Exploring Nutritype Signature of Type 2 Diabetes Risks in Women Post-Gestational Diabetes Mellitus

NCT ID: NCT04190199

Last Updated: 2019-12-09

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

270 participants

Study Classification

OBSERVATIONAL

Study Start Date

2020-05-31

Study Completion Date

2021-05-31

Brief Summary

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Women post-gestational diabetes mellitus (GDM) have more than 7-fold increased risk of having future type 2 diabetes mellitus (T2DM). While a healthful dietary pattern reduces the risk of diabetes in post-GDM, no data support a dietary pattern tailored to the Malaysian diet. To address this issue, the investigators propose to determine the effects of dietary patterns and plasma metabolites in predicting the risk of T2DM known as the Nutritype model. The aim of this study is to identify Nutritype signatures of T2DM risk in women post-GDM using metabolomics approach.

Detailed Description

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Women with a history of gestational diabetes mellitus (GDM) or post-GDM are at high risk of developing type 2 diabetes (T2DM). This is important in the present context because T2DM has reached epidemic proportions. In Malaysia, the prevalence of T2DM has increased by almost 80% in just over a 10 year period. Current recommendation supports early screening at 6 weeks postpartum via oral glucose tolerance testing (OGTT) after GDM. However, the screening of women after GDM remains suboptimal, with a very low compliance rate up to almost 20%. Also, none of the recommendations highlights the need of having nutrition screening assessments despite the fact that nutritional stimuli are highly relevant to expedite disease progression in women post-GDM.

As such, the metabolomics technique can be used as a tool to measure the full profile of small-molecule metabolites in bio-fluids. This technique has been expanded beyond biological disciplines towards nutrition research leading to the emerging concept of Nutritype. Nutritype refers to the expression of overall dietary intake in metabolites; work that capable to classify individuals into a certain dietary pattern based on the metabolomics profiles. While the role of metabolomics is significance, no exploration of the Nutritype signatures has been established.

Potential significant determinants for the progression from GDM to T2DM include genetics, factors during the index pregnancy, exogenous modifiable risk factors and factors specific to intermediate biological mechanisms with no data on metabolites profile. Although the metabolomic signatures predicting GDM transition to T2DM in women post-GDM have been identified, its metabolites related to a protective dietary pattern is unknown.

This concept is timely needed as the objective assessment of dietary intake is a huge challenge that lacks biological validation. Although several biomarkers of foods exist, identification of metabolites signature that reflects overall dietary patterns is scarce. While a healthful dietary pattern such as the alternate Healthy Eating Index (aHEI) reduces the risk of T2DM among women post-GDM, none of the patterns tailored to Malaysian diet. Direct extrapolation of these findings to the overall Malaysian diet is unknown.

Therefore, the study aims to discover and identify the Nutritype signatures which combine information on dietary pattern biomarkers and metabolites profiles of T2DM risk in women post-GDM using metabolomics approach. The data will then be used to identify a predictive model of Nutritype signatures to develop protective dietary pattern works according to individuals' metabolite in preventing T2DM among women post-GDM. The findings aid in establishing an early measure of T2DM prevention in women post-GDM based on the metabolite profile that reflects the overall diet. This new exciting work leads to the goal of achieving precision diabetes-nutrition prevention using a multi-pronged strategy.

This is a cross-sectional comparative study involving women post-GDM. Women with a history of GDM will have their nutritional status, metabolite profile, dietary pattern and lifestyle practices assessed. They will undergo Oral Glucose Tolerance Test (OGTT) to determine T2DM diagnosis, based on Clinical Practice Guidelines Malaysia. Based on their OGTT results, they will be divided into 3 groups: T2DM, prediabetes (impaired fasting glucose \[IFG\] or impaired glucose tolerance \[IGT\]), or non-T2DM.

Conditions

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Type 2 Diabetes Gestational Diabetes

Keywords

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Metabolomic Nutritype Dietary Pattern

Study Design

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Observational Model Type

OTHER

Study Time Perspective

CROSS_SECTIONAL

Study Groups

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Type 2 diabetes mellitus (T2DM)

Subjects in this group are diagnosed with type 2 diabetes mellitus. They receive no intervention. Their nutritional status, metabolite profile, dietary pattern, and lifestyle practices will be assessed.

Observational

Intervention Type OTHER

Cross-sectional only

Pre-diabetes (IFG or IGT)

Subjects in this group are diagnosed with pre-diabetes (impaired fasting glucose \[IFG\] or impaired glucose tolerance \[IGT\]). They receive no intervention. Their nutritional status, metabolite profile, dietary pattern, and lifestyle practices will be assessed.

Observational

Intervention Type OTHER

Cross-sectional only

Non-type 2 diabetes mellitus (healthy)

Subjects in this group are not diagnosed with type 2 diabetes mellitus or pre-diabetes (healthy). They receive no intervention. Their nutritional status, metabolite profile, dietary pattern, and lifestyle practices will be assessed.

Observational

Intervention Type OTHER

Cross-sectional only

Interventions

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Observational

Cross-sectional only

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Malaysian women at childbearing age of 18-50 years old
* Have a history of GDM
* Women with known case of impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) with or without medications

Exclusion Criteria

* Pregnant women
* Those with prior history of type 1 or type 2 diabetes
* Recent hospitalization (within 6 weeks)
* Presence of reported or previously diagnosed medical conditions
* Receiving drugs (such as steroids and weight-reducing agents)
* Have a significant weight loss of 10% from original body weight within 3 months.
Minimum Eligible Age

18 Years

Maximum Eligible Age

50 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Ministry of Health, Malaysia

OTHER_GOV

Sponsor Role collaborator

Universiti Teknologi Mara

OTHER

Sponsor Role collaborator

Universiti Putra Malaysia

OTHER

Sponsor Role lead

Responsible Party

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Barakatun Nisak Bt Mohd Yusof

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Barakatun Nisak Mohd. Yusof, PhD

Role: PRINCIPAL_INVESTIGATOR

Universiti Putra Malaysia

Farah Yasmin Hasbullah, MSc

Role: PRINCIPAL_INVESTIGATOR

Universiti Putra Malaysia

Geeta Appannah, PhD

Role: PRINCIPAL_INVESTIGATOR

Universiti Putra Malaysia

Rohana Abdul Ghani, PhD

Role: PRINCIPAL_INVESTIGATOR

Universiti Teknologi Mara (UiTM)

Zulfitri 'Azuan Mat Daud, PhD

Role: PRINCIPAL_INVESTIGATOR

Universiti Putra Malaysia

Winnie Chee, PhD

Role: PRINCIPAL_INVESTIGATOR

International Medical University (IMU)

Locations

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Universiti Putra Malaysia

Serdang, Selangor, Malaysia

Site Status

Countries

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Malaysia

Central Contacts

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Barakatun Nisak Mohd. Yusof, PhD

Role: CONTACT

Phone: +603-97692606

Email: [email protected]

Farah Yasmin Hasbullah, MSc

Role: CONTACT

Phone: +60123235874

Email: [email protected]

References

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Allalou A, Nalla A, Prentice KJ, Liu Y, Zhang M, Dai FF, Ning X, Osborne LR, Cox BJ, Gunderson EP, Wheeler MB. A Predictive Metabolic Signature for the Transition From Gestational Diabetes Mellitus to Type 2 Diabetes. Diabetes. 2016 Sep;65(9):2529-39. doi: 10.2337/db15-1720. Epub 2016 Jun 23.

Reference Type BACKGROUND
PMID: 27338739 (View on PubMed)

Bhupathiraju SN, Hu FB. One (small) step towards precision nutrition by use of metabolomics. Lancet Diabetes Endocrinol. 2017 Mar;5(3):154-155. doi: 10.1016/S2213-8587(17)30007-4. Epub 2017 Jan 13. No abstract available.

Reference Type BACKGROUND
PMID: 28089710 (View on PubMed)

Institute for Public Health [IPH]. 2015. Vol. II: Non-communicable diseases, risk factors and other health problems. National Health and Morbidity Survey (NHMS 2015). Kuala Lumpur, Malaysia: IPH, Ministry of Health.

Reference Type BACKGROUND

Malaysian Endocrine & Metabolic Society [MEMS] and Ministry of Health [MOH] Malaysia. 2015. Management of type 2 diabetes mellitus (5th Edition). Kuala Lumpur, Malaysia: MEMS & MOH.

Reference Type BACKGROUND

Nielsen KK, Kapur A, Damm P, de Courten M, Bygbjerg IC. From screening to postpartum follow-up - the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review. BMC Pregnancy Childbirth. 2014 Jan 22;14:41. doi: 10.1186/1471-2393-14-41.

Reference Type BACKGROUND
PMID: 24450389 (View on PubMed)

O'Gorman A, Brennan L. The role of metabolomics in determination of new dietary biomarkers. Proc Nutr Soc. 2017 Aug;76(3):295-302. doi: 10.1017/S0029665116002974. Epub 2017 Jan 16.

Reference Type BACKGROUND
PMID: 28091346 (View on PubMed)

Tee ES, Yap RWK. Type 2 diabetes mellitus in Malaysia: current trends and risk factors. Eur J Clin Nutr. 2017 Jul;71(7):844-849. doi: 10.1038/ejcn.2017.44. Epub 2017 May 17.

Reference Type BACKGROUND
PMID: 28513624 (View on PubMed)

Tobias DK, Hu FB, Chavarro J, Rosner B, Mozaffarian D, Zhang C. Healthful dietary patterns and type 2 diabetes mellitus risk among women with a history of gestational diabetes mellitus. Arch Intern Med. 2012 Nov 12;172(20):1566-72. doi: 10.1001/archinternmed.2012.3747.

Reference Type BACKGROUND
PMID: 22987062 (View on PubMed)

Zhang C, Hu FB, Olsen SF, Vaag A, Gore-Langton R, Chavarro JE, Bao W, Yeung E, Bowers K, Grunnet LG, Sherman S, Kiely M, Strom M, Hansen S, Liu A, Mills J, Fan R; DWH study team. Rationale, design, and method of the Diabetes & Women's Health study--a study of long-term health implications of glucose intolerance in pregnancy and their determinants. Acta Obstet Gynecol Scand. 2014 Nov;93(11):1123-30. doi: 10.1111/aogs.12425. Epub 2014 Jun 9.

Reference Type BACKGROUND
PMID: 24828694 (View on PubMed)

Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care. 2002 Oct;25(10):1862-8. doi: 10.2337/diacare.25.10.1862.

Reference Type BACKGROUND
PMID: 12351492 (View on PubMed)

Other Identifiers

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5540099

Identifier Type: -

Identifier Source: org_study_id