BackgroundAn increasingly large share of diet comes from ultra-processed foods (UPFs), which are assemblages of food substances designed to create durable, convenient and palatable ready-to-eat products. There is increasing evidence that high UPF consumption is indicative of poor diet and is associated with obesity and metabolic disorders. This study sought to examine the relationship between percent of energy intake from ultra-processed foods (PEI-UPF) during pregnancy and maternal gestational weight gain, maternal lipids and glycemia, and neonatal body composition. We also compared the PEI-UPF indicator against the US government’s Healthy Eating Index-2010 (HEI-2010).MethodsData were used from a longitudinal study performed in 2013–2014 at the Women’s Health Center and Obstetrics & Gynecology Clinic in St. Louis, MO, USA. Subjects were pregnant women in the normal and obese weight ranges, as well as their newborns (n = 45). PEI-UPF and the Healthy Eating Index-2010 (HEI-2010) were calculated for each subject from a one-month food frequency questionnaire (FFQ). Multiple regression (ANCOVA-like) analysis was used to analyze the relationship between PEI-UPF or HEI-2010 and various clinical outcomes. The ability of these dietary indices to predict clinical outcomes was also compared with the predictive abilities of total energy intake and total fat intake.ResultsAn average of 54.4 ± 13.2% of energy intake was derived from UPFs. A 1%-point increase in PEI-UPF was associated with a 1.33 kg increase in gestational weight gain (p = 0.016). Similarly, a 1%-point increase in PEI-UPF was associated with a 0.22 mm increase in thigh skinfold (p = 0.045), 0.14 mm in subscapular skinfold (p = 0.026), and 0.62 percentage points of total body adiposity (p = 0.037) in the neonate.DiscussionPEI-UPF (percent of energy intake from ultra-processed foods) was associated with and may be a useful predictor of increased gestational weight gain and neonatal body fat. PEI-UPF was a better predictor of all tested outcomes than either total energy or fat intake, and a better predictor of the three infant body fat measures than HEI-2010. UPF consumption should be limited during pregnancy and diet quality should be maximized in order to improve maternal and neonatal health.

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Inflammation is elevated in obese pregnant women and is associated with adverse maternal and neonatal outcomes. Maternal lipid metabolism and its relationships with maternal inflammation, insulin resistance and neonatal metabolic health are poorly understood in obese pregnant women. 18 lean (age: 26.1 ± 5.0 years, pre-pregnancy BMI: 21.5 ± 1.9 kg/m2) and 16 obese (age: 25.0 ± 4.8 years, pre-pregnancy BMI: 36.3 ± 4.3 kg/m2) women participated in this case-control study during the third trimester of pregnancy. Maternal plasma markers of insulin resistance (HOMA-IR) and inflammation (C-reactive protein (CRP)) were measured at rest, and lipid concentration and kinetics (lipid oxidation rate and lipolysis) were measured at rest, during a 30-minute bout of low-intensity (40% VO2peak) exercise, and during a recovery period. Umbilical cord blood was collected for measurement of neonatal plasma insulin sensitivity, inflammation, and lipid concentration. Neonatal body composition was measured via air displacement plethysmography. Pregnant obese women had higher plasma CRP (9.1 ± 4.0 mg/L versus 2.3 ± 1.8 mg/L, p<0.001) and higher HOMA-IR (3.8 ± 1.9 versus 2.3 ± 1.5, p=0.009) compared to pregnant lean women. Obese women had higher lipid oxidation rates during recovery from low-intensity exercise (0.13 ± 0.03 g/min versus 0.11 ±0.04 g/min, p=0.02) that was associated with higher maternal CRP (r=0.55, p=0.001). Maternal CRP was positively associated with maternal HOMA-IR (r=0.40, p<0.02) and systolic blood pressure (r=0.40, p<0.02). Maternal lipid metabolism-associated inflammation may contribute to insulin resistance and higher blood pressure in obese women during pregnancy.

BACKGROUND To test the hypothesis that infants born to obese women with pregestational type 2 diabetes mellitus (IBDM) have ventricular dysfunction at one month that is associated with markers of maternal lipid and glucose metabolism. METHODS In a prospective observational study of IBDM (OB+DM, n=25), echocardiography measures of septal, left (LV) and right ventricular (RV) function and structure were compared at one month of age to infants born to OB mothers without DM (OB, n=24), and non-OB without DM (Lean, n=23). Basal maternal lipid and glucose kinetics and maternal plasma and infant (cord) plasma were collected for hormone and cytokine analyses. RESULTS RV, LV, and septal strain measures were lower in the OB+DM infants vs. other groups, without evidence of septal hypertrophy. Maternal hepatic insulin sensitivity, maternal plasma free fatty acid concentration, and cord plasma insulin and leptin most strongly predicted decreased septal strain in the OB+DM infants. CONCLUSION IBDM’s have reduced septal function at one month in the absence of septal hypertrophy, which is associated with altered maternal and infant lipid and glucose metabolism. These findings suggest that maternal obesity and DM may have a prolonged impact on the cardiovascular health of their offspring, despite resolution of cardiac hypertrophy.

Background: Barth syndrome (BTHS) is a rare X-linked disorder that is characterized by mitochondrial abnormalities, cardio-skeletal myopathy, exercise intolerance, and premature mortality. The effect on endurance exercise training on exercise tolerance, cardio-skeletal function, and quality of life in BTHS is unknown.Methods: Four young adults (23 AE 5 years, n ¼ 4) with BTHS participated in a 12-week, supervised, individualized endurance exercise training program. Exercise training was performed on a cycle ergometer for 30-45 0 three times per week at a moderate intensity level.Exercise tolerance was measured by graded exercise testing and peak oxygen consumption, heart function via two-dimensional and M-mode echocardiography, skeletal muscle function by near-infrared spectroscopy, and quality of life through the Minnesota Living with Heart Failure questionnaire.Results: There were no adverse events during exercise testing or training for any participant. Peak oxygen consumption modestly (~5%) improved in three or four participants. Mean quality of life questions regarding dyspnea and side effects from medications significantly improved following exercise training. Mean resting heart function or skeletal muscle oxygen extraction during exercise did not improve after exercise training.Conclusion: Endurance exercise training is safe and appears to modestly improve peak exercise tolerance and certain measures of quality of life in young adults with BTHS. However, compared to improvements resulting from endurance exercise training seen in other non-BTHS mitochondrial myopathies and heart failure, these improvements appear blunted. Further research into the most beneficial mode, intensity and frequency of exercise training in BTHS is warranted.Barth syndrome (BTHS) is an X-linked disorder that results in cardio-skeletal myopathy, heart failure, fatigue, chronic/ cyclic neutropenia, growth delay, and premature mortality (Barth et al. 1983). The full scope of the pathological and clinical manifestations of BTHS is not fully understood, but involves a tafazzin gene defect that results in cardiolipin deficiency and severe mitochondrial dysfunction. BTHSassociated mitochondrial dysfunction is assumed to mediate the cardio-skeletal myopathy seen in the majority of those with BTHS (Spencer et al. 2006).

Purpose The primary purpose of this study was to compare maternal plasma inflammation between physically active and inactive obese women during late pregnancy. The secondary purpose was to examine the relationships between maternal plasma inflammation and lipid metabolism and maternal and neonatal metabolic health in these women. Methods A cross-sectional, observational study design was performed in 16 obese-inactive ((OBI) age: 25.0 ± 4.8 years, pre-pregnancy BMI: 36.3 ± 4.3kg/m2, body fat percentage in late gestation: 37.7 ± 3.5%) and 16 obese-active ((OBA) age: 28.9 ± 4.8 years, pre-pregnancy BMI: 34.0±3.7kg/m2, body fat in late gestation: 36.6 ± 3.8%) women during the third trimester of pregnancy. Maternal plasma inflammation (C -reactive protein (CRP)) and insulin resistance (Homeostatic Model Assessment-Insulin Resistance (HOMA-IR)) were measured at rest. Plasma lipid concentration and metabolism (lipid oxidation and lipolysis) were measured at rest, during a 30-minute bout of low-intensity (40% VO2peak) exercise, and during a resting recovery period using indirect calorimetry. Umbilical cord blood was collected for measurement of neonatal plasma insulin resistance, inflammation, and lipid concentration. Neonatal body composition was measured via air displacement plethysmography. Results Maternal plasma CRP concentration was significantly higher in OBI compared to OBA women (9.1 ± 4.0 mg/L versus 6.3 ±2.5mg/L, p=0.02). Maternal plasma CRP concentration was significantly associated with maternal lipolysis (r=0.43, p=0.02), baseline lipid oxidation rate (r=0.39, p=0.03), and baseline plasma free fatty acid concentration (r=0.36, p=0.04). Conclusions Maternal physical activity may reduce inflammation during pregnancy in obese women. Maternal lipid metabolism is related to systemic inflammation.

The objectives of this study were 1) to describe maternal glucose and lipid kinetics and 2) to examine the relationships with infant birth weight in obese women with pregestational type 2 diabetes during late pregnancy. Using stable isotope tracer methodology and mass spectrometry, maternal glucose and lipid kinetic rates during the basal condition were compared in three groups: lean women without diabetes (Lean, n = 25), obese women without diabetes (OB, n = 26), and obese women with pregestational type 2 diabetes (OB+DM, n = 28; total n = 79). Glucose and lipid kinetics during hyperinsulinemia were also measured in a subset of participants (n = 56). Relationships between maternal glucose and lipid kinetics during both conditions and infant birth weight were examined. Maternal endogenous glucose production (EGP) rate was higher in OB+DM than OB and Lean during hyperinsulinemia. Maternal insulin value at 50% palmitate Ra suppression (IC50) for palmitate suppression with insulinemia was higher in OB+DM than OB and Lean. Maternal EGP per unit insulin and plasma free fatty acid concentration during hyperinsulinemia most strongly predicted infant birth weight. Our findings suggest maternal fatty acid and glucose kinetics are altered during late pregnancy and might suggest a mechanism for higher birth weight in obese women with pregestational diabetes.

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