Applied nutritional investigationEffects of selenium supplementation on glucose homeostasis, inflammation, and oxidative stress in gestational diabetes: Randomized, double-blind, placebo-controlled trial
Introduction
Gestational diabetes mellitus (GDM) is a common complication of pregnancy that has been defined as impaired insulin metabolism and carbohydrate intolerance of varying degrees of severity with onset or first recognition during pregnancy [1]. Requirement for selenium is increased during pregnancy [2]. Selenium is involved in inhibiting the expression of cyclooxygenase (COX)-2 and P-selectin [3], therefore, its nutritional inadequacy during pregnancy might increase the risk for GDM. Mean serum levels of selenium are less than normal in healthy Iranian women [4]. On the other hand, the prevalence of GDM in Iranian pregnant women is 4.7% [5]. It is associated with short- and long-term health complications for the mother, fetus, and the neonate [6]. Additionally, previous studies have reported that hyperglycemia in patients with diabetes could result in increased oxidative stress and nitrosative stress [7]. Poor glycemic control in these patients has been associated with the depletion of serum antioxidant activity [8].
Several dietary [9], [10] and nondietary [11], [12] strategies have been proposed for management of GDM. Some studies have reported a significant inverse association between body selenium status and plasma glucose levels in patients with GDM [13], [14]. Others have shown that selenium supplementation in pregnant women might result in decreased oxidative stress and improved pregnancy outcomes [15], [16]. Dietary sources of selenium are nuts, cereals, meat, mushrooms, fish, and eggs [17]. Selenium is an important component of the enzymes that protect cells from the adverse effects of free radicals [18]. Selenium is also involved in the production of thyroid hormones and has been shown to contain anti-inflammatory effects [19]. Current data supports the beneficial effect of selenium on hypertension [20], coronary artery disease [21], certain cancers [22], and inflammatory diseases [23]. Others have examined the efficacy of selenium supplementation in cancers [24]. Some studies have indicated [25] a significant decrease in serum insulin levels and insulin resistance in centrally obese women after supplementation with 200 μg/d selenium added to a hypocaloric diet enriched with legumes; however, no significant effect on lipid profiles, inflammatory factors, and biomarkers of oxidative stress have been reported. Additionally, selenium supplementation has resulted in increased erythrocyte and plasma total antioxidant status (TAS), erythrocyte-reduced glutathione (GSH) and glutathione peroxidase (GPx) in patients with epilepsy and refractory epilepsy [26].
Selenium supplementation might affect glucose homeostasis, inflammation, and oxidative stress by inhibiting the production of advanced glycation end products [3] and decreased free radical production and lipid hydroperoxides [27]. Therefore, we hypothesized that selenium supplementation might affect the metabolic status of pregnant women with GDM. We are not aware of any studies that examined the effect of selenium supplementation on glucose homeostasis, lipid profiles, inflammatory factors, and biomarkers of oxidative stress in women with GDM. This study aimed to investigate the effect of selenium supplementation on the metabolic profile of women with GDM who were not on oral hypoglycemic agents (OHAs).
Section snippets
Participants
This randomized, double-blind, placebo-controlled trial was conducted in Arak, Iran, from February to April 2014. For estimating sample size, we considered type 1 (α) and type 2 errors (β) of 0.05 and 0.20 (power = 80%), respectively, and homeostasis model of assessment-insulin resistance (HOMA-IR) as a key variable. Based on a previous study [25], SD of HOMA-IR was 0.4 and the difference in mean (d) of HOMA-IR was 0.3. We reached the sample size of 28 women for each group using the suggested
Randomization characteristics
Three women from the selenium group were excluded: one because of IUFD; two were hospitalized. Two women in the placebo group were excluded: one for placenta abruption and one because she required insulin therapy. Finally, 65 participants (selenium group n = 32; placebo group n = 33) completed the trial (Fig. 1). However, as the analysis was done based on an intention-to-treat approach, all 70 women (35 in each group) were included in the final analysis. On average, the rate of compliance in
Discussion
Our findings demonstrated that selenium supplementation in pregnant women with GDM led to improved glucose homeostasis, reduced inflammation, and improved oxidative stress; however, it did not affect lipid profiles or plasma NO. To the best of our knowledge, this was the first study to examine the effects of selenium supplementation on glucose homeostasis, inflammation, and biomarkers of oxidative stress in pregnant women with GDM.
No side effects were reported after selenium administration in
Conclusion
Selenium supplementation in pregnant women with GDM had beneficial effects on glucose homeostasis, hs-CRP levels, and biomarkers of oxidative stress.
Acknowledgment
The authors acknowledge the staff of Taleghani and Emam Reza Clinics (Arak, Iran) for their assistance in this project.
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The present study was supported by a grant from the vice-chancellor for research, AUMS, and Iran. ZA conducted the study, carried out the statistical analyses, wrote the manuscript, and contributed to the interpretation of the findings. MJ and EM contributed to the data collection and assisted in writing the manuscript. AE contributed to the conception and design and also advised on statistical analyses and assisted in interpretation of the findings. None of the authors had any personal or financial conflict of interest. All authors approved the final version for submission. None of the authors had any personal or financial conflicts of interest to disclose.