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      Could gestational diabetes mellitus be managed through dietary bioactive compounds? Current knowledge and future perspectives

      research-article
      1 , 2 , 3 , 1 , 2 , 3 , 1
      The British Journal of Nutrition
      Cambridge University Press
      Gestational diabetes mellitus, Mediterranean diet, Dietary polyphenols, Adipokines, Molecular mechanisms, PUFA, MicroRNA, Akt, protein kinase B, ALA, α-linolenic acid, AMPK, AMP-activated protein kinase, AT, adipose tissue, C3G, cyanidin-3-glucoside, EGCG, epigallocatechin gallate, FA, fatty acids, FABP, FA-binding protein, GDM, gestational diabetes mellitus, IR, insulin resistance, IRS-1, insulin receptor substrate 1, LA, linoleic acid, LC-PUFA, long-chain PUFA, MedDiet, Mediterranean-style diet, miRNA, microRNA, RSV, resveratrol, T2D, type 2 diabetes

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          Abstract

          Gestational diabetes mellitus (GDM) is a serious problem growing worldwide that needs to be addressed with urgency in consideration of the resulting severe complications for both mother and fetus. Growing evidence indicates that a healthy diet rich in fruit, vegetables, nuts, extra-virgin olive oil and fish has beneficial effects in both the prevention and management of several human diseases and metabolic disorders. In this review, we discuss the latest data concerning the effects of dietary bioactive compounds such as polyphenols and PUFA on the molecular mechanisms regulating glucose homoeostasis. Several studies, mostly based on in vitro and animal models, indicate that dietary polyphenols, mainly flavonoids, positively modulate the insulin signalling pathway by attenuating hyperglycaemia and insulin resistance, reducing inflammatory adipokines, and modifying microRNA (miRNA) profiles. Very few data about the influence of dietary exposure on GDM outcomes are available, although this approach deserves careful consideration. Further investigation, which includes exploring the ‘omics’ world, is needed to better understand the complex interaction between dietary compounds and GDM.

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          Most cited references135

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          Polyphenols: chemistry, dietary sources, metabolism, and nutritional significance.

          Polyphenols constitute one of the most numerous and ubiquitous groups of plant metabolites and are an integral part of both human and animal diets. Ranging from simple phenolic molecules to highly polymerized compounds with molecular weights of greater than 30,000 Da, the occurrence of this complex group of substances in plant foods is extremely variable. Polyphenols traditionally have been considered antinutrients by animal nutritionists, because of the adverse effect of tannins, one type of polyphenol, on protein digestibility. However, recent interest in food phenolics has increased greatly, owing to their antioxidant capacity (free radical scavenging and metal chelating activities) and their possible beneficial implications in human health, such as in the treatment and prevention of cancer, cardiovascular disease, and other pathologies. Much of the literature refers to a single group of plant phenolics, the flavonoids. This review offers an overview of the nutritional effects of the main groups of polyphenolic compounds, including their metabolism, effects on nutrient bioavailability, and antioxidant activity, as well as a brief description of the chemistry of polyphenols and their occurrence in plant foods.
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            Impact of Dietary Polyphenols on Carbohydrate Metabolism

            Polyphenols, including flavonoids, phenolic acids, proanthocyanidins and resveratrol, are a large and heterogeneous group of phytochemicals in plant-based foods, such as tea, coffee, wine, cocoa, cereal grains, soy, fruits and berries. Growing evidence indicates that various dietary polyphenols may influence carbohydrate metabolism at many levels. In animal models and a limited number of human studies carried out so far, polyphenols and foods or beverages rich in polyphenols have attenuated postprandial glycemic responses and fasting hyperglycemia, and improved acute insulin secretion and insulin sensitivity. The possible mechanisms include inhibition of carbohydrate digestion and glucose absorption in the intestine, stimulation of insulin secretion from the pancreatic β–cells, modulation of glucose release from the liver, activation of insulin receptors and glucose uptake in the insulin-sensitive tissues, and modulation of intracellular signalling pathways and gene expression. The positive effects of polyphenols on glucose homeostasis observed in a large number of in vitro and animal models are supported by epidemiological evidence on polyphenol-rich diets. To confirm the implications of polyphenol consumption for prevention of insulin resistance, metabolic syndrome and eventually type 2 diabetes, human trials with well-defined diets, controlled study designs and clinically relevant end-points together with holistic approaches e.g., systems biology profiling technologies are needed.
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              Bioavailability of the Polyphenols: Status and Controversies

              The current interest in polyphenols has been driven primarily by epidemiological studies. However, to establish conclusive evidence for the effectiveness of dietary polyphenols in disease prevention, it is useful to better define the bioavailability of the polyphenols, so that their biological activity can be evaluated. The bioavailability appears to differ greatly among the various phenolic compounds, and the most abundant ones in our diet are not necessarily those that have the best bioavailability profile. In the present review, we focus on the factors influencing the bioavailability of the polyphenols. Moreover, a critical overview on the difficulties and the controversies of the studies on the bioavailability is discussed.
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                Author and article information

                Journal
                Br J Nutr
                Br. J. Nutr
                BJN
                The British Journal of Nutrition
                Cambridge University Press (Cambridge, UK )
                0007-1145
                1475-2662
                16 February 2016
                14 April 2016
                : 115
                : 7
                : 1129-1144
                Affiliations
                [1 ]Department of Veterinary Public Health and Food Safety, Unit of Nutrition, Italian National Institute of Health , Viale Regina Elena 299, 00161 Rome, Italy
                [2 ]Department of Experimental Medicine, 2nd Section of Cell Pathology, Sapienza University of Rome , Viale Regina Elena 324, 00161 Rome, Italy
                [3 ]Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome , Viale Regina Elena 324, 00161 Rome, Italy
                Author notes
                [* ] Corresponding author: C. Santangelo, email carmela.santangelo@ 123456iss.it
                Article
                S0007114516000222 00022
                10.1017/S0007114516000222
                4825102
                26879600
                2624b762-0d1f-47ce-83cf-2427af2e5e92
                © The Authors 2016

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 26 March 2015
                : 11 November 2015
                : 23 December 2015
                Page count
                Figures: 2, Tables: 2, Pages: 16
                Categories
                Full Papers
                Molecular Nutrition

                Nutrition & Dietetics
                gestational diabetes mellitus,mediterranean diet,dietary polyphenols,adipokines,molecular mechanisms,pufa,microrna

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