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Physical fitness and plasma leptin in women with recent gestational diabetes
C Gar1,2,3, M Rottenkolber1,2,3, H Grallert2
1Diabetes Research Group, Medizinische Klinik IV, Klinikum der Universitaet Muenchen, Munich, Germany.
Insights
Women with a history of gestational diabetes (GDM) have lower physical fitness (PF) than women with normoglycemic pregnancies. Low PF is linked to higher leptin levels, independent of body fat, suggesting a role in type 2 diabetes risk.
Area of Science:
- Endocrinology
- Metabolic Health
- Exercise Physiology
Background:
- Low physical fitness (PF) is a known risk factor for type 2 diabetes mellitus (T2D).
- Women with a history of gestational diabetes (GDM) face an elevated risk of developing T2D, even at a young age.
- The specific role of PF in women with a history of GDM remains unclear, as does its relationship with plasma leptin levels independent of body fat.
Purpose of the Study:
- To investigate whether women with a history of GDM exhibit lower PF compared to women with normoglycemic pregnancies.
- To determine the association between PF and fasting plasma leptin levels in this population, controlling for body fat mass.
Main Methods:
- Cross-sectional analysis of 236 women (152 post-GDM, 84 controls) 3-16 months after delivery.
- Assessment included medical history, physical examination with bioelectrical impedance analysis (BIA) and magnetic resonance imaging (MRI), oral glucose tolerance test, and cardiopulmonary exercise testing.
- Statistical analyses involved Mann-Whitney U, t-tests, Spearman correlation, and multiple linear regression to analyze PF and plasma leptin.
Main Results:
- Women with a history of GDM demonstrated significantly lower maximal oxygen uptake (VO2peak/kg and total VO2peak) and maximum workload compared to controls (p<0.0001 for all).
- Fasting plasma leptin showed a significant inverse correlation with PF measures (VO2peak/kg, total VO2peak, and max. load) (p<0.0001 to p=0.015).
- These associations between low PF and higher leptin levels remained significant after adjusting for body mass index and body fat mass (assessed by BIA and MRI).
Conclusions:
- Women with a recent history of GDM exhibit reduced physical fitness compared to their normoglycemic counterparts.
- The findings suggest that low PF may contribute to the increased risk of T2D following GDM.
- Low PF is associated with elevated leptin levels independently of body fat, indicating a potential role in leptin signaling and metabolic regulation that warrants further investigation.
Aims/Hypothesis:
Low 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.
Methods:
Cross-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.
Results:
Women 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; p<0.0001 for both), and maximum workload (122.5(105.5-136.5) vs. 141.0(128.5-159.5)W; p<0.0001). Fasting plasma leptin correlated inversely with PF (VO2peak/kg ρ = -0.72 p<0.0001; VO2peak ρ = -0.16 p = 0.015; max. load ρ = -0.35 p<0.0001). These associations remained significant with adjustment for body mass index, or for body fat mass (BIA and MRI).
Conclusions/Interpretation:
Women 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.
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