomes. Guidelines use body mass index to diagnose maternal obesity. Evidence suggests body fat distribution might better predict individual risk, but there is a lack of robust evidence during pregnancy. We explored associations between maternal adiposity and infant health. Searches included six databases, references, citations, and contacting authors. Screening and quality assessment were carried out by two authors independently. Random effects meta-analysis and narrative synthesis were conducted. We included 34 studies (n = 40,143 pregnancies). Meta-analysis showed a significant association between maternal fat-free mass and birthweight (average effect [AE] 18.07 g, 95%CI 12.75, 23.38) but not fat mass (AE 8.76 g, 95%CI -4.84, 22.36). Women with macrosomic infants had higher waist circumference than controls (mean difference 4.93 cm, 95% confidence interval [CI] 1.05, 8.82). There was no significant association between subcutaneous fat and large for gestational age (odds ratio 1.06 95% CI 0.91, 1.25). Waist-to-hip ratio, neck circumference, skinfolds, and visceral fat were significantly associated with several infant outcomes including small for gestational age, preterm delivery, neonatal morbidity, and mortality, although meta-analysis was not possible for these variables. Our findings suggest that some measures of maternal adiposity may be useful for risk prediction of infant outcomes. Individual participant data meta-analysis could overcome some limitations in our ability to pool published data.

The interaction between dietary inflammatory index and 6 P21 rs2010963 gene variants in metabolic syndrome

BACKGROUND

The Vascular endothelial growth factor (VEGF) regulates endothelial cell proliferation, migration and angiogenesis, promotes vascular and capillary permeability and also is involved in inflammation. VEGF gene has been suggested to play an important role in the pathogenesis of metabolic syndrome. The aim of this study was to investigate the association between inflammatory potential of a diet and + 405 VEGF C/G (rs2010963) polymorphism and metabolic components in patients with metabolic syndrome.

METHODS

One hundred fifty patients with metabolic syndrome and fifty healthy individuals were enrolled. A semi-quantitative food-frequency questionnaire (FFQ) was used for dietary assessments and dietary inflammatory index (DII) calculation. Biochemical assays including fasting serum glucose (FSG), serum insulin, matrix metalloproteinase-3 (MMP-3), liver enzymes and lipid profile were measured. Polymerase chain reaction-restriction fragments length polymorphism (PCR-RFLP) method was used for the determination of gene polymorphism.

RESULTS

In the current study, patients with metabolic syndrome had higher serum low density lipoprotein (LDL) and lower high density lipoprotein (HDL) concentrations compared with healthy subjects. Patients with lower DII quartiles and lower inflammatory potential of the diet had lower waist to hip ratio (WHR) and lower diastolic blood pressure (DBP) compared with patients in higher DII quartiles (P < 0.05). Moreover, patients and healthy subjects in second quartile of DII had significantly higher aspartate aminotransferase (AST) and alanine aminotransferase (ALT) concentrations compared with subjects in the first quartile; also healthy subjects in third quartile had significantly higher triglyceride (TG) and total cholesterol (TC) concentrations compared with subjects in second quartile (P < 0.05). Among different genotypes of 6 P21 rs2010963 gene variants in patients with metabolic syndrome, CC genotype indicated the highest DII compared with other genotypes (P < 0.05).

CONCLUSION

The current study revealed the association between DII and metabolic risk factors of metabolic syndrome.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Dietary total antioxidant capacity significantly interacts with 6-P21 rs2010963 gene polymorphisms in terms of cardio-metabolic risk factors in patients with metabolic syndrome

OBJECTIVE

Gene- nutrient interaction might possibly be involved in the pathogenesis of metabolic syndrome and its components. In the current report, the association between antioxidant potential of the diet with 6P21 rs2010963 gene polymorphism in patients with metabolic syndrome has been evaluated. Two hundred fifty-four patients with metabolic syndrome were enrolled. Total dietary antioxidant capacity (TAC) has been estimated and anthropometric assessments were assessed. Biochemical assays including serum glucose, matrix metalloproteinase-3, liver enzymes and lipid profiles were also assessed. Polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP) method was used for determination of 6P21 rs2010963 polymorphism.

RESULTS

Dietary vitamin E score was significantly higher in GC genotype compared with other genotypes (P = 0.035). Patients in CC genotype of 6P21 rs2010963 had significantly higher body mass index (BMI), fasting blood sugar and liver enzymes (P < 0.05). Being in the higher dietary TAC scores was also associated with lower liver enzymes. The interaction between 6P21 rs2010963 and dietary TAC significantly affected BMI, FBS and diastolic blood pressure (P < 0.05). According to our findings the CC genotype of 6P21 rs2010963 could be considered as the possible risk factor for obesity and metabolic disorders among patients with metabolic syndrome.

Relationship between Maternal Central Obesity and the Risk of Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of Cohort Studies

OBJECTIVE

Nowadays, body mass index (BMI) is used to evaluate the risk stratification of obesity-related pregnancy complications in clinics. However, BMI cannot reflect fat distribution or the proportion of adipose to nonadipose tissue. The objective of this study is to evaluate the association of maternal first or second trimester central obesity with the risk of GDM. Research Design and Methods. We searched in PubMed, Embase, and Web of Science for English-language medical literature published up to 12 May 2019. Cohort studies were only included in the search. Abdominal subcutaneous fat thickness, waist circumference, waist-hip ratio or body fat distribution were elected as measures of maternal central obesity, and all diagnostic criteria for GDM were accepted. The random effect meta-analysis was performed to evaluate the relationship between central obesity and the risk of GDM.

RESULTS

A total of 11 cohort studies with an overall sample size of 27,675 women and 2,226 patients with GDM were included in the analysis. The summary estimate of GDM risk in the central obesity pregnant women was 2.76 (95% confidence interval [CI]: 2.35-3.26) using the adjusted odds ratio (OR). The degree of heterogeneity among the studies was low (I ² = 14.4, P = 0.307). The subgroup analyses showed that heterogeneity was affected by selected study characteristics (methods of exposure and trimesters). After adjusting for potential confounds, the OR of adjusted BMI was significant (OR = 3.07, 95% CI: 2.35-4.00).

CONCLUSIONS

Our findings indicate that the risk of GDM was positively associated with maternal central obesity.