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Advancements in Nutritional Strategies for Gestational Diabetes Management: A Systematic Review of Recent Evidence.
Sánchez-García, JC, Saraceno López-Palop, I, Piqueras-Sola, B, Cortés-Martín, J, Mellado-García, E, Muñóz Sánchez, I, Rodríguez-Blanque, R
Journal of clinical medicine. 2023;13(1)
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Gestational Diabetes Mellitus (GDM) causes hyperglycaemia due to the deficit of insulin during pregnancy. Dietary and lifestyle management plays a vital role in maintaining glycaemic control in women with GDM to avoid health risks to the mother and baby. Therefore, this systematic review of fourteen randomised controlled trials evaluated the latest research advancements to identify effective nutritional strategies for managing hyperglycaemia in women with GDM. Among all the dietary strategies implemented in the included randomised controlled trials, probiotic supplementation and supplementation of probiotics and vitamin D were most effective in GDM. Further robust studies are required to evaluate the potential effectiveness of different nutritional strategies for managing GDM. Healthcare professionals can use the results of this systematic review to understand the latest evidence supporting nutritional strategy for women with GDM and the need for personalised support for managing hyperglycaemia in GDM.
Abstract
Gestational diabetes mellitus (GDM) is defined as hyperglycaemia first detected at any time during pregnancy with values lower than those determined by the WHO for diabetes diagnosis in adults. This pathology, with a worldwide prevalence of 13.4%, causes significant maternal and foetal risks. The first line of treatment consists of maintaining normo-glycaemia through an adequate diet and lifestyle changes. The aim is to synthesize the scientific evidence updating the nutritional recommendations for the effective management of GDM. A systematic review of the scientific literature was conducted following the PRISMA guidelines. Randomized clinical trials published within the last five years and providing information on nutritional recommendations to achieve an effective management of gestational diabetes were selected. The databases searched were PubMed, the WOS Core Collection, SCOPUS, and CINAHL, using the MeSH terms: "Diabetes, Gestational"; "Nutrition Assessment (nutrition*)"; "Diet"; "Eating"; and "Food"; with the Boolean operators "AND" and "OR". The PEDro scale (Physiotherapy Evidence Database) was used to assess the scientific quality of the studies, with a mean score of 8.9, indicating an average good scientific quality. Results: A total of 809 papers were collected, of which, after applying the inclusion and exclusion criteria, 14 randomized clinical trials were selected. Probiotic supplementation and co-supplementation with vitamin D have been found to be the most beneficial options for both mothers with GDM and neonates, but the most effective regimens are not known. Diets enriched with extra virgin olive oil (EVOO) and oat bran, as well as some recommendations focused on carbohydrates also seem effective, as well as diets designed for this group of women with GDM such as "CHOICE". Conclusions: Although there are numerous proposals that have been published in recent years focused on the diet of women with GDM in order to improve their results and those of their children, it is the supplementation with probiotics and the co-supplementation with vitamin D that is most agreed upon as beneficial; however, more research is needed into which protocols are most effective. Other proposals that could also be beneficial should be further studied.
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The effect of vitamin D supplementation on the gut microbiome in older Australians - Results from analyses of the D-Health Trial.
Pham, H, Waterhouse, M, Rahman, S, Baxter, C, Duarte Romero, B, McLeod, DSA, Ebeling, PR, English, DR, Hartel, G, O'Connell, RL, et al
Gut microbes. 2023;15(1):2221429
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Microbiota are communities of microorganisms that co-exist with the host ecosystem in a specific environment. The term microbiome refers to the microbial genome. The aim of this study was to investigate the effect of supplementing older adults with 60,000 IU of vitamin D per month on the gut microbiome for a period of five years, using a subsample (n = 835) of participants recruited from the large population-based D-Health Trial. This study is based on a subsample from the D-Health Trial, which was a randomised, double-blind trial with two parallel arms. Participants were randomly allocated (1:1 ratio) to monthly doses of either 60,000 IU of cholecalciferol (vitamin D3) or matching placebo. Results showed that monthly doses of 60,000 IU vitamin D over 5 years did not alter the composition of the gut microbiome in a population that is largely vitamin D replete. Authors conclude that further investigation is required to examine whether non-bolus doses of vitamin D would influence the gut microbiome or whether vitamin D supplementation would be beneficial in populations with a higher prevalence of vitamin D deficiency.
Abstract
Observational studies suggest a link between vitamin D and the composition of the gut microbiome, but there is little evidence from randomized controlled trials of vitamin D supplementation. We analyzed data from the D-Health Trial, a randomized, double-blind, placebo-controlled trial. We recruited 21,315 Australians aged 60-84 y and randomized them to 60,000 IU of vitamin D3 or placebo monthly for 5 y. Stool samples were collected from a sample of 835 participants (417 in the placebo and 418 in the vitamin D group) approximately 5 y after randomization. We characterized the gut microbiome using 16S rRNA gene sequencing. We used linear regression to compare alpha diversity indices (i.e. Shannon index (primary outcome), richness, inverse Simpson index), and the ratio of Firmicutes to Bacteroidetes between the two groups. We analyzed between-sample (beta) diversity (i.e. Bray Curtis distance and UniFrac index) using principal coordinate analysis and used PERMANOVA to test for significant clustering according to randomization group. We also assessed the difference in the abundance of the 20 most abundant genera between the two groups using negative binomial regression model with adjustment for multiple testing. Approximately half the participants included in this analysis were women (mean age 69.4 y). Vitamin D supplementation did not alter the Shannon diversity index (mean 3.51 versus 3.52 in the placebo and vitamin D groups, respectively, p = 0.50). Similarly, there was little difference between the groups for other alpha diversity indices, the abundance of different genera, and the Firmicutes-to-Bacteroidetes ratio. We did not observe clustering of bacterial communities according to randomization group. In conlusion, monthly doses of 60,000 IU of vitamin D supplementation for 5 y did not alter the composition of the gut microbiome in older Australians.
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Association of Vitamin D Level and Maternal Gut Microbiome during Pregnancy: Findings from a Randomized Controlled Trial of Antenatal Vitamin D Supplementation.
Aparicio, A, Gold, DR, Weiss, ST, Litonjua, AA, Lee-Sarwar, K, Liu, YY
Nutrients. 2023;15(9)
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Changes in the gut bacteria during pregnancy and a lack of vitamin D can have negative health consequences for both mother and child. Vitamin D has important functions in the human body and is key in regulating immune and inflammatory responses. Evidence suggests that vitamin D helps to maintain gut wall integrity and regulate inflammatory mechanisms in response to bacteria. Gut bacteria themselves have immune regulatory functions, and unfavourable disruptions in the composition of the bacteria are associated with chronic inflammatory diseases. Evidence shows gut bacteria composition is influenced by Vitamin D. During pregnancy, a substantial alteration in gut bacteria composition occurs and as pregnancy advances, there's typically an increase in bacteria linked to inflammation. This study analysed the data from the Vitamin D Antenatal Asthma Reduction Trial (VDAART, 2014), a randomised placebo controlled trial which gathered information on the impact of vitamin D on various markers as well as gut microbiome composition in pregnant women. For the study all participants took a daily multivitamin with 400 IU Vitamin D during the third trimester of pregnancy, and were given either an additional 4000IU of Vitamin D or a placebo. Results were drawn from 114 participants and their baseline vitamin D levels in early pregnancy, its changes over the trial period, as well as gut bacteria composition. The vitamin D levels at the start aligned with expected outcomes and was strongly linked to race, income, and education level. The baseline vitamin D level in early pregnancy also showed a connection to certain gut microbiome composition. However, these bacterial constellations remained robust and did not show any changes in response to Vitamin D supplementation throughout pregnancy. During the trial, most participant's vitamin D levels increased, especially those in the 4400 IU treatment group. Interestingly, women whose vitamin D levels did not increase much throughout the trial displayed a higher abundance of a bacteria called Desulfovibrio. Desulfovibrio is associated with an increased incidence of respiratory and inflammatory bowel diseases and the authors suggested that increasing vitamin D during pregnancy might help prevent the growth of more unfavourable bacteria like Desulfovibrio. Further long-term research is needed to confirm this idea.
Abstract
Shifts in the maternal gut microbiome and vitamin D deficiency during pregnancy have been associated, separately, with health problems for both the mother and the child. Yet, they have rarely been studied simultaneously. Here, we analyzed the gut microbiome (from stool samples obtained in late pregnancy) and vitamin D level (from blood samples obtained both in early and late pregnancy) data of pregnant women in the Vitamin D Antenatal Asthma Reduction Trial (VDAART), a randomized controlled trial of vitamin D supplementation during pregnancy, to investigate the association of vitamin D status on the pregnant women's microbiome. To find associations, we ran linear regressions on alpha diversity measures, PERMANOVA tests on beta diversity distances, and used the ANCOM-BC and Maaslin2 algorithms to find differentially abundant taxa. Analyses were deemed significant using a cut-off p-value of 0.05. We found that gut microbiome composition is associated with the vitamin D level in early pregnancy (baseline), the maternal gut microbiome does not show a shift in response to vitamin D supplementation during pregnancy, and that the genus Desulfovibrio is enriched in women without a substantial increase in vitamin D level between the first and the third trimesters of pregnancy. We conclude that increasing the vitamin D level during pregnancy could be protective against the growth of sulfate-reducing bacteria such as Desulfovibrio, which has been associated with chronic intestinal inflammatory disorders. More in-depth investigations are needed to confirm this hypothesis.
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Effect of a Hop Extract Standardized in 8-Prenylnaringenin on Bone Health and Gut Microbiome in Postmenopausal Women with Osteopenia: A One-Year Randomized, Double-Blind, Placebo-Controlled Trial.
Lecomte, M, Tomassi, D, Rizzoli, R, Tenon, M, Berton, T, Harney, S, Fança-Berthon, P
Nutrients. 2023;15(12)
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Osteoporosis is a bone condition characterized by weakened and brittle bones, leading to an increased risk of fractures. Oestrogens play a vital role in maintaining bone health, whereby oestrogen deficiency elevates the risk of osteoporosis and fractures, particularly in menopausal women due to the decline in oestrogen levels. Phytoestrogens, plant-derived compounds capable of interacting with human oestrogen receptors, have presented an intriguing non-pharmaceutical avenue for preventing bone loss. Other phytoestrogens have received some attention in the field, however, limited human research exists on prenylflavonoids, a phytoestrogens found in hops (Humulus lupulus). This randomized, double-blinded, placebo-controlled trial aimed to investigate the effects of a year-long supplementation of standardised hop extract (8-PN) Lifenol® on bone mineral density in postmenopausal women. Additionally, the study explored potential mechanisms, particularly focusing on changes in gut bacteria. Notably, gut bacteria play a role in bone metabolism and the pathogenesis of osteoporosis. They are also, along with the liver, responsible for converting hops phenols into active phytoestrogenic compounds. The trial was completed by 95 postmenopausal, women with Osteopenia aged 50 to 85. They all received calcium and vitamin D3 tablets in addition either a hop extract (100mcg) or a placebo for 48 weeks. Changes were monitored using DXA scans for bone mineral density (BMD) and bone metabolism, blood samples for markers for bone health, a quality of life questionnaire, gut microbiome testing, and tests for short-chain fatty acid (SCFA) levels. In conclusion, the intake of hop extract confirmed a previously observed trend of a slight increase in total bone mineral density (BMD), in addition to the benefits linked to calcium and vitamin D supplementation. Although there were no significant changes in the composition of gut bacteria and SCFA levels, the hop extract candidates had a higher abundance of specific genera associated with total body BMD, suggesting a potential positive impact. Larger studies are required to validate these findings.
Abstract
Estrogen deficiency increases the risk of osteoporosis and fracture. The aim of this study was to investigate whether a hop extract standardized in 8-prenylnaringenin (8-PN), a potent phytoestrogen, could improve bone status of osteopenic women and to explore the gut microbiome roles in this effect. In this double-blind, placebo-controlled, randomized trial, 100 postmenopausal, osteopenic women were supplemented with calcium and vitamin D3 (CaD) tablets and either a hop extract (HE) standardized in 8-PN (n = 50) or a placebo (n = 50) for 48 weeks. Bone mineral density (BMD) and bone metabolism were assessed by DXA measurements and plasma bone biomarkers, respectively. Participant's quality of life (SF-36), gut microbiome composition, and short-chain fatty acid (SCFA) levels were also investigated. In addition to the CaD supplements, 48 weeks of HE supplementation increased total body BMD (1.8 ± 0.4% vs. baseline, p < 0.0001; 1.0 ± 0.6% vs. placebo, p = 0.08), with a higher proportion of women experiencing an increase ≥1% compared to placebo (odds ratio: 2.41 ± 1.07, p < 0.05). An increase in the SF-36 physical functioning score was observed with HE versus placebo (p = 0.05). Gut microbiome α-diversity and SCFA levels did not differ between groups. However, a higher abundance of genera Turicibacter and Shigella was observed in the HE group; both genera have been previously identified as associated with total body BMD. These results suggest that an 8-PN standardized hop extract could beneficially impact bone health of postmenopausal women with osteopenia.
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Impact of Blueberry Consumption on the Human Fecal Bileacidome: A Pilot Study of Bile Acid Modulation by Freeze-Dried Blueberry.
Gagnon, W, Garneau, V, Trottier, J, Verreault, M, Couillard, C, Roy, D, Marette, A, Drouin-Chartier, JP, Vohl, MC, Barbier, O
Nutrients. 2022;14(18)
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Primary bile acids (BAs) are made in the liver from cholesterol. They are released into the small intestine, where they aid fat digestion and absorption. Most BAs are reabsorbed from the gut, yet a small amount gets modified by the gut bacteria, forming secondary BAs destined for faecal excretion. Excess secondary BAs have negative health consequences. The different types of primary BAs influence many physiological functions. Such as glucose regulation, fat metabolism and absorption, intestinal inflammation and immunity, as well as gut bacteria diversity. For optimal BA metabolism, they are tightly regulated by the body, as minimal changes in BA pool and composition can have a significant impact on overall health. The composition of the BA pool can be influenced by gut bacteria, metabolic disorders, pathologies of the liver and gut, and diet. Dietary polyphenols, a plant-based compound, have been of particular interest here. This study sought to investigate the impact of supplementary freeze-dried blueberry powder (BBP), a rich polyphenol source, on the faecal BA pool composition in people at risk of metabolic syndrome. For this 11 men and 13 women were supplemented for 8 weeks. When compared to the data before the intervention, no significant changes in total BAs were observed. However, the composition of the BA pool changed leading to the accumulation of particular BAs and a reduction in secondary BA levels. This suggested that the consumption of blueberries can be considered a potential clinical intervention to aid the elimination of toxic secondary BAs. As the mechanisms leading to such modifications and their consequences for human health are complex, the authors advocate for investigation in larger population groups and also alert that such changes may be subject to interindividual variability and health status.
Abstract
Cholesterol-derived bile acids (BAs) affect numerous physiological functions such as glucose homeostasis, lipid metabolism and absorption, intestinal inflammation and immunity, as well as intestinal microbiota diversity. Diet influences the composition of the BA pool. In the present study, we analyzed the impact of a dietary supplementation with a freeze-dried blueberry powder (BBP) on the fecal BA pool composition. The diet of 11 men and 13 women at risk of metabolic syndrome was supplemented with 50 g/day of BBP for 8 weeks, and feces were harvested before (pre) and after (post) BBP consumption. BAs were profiled using liquid chromatography coupled with tandem mass spectrometry. No significant changes in total BAs were detected when comparing pre- vs. post-BBP consumption samples. However, post-BBP consumption samples exhibited significant accumulations of glycine-conjugated BAs (p = 0.04), glycochenodeoxycholic (p = 0.01), and glycoursodeoxycholic (p = 0.01) acids, as well as a significant reduction (p = 0.03) in the secondary BA levels compared with pre-BBP feces. In conclusion, the fecal bileacidome is significantly altered after the consumption of BBP for 8 weeks. While additional studies are needed to fully understand the underlying mechanisms and physiological implications of these changes, our data suggest that the consumption of blueberries can modulate toxic BA elimination.