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The effects of inadequate nutrition, especially predominant in carbohydrates and saturated fats (fast food), are the triggers of an increasing prevalence of population with overweight and obesity. There is no doubt that the food economy is increasing and therefore the population prefers the lowest cost food, which are precisely those carbohydrates that predominate in the diet of the majority of the population.
Nutrition in adults is generally valued for the relationship between weight and height (body mass index: BMI), although this does not indicate the true nutritional status, since the breadth of this term implies besides the entrance of the great nutrients, The dietary intake of vitamins, minerals and trace elements, some of which are vital and of great physiological and metabolic importance, as is the case with iron and hemoglobin concentration, since populations with low levels of hemoglobin can easily be found. To present obesity. Thus, the term nutrition is not always well defined in the health status of people, because its breadth implies not only the presentation of a proper BMI, but also the provision of other micronutrients (vitamins and trace elements), which fulfill metabolic functions determinant In the state of health of an individual.
Obesity is a term related to the marked increase in BMI. This increase in BMI is due to an excess of triglycerides deposited in fatty cell tissue; Therefore it is important to recognize how and why triglycerides form and where they come from.
In the daily diet of all humans enter starches, which disintegrate the digestive process to enter intestinal level in the form of monosaccharides, especially in the form of glucose. Glucose passes into the circulation, causing transient hyperglycemia, because the insulin secreted by the pancreas leads to the ingress of glucose into the cell. Once in the cell, the glucose is immediately phosphorylated (to lose the osmotic effect) and forms the Glucose-6-Phosphate, which will follow the path of glycolysis to seek to produce energy for the body (in the form of ATP). This energy is regulated by the activities of each person, as we must remember that humans on average require 2200 Kcal day; 50% of this energy is used for basal metabolism and the remaining 50% is for daily activities.
If the caloric intake is excessive, then a repression of the metabolites of the glycolysis leads to the formation of triglycerides. For the formation of triglycerides two products are required: Glycerol-3-phosphate and fatty acids. Glycerol-3-Phosphate comes from the metabolite of glycolysis called Glyceraldehyde -3-Phosphate, which because it is in excess, because the dietary intake was higher in calories, it stops being aldehyde and happens to be alcohol, and in this way Can be linked to the saturated fatty acids, which are the triglycerides.
Normally Glyceraldehyde -3- Phosphate must follow its catalytic path and reach to pyruvate, which later in the form of Acetyl CoA will enter the cycle of Krebs, to be able to produce NADH + H and FADH2, nucleotides that will then enter the chain transporting of electrons (Also called oxidative phosphorylation), to produce water and energy (ATP). Thus, the excess energy supplied (due to the excess of carbohydrates in the food), leads to the accumulation of Glyceraldehyde -3-Phosphate and its subsequent transformation into Glycerol-3-phosphate, which expects the presence of saturated fatty acids for Synthesize the triglycerides.
In turn, fatty acids can be a product of the entry of fatty acids into the diet and / or be synthesized into the cell. When they enter the diet (whether in the form of fatty acids or in the form of triglycerides, which disintegrate into fatty acids to be entered into the circulation), then triglycerides can be synthesized. But if they did not enter the diet, the organism can synthesize when the excess glucose enters the diet, it reaches pyruvate and enters the Krebs, which stops and allows to accumulate citrate, a metabolite that leaves the mitochondria and is transformed In cytoplasmic oxalacetate and acetyl CoA. This latter metabolite is the source for the body to synthesize fatty acids. In turn the oxalacetate returns to Phosphoenol Pyruvate, ending in a further increase of Glcierol -3-Phosphate.
From the foregoing analysis it is concluded that it is not necessary to enter fatty acids in the food in order to form triglycerides, because with the excess carbohydrate alone, there is an over-supply of Glycerol-3-Phosphate and the synthesis of fatty acids. The triglycerides form
Only patients with a BMI = 20 should gain 12 kg of weight; Patients with BMI = 24, should gain 10% less than 12 kg (10.8 kg); Also patients with BMI = 18, will gain 15% more than 12 kg (13.8 kg). For a patient who will gain 12 kg, the weight growth should follow the following scheme:
In the case of a pregnant woman, there are two classifications to identify obesity:
to. Obesity prior to pregnancy: in this case, the woman is already overweight and / or obese.
B. Obesity during pregnancy: in this case, the patient develops overweight and / or obesity during pregnancy.
The patient who enters with obesity to gestation, the prenatal control must be rigorous in the restriction of carbohydrates in the diet, since this patient must gain less weight (depending on BMI) and in the same it must be considered that the patient already Have triglycerides before gestation and therefore their weight gain will be lower. If this patient has no control over their weight gain, the complications of gestational overweight will increase the risks (diabetes, polyhydramnios, macrosomia, etc.).
The patient who develops overweight and obesity in pregnancy, is due to a high intake of carbohydrates. The excess energy entered in the diet, behaves just as it does in the non-pregnant woman. Over-supply of Glycerol-3-Phosphate is produced as well as the excess of citrate in the Krebs cycle, on the supply of acetyl CoA cytoplasmic, which leads to the synthesis of saturated fatty acids, which will be linked with Glycerol -3- Phosphate , Leading to increased synthesis of triglycerides.
There is no doubt that this complication is the responsibility of the professional who performs the prenatal control, because during this period of preventive control, the evolution of maternal weight has not been adequately evaluated and the necessary restriction of carbohydrates has not been indicated to avoid overweight or obesity.
Usually the complications of the patient with obesity are almost similar, the same that are related to both the mother, the fetus and / or newborn. If the pregnant woman was obese prior to gestation it is probable that there is excess cholesterol esterified with fatty acids and therefore there is already a deposit of atheromatous plaques in the vascular endothelium. (5, 6) If this is present, even if there is no hypertension During pregnancy there will be no adequate production of nitric oxide, which is essential to produce the physiological vasodilatation of gestation and therefore the placental and fetal blood supply will be lower, leading to fetal alterations in its growth. In these cases there is an increase in the risk of hypertension, in addition to a 17% increase in the possibility of developing diabetes during pregnancy and 90% to lead to fetal macrosomia. The risk of prematurity is also present (7) In these patients, the treatment is only preventive, such as a strict prenatal control, especially in the hydrocarbon diet and its level of weight gain.
In the case of the pregnant woman who develops on weight or obesity during gestation, the complications are the same as the patient described previously, but usually there is no atheromatosis, being therefore very remote the possibility of developing chronic hypertension, although If there is an increased risk of preeclampsia.
There will also be greater risks to develop fetal macrosomia because the excessive intake of carbohydrates will lead to states of maternal hyperglycemia, which produce in the fetus greater insulinism and consequently the synthesis of fetal cells will lead to produce larger cells, thanks to the content Of the cellular water, produce a fetus finally of greater weight, although not necessarily of greater number of cells. Also, the uncontrolled increase in fetal weight carries the risk of premature labor, because the uterine cavity will be overdistensed.
In both cases, the patient with a macrosomic fetus will lead to an increased risk of hypoglycemia in the newborn, and surely the birth path will be by cesarean section and the healing of the maternal tissue will certainly be more difficult due to excess fat tissue, Which facilitates wound infection more easily.
The nutritional aspects in humans are vital in metabolic analysis. Excess carbohydrate leads to storage of triglycerides that alter BMI. If the pregnant woman has these conditions (either before or during gestation), she must have a strict prenatal control in the nutritional aspects (carbohydrate intake), since the risks are increased with pathologies such as chronic hypertension, preeclampsia, Preterm birth, fetal macrosomia and even polyhydramnios, in addition to a higher prevalence of cesarean section and wound infection.
* Written by Dr. Dr. Andrés Calle M., taken from the Peruvian Society of Obstetrics and Gynecology.
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