Medical Bulletin 14/ May/ 2024

According to research presented at the 26th European Congress of Endocrinology, the higher the blood sugar level in pregnant women when first diagnosed with diabetes, the higher the risk of complications around and after birth.

Gestational diabetes — a condition in which women have elevated blood sugar, or glucose, levels during pregnancy — affects around 20 million pregnancies worldwide and poses increased health risks for both mothers and their babies. For example, mothers are more likely to develop type 2 diabetes and to give birth to especially large babies who face a high risk of birth injuries or even obesity later in life. Women are diagnosed with gestational diabetes if their fasting (pre-meal) blood glucose levels are above 92 mg/dL in the first trimester or their 2-hour oral post-meal glucose levels (OGTT) in the second trimester is above 153 mg/dL.

For every 5mg/L above the diagnosis threshold, the risk of newborns having low blood sugar levels, or a large birth weight, rises by 9% and 6%, respectively, while mothers have a 31% higher risk of diabetes after birth.

In the study, researchers analysed data on blood sugar levels and birth complications of 6,927 pregnant women, aged 30-37 years old, who were diagnosed with gestational diabetes between 2012 and 2017. The researchers found that for every 5mg/L increase in their blood sugar levels, there was a 9% higher risk of low blood sugar (hypoglycemia) and a 6% higher risk of large birth weight (large for gestational age) in newborns and a 31% higher risk of maternal high blood levels (hyperglycemia) after birth.

The findings suggested that high-risk women with gestational diabetes should be classified further to limit these complications for both mothers and newborns.

“While it is not surprising that high glucose levels are associated with these adverse outcomes in mothers and newborns, our study shows for the first time how much increase in risk there is with 5 mg/dL of increase in the mother’s blood glucose levels when first diagnosed with gestational diabetes. The magnitude of elevated risk can be calculated with our measurements and, in practice, could be used to identify and stratify women at higher risk of developing these complications.” said co-lead researcher Dr Catarina Cidade-Rodrigues.

Reference: Dr Catarina Cidade-Rodrigues. Et al.; Blood sugar level at gestational diabetes diagnosis linked to harmful outcomes for mothers and babies; EUROPEAN SOCIETY OF ENDOCRINOLOGY; MEETING: European Congress of Endocrinology

According to research presented at Heart Failure 2024, a scientific congress of the European Society of Cardiology (ESC), yoga focused on breathing, meditation, and relaxation is linked with symptom improvement in patients with heart failure.

Heart Failure affects vast numbers of people – more than 64 million globally2 – and can have devastating impacts on quality of life, with patients feeling tired and breathless, and being unable to participate in their usual activities. While previous studies have shown the short-term benefits of yoga in patients with heart failure, this study provides new information about the long-term effects.

Yoga holds promise as an adjunctive therapy for heart failure patients owing to its multifaceted physiological and psychological benefits. Through its emphasis on controlled breathing, postures, and meditation, yoga can enhance autonomic nervous system regulation, improving cardiac function. Moreover, yoga's stress-reducing properties mitigate sympathetic overactivity and cortisol release, thereby lowering the adverse effects of chronic stress on cardiovascular health.

In the study, conducted at Kasturba Hospital in Manipal, India, researchers enrolled heart failure patients aged 30 to 70 who had undergone cardiac procedures within the past six months to one year and were on guideline-recommended medications. Out of 85 participants, 40 were assigned to the yoga group, while 45 were in the control group. The yoga group received training in pranayama, meditation, and relaxation techniques and practised at home once a week under supervision.

Researchers assessed heart structure and function at baseline, six months, and one year in both the yoga and control groups. Measurements included left ventricular ejection fraction and right ventricular function. Additionally, blood pressure, heart rate, body weight, body mass index, symptom burden, and functional capacity were evaluated using the New York Heart Association classification system.

The results revealed that compared to the control group, the yoga group demonstrated significantly greater improvements in all measurements at six months and one year relative to baseline.

“Patients who did yoga had healthier hearts and were more able to carry out ordinary activities such as walking and climbing stairs than those who only took medications. Patients with heart failure should speak to their doctor before starting yoga and should then receive training from an experienced instructor. Prescribed medications should be continued as before. Yoga may be unsuitable for heart failure patients with severe symptoms, who were excluded from our study,” said study author Dr. Ajit Singh of the Indian Council of Medical Research (ICMR), Manipal Academy of Higher Education, India.

Reference: Dr. Ajit Singh, the Indian Council of Medical Research (ICMR), Manipal Academy of Higher Education, India; ‘Impact of yoga therapy on long-term outcomes in heart failure patients using functional and echocardiographic parameters’ ‘Chronic heart failure - treatment 16 Session’

New research being presented at the European Congress on Obesity (ECO) suggested that the source of sugar is more important than the amount of sugar when it comes to the development of obesity in children.

High consumption of sugary foods is recognised as a risk factor for childhood overweight and obesity, prompting recommendations for reduced intake of sugar-rich foods like cakes, and sugar-sweetened beverages. Instead, children are encouraged to consume more fruit and unsweetened dairy products such as milk and yoghurt. However, despite being perceived as healthy choices, these foods contain significant amounts of intrinsic sugars—naturally occurring sugars within the food itself—rather than added sugars.

The intrinsic sugars found these food products can still contribute to obesity if consumed excessively. While these dairy products offer essential nutrients like protein, calcium, and vitamins, they also contain lactose, a type of sugar. When consumed in moderation as part of a balanced diet, the intrinsic sugars in milk and yogurt are typically metabolized efficiently by the body. However, overconsumption of these dairy products can lead to an excessive intake of calories from sugars, which may contribute to weight gain and obesity over time.

In the study, researchers analysed data from the GEKCO Drenthe study, between April 2006 and April 2007 and aimed to investigate the relationship between early childhood sugar intake and weight-related outcomes. A food intake questionnaire completed by parents of 891 children at age 3 provided data on total sugar intake and sugar intake from various sources. Height and weight measurements were used to calculate BMI Z-scores and weight status at age 10.

The study found that while the average total daily sugar intake was 112g, it wasn't associated with BMI, weight gain, or weight status. However, higher sugar intake from sugary snacks correlated with a higher BMI Z-score at 10 years. Conversely, greater sugar intake from whole fruit was linked to a lower BMI Z-score and less weight gain.

Similarly, higher sugar intake from unsweetened liquid dairy products was associated with a reduced risk of developing overweight/obesity, with children having a 67% lower risk compared to those with lower intake.

“When it comes to developing obesity in childhood, the source of sugar seems to be more important than the amount. Children should be encouraged to have fruit and milk instead of sweetened milk and yoghurt drinks, sweets, cakes and other foods rich in added sugar,” said lead researcher Junyang Zou, of the Department of Epidemiology, University of Groningen and University Medical Center Groningen, The Netherlands.

Reference: Junyang Zou, University of Groningen and University Medical Center Groningen, The Netherlands, et al.; Source of sugar may be more important than amount when it comes to the development of obesity in children; EUROPEAN ASSOCIATION FOR THE STUDY OF OBESITY; MEETING: European Congress on Obesity (ECO2024)