Effects Of Dietary Capsaicin Intake On GDM In Chongqing And The Underlying Mechanism Research

Gestational diabetes mellitus(GDM) is a kind of pregnancy endocrine metabolic disease which occurred while pregnancy for the first time. It shows varying degrees of sugar metabolic abnormalities. GDM patients are more likely to have pregnancy hypertension disease, hydramnios, preeclampsia, pregnancy merge infection, electrolyte disorder and other complications than normal pregnant women. Besides GDM is the cause of fetal and some other neonatal diseases. Boyd did a research on the relationship between hyperglycemia and adverse pregnancy(HAPO) with 23000 pregnacy women. He pointed out that the morbidity of GDM is over 16% according to the present diagnostic criteria. Feig, etc studied 1109605 cases and found that the incidence of GDM had been doubled from the year 1996 to 2014. As a developing country with large population, China has large number of pregnancy women and GDM became one of the serious public health problem in the country. Therefore, the study of the prevention and treatment of GDM has significant meanings for improving the health of pregnant women and their babies.During the period of pregnancy, the slight damage of the metabolic function and endocrine adjustment function will be enlarged. Studies have shown that blood glucose levels in the body may change a lot during pregnancy. Maternal glucose is the main energy source for the fetal. In the early weeks of pregnancy, the energy demand is not big. After 24 weeks, the fetus begin to develop rapidly, and the demand of energy increases obviously. Therefore, in order to maintain the normal blood sugar levels the hormone levels in pregnant women is adjusted, such as estrogen, progesterone, placental insulin enzyme and so on. And in order to adapt to the changes the insulin secretion volume must be increased. However some pregnant women sugar metabolic regulation function can not compensate the physiological changes and eventually lead to the occurrence of GDM. Epidemiological studies have found that GDM is closely related to the excessive intake of energy, fat and the lack of exercise. So it is generally believed that GDM is a kind of sugar and lipid metabolic disorder caused by unhealthy diet and lack of exercise. And it is also believed that adjusting the diet structure can prevent and improve the GDM. Pettersson fed capsaicin and glucose to mice, and found that capsaicin can combat the effects of glucose on mice blood glucose. Ahuja found in the study that regular intake of food capsaicin obviously had significant effect on the glucose metabolic disorder, especially on the postprandial hyperinsulinemia. It is known that capsaicin can improve the blood glucose level and insulin resistance of animals and people, while the effect on the prevention of GDM has not been clear.As the oral medications may have effects on the fetus its security has been questioned and it is not recommended to use oral medications during pregnancy. The acceptable treatment of GDM in China is life style guide and insulin therapy. If the lifestyle intervention is not useful pregnant women with GDM have to bear the subcutaneous of insulin injections. In the present research, we intend to find a safe and natural food ingredients that can replace or partly replace insulin, as a new type of special hypoglycemic food during pregnancy. We studied whether chili intake can prevent or treat GDM according to the Chongqing region habit that pregnant women still keep the chili intake. We chose the types of chili according to our market investigation. After the analysis of the risk factors for GDM, we chose the varieties and dosage of the chili pepper. The effect of capsaicin on glucolipid metabolic disorders and the impact on infant outcomes in patients with GDM were analysed. The present research has significant meaning on standardizing the control of clinical medical nutrition therapy and the use of capsaicin on GDM prevention, and at the same time the research can provide us a safe and effective new method for the treatment of GDM.Results:1. The case- control study between Chongqing chili species, capsaicin intake and GDM occurrence1.1 The determination of variance dietary capsaicin in Chongqing1.1.1 According to the dietary survey, the literature and the market research, 18 kinds of dietary capsaicin in Chongqing was determined. According to our survey in Chongqing common varieties of fresh chilli peppers and chilli products, we designed semi-quantitative food table(18 items) for subsequent meals investigation.1.1.2 The content analysis of capsaicin in different chilli in Chongqing was determined with the high-performance liquid chromatography(HPLC). The results suggest that the chili powder contained the highest capsaicin of 2.123 g / kg, while the sweet pepper and bell peppers contained none of capsaicin.1.2 The case- control study between high dietary capsaicin with the incidence of GDM in Chongqing.1.2.1 The 20 indicators of place of residence, pre-pregnancy BMI, weight, education level, living area, sleep, exercise steps, energy intake, carbohydrate intake, protein intake, fat intake and pepper intake between the age GDM group and the control group were conducted with multivariate Logistic regression analysis. The results showed that the amount and time of capsaicin intake were protective factors against GDM occurrence, while the age and total energy intake were risk factors.1.2.2 The value of the fasting glucose, fasting insulin, fasting insulin resistance; postprandial blood glucose, postprandial insulin and postprandial insulin between the GDM group and the control group were significant different, which suggested that the glucose metabolism of GDM patient obviously abnormal.1.2.3 The total cholesterol and triglycerides up-regulated in the GDM group significantly, and the high density lipoprotein decreased, which suggesting that patients with GDM occurs abnormal lipid metabolism.1.2.4 Comparing to the control group, the calcitonin gene-related peptide(CGRP) is significantly down-regulated and the tumor necrosis factor-α(TNF-α) and retinol-binding protein-4(RBP-4) were significantly increased, which suggesting the cytokine disorders in GDM patients may responsible for the occurrence and development of GDM. Second, The therapy effect of combination of capsaicin and medical nutrition(MNT) intervention in patients with GDM2. The treatment of capsaicin and MNT for GDM2.1 Screening, production and dose assessment of capsaicin intervention2.1.1 The screening of capsaicin intervention. The dried chilli powder was chosen as capsaicin intervention after analysis of different kinds of chilli, which showed a moderate spiciness, easy intake and preservation. We choose the six varieties of capsaicin which has the largest market sales through market research. According to the variety of color degrees, aroma, spicy sensation and irritation, the dry chili(Qinxin cards) was chosen as the final selection intervention.2.1.2 Determination of capsaicin and production of pepper intervention. Qinxin dry paprika(brilliant pepper 425) contents the capsaicin of 4mg / g. Xinjiang paprika content the capsaicin of 0mg / g. The chili powder was dispensed of 1.25 g / bag, stored for use after irradiation.2.1.3 The dose of the pepper intervention. Two steps were taken for the testing of the dose of pepper intervention. First step was taken the normal population, and then the pregnant women. The intervention last for one week. We decided to choose 5mg dry paprika as intervention.2.2 The influence of hot pepper to GDM pregnant women and fetus2.2.1 Forty-two women completed the trial. No differences were found for age, weight and BMI before pregnancy and at baseline, and the gestational age of the women with GDM between the two groups. No differences were observed in the blood pressure, fundal height, and abdominal circumference of the women with GDM, as well as the fetal heart rate between the groups at baseline. After the 4-week trial, the above routine obstetric examination indicators were not significantly changed. Additionally, no differences in the mean daily energy and nutrient intake of the women with GDM were observed between the groups.2.2.2 Compared to the placebo group, 2-h PG and 2-h INS concentrations and 2-hour postprandial HOMA-IR(2-h HOMA-IR) levels, and the fasting serum total cholesterol and triglycerides concentrations significantly decreased in the capsaicin group after treatment(P<0.05). The fasting serum apolipoprotein B and CGRP concentrations significantly increased in the capsaicin group(P<0.05). The changes in the 2-h PG and 2-h INS concentrations and in the 2-h HOMA-IR were negatively correlated with the change in the serum CGRP concentration(P<0.05).2.2.3 There were no significant differences in the maternal outcomes between the two groups,Among the newborns, the proportion of LGA newborns was lower in the capsaicin group than in the placebo group(P = 0.022). No significant differences were observed between the groups with regard to the proportion of SGA newborns, Apgar scores, hyperbilirubinemia and newborn hypoglycemia.Conclusion:GDM is associated with the diet and eating habits during pregnancy. Capsaicin-rich diet can reduce the incidence of GDM. Higher in taking of capsaicin usually may reduce the insulin resistance of patients with GDM and the abnormal lipid metabolism. In the same time reduce the probability of the occurrence of gestational age baby.