Razi Journal of Medical Sciences

fa تاثیر تمرین یوگا همراه با رژیم غذایی DASH برسطوح پلاسمایی ویتامین D و کلسیم زنان مبتلا به دیابت بارداری The effect of yoga training with DASH diet on plasma levels of vitamin D and calcium in female with gestational diabetes علوم تغذیه Nutrition Sciences پژوهشي Research زمینه و هدف: ویتامین D یکی از ریزمغذی‌هایی است که در ارتباط با مقاوت به انسولین می‌باشد. هدف تحقیق حاضر بررسی اثر هشت هفته ورزش یوگا به همراه رژیم غذایی DASH بر سطوح پلاسمایی ویتامین D و کلسیم زنان مبتلا به دیابت بارداری بود. روش کار: در تحقیق نیمه تجربی حاضر 20 زن مبتلا به دیابت بارداری به سه گروه تمرین یوگا (8 نفر)، رژیم DASH (5 نفر) و تمرین همراه با رژیم (7 نفر)  تقسیم شدند. برنامه تمرین شامل هشت هفته تمرینات یوگا، سه جلسه در هفته و هر جلسه نیز به مدت 60-50 دقیقه بود. رژیم غذایی DASH نیز طبق برنامه متخصصص تغذیه کنترل شد. خونگیری قبل و پس از هشت هفته مداخلات اندازه گیری شد. برای بررسی تغییرات درون گروهی و بین گروهی به ترتیب از آزمون t همبسته و تحلیل کوواریانس و با استفاده از نرم افزار SPSS نسخه 22 و سطح معنی داری 05/0 ≥ P استفاده شد. یافته‌ها: کاهش معنی داری در سطح ویتامین D در گروه تمرین (017/0 = P) و افزایش معنی داری در سطح کلسیم گروه DASH (009/0 = P) و کاهش معنی داری در قند خون ناشتا در گروه ترکیبی (019/0 = P) و DASH (008/0 = P) مشاهده شد. کاهش قند خون ناشتا در گروه ترکیبی به صورت معنی داری بیشتر از گروه DASH بود (045/0 = P). نتیجه‌گیری: با توجه به نتایج تحقیق حاضر می توان گفت که روش های مداخله تمرین یوگا و رژیم غذایی DASH روش‌های مناسبی برای کنترل گلیسمیک در دیابت بارداری هستند. Background and Aims: Gestational diabetes mellitus (GDM) is a type of diabetes in which a pregnant woman develops glucose intolerance between 24 and 28 weeks of gestation (1). This type of diabetes usually resolves after delivery, but may pose risks to the mother and baby during pregnancy or after delivery (1). The results of some studies have shown that vitamin D can play a role in insulin secretion and dysfunction (13, 14). Maternal vitamin D deficiency is associated with preeclampsia, gestational diabetes, reduced birth size, preterm delivery, and adverse outcomes such as rickets, skeletal problems, diabetes, schizophrenia, developmental disorders, fetal immune dysfunction and asthma (13). The most important known role for vitamin D is to help balance and absorb calcium; Researches have shown that almost all cells in the body have vitamin D receptors. Vitamin D plays an important role in coordinating the immune system, preventing malignancy, controlling blood pressure and regulating blood sugar. Vitamin D plays a key role in insulin secretion and function, and there is a significant association between vitamin D deficiency and the incidence of insulin resistance and diabetes (15, 16). During pregnancy, significant changes in calcium and vitamin D metabolism occur in pregnant women to provide the calcium needed for fetal ossification. About 30 grams of calcium is transferred from the mother to the fetal skeleton by the end of pregnancy, and it is estimated that the fetus can receive more than 150 micrograms per kilogram of this amount daily through active transfer from the placenta during the third trimester of pregnancy (17). Regarding the importance of calcium and vitamin D, Asemi et al. In an interventional study showed that vitamin D and calcium supplementation can have positive effects on the metabolic profile of women with GDM (18). Exercise training is one of the main pillars of blood sugar control in diabetic patients (19). Non-pharmacological interventions to control blood sugar in GDM include lifestyle changes in mothers with GDM such as increased levels of daily physical activity (1, 20) and diet (21). One of the diets that is also useful for diabetics is the diet to stop high blood pressure (DASH) (25, 26). The DASH diet is a low-calorie, low-glycemic index diet. This diet contains large amounts of dietary fiber, phytoestrogens, potassium, calcium, magnesium and folic acid, and the beneficial effects of these components on gestational diabetes have been identified (27, 28). Given the importance of vitamin D and calcium in GDM, and given that no specific research has been done to compare the effect of DASH diet and yoga exercise as two non-pharmacological intervention methods in GDM; The aim of this study was to answer the question of whether there is a difference between the effect of regular yoga exercise and DASH diet alone and in combination on the control of blood glycemic and serum levels of vitamin D and calcium in women with GDM. Methods: In this quasi-experimental study, 20 women with gestational diabetes were divided into three groups, yoga training (n=8), DASH diet (n=5) and training with diet (n=7). The exercise protocol consisted of eight weeks of yoga practice, three sessions per week, and each session lasted 50-60 minutes. The DASH diet was also controlled by a nutritionist. Blood samples were taken before and after eight weeks of interventions. In order to investigate the intra- and inter-group changes, respectively, t-test and covariance analysis and using SPSS software version 22 and a significant level of P 05 0.05 was used. Results: Significant decrease was founded in vitamin D level in yoga training group (P = 0.017) and significant increase was founded calcium level in DASH group (P = 0.009) and significant decrease was founded in FBS in Combined group (P = 0.019) and DASH (P = 0.008). Fasting blood sugar reduction in the combined group was significantly higher than in the DASH group (P = 0.045). Conclusion: In the present study, all three intervention groups reduced fasting blood sugar in women with gestational diabetes, but this blood glycemic control was higher in the combined exercise group (yoga training with DASH diet) than the DASH group, which indicates the importance of diet combination and exercise control on blood glycemic. Regarding the effect of exercise on glucose uptake, it can be said that acute exercise stimulates glucose uptake through the upregulation of exercise on GLUT4 levels in skeletal muscle membranes. This effect is independent of insulin and glucose uptake continues for several hours after the end of exercise. Second, exercise increases insulin sensitivity in skeletal muscle. This effect lasts for several hours after the end of exercise and is clearly insulin dependent (19, 34, 35). Also, due to the fact that the DASH diet has limited the consumption of foods with high glycemic index, it has reduced blood sugar levels and controlled gestational diabetes. On the other hand, this diet includes large amounts of dietary fiber, phytoestrogens, potassium, calcium, magnesium and folic acid , which can be shown to have beneficial effects of these components on reducing insulin resistance in gestational diabetes (27, 28). In comparison between the methods, the fasting blood glycemic level in the combined group was significantly lower than the DASH diet group alone, which indicates the role of regular exercise in glycemic control in gestational diabetes. After eight weeks of yoga practice, a significant reduction in vitamin D was observed; however, in the group comparison, no significant difference was observed between the research groups and the average of 25-hydroxyvitamin D was still in the range of vitamin D deficiency. These findings suggest that none of the clinical intervention methods are effective on vitamin D levels in women with gestational diabetes. After the research interventions, a significant increase in plasma calcium levels was observed in the DASH diet group, but there was no significant difference between the intervention groups in the study of intergroup changes. Given that vitamin D is one of the parameters associated with serum calcium (40, 43). Overall, the findings of the present study showed that if you combine yoga exercise and DASH diet, you can achieve better results in glycemic control of women with gestational diabetes. Considering that the decrease in vitamin D levels was less in DASH and combination groups than in yoga exercises, it can be said that nutritional interventions are needed to prevent vitamin D deficiency as one of the important vitamins during pregnancy in gestational diabetes.   دیابت بارداری, تمرین یوگا, رژیم غذایی DASH, ویتامین D, کلسیم Gestational Diabetes, Yoga Training, DASH Diet, Vitamin D, Calcium 33 43 http://rjms.iums.ac.ir/browse.php?a_code=A-10-5103-1&slc_lang=fa&sid=1 Kobra Ayashizadeh کبری عیاشی زاده k.ayashizadeh@yahoo.com 3900319475328460056859 3900319475328460056859 No Islamic Azad University, Ahvaz, Iran دانشگاه آزاد اسلامی، اهواز، ایران Mohammad Galedari محمد گله داری Researchayashizadeh@gmail.com 3900319475328460056860 3900319475328460056860 Yes Islamic Azad University, Ahvaz, Iran دانشگاه آزاد اسلامی، اهواز، ایران