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Delayed Metabolic and Thermogenic Response to a Mixed Meal in Normoglycemic European Women with Previous Gestational Diabetes

Section of Endocrinology and Metabolic Medicine (E.K., N.J.L., A.P., B.A.M., V.A., H.M., S.R., M.I.M., D.G.J.), Imperial College Faculty of Medicine, St. Mary’s Hospital, London W2 1PG, United Kingdom; Department for Biological and Medical Systems (K.H.P.), Imperial College of Science, Technology, and Medicine, London SW7 2BY, United Kingdom; and School of Biomedical Sciences (D.C.F., I.A.M.), Nottingham University Medical School, Queen’s Medical Centre, Nottingham NG7 2UH, United Kingdom

Address all correspondence and requests for reprints to: Desmond G. Johnston, M.D., Section of Endocrinology and Metabolic Medicine, Imperial College Faculty of Medicine at St. Mary’s Hospital, Norfolk Place, London W2 1PG, United Kingdom. E-mail: . d.johnston{at}ic.ac.uk

Abstract

We assessed postprandial thermogenesis (PPT) for 3 h following a mixed meal in 29 normoglycemic European women with previous gestational diabetes (GDM), compared with 37 control women. Given the potential role of catecholamines and insulin in the regulation of PPT, we assessed insulin and catecholamine responses to the meal. There was no significant difference between the two groups in resting energy expenditure, PPT (although lower in the GDM group), or catecholamine levels. However, we observed a difference in the shape of the PPT curve between groups, and by applying a mathematical model, there was a consistent delay in PPT, insulin, and noradrenaline responses to the meal in the GDM group (T: fitted time constant, geometric mean (95% confidence interval), T_PPT 58 (47–72) vs. 42 (37–48) min, P = 0.006; T_ins 32 (28–37) vs. 22 (19–27) min, P = 0.002; T_NA 30 (23–38) vs. 18 (14–23) min, P = 0.01, respectively). Fidgeting activity during the study was assessed by a novel technique and was lower in the GDM group, resting [427 (381–477) vs. 511 (466–560) kJ/min, P = 0.02] but not postprandially. These delayed PPT, insulin, and noradrenaline responses to the meal in post-GDM women represent early metabolic changes. The decrease in fidgeting activity while resting, observed in the post-GDM group, may have physiological significance for energy balance.