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Mehmood S, Margolis M, Ye C, et al. Hepatic fat and glucose tolerance in women with recent gestational diabetes. BMJ Open Diabetes Res Care. 2018;6(1):e000549doi: 10.1136/bmjdrc-2018-000549.
Mehmood, S., Margolis, M., Ye, C., Maple-Brown, L., Hanley, A. J., Connelly, P. W., Sermer, M., Zinman, B., & Retnakaran, R. (2018). Hepatic fat and glucose tolerance in women with recent gestational diabetes. BMJ open diabetes research & care, 6(1), e000549. https://doi.org/10.1136/bmjdrc-2018-000549
Mehmood, Sadia, et al. "Hepatic fat and glucose tolerance in women with recent gestational diabetes." BMJ open diabetes research & care vol. 6,1 (2018): e000549. doi: https://doi.org/10.1136/bmjdrc-2018-000549
Mehmood S, Margolis M, Ye C, Maple-Brown L, Hanley AJ, Connelly PW, Sermer M, Zinman B, Retnakaran R. Hepatic fat and glucose tolerance in women with recent gestational diabetes. BMJ Open Diabetes Res Care. 2018 Sep 08;6(1):e000549. doi: 10.1136/bmjdrc-2018-000549. eCollection 2018. PMID: 30233804; PMCID: PMC6135458.
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BMJ Open Diabetes Res Care. 2018 Sep 08;6(1):e000549. doi: 10.1136/bmjdrc-2018-000549. eCollection 2018.

Hepatic fat and glucose tolerance in women with recent gestational diabetes.

BMJ open diabetes research & care

Sadia Mehmood, Myles Margolis, Chang Ye, Louise Maple-Brown, Anthony J Hanley, Philip W Connelly, Mathew Sermer, Bernard Zinman, Ravi Retnakaran

Affiliations

  1. Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada.
  2. Department of Medical Imaging, Mount Sinai Hospital, Toronto, Ontario, Canada.
  3. Menzies School of Health Research, Casuarina, Australia.
  4. Division of Medicine, Royal Darwin Hospital, Darwin, Australia.
  5. Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada.
  6. Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
  7. Keenan Research Centre for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada.
  8. Division of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada.
  9. Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.

PMID: 30233804 PMCID: PMC6135458 DOI: 10.1136/bmjdrc-2018-000549

Abstract

OBJECTIVE: Women with a history of gestational diabetes mellitus (GDM) have an elevated risk of ultimately developing pre-diabetes and diabetes later in life. They also have an increased prevalence of fatty liver, but recent studies have reported conflicting findings on whether hepatic fat affects their risk of pre-diabetes/diabetes. Thus, we sought to evaluate the associations of liver fat with glucose homeostasis and determinants thereof in women with and without recent gestational dysglycemia.

METHODS: Two hundred and fifty-seven women underwent an antepartum oral glucose tolerance test (OGTT), which diagnosed 97 with GDM, 40 with gestational impaired glucose tolerance (GIGT), and 120 with normal glucose tolerance (NGT). At a mean of 4.8 years post partum, they underwent an OGTT (which revealed that 52 had progressed to pre-diabetes/diabetes) and hepatic ultrasound, on which liver fat was graded as none (n=164), mild (n=66), or moderate (n=27).

RESULTS: Liver fat was more prevalent in women with previous GDM than in those with GIGT or NGT (p=0.009) and in women with current pre-diabetes/diabetes than in those without (p=0.0003). As the severity of liver fat increased, there was a progressive worsening of insulin sensitivity and beta-cell function, coupled with rising fasting and 2-hour glucose (all p<0.0001). On multiple linear regression analyses, moderate liver fat was independently associated with lower insulin sensitivity (p=0.0002) and higher 2-hour glucose (p=0.009). Moreover, moderate liver fat emerged as an independent predictor of pre-diabetes/diabetes (OR=3.66, 95% CI 1.1 to 12.5).

CONCLUSION: The higher prevalence of liver fat in women with previous GDM is associated with their increased risk of pre-diabetes/diabetes.

Keywords: fatty liver; gestational diabetes; insulin sensitivity; liver fat; pre-diabetes

Conflict of interest statement

Competing interests: None declared.

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