human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: HighlightsChemerin and leptin are increased , omentin‐1 and visfatin are decreased in at term GDM‐obese women .  Chemerin and omentin‐1 are expressed mainly by the maternal VAT . Leptin is expressed mainly in maternal SAT.Circulating chemerin and leptin in at term pregnancy correlate with BMI and HOMA‐IR.Chemerin and leptin could contribute to insulin resistance and low grade inflammation that characterizes GDM women complicated by obesity . Weight control during pregnancy is necessary to avoid adverse metabolic complications for the mother and the offspring . & NA ; Maternal adipose tissue and the placenta secrete various molecules commonly called adipokines such as chemerin , omentin‐1 , visfatin , adiponectin , and leptin that are important players in the pathogenesis of insulin resistance . Gestational diabetes mellitus ( GDM ) is defined as a state of glucose intolerance characterized by & bgr;‐cell dysfunction and insulin resistance . To examine whether circulating adipokines and their mRNA expression in the adipose tissue and the placenta are altered in GDM pregnancy , we compared 15 GDM women [ obese ( BMI > 30 ) and non‐obese ( BMI < 30 ) ] to 23 NGT ( normal glucose tolerance ) women [ obese and non‐obese ] , at the time of the Cesarean section .  Circulating chemerin and leptin were higher ( p = 0.009 and p = 0.005 , respectively ) and circulating omentin‐1 , visfatin , as well as the adiponectin/leptin ratio were lower ( p = 0.039 , p = 0.007 and p = 0.011 , respectively ) in GDM‐obese compared to NGT‐non‐obese women . Chemerin and leptin correlated positively with BMI and HOMA‐IR and omentin‐1 correlated negatively with BMI . Serum TNF‐&agr ; was significantly elevated in all obese compared to non‐obese pregnant women and correlated positively with BMI . Adiponectin levels were reduced ‐although not significantly‐ in GDM‐ and NGT‐obese women compared to their non‐obese counterparts . Resistin , RPB4 and IL‐6 levels did not differ significantly between groups . Chemerin mRNA expression in subcutaneous adipose tissue ( SAT ) and visceral adipose tissue ( VAT ) was significantly higher compared to placenta in all women ( 6‐to 24‐times , p < 0.05 ) . Chemerin‐VAT mRNA expression in GDM‐obese tended to be significantly higher compared to NGT‐non‐obese women ( 3‐times , p = 0.005 ) . Omentin‐1 mRNA expression was significantly higher in VAT compared to SAT ( 50‐ to 100‐times , p < 0.01 ) and its expression in placenta was negligible in all women . Although , leptin was expressed significantly higher in SAT compared to VAT and the placenta in all women ( 5‐ to 46‐times , p < 0.05 ) , only its mRNA expression in VAT of obese ( GDM and NGT ) differed significantly when compared to NGT‐non‐obese women ( 3‐times higher , p < 0.02 ) . Visfatin mRNA expression was comparable in all tissues . In conclusion , chemerin and leptin are elevated and omentin‐1 and visfatin levels are decreased in GDM women complicated by obesity . This finding together with the positive association of chemerin and leptin with markers of insulin resistance , suggests that these adipokines and more especially chemerin and leptin accompanied by their adipose tissue expression could contribute to the increased insulin resistance and low grade inflammation that characterizes GDM‐obese women Purpose To evaluate the effect of gestational diabetes on omentin-1 in maternal and cord plasma . As a potent mediator of insulin resistance , Omentin-1 , an adipokine derived from human adipose and placental tissue , may be an important player in the pathophysiology of gestational diabetes . Methods This was a prospect i ve case – control study . The study included 96 women with gestational diabetes and 96 pregnant women without .  Omentin-1  was measured at the time of the oral glucose tolerance test , at 32 weeks in maternal plasma and right after delivery in umbilical cord blood by ELISA assay . Results Over a period of 2 years , 200 patients were enrolled . Omentin-1 levels did not significantly differ between both groups throughout the pregnancy : omentin-1 levels were 157 ± 83 ng/ml in women with gestational diabetes and 158 ± 93 ng/ml in women without gestational diabetes ( p = 0.94 ) at time of the oral glucose tolerance test and 118 ± 77 ng/ml in women with diabetes and 150 ± 89 ng/ml in women without ( p = 0.12 ) at 32 weeks , respectively . Both groups showed a decrease in omentin-1 levels throughout pregnancy , with a more pronounced decrease in diabetic women ( 13 ± 53 versus 4 ± 48 ng/ml ; p = 0.5 ) . Neonatal omentin-1 levels were significantly lower in offspring of diabetic mothers : 106 ± 61 versus 134 ± 45 ng/ml ( p = 0.03 ) . Conclusions There was no significant difference in omentin-1 levels between healthy and diabetic mothers throughout the pregnancy . However , we found significantly lower omentin-1 levels in offspring of diabetic mothers . This may indicate a risk for the development of insulin resistance in later life Background Maternal overweight , obesity and consequently the incidence of gestational diabetes are increasing rapidly worldwide . The objective of the study was to assess the efficacy and cost-effectiveness of a combined diet and physical activity intervention implemented before , during and after pregnancy in a primary health care setting for preventing gestational diabetes , later type 2 diabetes and other metabolic consequences . Methods RADIEL is a r and omized controlled multi-center intervention trial in women at high risk for diabetes ( a previous history of gestational diabetes or prepregnancy BMI ≥30 kg/m2 ) . Participants planning pregnancy or in the first half of pregnancy were parallel-group r and omized into an intervention arm which received lifestyle counseling and a control arm which received usual care given at their local antenatal clinics . All participants visited a study nurse every three months before and during pregnancy , and at 6 weeks , 6 and 12 months postpartum . Measurements and laboratory tests were performed on all participants with special focus on dietary and exercise habits and metabolic markers . Of the 728 women [ mean age 32.5 years ( SD 4.7 ) ; median parity 1 ( range 0 - 9 ) ] considered to be eligible for the study 235 were non-pregnant and 493 pregnant [ mean gestational age 13 ( range 6 to 18 ) weeks ] at the time of enrollment . The proportion of nulliparous women was 29.8 % ( n = 217 ) . Out of all participants , 79.6 % of the non-pregnant and 40.4 % of the pregnant women had previous gestational diabetes and 20.4 % of the non-pregnant and 59.6 % of the pregnant women were recruited because of a prepregnancy BMI  ≥30 kg/m2 . Mean BMI at first visit was 30.1 kg/m2 ( SD 6.2 ) in the non-pregnant and 32.7 kg/m2 ( SD 5.6 ) in the pregnant group . Discussion To our knowledge , this is the first r and omized lifestyle intervention trial , which includes , besides the pregnancy period , both the prepregnancy and the postpartum period . This study design also provides an opportunity to focus upon the health of the next generation . The study is expected to produce novel information on the optimal timing and setting of interventions and for allocating re sources to prevent obesity and diabetes in women of reproductive age . Trial registration Clinical trials.gov Identifier : AIM To examine the prediction of gestational diabetes in obese women using routine clinical measures and measurement of biomarkers related to insulin resistance in the early second trimester . METHODS A total of 117 obese pregnant women participating in a pilot trial of a complex intervention of dietary advice and physical activity  were studied . Blood sample s were obtained at recruitment ( 15⁺⁰-17⁺⁶ weeks ' gestation ) and demographic , clinical history and anthropometric measures recorded . The biomarkers analysed were plasma lipids ( HDL cholesterol , LDL cholesterol , triglycerides ) , high-sensitivity C-reactive protein , alanine transaminase , aspartate transaminase , ferritin , fructosamine , insulin , adiponectin , tissue plasminogen activator , interleukin-6 , visfatin and leptin . Univariate and logistic regression analyses were performed to determine independent predictors and area under the receiver-operating curve was calculated for the model . RESULTS Of the 106 participants included in the analysis , 29 ( 27.4 % ) developed gestational diabetes . Participants with gestational diabetes were older ( P = 0.002 ) , more often of parity ≥ 2 , had higher systolic ( P = 0.02 ) and diastolic blood pressure ( P = 0.02 ) and were more likely to be black ( P = 0.009 ) . Amongst the blood biomarkers measured , plasma adiponectin alone remained independently associated with gestational diabetes in adjusted models ( P = 0.002 ) . The area under the receiver-operating curve for clinical factors alone ( 0.760 ) increased significantly ( area under the curve 0.834 , chi-square statistic ( 1 ) = 4.00 , P = 0.046 ) with the addition of adiponectin . CONCLUSIONS A combination of routinely measured clinical factors and adiponectin measured in the early second trimester in obese women may provide a useful approach to the prediction of gestational diabetes . Validation in a large prospect i ve study is required to determine the usefulness of this algorithm in clinical practice Background Obesity is increasing in the child-bearing population as are the rates of gestational diabetes . Gestational diabetes is associated with higher rates of Cesarean Section for the mother and increased risks of macrosomia , higher body fat mass , respiratory distress and hypoglycemia for the infant . Prevention of gestational diabetes through life style intervention has proven to be difficult . A Finnish study showed that ingestion of specific probiotics altered the composition of the gut microbiome and thereby metabolism from early gestation and decreased rates of gestational diabetes in normal weight women . In SPRING ( the Study of Probiotics IN the prevention of Gestational diabetes ) , the effectiveness of probiotics ingestion for the prevention of gestational diabetes will be assessed in overweight and obese women . Methods / design SPRING is a multi-center , prospect i ve , double-blind r and omized controlled trial run at two tertiary maternity hospitals in Brisbane , Australia . Five hundred and forty ( 540 ) women with a BMI > 25.0 kg/m2 will be recruited over 2 years and receive either probiotics or placebo capsules from 16 weeks gestation until delivery . The probiotics capsules contain > 1x109 cfu each of Lactobacillus rhamnosus GG and Bifidobacterium lactis BB-12 per capsule . The primary outcome is diagnosis of gestational diabetes at 28 weeks gestation . Secondary outcomes include rates of other pregnancy complications , gestational weight gain , mode of delivery , change in gut microbiome , preterm birth , macrosomia , and infant body composition . The trial has 80 % power at a 5 % 2-sided significance level to detect a > 50 % change in the rates of gestational diabetes in this high-risk group of pregnant women . Discussion SPRING will show if probiotics can be used as an easily implementable method of preventing gestational diabetes in the high-risk group of overweight and obese pregnant women Abstract Introduction : Gestational diabetes mellitus ( GDM ) occurs in ∼10–25 % of pregnancies . Nesfatin-1 , plays a role in carbohydrate metabolism by inhibiting glucagon secretion , besides has a glucose-dependent insulinotropic effect . Explanation of the GDM pathogenesis is important due to preventing gestational complications . We aim ed to investigate relationship between GDM and Nesfatin-1 . Material and methods : Seventy-nine pregnant subjects were r and omly allocated to either GDM group ( GDG , n = 38 ) or control group ( CG , n = 41 ) . For GDM diagnosis , 50 and 100 g oral glucose tolerance test ( OGTT ) were used . Nesfatin-1 , insulin and other parameters were measured for all subjects . The homeostasis model assessment -insulin resistance ( HOMA-IR ) was calculated . Results : Nesfatin-1 was found lower and insulin was found higher in GDG than CG . Negative correlation has been founded between Nesfatin-1 with weight , BMI , fasting glucose , serum glucose level at first hour of the 50 g OGTT and HOMA-IR . Conclusion : In this 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: HighlightsChemerin and leptin are increased , omentin‐1 and visfatin are decreased in at term GDM‐obese women .  Chemerin and omentin‐1 are expressed mainly by the maternal VAT . Leptin is expressed mainly in maternal SAT.Circulating chemerin and leptin in at term pregnancy correlate with BMI and HOMA‐IR.Chemerin and leptin could contribute to insulin resistance and low grade inflammation that characterizes GDM women complicated by obesity . Weight control during pregnancy is necessary to avoid adverse metabolic complications for the mother and the offspring . & NA ; Maternal adipose tissue and the placenta secrete various molecules commonly called adipokines such as chemerin , omentin‐1 , visfatin , adiponectin , and leptin that are important players in the pathogenesis of insulin resistance . Gestational diabetes mellitus ( GDM ) is defined as a state of glucose intolerance characterized by & bgr;‐cell dysfunction and insulin resistance . To examine whether circulating adipokines and their mRNA expression in the adipose tissue and the placenta are altered in GDM pregnancy , we compared 15 GDM women [ obese ( BMI > 30 ) and non‐obese ( BMI < 30 ) ] to 23 NGT ( normal glucose tolerance ) women [ obese and non‐obese ] , at the time of the Cesarean section .  Circulating chemerin and leptin were higher ( p = 0.009 and p = 0.005 , respectively ) and circulating omentin‐1 , visfatin , as well as the adiponectin/leptin ratio were lower ( p = 0.039 , p = 0.007 and p = 0.011 , respectively ) in GDM‐obese compared to NGT‐non‐obese women . Chemerin and leptin correlated positively with BMI and HOMA‐IR and omentin‐1 correlated negatively with BMI . Serum TNF‐&agr ; was significantly elevated in all obese compared to non‐obese pregnant women and correlated positively with BMI . Adiponectin levels were reduced ‐although not significantly‐ in GDM‐ and NGT‐obese women compared to their non‐obese counterparts . Resistin , RPB4 and IL‐6 levels did not differ significantly between groups . Chemerin mRNA expression in subcutaneous adipose tissue ( SAT ) and visceral adipose tissue ( VAT ) was significantly higher compared to placenta in all women ( 6‐to 24‐times , p < 0.05 ) . Chemerin‐VAT mRNA expression in GDM‐obese tended to be significantly higher compared to NGT‐non‐obese women ( 3‐times , p = 0.005 ) . Omentin‐1 mRNA expression was significantly higher in VAT compared to SAT ( 50‐ to 100‐times , p < 0.01 ) and its expression in placenta was negligible in all women . Although , leptin was expressed significantly higher in SAT compared to VAT and the placenta in all women ( 5‐ to 46‐times , p < 0.05 ) , only its mRNA expression in VAT of obese ( GDM and NGT ) differed significantly when compared to NGT‐non‐obese women ( 3‐times higher , p < 0.02 ) . Visfatin mRNA expression was comparable in all tissues . In conclusion , chemerin and leptin are elevated and omentin‐1 and visfatin levels are decreased in GDM women complicated by obesity . This finding together with the positive association of chemerin and leptin with markers of insulin resistance , suggests that these adipokines and more especially chemerin and leptin accompanied by their adipose tissue expression could contribute to the increased insulin resistance and low grade inflammation that characterizes GDM‐obese women Purpose To evaluate the effect of gestational diabetes on omentin-1 in maternal and cord plasma . As a potent mediator of insulin resistance , Omentin-1 , an adipokine derived from human adipose and placental tissue , may be an important player in the pathophysiology of gestational diabetes . Methods This was a prospect i ve case – control study . The study included 96 women with gestational diabetes and 96 pregnant women without .  Omentin-1  was measured at the time of the oral glucose tolerance test , at 32 weeks in maternal plasma and right after delivery in umbilical cord blood by ELISA assay . Results Over a period of 2 years , 200 patients were enrolled . Omentin-1 levels did not significantly differ between both groups throughout the pregnancy : omentin-1 levels were 157 ± 83 ng/ml in women with gestational diabetes and 158 ± 93 ng/ml in women without gestational diabetes ( p = 0.94 ) at time of the oral glucose tolerance test and 118 ± 77 ng/ml in women with diabetes and 150 ± 89 ng/ml in women without ( p = 0.12 ) at 32 weeks , respectively . Both groups showed a decrease in omentin-1 levels throughout pregnancy , with a more pronounced decrease in diabetic women ( 13 ± 53 versus 4 ± 48 ng/ml ; p = 0.5 ) . Neonatal omentin-1 levels were significantly lower in offspring of diabetic mothers : 106 ± 61 versus 134 ± 45 ng/ml ( p = 0.03 ) . Conclusions There was no significant difference in omentin-1 levels between healthy and diabetic mothers throughout the pregnancy . However , we found significantly lower omentin-1 levels in offspring of diabetic mothers . This may indicate a risk for the development of insulin resistance in later life Background Maternal overweight , obesity and consequently the incidence of gestational diabetes are increasing rapidly worldwide . The objective of the study was to assess the efficacy and cost-effectiveness of a combined diet and physical activity intervention implemented before , during and after pregnancy in a primary health care setting for preventing gestational diabetes , later type 2 diabetes and other metabolic consequences . Methods RADIEL is a r and omized controlled multi-center intervention trial in women at high risk for diabetes ( a previous history of gestational diabetes or prepregnancy BMI ≥30 kg/m2 ) . Participants planning pregnancy or in the first half of pregnancy were parallel-group r and omized into an intervention arm which received lifestyle counseling and a control arm which received usual care given at their local antenatal clinics . All participants visited a study nurse every three months before and during pregnancy , and at 6 weeks , 6 and 12 months postpartum . Measurements and laboratory tests were performed on all participants with special focus on dietary and exercise habits and metabolic markers . Of the 728 women [ mean age 32.5 years ( SD 4.7 ) ; median parity 1 ( range 0 - 9 ) ] considered to be eligible for the study 235 were non-pregnant and 493 pregnant [ mean gestational age 13 ( range 6 to 18 ) weeks ] at the time of enrollment . The proportion of nulliparous women was 29.8 % ( n = 217 ) . Out of all participants , 79.6 % of the non-pregnant and 40.4 % of the pregnant women had previous gestational diabetes and 20.4 % of the non-pregnant and 59.6 % of the pregnant women were recruited because of a prepregnancy BMI  ≥30 kg/m2 . Mean BMI at first visit was 30.1 kg/m2 ( SD 6.2 ) in the non-pregnant and 32.7 kg/m2 ( SD 5.6 ) in the pregnant group . Discussion To our knowledge , this is the first r and omized lifestyle intervention trial , which includes , besides the pregnancy period , both the prepregnancy and the postpartum period . This study design also provides an opportunity to focus upon the health of the next generation . The study is expected to produce novel information on the optimal timing and setting of interventions and for allocating re sources to prevent obesity and diabetes in women of reproductive age . Trial registration Clinical trials.gov Identifier : AIM To examine the prediction of gestational diabetes in obese women using routine clinical measures and measurement of biomarkers related to insulin resistance in the early second trimester . METHODS A total of 117 obese pregnant women participating in a pilot trial of a complex intervention of dietary advice and physical activity  were studied . Blood sample s were obtained at recruitment ( 15⁺⁰-17⁺⁶ weeks ' gestation ) and demographic , clinical history and anthropometric measures recorded . The biomarkers analysed were plasma lipids ( HDL cholesterol , LDL cholesterol , triglycerides ) , high-sensitivity C-reactive protein , alanine transaminase , aspartate transaminase , ferritin , fructosamine , insulin , adiponectin , tissue plasminogen activator , interleukin-6 , visfatin and leptin . Univariate and logistic regression analyses were performed to determine independent predictors and area under the receiver-operating curve was calculated for the model . RESULTS Of the 106 participants included in the analysis , 29 ( 27.4 % ) developed gestational diabetes . Participants with gestational diabetes were older ( P = 0.002 ) , more often of parity ≥ 2 , had higher systolic ( P = 0.02 ) and diastolic blood pressure ( P = 0.02 ) and were more likely to be black ( P = 0.009 ) . Amongst the blood biomarkers measured , plasma adiponectin alone remained independently associated with gestational diabetes in adjusted models ( P = 0.002 ) . The area under the receiver-operating curve for clinical factors alone ( 0.760 ) increased significantly ( area under the curve 0.834 , chi-square statistic ( 1 ) = 4.00 , P = 0.046 ) with the addition of adiponectin . CONCLUSIONS A combination of routinely measured clinical factors and adiponectin measured in the early second trimester in obese women may provide a useful approach to the prediction of gestational diabetes . Validation in a large prospect i ve study is required to determine the usefulness of this algorithm in clinical practice Background Obesity is increasing in the child-bearing population as are the rates of gestational diabetes . Gestational diabetes is associated with higher rates of Cesarean Section for the mother and increased risks of macrosomia , higher body fat mass , respiratory distress and hypoglycemia for the infant . Prevention of gestational diabetes through life style intervention has proven to be difficult . A Finnish study showed that ingestion of specific probiotics altered the composition of the gut microbiome and thereby metabolism from early gestation and decreased rates of gestational diabetes in normal weight women . In SPRING ( the Study of Probiotics IN the prevention of Gestational diabetes ) , the effectiveness of probiotics ingestion for the prevention of gestational diabetes will be assessed in overweight and obese women . Methods / design SPRING is a multi-center , prospect i ve , double-blind r and omized controlled trial run at two tertiary maternity hospitals in Brisbane , Australia . Five hundred and forty ( 540 ) women with a BMI > 25.0 kg/m2 will be recruited over 2 years and receive either probiotics or placebo capsules from 16 weeks gestation until delivery . The probiotics capsules contain > 1x109 cfu each of Lactobacillus rhamnosus GG and Bifidobacterium lactis BB-12 per capsule . The primary outcome is diagnosis of gestational diabetes at 28 weeks gestation . Secondary outcomes include rates of other pregnancy complications , gestational weight gain , mode of delivery , change in gut microbiome , preterm birth , macrosomia , and infant body composition . The trial has 80 % power at a 5 % 2-sided significance level to detect a > 50 % change in the rates of gestational diabetes in this high-risk group of pregnant women . Discussion SPRING will show if probiotics can be used as an easily implementable method of preventing gestational diabetes in the high-risk group of overweight and obese pregnant women Abstract Introduction : Gestational diabetes mellitus ( GDM ) occurs in ∼10–25 % of pregnancies . Nesfatin-1 , plays a role in carbohydrate metabolism by inhibiting glucagon secretion , besides has a glucose-dependent insulinotropic effect . Explanation of the GDM pathogenesis is important due to preventing gestational complications . We aim ed to investigate relationship between GDM and Nesfatin-1 . Material and methods : Seventy-nine pregnant subjects were r and omly allocated to either GDM group ( GDG , n = 38 ) or control group ( CG , n = 41 ) . For GDM diagnosis , 50 and 100 g oral glucose tolerance test ( OGTT ) were used . Nesfatin-1 , insulin and other parameters were measured for all subjects . The homeostasis model assessment -insulin resistance ( HOMA-IR ) was calculated . Results : Nesfatin-1 was found lower and insulin was found higher in GDG than CG . Negative correlation has been founded between Nesfatin-1 with weight , BMI , fasting glucose , serum glucose level at first hour of the 50 g OGTT and HOMA-IR . Conclusion : In this 
    Output:
    