Physical fitness and plasma leptin in women with recent gestational diabetes

Aims/HypothesisLow physical fitness (PF) is a risk factor for type 2 diabetes mellitus (T2D). Women with a history of gestational diabetes (GDM) are at risk for T2D at a young age, but the role of PF in this population is not clear. PF has also been found to correlate inversely with plasma leptin in previous studies. Here, we examine whether women who had GDM have lower PF than women after a normoglycemic pregnancy and, second, whether PF is associated with plasma leptin, independently of body fat mass.MethodsCross-sectional analysis of 236 participants in the PPSDiab Study (cohort study of women 3–16 months after delivery, 152 after gestational diabetes (pGDM), 84 after normoglycemic pregnancy (control subjects); consecutively recruited 2011–16); medical history, physical examination with bioelectrical impedance analysis (BIA), whole body magnetic resonance imaging (MRI) (n = 154), 5-point oral glucose tolerance test, cardiopulmonary exercise testing, clinical chemistry including fasting plasma leptin; statistical analysis with Mann–Whitney U and t -test, Spearman correlation coefficient, multiple linear regression.ResultsWomen pGDM had lower maximally achieved oxygen uptake (VO2peak/kg: 25.7(21.3–29.9) vs. 30.0(26.6–34.1)ml/min/kg; total VO2peak: 1733(1552–2005) vs. 1970(1767–2238)ml/min; p2peak/kg ρ = -0.72 p2peak ρ = -0.16 p = 0.015; max. load ρ = -0.35 pConclusions/InterpretationWomen with a recent history of GDM were less fit than control subjects. Low PF may therefore contribute to the risk for T2D after GDM. This should be tested in intervention studies. Low PF also associated with increased leptin levels–independently of body fat. PF may therefore influence leptin levels and signaling. This hypothesis requires further investigation.研究目的与假设： 低体能（Physical Fitness, PF）是2型糖尿病（Type 2 Diabetes Mellitus, T2D）的危险因素。有妊娠期糖尿病（Gestational Diabetes Mellitus, GDM）病史的女性在年轻时罹患T2D的风险更高，但PF在该人群中的作用尚不明确。既往研究显示，PF与血浆瘦素呈负相关。本研究首先探讨曾患GDM的女性与血糖正常妊娠后女性相比，其PF水平是否更低；其次分析PF是否与血浆瘦素独立于体脂质量相关。 研究方法： 本研究对PPSDiab研究的236名受试者开展横断面分析。该队列研究纳入分娩后3~16个月的女性，其中152名有妊娠期糖尿病病史（pGDM组），84名为血糖正常妊娠后的对照受试者，于2011-2016年连续招募。研究采集受试者病史资料，进行体格检查并采用生物电阻抗分析（Bioelectrical Impedance Analysis, BIA）、全身磁共振成像（Magnetic Resonance Imaging, MRI，n=154）、5点口服葡萄糖耐量试验、心肺运动试验，以及包含空腹血浆瘦素检测的临床生化项目；统计分析采用Mann-Whitney U检验、t检验、Spearman相关系数及多元线性回归。 研究结果： pGDM组女性的最大摄氧量（VO₂peak/kg：25.7(21.3~29.9) vs. 30.0(26.6~34.1)ml·min⁻¹·kg⁻¹；总体最大摄氧量：1733(1552~2005) vs. 1970(1767~2238)ml·min⁻¹；p<0.001）显著更低。VO₂peak/kg与血浆瘦素水平的Spearman相关系数ρ=-0.72，总体VO₂peak与瘦素水平的ρ=-0.16（p=0.015）；最大运动负荷与瘦素水平的ρ=-0.35（p<0.001）。 结论与解读： 近期有GDM病史的女性体能较对照受试者更差，提示低PF可能是GDM后T2D发病风险的潜在促成因素，该结论需在干预性研究中进一步验证。此外，低PF与瘦素水平升高呈独立相关（不受体脂质量影响），表明PF可能影响瘦素水平及其信号通路，该假说尚需后续研究深入验证。