The Association of the Triglyceride and Muscle to Fat Ratio During Early Pregnancy with the Development of Gestational Diabetes Mellitus

Figures & data

Figure 1 Flowchart showing recruitment in the study according to STROBE guideline.¹⁷

Table 1 Characteristics of GDM and Non-GDM Group

	NGT (n=243)	GDM (n=59)	T	P value
Age (year)	32.21±3.44	33.65±3.87	−0.263	0.008
Pre-BMI (kg/m2)	20.96±2.88	22.17±3.12	−0.274	0.006
WG within 1 month*	0.00 (−0.98, 1.13)	0.50 (−1.21, 1.06)	−1.137	0.257
Percentage of WG within 1 month* (%)	0.00 (−0.02, 0.02)	0.01 (−0.02, 0.02)	−0.941	0.347
IVF pregnancy (%)^#	9.75	10.56	3.340	0.068
Family history of T2DM (%)^#	15.63	30.00	7.310	0.003
GDM history (%)^#	1.25	4.92	5.605	0.018
Macrosomia delivery history (%)^#	1.60	1.69	0.585	0.444
LDL-C (mmol/L)	2.12±0.55	2.22±0.60	−1.019	0.310
HDL-C (mmol/L)	0.92±0.13	1.02±0.21	−1.243	0.426
TC (mmol/L)	4.17±0.61	4.38±0.68	−1.847	0.066
TG (mmol/L)	0.86±0.40	1.18±0.68	−2.477	0.017
FPG (mmol/L)	4.78±0.36	4.89±0.41	−1.905	0.058
GA (%)	13.64±1.51	13.42±1.18	1.067	0.287
FM (kg)	17.08±5.53	19.44±5.56	−2.852	0.003
BFR (%)	29.84±7.24	32.07±5.55	−2.186	0.030
VFA (cm^2)	78.15±30.04	91.02±32.36	−2.816	0.005
SMM (kg)	21.11±2.64	21.54±3.04	−1.046	0.297
SMI (kg/m^2)*	8.12 (6.61, 9.63)	7.77 (6.76, 8.81)	−1.775	0.046
SMM/FM	1.37±0.43	1.14±0.25	4.817	<0.001
Percentage of extracellular water (%)	0.38±1.51	0.38±0.01	1.134	0.059
PA (mg/L)	4.76±0.50	4.99±0.55	−2.959	0.003
OGTT 0h (mmol/L)	4.37±0.44	4.75±0.48	−5.561	<0.001
OGTT 1h (mmol/L)	7.30±1.32	9.65±1.44	−11.587	<0.001
OGTT 2h (mmol/L)	6.20±1.13	9.04±1.34	−15.872	<0.001

Notes: Normally distributed data are presented by mean± SD. *Non-normally distributed data are presented by median and IQR. ^#Chi-square value was used to compare the category data.

Abbreviations: BFR, body fat ratio; FM, fat mass; GA, glycated albumin; FPG, fasting plasma glucose; GDM, gestational diabetes mellitus; IVF, in Vitro fertilization; LDL, C, low, density lipoprotein cholesterol; PA, phase angle; pre, BMI, body mass index before pregnancy; SMI, Skeletal muscle index; SMM, Skeletal muscle mass; TC, total cholesterol; TG, triglycerides; VFA, visceral fat area; WG, weight gain.

Table 2 Pearson’s Correlation Analysis Associated with GDM Diagnosis

Variables	r	P value	r^	P value^
Age	0.232	0.030	–	–
Pre-BMI	0.300	0.005	–	–
WG within 1 month	0.116	0.281	0.131	0.349
Percentage of WG within 1 month	0.035	0.743	0.004	0.975
LDL-C	0.140	0.281	0.050	0.721
HDL-C	0.072	0.425	0.040	0.817
TC	0.143	0.267	0.158	0.257
TG	0.313	0.014	0.376	0.012
FPG	0.087	0.472	0.150	0.312
GA	−0.166	0.124	0.018	0.797
FM	0.250	0.019	0.157	0.055
BFR	0.164	0.126	0.189	0.047
VFA	0.242	0.044	0.123	0.134
SMM	0.287	0.041	0.069	0.529
SMI	0.319	0.006	−0.253	0.024
SMM/FM	0.362	0.001	−0.397	<0.001
Extracellular water	0.176	0.100	−0.010	0.879
PA	0.310	0.003	0.130	0.237
GDM history	0.113	0.294	–	–
IVF	0.131	0.224	0.043	0.695
Family history of T2DM	0.227	0.003	–	–

Note: ^Adjusted for age, pre-BMI, family history of T2DM, and GDM history.

Abbreviations: BFR, body fat ratio; FM, fat mass; FPG, fasting plasma glucose; GA, glycated albumin; GDM, gestational diabetes mellitus; IVF, in Vitro fertilization; LDL, C-low-density lipoprotein cholesterol; TC, total cholesterol; TG, triglycerides; SMM, skeletal muscle mass; SMI, skeletal muscle index; PA, phase angle; pre-BMI, body mass index before pregnancy; VFA, visceral fat area; WG, weight gain.

Table 3 Poisson Regression Analysis

	Single-Factor Model		Multiple-Factor Model
Variables	RRs (95% CI)	P-value	RRs (95% CI)	P-value
Age	1.080 (1.022–1.141)	<0.0001	1.076 (1.005–1.152)	0.036
Pre-BMI	1.099 (1.039–1.163)	0.001	1.012 (1.005–1.063)	0.044
FPG	1.638 (0.918–2.923)	0.095
GA	0.857 (0.710–1.035)	0.109
TG	1.724 (1.342–2.214)	<0.0001	4.052 (1.641–6.741)	0.025
TC	1.564 (1.082–2.261)	0.017
HDL-C	0.613 (0.729–1.213)	0.412
LDL-C	1.361 (0.819–2.263)	0.234
BFR	1.025 (0.999–1.052)	0.062
VFA	1.010 (1.003–1.016)	0.032
SMM	1.050 (0.976–1.130)	0.193
SMI	1.246 (1.045–1.486)	0.014
SMM/FM	0.406 (0.208–0.794)	0.008	0.213 (0.051–0.890)	0.034
GDM History	2.685 (1.248–5.776)	<0.0001	1.486 (0.891–4.422)	0.093
IVF pregnancy	1.647 (1.001–2.708)	0.049
Family history of T2DM	1.764 (1.136–2.740)	0.012	1.496 (1.014–2.667)	0.045

Abbreviations: BFR, body fat ratio; FPG, fasting plasma glucose; GA, glycated albumin; GDM, gestational diabetes mellitus; IVF, in Vitro fertilization; LDL, C-low-density lipoprotein cholesterol; pre-BMI, body mass index before pregnancy; SMI, skeletal muscle index; SMM, skeletal muscle mass; TC, total cholesterol; TG, triglycerides; VFA, visceral fat area.

Table 4 AUC for Variables Computed with ROC Analysis for GDM

Predictive Variables	AUC	95% CI	P value
Pre-BMI	0.609	0.500–0.751	0.039
VFA	0.630	0.525–0.745	0.042
SMI	0.632	0.521–0.764	0.035
SMM/FM	0.602	0.502–0.705	0.051
TG	0.676	0.576–0.787	0.027

Abbreviations: Pre-BMI, body mass index before pregnancy; SMI, skeletal muscle index; SMM/FM, skeletal muscle mass/fat mass; TG, triglycerides; VFA, visceral fat area.

Figure 2 ROC curves for the accuracy of the GDM prediction model.

Figure 3 Relationships between adipose tissue, skeletal muscle, blood glucose and TG. This figure summarizes the relevance of inadequate muscle to increased blood glucose and FFA, and insulin resistance via inflammation and cytokines; and the relevance of excessive of adipose tissue to the increased TG and insulin resistance via inflammatory pathways. High level of FFA can cause hypertriglyceride, insulin resistance, and toxicity to muscle directly. Poor glucose control will lead to muscle loss.

Vandenbroucke JP, von Elm E, Altman DG, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg. 2014;12(12):1500–1524. doi:10.1016/j.ijsu.2014.07.014

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