Women With Gestational Diabetes Mellitus Randomized to a Higher–Complex Carbohydrate/Low-Fat Diet Manifest Lower Adipose Tissue Insulin Resistance, Inflammation, Glucose, and Free Fatty Acids: A Pilot Study
Open accessAbstract
OBJECTIVE: Diet therapy in gestational diabetes mellitus (GDM) has focused on carbohydrate restriction but is poorly substantiated. In this pilot randomized clinical trial, we challenged the conventional low-carbohydrate/higher-fat (LC/CONV) diet, hypothesizing that a higher-complex carbohydrate/lower-fat (CHOICE) diet would improve maternal insulin resistance (IR), adipose tissue (AT) lipolysis, and infant adiposity. RESEARCH DESIGN AND METHODS: At 31 weeks, 12 diet-controlled overweight/obese women with GDM were randomized to an isocaloric LC/CONV (40% carbohydrate/45% fat/15% protein; n = 6) or CHOICE (60%/25%/15%; n = 6) diet. All meals were provided. AT was biopsied at 37 weeks. RESULTS: After ∼7 weeks, fasting glucose (P = 0.03) and free fatty acids (P = 0.06) decreased on CHOICE, whereas fasting glucose increased on LC/CONV (P = 0.03). Insulin suppression of AT lipolysis was improved on CHOICE versus LC/CONV (56 vs. 31%, P = 0.005), consistent with improved IR. AT expression of multiple proinflammatory genes was lower on CHOICE (P < 0.01). Infant adiposity trended lower with CHOICE (10.1 ± 1.4 vs. 12.6 ± 2%, respectively). CONCLUSIONS: A CHOICE diet may improve maternal IR and infant adiposity, challenging recommendations for a LC/CONV diet.
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Fasting glucose was paradoxically higher in women randomised to the relatively lower-carbohydrate (40% of total calories) and higher-fat diet than women consuming a relatively higher-carbohydrate diet (60% of total calories).
“Rather unexpectedly, fasting glucose was reported to be paradoxically higher in women randomised to the relatively lower-carbohydrate (40% of total calories) and higher-fat diet than women consuming a relatively higher-carbohydrate diet (60% of total calories) [77].”
From Medical Nutrition Therapy for Women with Gestational Diabetes: Current Practice and Future Perspectives (2025) · cites this paper as [77]
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- Authors
- Hernandez, T. L., Van Pelt, R. E., Anderson, M. A., Reece, M. S., Reynolds, R. M., de la Houssaye, B. A., Heerwagen, M., Donahoo, W. T., Daniels, L. J., Chartier-Logan, C., Janssen, R. C., Friedman, J. E., & Barbour, L. A.
- Affiliations
- University of Colorado Anschutz (US)
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
- Division of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
- Kaiser Permanente (US)
- Corresponding author
- Hernandez, Teri L.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2015-07-30
- Volume
- 39
- Issue
- 1
- Pages
- 39-42
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC4686845
- OpenAlex
- W935688119
- Cited by
- 157
- References
- 14
- Citations by year
- 2026: 8 · 2025: 11 · 2024: 15 · 2023: 11 · 2022: 6 · 2021: 13 · 2020: 23 · 2019: 15 · 2018: 21 · 2017: 18 · 2016: 14 · 2015: 2
- FWCI
- 20.86
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (R21 DK 088324)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Keywords
- gestational diabetes mellitus, low-fat diet, carbohydrate restriction, insulin resistance, adipose tissue lipolysis, adipose tissue inflammation, free fatty acids, fasting blood glucose, infant adiposity, maternal obesity, dietary intervention
- MeSH terms
- Adipose Tissue, Adult, Blood Glucose, Diet, Diabetic, Fasting, Fatty Acids, Nonesterified, Female, Humans, Inflammation, Insulin, Insulin Resistance, Obesity, Pilot Projects, Pregnancy, Diabetes, Gestational, Diet, Fat-Restricted, Glycemic Index, Overweight, Young Adult
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