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PubMedDate not supplied

[Longitudinal changes in rigidity in old age].

This investigation attempted to deal with the question of longitudinal changes in the rigidity of attitudes and behaviour in a sample of elderly persons (68--90 years old). This was done by collecting data twice (1969/70 and 1976) from 86 subjects on a serie of measures of rigidity. At the same time additional data were collected on external variables such as intelligence, anxiety, state of health, extraversion, neuroticism, etc. Analyses of variance with the factors "time of measurement" and "sex" indicated a change in the predicted direction for the majority of the measures used. After an internal of six years, the capacity for adaptive and spontaneous flexibility had decreased, whereas intolerance and dispositional rigidity had increased. On the Riegel-scales R1 and R2, a rise in age was accompanied by a rise in rigidity, as measured in terms of statement in the form of personal judgments. Agreement with other judgments in the form of more generally formulated statements, on the other hand, decreased. Sex differences were found for Brengelmann's NR-scale and the Gottschaldt Hidden Figure test. Women were found to be less rigid than men, but also revealed less adaptive flexibility. A comparison of the test scores of longitudinal subjects and a comparable group of control group subjects yielded no signs of differences which would be traced back to a biased selection of the longitudinal sample.

Adaptation, Psychological↗
PubMed1993

Longitudinal changes in proton magnetic resonance spectroscopy in cerebral infarction.

BACKGROUND AND PURPOSE: Proton magnetic resonance spectroscopy has revealed changes in lactate and N-acetyl-aspartate in acute cerebral infarction. However, the details of these drastic changes and subsequent chronic changes have not been clarified. The purpose of this study was to disclose longitudinal changes in spectra seen in proton magnetic resonance spectroscopy. METHODS: Six patients with completed cerebral infarction were examined longitudinally with localized proton magnetic resonance spectroscopy. RESULTS: (1) In the acute stage (within 2 days after onset), two drastic changes were observed: N-acetyl-aspartate decreased rapidly and severely within 2 days after onset, and lactate increased immediately and reached a high level in the acute stage after onset. (2) In the chronic stage (more than 1 month after onset), two features were observed: lactate, which had increased in the acute stage, remained high for more than 1 month, and other signals such as those of N-acetyl-aspartate, choline, and phosphocreatine/creatine decreased dramatically. CONCLUSIONS: These results suggest that N-acetyl-aspartate and lactate as revealed by proton magnetic resonance spectroscopy can be useful indicators of the ischemic damage to the brain in clinical cases of cerebral infarction.

Adult↗
PubMed1991

Longitudinal changes of serum albumin in elderly people living in the community.

The relationship of serum albumin at baseline to mortality, and longitudinal changes of serum albumin were investigated in a 10-year longitudinal study of 421 (197 men, 224 women) community residents aged 69-71. The 10-year survival rate was the lowest in the first quartile of serum albumin at baseline, followed by the second quartile, and third and fourth quartiles (p less than 0.05). In both sexes, 10-year survival curves did not differ between the group with diseases or disabilities at baseline or over time and the group without them.

Aged↗
PubMed1987

Longitudinal changes in forced expiratory volume in one second in adults. Effects of smoking and smoking cessation.

Longitudinal changes in FEV1 (delta FEV1) in relationship to smoking habits were examined in 1,705 adults enrolled in a prospective study of a general population sample. In both men and women, there were excessive rates of decline in FEV1 in smokers, at least in those smoking more than 10 cigarettes per day. The excess decline of smokers was age dependent, particularly in men, with much of the excess loss of function occurring between 50 and 70 yr of age. Effects of smoking on delta FEV1, observed minus expected delta FEV1 and observed minus expected percent delta FEV1, were greater in men than in women even when controlled for current cigarette dose. Ex-smokers show delta FEV1 values similar to those of nonsmokers. In subjects younger than 35 yr of age, quitting smoking during follow-up was associated with an actual increase in FEV1. In men 50 to 70 yr of age, smoking cessation early in the study appeared to lead to a relatively prompt return to normal rates of functional decline. Thus, the findings suggest relatively prompt beneficial effect of smoking cessation even in late middle age.

Age Factors↗
PubMed1994

Longitudinal changes in time domain spirogram indices and their variability.

The purpose of this study was to describe longitudinal changes in time domain spirogram indices and their variability. We therefore measured forced expiratory spirograms of 326 middle-aged male employees in two asbestos-using factories four times over 5 yrs. From the original sample of 326, 225 healthy subjects, who provided reliable results for three or more surveys, were selected for analysis. The mean and standard deviation of transit time and their log-transformed values (MTT, STT, ln(MTT), and ln(STT), respectively), as well as two indices of the estimated time constant distribution (Mu and Sigma, respectively) were analysed using a longitudinal model. The longitudinally estimated annual increase of MTT, STT, ln(MTT), and ln(STT) was about three times larger than the cross-sectional estimate, whilst they were comparable in Mu and Sigma. A highly significant contribution of between-subject variability was found in all indices. This was particularly remarkable in the mean components. The between-subject variability was about eight times larger than the error variance in Mu, and three times in MTT and ln(MTT). We conclude that the longitudinal data of transit time indices should not be compared with cross-sectional reference values, and that the magnitude of error variance of these indices in longitudinal repeated measurements will be rather less than the cross-sectional counterpart reported previously.

Adult↗
PubMed1997

Weight gain and longitudinal changes in lung function in steel workers.

Associations among dust exposure, smoking habits, and demographic factors and longitudinal changes of lung function were assessed among male steel workers. Cohort descriptive data analysis was conducted in 541 steel workers who had performed spirometry at least twice between 1982 and 1991 (mean follow-up, 6.1 years). The annual change (slope) in FVC, FEV1, FEV1/FVC%, and in body weight was determined by simple linear regression. The Pearson correlation coefficient between weight change and spirometry changes was calculated. Comparisons were also done in 75 pairs of steel workers matched by age, height, initial FEV1, and smoking status, but whose FEV1 declines differed by > or = 60 mL/yr. The FEV1 and FVC declined an average of 44 and 50 mL/yr, respectively, for the cohort as a whole. The FEV1 and FVC declined 52 and 54 mL/yr for current smokers, 43 and 53 mL/yr for ex-smokers, and 36 and 43 mL/yr for nonsmokers, respectively. Increasing weight was highly correlated with accelerated decline in lung function (p<0.0001). In the matched pairs, mean slopes for FVC, FEV1, and FEV1/FVC ratio were -96 mL/yr, -95 mL/yr, and -0.40%/yr for the rapid decliners; and +5 mL/yr, +10 mL/yr, and +0.10%/yr for their partners (p<0.0001). Matched pair comparisons showed that the rapid decliners averaged a 4.313 kg weight gain, while their partners gained 1.044 kg during the follow-up period. The slope of weight gain was 0.708 kg/yr for rapid decliners and 0.191 kg/yr for comparison workers (p<0.0036). Weight gain, in addition to aging and cigarette smoking, was found to be associated with the longitudinal rate of decline in FVC, FEV1, and FEV1/FVC ratio.

Adult↗
PubMed1998

The relationship of obesity and the development of coronary heart disease to longitudinal changes in systolic blood pressure.

In an investigation of the relationship of obesity and the development of coronary heart disease (CHD) to longitudinal changes in systolic blood pressure (SBP), a sample of 1029 male participants from the Baltimore Longitudinal Study of Baltimore (BLSA), who were free of CHD at the beginning of the study, were examined with a total of 4111 examinations (mean of four examinations per person) conducted during the study period. The mean follow-up time was 8.1 years with a maximum of 16 examinations and 30.9 years of follow-up. During the follow-up period, 192 participants developed CHD, and these participants' data collected after the CHD event were excluded from the analysis. A proportional hazards regression model was used to calculate the relative risk of developing CHD for several CHD risk factors. Both simple and multiple proportional hazards regression models indicate a strong association between body mass index (BMI), cholesterol, cigarette smoking, and systolic blood pressure (SBP) with the risk of developing CHD. In addition, a linear mixed-effects model was used to examine changes in SBP measurements over time and to identify factors, including the age at first examination and time in study, that are related to that change. The results from the linear mixed-effects model analysis indicate that those in the obese group (BMI > or = 30 kg/m2) have SBP measurements that are on average 9.0 mm Hg higher than those in the normal group (20 < or = BMI < 25). Also, SPB measurements were on average 6.6 mm Hg higher in those who developed CHD during the study period than those who remained free of disease. In addition, SPB showed a quadratic relationship with time, and its patterns of change with time were different among the different age groups. Also, the relationship between changes in SBP with respect to cholesterol was dependent on time in the study as well.

Adult↗
PubMed1995

Longitudinal changes in peritoneal equilibration test with or without peritonitis in children.

This study was conducted to evaluate longitudinal changes in the peritoneal equilibration test (PET) in children treated with continuous peritoneal dialysis (CPD). The effects of prolonged CPD and episodes of peritonitis on the PET were examined. PET was repeated up to five times in 12 paediatric patients who were subdivided into groups with and without peritonitis. In the peritonitis group (n = 6), the dialysate/plasma (D/P) creatinine ratio at a 4-h dwell time decreased progressively with time on CPD in five of six patients. In a comparison of the initial and final PETs performed at a mean interval of 22.8 +/- 11.6 months, the D/P creatinine ratio in the final PET was significantly lower than in the initial PET (P < 0.01). In contrast, in the non-peritonitis group (n = 6), the D/P creatinine ratio in the final PET was unchanged for 28.2 +/- 12.3 months from the initial PET. The D/Do glucose ratio at a 4-h dwell time was unchanged over time in each group. Thus, repeated PET measurements revealed that membrane permeability for creatinine was not affected by prolonged CPD itself, but decreased with time after episodes of peritonitis. Although the protocol for PET is not standardised in children, PET was useful for determining the sequential changes in peritoneal function in such patients on CPD.

Child↗
PubMed1992

Relationships between 3-y longitudinal changes in body mass index, waist-to-hip ratio, and metabolic variables in an active French female population.

Three-year longitudinal changes in body mass index (BMI), waist-to-hip ratio (WHR), and metabolic variables were examined in 209 active French women. For the entire group, a weak but significant positive association was found between change in BMI and change in WHR. However, analysis of covariance according to the degree of abdominal fat distribution showed a heterogeneity of this association that was confined to women with abdominal fat distribution. Changes in BMI were positively associated with changes in total cholesterol (P less than 0.05), triglycerides (P less than 0.10), and blood pressure (P less than 0.001), whereas changes in WHR were associated with changes in triglycerides (P less than 0.05) and diastolic blood pressure (P less than 0.10). These longitudinal results suggest that a more favorable body-fat pattern and metabolic profile might be achieved by reducing weight, or at least by preventing weight gain, particularly in women with high abdominal-fat distribution.

Abdomen↗
PubMed1998

Longitudinal changes in selected physical capabilities: muscle strength, flexibility and body size.

OBJECTIVES: first, to record, in a representative sample of older men and women, longitudinal changes in (i) maximal voluntary strength of the handgrip muscles, (ii) maximal range of movement in the shoulder joint and (iii) body weight and skeletal size; second, to explore associations between the changes in muscle strength and both customary physical activity and health outcomes. DESIGN: longitudinal analyses of survivors measured at baseline, and 4-year and 8-year follow-ups. PARTICIPANTS: 350 survivors of a random sample originally aged 65 and over. RESULTS: over 8 years average loss of body weight was slight but significant at about 2 kg (less than 5%). Loss of shoulder range was negligible, while loss of muscle strength was significant at about 40 N (less than 2% per year). Demispan remained stable across all three points of measurement. These mean values concealed substantial variation in the rate of loss of strength, which was twice as fast in the older groups, especially in the women. These losses could not be attributed to worsening health, although this was observed. All the respondents had at least two chronic health problems at the 8-year stage. For the changes in handgrip strength, reduced reported habitual use of the handgrip muscles and increased symptoms of anxiety and depression were significant independent covariates in addition to age and time (all P < 0.0001). CONCLUSION: there are significant independent associations between the loss of muscle strength in old age and both decline in physical activity and increase in depression scores. This is strongly suggestive of causal links and confirms the need to encourage physical activity and control depression in order to maintain strength and function in old age.

Aged↗
PubMed1989

The relationship between longitudinal change in pulmonary function and nonspecific airway responsiveness in children and young adults.

The relationship between airway hyperresponsiveness and longitudinal change in lung function was assessed in a population-based sample of 184 children and young adults observed over a maximum span of 12 yr. Pulmonary function was assessed annually with spirometry, and health and household information was obtained with standardized questionnaires. Nonspecific airway responsiveness to eucapneic hyperventilation with subfreezing air was measured on at least two occasions between the sixth and twelfth annual surveys. At any given survey, a significant bronchoconstrictor response was defined as [( prechallenge FEV1-postchallenge FEV1]/pre-FEV1) greater than or equal to 0.13, a value that identified 10% of the population. Subjects were classified as "never", "always", or "inconsistent" responders according to the consistency of responsiveness determined in different surveys. Subjects were classified further as "labile" if their maximal survey-to-survey difference in delta FEV1/FEV1 was greater than or equal to 0.18, and as "nonlabile" otherwise. A Markov-type autoregressive model that adjusts for previous pulmonary function level, sex, growth variables, and smoking exposures was used to model growth of FEV1, FEF25-75, and FVC. Overall, 135 (73%) of subjects never responded to the cold air challenge, six (3%) always responded, and 43 (24%) responded on one but not all occasions. Levels and rates of increase in level of FEF25-75 were significantly lower in the inconsistent and always responders. In contrast, levels of FVC were greatest and increased most in the always responders. In labile subjects, both FEF25-75 and FEV1 growth rates were reduced. These effects persisted when asthmatics were excluded from the analyses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2000

Longitudinal changes in submaximal oxygen uptake in 11- to 13-year-olds.

The aim of this study was to monitor longitudinal changes in young people's submaximal oxygen uptake (VO2) responses during horizontal treadmill running at 8 km x h(-1). The 236 participants (118 boys, 118 girls) were aged 11.2+/-0.4 years (mean +/- s) at the onset of the study. Submaximal VO2, peak VO2 and anthropometry were recorded annually for three consecutive years. The data were analysed using multi-level regression modelling within a multiplicative, allometric framework. The initial model examined sex, age and maturity-related changes in submaximal VO2 relative to body mass as the sole anthropometric covariate. Our results demonstrate that the conventional ratio standard ml x kg(-1) x min(-1) does not adequately describe the true relationship between body mass and submaximal VO2 during this period of growth. The effects of maturity and age were non-significant, but girls consumed significantly less VO2 than boys running at 8 km x h(-1). In subsequent models, stature was shown to be a significant explanatory variable, but this effect became non-significant when the sum of two skinfolds was added. Thus, within this population, submaximal VO2 responses were explained predominantly by changes in body mass and skinfold thicknesses, with no additional maturity-related increments. When differences in body mass and skinfolds were controlled for, there was still a difference between the sexes in submaximal VO2, with girls becoming increasingly more economical with age.

Adolescent↗
PubMed1999

Predictors of longitudinal change in diffusing capacity over 8 years.

Low single-breath diffusing capacity (DL(CO)) values are associated with anatomic emphysema, but the predictors of longitudinal change in DL(CO) over many years are unknown. Study subjects were adult participants in the longitudinal Tucson Epidemiology Study of Obstructive Lung Disease who had at least one DL(CO) measurement during either of two surveys 8 yr apart (n = 543). Smoking status was determined at each examination (current, former, or never smoker). Quitters were defined as those currently smoking at the baseline DL(CO) examination (1982-1983) and self-reported as no longer smoking at the follow-up exam (1990-1991). The longitudinal DL(CO) data were analyzed using repeated measures analysis; because of missing observations this was done using a saturated random effects model. The results showed that males had higher levels of DL(CO) than females, current smokers had significantly lower levels of DL(CO) than never smokers, but there was no difference in their mean slopes over time. Smoking history, assessed using pack-years of smoking, was associated with reduced DL(CO) levels, independent of whether current or ex-smokers. Males and females demonstrated equivalent rates of decline in DL(CO) that accelerated with increasing age, and mean DL(CO) declines were associated with declines in FEV(1) between surveys.

Adult↗
PubMed1998

Longitudinal changes in maternal serum leptin concentrations, body composition, and resting metabolic rate in pregnancy.

OBJECTIVE: We sought to evaluate the longitudinal changes in maternal serum leptin concentrations, body composition, and resting metabolic rate during pregnancy. STUDY DESIGN: Ten women were evaluated before pregnancy, in early pregnancy (12 to 14 weeks), and in late pregnancy (34 to 36 weeks). Leptin concentrations were measured by radioimmunoassay, body composition with hydrodensitometry with adjustment for total body water, and resting metabolic rate by use of indirect calorimetry. RESULTS: Using analysis of variance with repeated measures from pregravid to late pregnancy, a 66% increase (mean +/- SD) was found in leptin concentrations (in nanograms per milliliter) (before pregnancy, 25.4 +/- 19.9; in early pregnancy, 37.5 +/- 26.2; and in late pregnancy, 38.4 +/- 27.3, p = 0.003); a 9% increase in body fat (in kilograms) (before pregnancy, 29.4 +/- 15.7; in early pregnancy, 28.7 +/- 14.0; in late pregnancy, 31.4 +/- 14.6; p = 0.04); a 28% increase in oxygen consumption (in milliliters of oxygen per minute) (before pregnancy, 221.2 +/- 29.5; in early pregnancy, 230.4 +/- 42.9; in late pregnancy, 285.3 +/- 51.9; p < 0.0001); and a 9% increase in oxygen consumption (milliliters of oxygen per kilogram per minute) (before pregnancy, 3.02 +/- 0.43; in early pregnancy, 3.05 +/- 0.30; in late pregnancy, 3.31 +/- 0.37, p = 0.002) with advancing gestation. A significant positive correlation was present between leptin and body fat before pregnancy (r = 0.90, p < 0.0001), in early pregnancy (r = 0.91, p < 0.0001), and in late pregnancy (r = 0.87, p = 0.0005) and between leptin and oxygen consumption before pregnancy (r = 0.80, p = 0.004), in early pregnancy (r = 0.92, p < 0.0001), and in late pregnancy (r = 0.62, p = 0.06). When oxygen consumption was adjusted for maternal and fetal tissue mass, a significant negative correlation was found between leptin and oxygen consumption before pregnancy (r = -0.96, p < 0.0001), in early pregnancy (r = -0.80, p = 0.0034), and in late pregnancy (r = -0.70, p = 0.02). CONCLUSION: We conclude that leptin increases significantly during early pregnancy before any major changes in body fat and resting metabolic rate. These data suggest that pregnancy represents a leptin-resistant state.

Adult↗
PubMed1997

Longitudinal changes of metacarpal cortical striation in Graves' disease.

RATIONALE AND OBJECTIVES: The authors verify whether metacarpal cortical striation can be used to assess longitudinal changes in bone turnover in Graves' disease. METHODS: Eight patients with untreated Graves' disease (5 men, 3 women; age 36 +/- 12 years) and six patients with the disease in remission (1 man, 5 women; age 38 +/- 12) were studied. Posteroanterior radiographs of the bilateral hands were obtained using fine-grain mammography film and direct magnification. Three observers independently determined the grade of cortical striation (striation index; SI) of the second and third metacarpals in randomly presented radiographs. RESULTS: The SI determined by all observers decreased significantly after the beginning of antihyperthyroid therapy compared with the SI before treatment (P < 0.05). Significant correlation was found between the observers' assessments (r = 0.74, P < 0.001). The average kappa value and percent agreement were 0.27 and 51.8%, respectively. Intraobserver variability provided relatively good kappa statistics (kappa: 0.56; percent agreement: 79.9%). Longitudinal decrease in the SI was in accordance with a decline in urinary pyridinoline cross-link excretion, a decline in serum osteocalcin, and an increase in bone mineral density of lumbar spine. CONCLUSIONS: The change in the SI can be used to detect increased and decreased bone turnover. Thus, the SI can be used as one index of bone turnover in patients with Graves' disease.

Absorptiometry, Photon↗
PubMed2000

Longitudinal changes of circadian leptin, insulin and cortisol plasma levels and their correlation during refeeding in patients with anorexia nervosa.

OBJECTIVE: To study the longitudinal changes in plasma levels of leptin, insulin and cortisol during the transition from the state of starvation to the state of refeeding focussing on diurnal secretion characteristics and their temporal relationships. DESIGN: Leptin, insulin and cortisol were measured every 2h for 24h during acute starvation (T1). Sampling was repeated after reaching half the target-body mass index (BMI) (T2) and again at target-BMI (17. 5kg/m(2); T3). The temporal relationships between the diurnal secretion patterns were assessed by cross-correlation analysis. RESULTS: Although BMIs at T1 were uniformly low, leptin levels varied widely within a range clearly below normal levels (0.03-1. 7microg/l). With increasing body fat during the course of refeeding, mean leptin levels increased from 0.64microg/l (range: 0.27-1. 73microg/l) (T1) to 1.61microg/l (range: 0.36-4.2microg/l) (T2) and to 3.67microg/l (range: 0.7-9.8microg/l) (T3). Circadian leptin secretion patterns showed maximal values uniformly around 0200h and minimal values around 0800h at all stages of the study. At all three weight levels, plasma leptin levels were highest between midnight and the early morning hours and lowest around the late morning hours. Refeeding neither profoundly changed secretion patterns of leptin nor did it change the positive, time-delayed relationship between leptin and insulin with increments in insulin secretion preceding those of leptin by 6h. A temporal relationship between leptin and cortisol could not be demonstrated in the state of semistarvation but emerged after a substantial weight gain; at that time, leptin increases preceded cortisol increases by 8h. CONCLUSIONS: Absolute leptin, insulin and cortisol levels are profoundly changed during starvation in anorectic patients, while refeeding, paralleled by a BMI gain, reverses these changes. During refeeding the relationship between leptin and cortisol changed profoundly, showing no significant correlation in the state of starvation, whereas at T3 after refeeding a strong inverse relationship could be observed. Leptin and insulin did not correlate significantly at any of the three stages studied.

Adult↗
PubMed1982

Longitudinal changes in serum cholesterol in man: an epidemiologic search for an etiology.

Serum cholesterol levels were determined in 1011 male participants of the Baltimore Longitudinal Study of Aging. This study presents the longitudinal changes in serum cholesterol from 1 July 1963 to 30 June 1977. Serum cholesterol values dropped 6% between 1970 and 1972. The span of this study was divided into two eras, one preceding and one following the drop. The effects of obesity, selected dietary constituents and physical activity were examined in an attempt to explain the secular change in serum cholesterol. Serum cholesterol levels were not significantly correlated to levels of weight or body mass index. Changes in weight were significantly positively correlated with changes in serum cholesterol. Overall, however, the study population did not experience a significant drop in weight and therefore, this relationship could not explain the observed drop in serum cholesterol. There were virtually no significant correlations between the absolute value of any of the dietary variables examined and the absolute level of serum cholesterol. There were significant but small changes in most dietary constituents; however, only changes in caloric intake were significantly positively correlated with changes in serum cholesterol. Because the overall change in caloric intake was small, it could explain less than 1 mg/dl of the 11 mg/dl drop. There was no overall change in physical activity. No significant correlations were found between either the level or change in physical activity and the level or change in serum cholesterol. It is concluded that neither weight nor physical activity could account for the observed changes in serum cholesterol. Changes in dietary constituents were significant and in a direction which would predict a lower serum cholesterol. However, for the group, dietary changes could not fully explain the drop in serum cholesterol. For individuals, the changes in diet poorly predicted changes in serum cholesterol. It is suggested that the observed secular drop in serum cholesterol may be due to factor(s) other than those studied.

Adolescent↗
PubMed1999

Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus.

OBJECTIVE: This study prospectively evaluated the longitudinal changes in insulin sensitivity, insulin response, and endogenous (primarily hepatic) glucose production and suppression during insulin infusion in women with normal glucose tolerance (control) and gestational diabetes mellitus before and during a planned pregnancy. STUDY DESIGN: Eight control subjects and 7 subjects in whom gestational diabetes mellitus developed were evaluated with an oral glucose tolerance test, an intravenous glucose tolerance test, and hyperinsulinemic-euglycemic clamp with infusion of [6,6 (2)H2 ]glucose before conception and at 12 to 14 and 34 to 36 weeks' gestation. Insulin response was estimated as the area under the curve during the intravenous glucose tolerance test. Basal endogenous glucose production was estimated from isotope tracer dilution during steady state with [6,6 (2)H2 ]glucose and suppression during insulin infusion. Insulin sensitivity to glucose was defined as the glucose infusion rate required to maintain euglycemia during steady-state insulin infusion. Body composition was estimated with hydrodensitometry. Data were analyzed with 2-way analysis of variance with repeated measures for 2 groups. RESULTS: There were increases in first-phase (P =.006) and second-phase (P =. 0001) insulin responses in both groups with advancing gestation, but the increase in second-phase response was significantly greater (P =. 02) in the gestational diabetes mellitus group than in the control group. Basal glucose production increased significantly (P =.0001) with advancing gestation, and there was resistance to suppression during insulin infusion in both groups (P =.0001). There was less suppression of endogenous glucose production however, in the gestational diabetes mellitus group than in the control group (P =. 01). Insulin sensitivity decreased with advancing gestation in both groups (P =.0001), and there was lower insulin sensitivity in the gestational diabetes mellitus group than in the control group (P =. 04). Significant decreases in insulin sensitivity with time (P =. 0001) and between groups (P =.03) remained when the data were adjusted for differences in insulin concentration or residual hepatic glucose production. CONCLUSION: Obese women in whom gestational diabetes mellitus develops have a significant increase in insulin response but decreases in insulin sensitivity and suppression of hepatic glucose production during insulin infusion with advancing gestation with respect to a matched control group. These metabolic abnormalities in glucose metabolism are the hallmarks of type 2 diabetes, for which these women are at increased risk in later life.

Adult↗