血浆中氧化三甲胺水平与妊娠糖尿病的患病风险。
Plasma concentration of trimethylamine-N-oxide and risk of gestational diabetes mellitus.
机构信息
Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety.
Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
Am J Clin Nutr. 2018 Sep 1;108(3):603-610. doi: 10.1093/ajcn/nqy116.
BACKGROUND
The microbiota-dependent metabolite trimethylamine-N-oxide (TMAO) has been reported as a novel and independent risk factor for the development of cardiovascular and metabolic diseases, but the association with gestational diabetes mellitus (GDM) remains unclear.
OBJECTIVE
The aim of this study was to investigate the association between plasma TMAO concentration and GDM in a 2-phase study.
DESIGN
A 2-phase design was used in the current study. An initial phase included 866 participants (433 GDM cases and 433 matched controls) with fasting blood samples collected at the time of GDM screening (24-32 wk of gestation). An independent-phase study, with 276 GDM cases and 552 matched controls who provided fasting blood samples before 20 wk of gestation and who had GDM screened during 24-32 wk of gestation, was nested within a prospective cohort study. These 2 studies were both conducted in Wuhan, China, and the incidence of GDM in the cohort study was 10.8%. Plasma TMAO concentrations were determined by stable isotope dilution liquid chromatography-tandem mass spectrometry. GDM was diagnosed according to the American Diabetes Association criteria by using an oral-glucose-tolerance test.
RESULTS
In the initial case-control study, the adjusted OR of GDM comparing the highest TMAO quartile with the lowest quartile was 1.94 (95% CI: 1.28, 2.93). Each SD increment of ln-transformed plasma TMAO was associated with 22% (95% CI: 5%, 41%) higher odds of GDM. In the nested case-control study, women in the highest quartile also had increased odds of GDM (adjusted OR: 2.06; 95% CI: 1.28, 3.31) compared with women in the lowest quartile, and the adjusted OR for GDM per SD increment of ln-transformed plasma TMAO was 1.26 (95% CI: 1.08, 1.47).
CONCLUSIONS
Consistent findings from this 2-phase study indicate a positive association between plasma TMAO concentrations and GDM. Future studies are warranted to elucidate the underlying mechanisms. This trial was registered at www.clinicaltrials.gov as NCT03415295.
背景
微生物依赖的代谢产物三甲胺 N-氧化物（TMAO）已被报道为心血管和代谢疾病发展的新型独立危险因素，但与妊娠糖尿病（GDM）的关系尚不清楚。
目的
本研究旨在通过两阶段研究探讨血浆 TMAO 浓度与 GDM 的关系。
设计
本研究采用两阶段设计。初始阶段纳入 866 名参与者（433 例 GDM 病例和 433 例匹配对照），于 GDM 筛查时（妊娠 24-32 周）采集空腹血样。一个独立的阶段研究，纳入了 276 例 GDM 病例和 552 例匹配对照，这些对照在妊娠 20 周前采集空腹血样，并在妊娠 24-32 周期间接受 GDM 筛查。这两项研究均在中国武汉进行，队列研究中 GDM 的发病率为 10.8%。采用稳定同位素稀释液相色谱-串联质谱法测定血浆 TMAO 浓度。GDM 诊断采用美国糖尿病协会标准，口服葡萄糖耐量试验。
结果
在初始病例对照研究中，与最低 TMAO 四分位组相比，最高四分位组的 GDM 调整比值比为 1.94（95%CI：1.28，2.93）。ln 转化后血浆 TMAO 每增加一个标准差，GDM 的发生几率增加 22%（95%CI：5%，41%）。在嵌套病例对照研究中，与最低四分位组相比，最高四分位组的女性 GDM 发生几率也增加（调整比值比：2.06；95%CI：1.28，3.31），ln 转化后血浆 TMAO 每增加一个标准差，GDM 的调整比值比为 1.26（95%CI：1.08，1.47）。
结论
这项两阶段研究的一致发现表明，血浆 TMAO 浓度与 GDM 呈正相关。未来的研究需要阐明其潜在机制。本试验在 www.clinicaltrials.gov 注册，编号为 NCT03415295。
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