A prospective study of dietary patterns, meat intake and the risk of gestational diabetes mellitus

The association between dietary patterns before and in early pregnancy and the risk of gestational diabetes mellitus (GDM): Data from the Malaysian SECOST cohort

Generally, dietary patterns (DP)s have been linked to the risk of diabetes mellitus, however, only few studies examined the associations between DPs in early pregnancy and the risk of gestational diabetes mellitus (GDM). This study aims to determine the association between DPs before and during pregnancy and risk of GDM in Malaysian pregnant women. DPs were derived using principal component analysis of consumed 126 food and beverage items assessed using a validated semi-quantitative food frequency questionnaire collecting data retrospectively for pre-pregnancy, but prospectively for the first and second trimester. Three different DPs were identified at each time point and labelled as DP 1–3 (pre-pregnancy), DP 4–6 (first trimester), and DP 7–9 (second trimester). About 10.6% (n = 48) of pregnant women were diagnosed with GDM in our cohort. Women with high adherence (HA) to DP 2 (adjusted OR: 0.45, 95% CI: 0.20–0.91) and DP 5 (adjusted OR: 0.28, 95% CI: 0.11–0.68) showed a significantly reduced risk of GDM compared to women with low adherence (LA). Other DPs were not significantly associated with GDM risk. Compared to women with GDM, non-GDM women showed HA scores for all DPs throughout pregnancy. Overall, a relative low percentage of women with GDM was found in this cohort. The risk was lower in women with HA to a relatively unhealthy dietary pattern, i.e. DP 2 and DP 5. The lower body mass index (BMI) status and energy intake of women showing a HA to DP 2 in the first trimester may underlie the observed association with a lower GDM risk. Additionally, genetic variance might explain the less susceptibility to GDM despite HA to unhealthy DPs among non-GDM women.

Cohort Profile: The Dutch Perined-Lifelines birth cohort

BACKGROUND

Maternal nutrition status (e.g. dietary/nutrient intake) during pregnancy has been associated with pregnancy outcomes including birth weight, infant survival and metabolic health of the offspring during later life. During the past few years, maternal dietary intake, at least three months before conception, has been shown to affect pregnancy outcomes also. However, literature investigating this link is still scarce. The studies that have looked at preconception dietary intake in relation to pregnancy outcome were either animal studies, had small sample sizes or focused on only selected macronutrient intake rather than complete (macro)nutrient composition or dietary intakes (e.g. food groups). Therefore, we aim to investigate the association between preconception diet and pregnancy outcomes in a linked birth cohort. The main objective of this manuscript is to describe the methodology of establishing this birth cohort and to describe both the characteristics of the study population included as well as the representativeness in terms of dietary intake.

METHODS

We created the birth cohort by linking two existing databases; a large population-based cohort study in the Netherlands (The Lifelines Cohort study) and the Dutch national birth registry (Perined), through a 'trusted third party'. The birth cohort contains information on maternal dietary intake during preconception as well as pregnancy outcomes.

RESULTS AND DISCUSSION

In the Lifelines Cohort study, 3,418 pregnancies were available for linking with Perined. In total, 2,368 pregnancies (86.9%) were linked with Perined, resulting in the birth cohort. With this linked cohort we are able to provide insights on the associations between dietary intake before conception and pregnancy outcomes. Such data could potentially improve nutritional care for women of childbearing age. Lifestyle changes in the period preceding pregnancy may be most effective in improving pregnancy outcomes. A focus on this window of opportunity may provide both sufficient time, as well as a period when women are potentially motivated to adopt health optimizing behaviours.

The Association between Maternal Dietary Protein Intake and Risk of Gestational Diabetes Mellitus

BACKGROUND

The amount and type of dietary protein affect glucose metabolism. However, the association between dietary protein intake and gestational diabetes mellitus (GDM) risk is vague. We examined this association. Methods: We included 152 GDM and 168 non-GDM participants (total 320), age 18-45 years from Arash Women's Hospital, Tehran, Iran. Protein intake was ascertained from 168-item Food Frequency Questionnaire at 24-40 weeks' gestation. GDM was defined as fasting blood sugar >95 mg/dL and/or oral glucose tolerance test >155 mg/dL. Dietary data were assessed using N4 software and statistical analysis was performed using SPSS 21. We tested the association between the amount of protein consumed from red and processed meat, poultry, dairy, egg, seafood, and vegetable plus sociodemographic and lifestyle covariates and GDM risk using multivariate logistic regression analysis.

RESULTS

There was a significant association between the physical activity (P < 0.035), socioeconomic status (P < 0.013), body mass index, age, and each trimester's weight (P < 0.001), and risk of GDM. No significant association was observed between the intake of protein from major protein sources and risk of GDM. The only significant association was observed for egg consumption which was lower in GDM participants (P = 0.004), yet this association turned nonsignificant after adjustment for confounders, except for the fourth quartile (odds ratio: 0.43, 95% confidence interval: 0.208, 0.893).

CONCLUSIONS

According to our findings, dietary intake of total and major protein sources could not affect the GDM risk. Differences between Iranian and Western population and the reverse causality might be the main reasons for this nonsignificant association.

Predictive and diagnostic biomarkers for gestational diabetes and its associated metabolic and cardiovascular diseases

Gestational diabetes mellitus (GDM) is defined as the presence of high blood glucose levels with the onset, or detected for the first time during pregnancy, as a result of increased insulin resistance. GDM may be induced by dysregulation of pancreatic β-cell function and/or by alteration of secreted gestational hormones and peptides related with glucose homeostasis. It may affect one out of five pregnancies, leading to perinatal morbidity and adverse neonatal outcomes, and high risk of chronic metabolic and cardiovascular injuries in both mother and offspring. Currently, GDM diagnosis is based on evaluation of glucose homeostasis at late stages of pregnancy, but increased age and body-weight, and familiar or previous occurrence of GDM, may conditionate this criteria. In addition, an earlier and more specific detection of GDM with associated metabolic and cardiovascular risk could improve GDM development and outcomes. In this sense, 1st-2nd trimester-released biomarkers found in maternal plasma including adipose tissue-derived factors such as adiponectin, visfatin, omentin-1, fatty acid-binding protein-4 and retinol binding-protein-4 have shown correlations with GDM development. Moreover, placenta-related factors such as sex hormone-binding globulin, afamin, fetuin-A, fibroblast growth factors-21/23, ficolin-3 and follistatin, or specific micro-RNAs may participate in GDM progression and be useful for its recognition. Finally, urine-excreted metabolites such as those related with serotonin system, non-polar amino-acids and ketone bodies, may complete a predictive or early-diagnostic panel of biomarkers for GDM.

Non-pharmacological management of gestational diabetes: The role of myo-inositol

Gestational diabetes mellitus (GDM) is the most common metabolic disorder occurring in pregnancy. GDM plays an important role in the current diabetes epidemic: exposure to a high glycemic environment during the early stages of development increases the risk of the fetus to develop type two diabetes mellitus (T2DM) in adult life. Various cardiometabolic risk factors are linked to GDM. A thorough knowledge of the risk factors and genes involved in the development of GDM, along with an understanding of the underlying pathophysiological mechanisms are crucial to properly identify patients at risk of developing this condition. There is growing evidence showing that myo-inositol, combined with an appropriate therapeutic regimen for GDM, can provide additional benefits to the patient. The aim of this review is to analyze the role of inositol isomers - especially myo-inositol (MYO-INS) - in the treatment of patients with GDM.

Obesity Status Affects the Relationship Between Protein Intake and Insulin Sensitivity in Late Pregnancy

The purpose of this study was to determine the associations between amount and type of dietary protein intake and insulin sensitivity in late pregnancy, in normal weight and overweight women (29.8 ± 0.2 weeks gestation, n = 173). A 100-g oral glucose tolerance test (OGTT) was administered following an overnight fast to estimate the metabolic clearance rate of glucose (MCR, mg·kg⁻¹·min⁻¹) using four different equations accounting for the availability of blood samples. Total (TP), animal (AP), and plant (PP) protein intakes were assessed using a 3-day food record. Two linear models with MCR as the response variable were fitted to the data to estimate the relationship of protein intake to insulin sensitivity either unadjusted or adjusted for early pregnancy body mass index (BMI) because of the potential of BMI to influence this relationship. There was a positive association between TP (β = 1.37, p = 0.002) and PP (β = 4.44, p < 0.001) intake in the last trimester of pregnancy and insulin sensitivity that weakened when accounting for early pregnancy BMI. However, there was no relationship between AP intake and insulin sensitivity (β = 0.95, p = 0.08). Therefore, early pregnancy BMI may be a better predictor of insulin sensitivity than dietary protein intake in late pregnancy.

Maternal dietary pattern characterised by high protein and low carbohydrate intake in pregnancy is associated with a higher risk of gestational diabetes mellitus in Chinese women: a prospective cohort study

Maternal dietary patterns and macronutrients intake have been shown to affect the development of gestational diabetes mellitus (GDM), but the findings are inconsistent. We aimed to identify maternal dietary patterns and examine their associations with GDM risk, and to evaluate the contributions of macronutrients intake to these associations. We included 2755 Chinese pregnant women from the Tongji Maternal and Child Health Cohort. Dietary intakes were assessed using a validated semi-quantitative FFQ 2 weeks before the diagnosis of GDM. GDM (n 248) was diagnosed based on the results of a 75-g, 2-h oral glucose tolerance test at 24-28 weeks gestation. We derived five different dietary patterns from a principal component analysis. The results showed that high fish-meat-eggs scores, which were positively related to protein intake and inversely related to carbohydrate intake, were associated with a higher risk of GDM (adjusted OR for quartile 4 v. quartile 1: 1·83; 95 % CI 1·21, 2·79; P trend=0·007) and higher plasma glucose levels. In contrast, high rice-wheat-fruits scores, which were positively related to carbohydrate intake and inversely related to protein intake, were associated with lower risk of GDM (adjusted OR for quartile 3 v. quartile 1: 0·54; 95 % CI 0·36, 0·83; P trend=0·010) and lower plasma glucose levels. In addition, dietary protein and carbohydrate intake significantly contributed to the associations between dietary patterns and GDM risk or glucose levels. These findings suggest that a dietary pattern characterised by high protein and low carbohydrate intake in pregnancy was associated with a higher risk of GDM, which may provide important clues for dietary guidance during pregnancy to prevent GDM.

Can a Simple Dietary Screening in Early Pregnancy Identify Dietary Habits Associated with Gestational Diabetes?

Gestational diabetes mellitus (GDM) is predominantly a lifestyle disease, with diet being an important modifiable risk factor. A major obstacle for the prevention in clinical practice is the complexity of assessing diet. In a cohort of 1651 Icelandic women, this study examined whether a short 40-item dietary screening questionnaire administered in the 1st trimester could identify dietary habits associated with GDM. The dietary variables were aggregated into predefined binary factors reflecting inadequate or optimal intake and stepwise backward elimination was used to identify a reduced set of factors that best predicted GDM. Those binary factors were then aggregated into a risk score (range: 0–7), that was mostly characterised by frequent consumption of soft drinks, sweets, cookies, ice creams and processed meat. The women with poor dietary habits (score ≥ 5, n = 302), had a higher risk of GDM (RR = 1.38; 95%CI = 3, 85) compared with women with a more optimal diet (score ≤ 2, n = 407). In parallel, a pilot (n = 100) intervention was conducted among overweight and obese women examining the effect of internet-based personalized feedback on diet quality. Simple feedback was given in accordance with the answers provided in the screening questionnaire in 1st trimester. At the endpoint, the improvements in diet quality were observed by, as an example, soft drink consumption being reduced by ~1 L/week on average in the intervention group compared to the controls. Our results suggest that a simple dietary screening tool administered in the 1st trimester could identify dietary habits associated with GMD. This tool should be easy to use in a clinical setting, and with simple individualized feedback, improvements in diet may be achieved.

Nutritional Supplementation for the Prevention and/or Treatment of Gestational Diabetes Mellitus

PURPOSE OF REVIEW

Gestational diabetes mellitus (GDM) is a common pregnancy complication that has short- and long-term health implications for both the mother and child. While lifestyle modifications, insulin therapy, and oral agents such as metformin are effective, they can be difficult to adhere to, and there remain concerns over long-term effects of oral agents on the infant. Further, GDM has no proven preventive strategies, which could be more effective than treatment postdiagnosis. Nutritional supplements are an appealing, potentially safer, and better tolerated alternative to pharmaceuticals to treat and/or prevent GDM. Here, we review the existing evidence for nutritional supplementation for treatment and prevention of GDM.

RECENT FINDINGS

There is limited evidence that myo-inositol, vitamins D and B6, magnesium, selenium, zinc, fatty acids, and probiotics might be beneficial for the prevention or treatment of GDM. There are very few studies for each nutrient, and the existing studies tend to have few participants. Where multiple studies of a nutrient exist, often those studies were conducted within the same country, limiting the generalizability of the findings, or alternatively there was no consensus across findings. There is limited evidence that nutritional supplementation of myo-inositol, vitamins D and B6, magnesium, selenium, zinc, fatty acids, and probiotics could improve glycemic control or prevent GDM. Our understanding is constrained by the small number of studies, small sample sizes in most studies, and by lack of consistency across findings. Further large, high-quality, randomized controlled trials are required to determine the efficacy of nutritional supplements to treat or prevent GDM.

Pregnancy dietary cholesterol intake, major dietary cholesterol sources, and the risk of gestational diabetes mellitus: A prospective cohort study

BACKGROUND & AIMS

The Scientific Report of 2015 Dietary Guidelines Advisory Committee recommended the elimination of dietary cholesterol limits. However, cholesterol intake increases during pregnancy and studies regarding the association between dietary cholesterol and gestational diabetes mellitus (GDM) are limited. We evaluate the association of total dietary cholesterol and different sources of cholesterol intake during pregnancy, with GDM risk and blood glucose levels in a Chinese prospective cohort study.

METHODS

A total of 2124 pregnant women from the Tongji Maternal and Child Health Cohort was included. A validated semi-quantitative food frequency questionnaire was used to assess dietary cholesterol intake prior to GDM diagnosis. GDM was diagnosed by the 75-g 2-h oral glucose tolerance test. Cubic-restricted spline function and logistic regression analyses were used to evaluate the association between dietary cholesterol intake during pregnancy and GDM. Generalized linear models were conducted to examine the associations of cholesterol intake with fasting blood glucose (FBG), 1-h post-load blood glucose (PBG) and 2-h PBG.

RESULTS

The average dietary cholesterol intake was 379.1 mg/d, and cholesterol from eggs explained 64.2% of the variability. Total dietary cholesterol intake and cholesterol from eggs rather than other foods, were linearly associated with GDM risk, with adjusted OR for GDM of 2.10 (95%CI: 1.24, 3.58) for total cholesterol intake and 1.83 (95%CI: 1.08, 3.07) for cholesterol from eggs comparing the highest versus lowest quintile. A 100-mg/d increase in total cholesterol and cholesterol from eggs intake were associated with an increased GDM risk by 18% and 16%, respectively. Moreover, higher maternal dietary total cholesterol could increase FBG and 1-h PBG, while cholesterol from eggs increased FBG only.

CONCLUSION

Higher dietary cholesterol from eggs intake during pregnancy was associated with greater risk of GDM.

Inverse relation between fruit and vegetable intake and the risk of gestational diabetes mellitus

Background: The aim of this study was to investigate the association of intakes of fruit, vegetable and dairy with gestational diabetes mellitus (GDM). Methods: This prospective study was conducted over a 17 month period, on a random sample of pregnant women (n = 1026), aged 18-45 y, in their first half of pregnancy, attending prenatal clinics in five hospitals' affiliated to universities of medical sciences in different districts of Tehran, Iran. Dietary intakes were assessed during gestational age ≤ 6 weeks using a 168-item validated semi-quantitative food frequency questionnaire. Between 24 and 28 weeks of gestation, all pregnant women underwent a scheduled 100 g 3-h oral glucose tolerance test. Diagnosis of GDM was based on criteria set by the American Diabetes Association. Results: Of 1026 study participants, 71 had GDM, with a mean age and pre-pregnancy BMI of 26.7 ± 4.3 y and 25.4 ± 4.5 Kg/m², respectively. High fruit and vegetable intakes were negatively associated with GDM risk. Compared with women who consumed < 2.1 servings/day, odds ratio (ORs) for those who consumed ≥ 4.9 servings/day was 0.44 (95% CI: 0.20-0.93), after adjustment for confounding factors. Fruit and vegetable intakes were significantly and inversely associated with the GDM; ORs (95% CIs) for GDM among participants with the highest, compared to the lowest quartiles were 0.48 (0.18-0.89) for fruit and 0.46 (0.22-0.99) for vegetables intake. No association was found between dairy products and GDM. Conclusions: Fruit and vegetable consumption in women of reproductive age have beneficial effects in the prevention of GDM.

Effect of diet composition on insulin sensitivity in humans

Diet composition has a marked impact on the risk of developing type 2 diabetes and cardiovascular disease. Prospective studies show that dietary patterns with elevated amount of animal products and low quantity of vegetable food items raise the risk of these diseases. In healthy subjects, animal protein intake intensifies insulin resistance whereas plant-based foods enhance insulin sensitivity. Similar effects have been documented in patients with diabetes. Accordingly, pre-pregnancy intake of meat (processed and unprocessed) has been strongly associated with a higher risk of gestational diabetes whereas greater pre-pregnancy vegetable protein consumption is associated with a lower risk of gestational diabetes. Population groups that modify their traditional dietary habit increasing the amount of animal products while reducing plant-based foods experience a remarkable rise in the frequency of type 2 diabetes. The association of animal protein intake with insulin resistance is independent of body mass index. In obese individuals that consume high animal protein diets, insulin sensitivity does not improve following weight loss. Diets aimed to lose weight that encourage restriction of carbohydrates and elevated consumption of animal protein intensify insulin resistance increasing the risk of developing type 2 diabetes and cardiovascular disease. The effect of dietary components on insulin sensitivity may contribute to explain the striking impact of eating habits on the risk of type 2 diabetes and cardiovascular disease. Insulin resistance predisposes to type 2 diabetes in healthy subjects and deteriorates metabolic control in patients with diabetes. In nondiabetic and diabetic individuals, insulin resistance is a major cardiovascular risk factor.

The Association of Maternal Protein Intake during Pregnancy in Humans with Maternal and Offspring Insulin Sensitivity Measures

The purpose of this review is to critically evaluate the studies assessing the relations between protein intake during human pregnancy and insulin sensitivity measures in the mother and offspring, and to get a better understanding of the knowledge gaps that still exist. Overall, there is insufficient evidence to conclude about implications of higher amounts of protein intake during pregnancy on maternal or offspring insulin sensitivity. However, studies show a relation between protein quality and insulin sensitivity, such that animal protein may be associated with negative outcomes and plant protein may be associated with positive insulin sensitivity outcomes. There is an urgent need for standardized studies using comparable terminology to evaluate any potential relations between insulin sensitivity in mothers and offspring and truly low and high maternal protein intake while maintaining eucaloric balance to better inform about optimal protein dosage and quality during this period.

Maternal diet and gestational diabetes mellitus development

Purpose: All possible measures should be taken to prevent glucose tolerance disorders and limit their consequences. The aim of this study was to show the relationship between maternal eating habits and the risk of developing gestational diabetes mellitus (GDM).Materials and methods: The nutrition of 55 pregnant women was evaluated using a three-day food record and food frequency questionnaire (FFQ) and nutrition of 12 months before pregnancy was assessed only by means of the FFQ. The patients were divided into groups: H - with uncomplicated pregnancy (n = 42) and GDM - with gestational diabetes mellitus (n = 13), based on oral glucose tolerance test (OGTT) results performed between 24 and 28 weeks.Results: Significant differences were found between groups H and GDM in terms of daily fat intake (32.1 versus 36.2%) and dietary reference values (standards) for total fat, monosaturated fatty acids (MUFA), and polysaturated fatty acids (PUFA). In the GDM group, the coverage of standards for total fat, staturated fatty acids (SFA) and MUFA exceeded the recommended values. Moreover, patients from this group consumed products typical for the "Western model of nutrition" more often, which may contribute to GDM.Conclusions: A "Western diet" and higher intake of energy from total fat and saturated fatty acid in the first half of pregnancy and before pregnancy may contribute to an increased risk of developing GDM.

Dietary patterns before and during pregnancy and maternal outcomes: a systematic review

BACKGROUND

Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are common maternal complications during pregnancy, with short- and long-term sequelae for both mothers and children.

OBJECTIVE

Two systematic review questions were used to examine the relation between 1) dietary patterns before and during pregnancy, 2) HDP, and 3) GDM.

METHODS

A search was conducted from January 1980 to January 2017 in 9 databases including PubMed, Embase, and Cochrane. Two analysts independently screened articles using a priori inclusion and exclusion criteria; data were extracted from included articles, and risk of bias was assessed. After qualitative synthesis, a conclusion statement was drafted for each question and the evidence supporting the conclusion was graded.

RESULTS

Of the 9103 studies identified, 8 [representing 4 cohorts and 1 randomized controlled trial (RCT)] were included for HDP and 11 (representing 6 cohorts and 1 RCT) for GDM. Limited evidence in healthy Caucasian women with access to health care suggests dietary patterns before and during pregnancy that are higher in vegetables, fruits, whole grains, nuts, legumes, fish, and vegetable oils and lower in meat and refined grains are associated with reduced risk of HDP, including preeclampsia and gestational hypertension. Limited but consistent evidence suggests certain dietary patterns before pregnancy are associated with reduced risk of GDM. These protective dietary patterns are higher in vegetables, fruits, whole grains, nuts, legumes, and fish and lower in red and processed meats. Most of the research was conducted in healthy, Caucasian women with access to health care. Insufficient evidence exists on the associations between dietary patterns before and during pregnancy and risk of HDP in minority women and those of lower socioeconomic status, and dietary patterns during pregnancy and risk of GDM.

CONCLUSIONS

Although some conclusions were drawn from these systematic reviews, more research is needed to address gaps and limitations in the evidence.

Changes in Micronutrient Intake and Status, Diet Quality and Glucose Tolerance from Preconception to the Second Trimester of Pregnancy

Data on changes in dietary intake and related blood parameters throughout pregnancy are scarce; moreover, few studies have examined their association with glucose homeostasis. Therefore, we monitored intake of folate, vitamin B6, vitamin B12, vitamin D and iron, their status markers, and diet quality from preconception to the second trimester of pregnancy, and we examined whether these dietary factors were associated with glucose homeostasis during pregnancy. We included 105 women aged 18⁻40 years with a desire to get pregnancy or who were already <24 weeks pregnant. Women at increased gestational diabetes (GDM) risk were oversampled. Measurements were scheduled at preconception (n = 67), and 12 (n =53) and 24 weeks of pregnancy (n =66), including a fasting venipuncture, 75-grams oral glucose tolerance test, and completion of a validated food frequency questionnaire. Changes in micronutrient intake and status, and associations between dietary factors and glucose homeostasis, were examined using adjusted repeated measures mixed models. Micronutrient intake of folate, vitamin B6 and vitamin D and related status markers significantly changed throughout pregnancy, which was predominantly due to changes in the intake of supplements. Micronutrient intake or status levels were not associated with glucose homeostasis, except for iron intake (FE µg/day) with fasting glucose (β = -0.069 mmol/L, p = 0.013) and HbA1c (β = -0.4843 mmol, p = 0.002). Diet quality was inversely associated with fasting glucose (β = -0.006 mmol/L for each DHD15-index point, p = 0.017). It was shown that micronutrient intakes and their status markers significantly changed during pregnancy. Only iron intake and diet quality were inversely associated with glucose homeostasis.

Association of food groups intake and physical activity with gestational diabetes mellitus in Iranian women

Background: It is suggested that combining a healthy diet with physical activity during and before pregnancy have a significant effect on insulin sensitivity. This study aimed to investigate the relationship between physical activity and diet before and during pregnancy with the risk of gestational diabetes mellitus (GDM).Methods: A case-control study was conducted on 173 women with GDM diagnosed during the pregnancy as the case group and 168 women with a negative test for GDM as controls. Weight and height were measured and BMI was calculated. Dietary intake and physical activity data during pregnancy were collected using 24-hour food recall questionnaire and international physical activity questionnaire (IPAQ).Results: Body mass index and the intake of refined sugars, high fat dairy products, and fried foods were significantly higher and the intake of fruit and animal oil intake were significantly lower in the case group compared to the control group (All p < .05). However, there was not any significant association between the level of physical activity, vegetable intake, and total energy intake with the risk of GDM.Conclusions: According to the results of this study, dietary intake before and during the pregnancy have a critical effect on the risk of GDM. Appropriate dietary planning for pregnant women can reduce the risk of GDM.

Dietary Patterns during Pregnancy Are Associated with the Risk of Gestational Diabetes Mellitus: Evidence from a Chinese Prospective Birth Cohort Study

Dietary patterns during pregnancy have been shown to influence the development of gestational diabetes mellitus (GDM). However, evidence from Asian populations is limited and inconsistent. We conducted a prospective cohort study in China to assess the relationship between dietary patterns and GDM. We administered three-day food diaries (TFD) and food frequency questionnaires (FFQ) at the second trimester. GDM was diagnosed with a 75 g 2-h oral glucose tolerance test at 24–28 weeks of gestation. We identified dietary patterns using principal components analysis and used multivariable logistic regression to investigate associations of dietary patterns with GDM. Of the 1014 participants, 23.5% were diagnosed with GDM. Both the TFD and FFQ identified a “traditional pattern”, consisting of high vegetable, fruit, and rice intake, which was associated with a lower GDM risk (odds ratio (OR) for quartile 4 versus quartile 1: 0.40, 95% CI: 0.23–0.71 for traditional pattern (TFD); OR: 0.44, CI: 0.27–0.70 for traditional pattern (FFQ)). The protective associations were more pronounced among women ≥35 years old. A whole grain–seafood TFD pattern was associated with higher risk of GDM (OR: 1.73, 95% CI: 1.10–2.74). These findings may provide evidence for making dietary guidelines among pregnant women in Chinese populations to prevent GDM.

The relationship between pre-pregnancy dietary patterns adherence and risk of gestational diabetes mellitus in Iran: A case-control study

AIM

The present study aimed to investigate major dietary patterns and their association with risk of gestational diabetes mellitus (GDM) in Yazd city located in Iran.

METHODS

This case-control designed study was conducted at six healthcare centres. Two hundred and seventy-eight pregnant women who referred for GDM screening participated. Dietary assessment was carried out by using a 67-item validated food frequency questionnaire to evaluate dietary history of participants during the last year. Principal component analysis was used to identify major food patterns. Multivariable logistic regression model was employed to identify the association between dietary patterns and risk of GDM.

RESULTS

Two major dietary patterns were detected. The Western dietary pattern was associated with higher intakes of sugar-sweetened beverages, refined grain products, fast foods, salty snacks, sweets and biscuit, mayonnaise and saturated oils, while the prudent dietary pattern was associated with higher intakes of fruits, low-fat dairy, potato, egg, fish, poultry, nuts, organs meat and red meat. Furthermore, prudent dietary pattern was negatively associated with GDM risk (OR = 0.88, 95% CI: 0.44-0.99). However, there was no significant association between adherence of the Western dietary pattern and risk of GDM.

CONCLUSIONS

Pre-pregnancy adherence of the prudent dietary pattern was significantly associated with reduced risk of GDM.

Maternal Dietary Patterns and Their Association with Pregnancy Outcomes

Maternal nutritional status during pregnancy will affect the outcomes for the mother and the newborn. Maternal diet was assessed in 150 pregnant women during the first trimester of pregnancy by a 168-item food frequency questionnaire. Dietary patterns were explored by Factor analysis, and association of patterns with maternal and neonatal outcomes such as gestational diabetes mellitus (GDM), anemia and anthropometric indices were determined by analysis of variance and linear regression analysis. Three major dietary patterns were identified: 1) High Carbohydrate-Lower Fat (mean age, 27.67 ± 6.1; n = 34), 2) High Carbohydrate-Higher Fat (27.70 ± 4.1; n = 55), and 3) High Fiber (29.27 ± 5.8; n = 61). A significant difference was observed between maternal dietary patterns (p < 0.01) for GDM, while it was not significant for anemia. Also, the number of preterm and low birth weight (LBM) infants as well as mean weight, height and head circumference of the infants did not differ significantly between patterns, but there was a significant difference between the maternal dietary patterns about the number of macrosomic babies, which was higher in the second (n = 9) and third (n = 9) dietary patterns (p < 0.01). After adjusting for mothers' age, disease history, disease status, and energy intake, High Carbohydrate-Lower Fat dietary pattern was more associated with GDM than crude model (p = 0.01 vs. p = 0.02). The present study indicated a significant relationship between maternal dietary patterns before pregnancy and GDM and fetal macrosomia.

Association of a plant-based dietary pattern in relation to gestational diabetes mellitus

AIM

The prevalence of gestational diabetes mellitus (GDM), which has adverse effects on mothers and their offspring, is increasing worldwide. The role of a plant-based dietary pattern as a determinant of GDM is not well understood. Therefore, we examined the association between plant-based dietary patterns and the risk of GDM.

METHODS

We enrolled 460 pregnant women in this case-control study, of them 200 were cases and 260 were controls. Dietary intake of participants was evaluated using three 24-hour dietary records. Adherence to the plant-based dietary patterns was scored using three indices of the overall plant-based dietary index (PDI), healthy plant-based diet (hPDI) and unhealthy plant-based diet index (uPDI). The risk of GDM was compared across tertiles of PDI, hPDI and uPDI.

RESULTS

After multivariable adjustment, we demonstrated that the high PDI score was inversely associated with risk of GDM (OR = 0.47; 95% CI: 0.28-0.78, P = 0.004), but there was no significant association between hPDI (OR = 1.03; 95% CI: 0.64-1.65, P = 0.884) or uPDI (OR = 1.65; 95% CI: 0.98-2.78, P = 0.06) and GDM risk.

CONCLUSIONS

We found that following an overall plant-based diet was associated with lower risk of GDM. Future studies are warranted with longitudinal designs to confirm these findings.

Relationships between stress, demographics and dietary intake behaviours among low-income pregnant women with overweight or obesity

OBJECTIVE

To identify demographic risk factors associated with high stress and examine the relationships between levels of stress, demographics and dietary fat, fruit and vegetable intakes in low-income pregnant women with overweight or obesity.

DESIGN

A cross-sectional study.

SETTING

Participants were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children in Michigan, USA.ParticipantsParticipants (n 353) were non-Hispanic Black (black) or White (white).

RESULTS

Women aged 35 years or older (OR=4·09; 95% CI 1·45, 11·51) and who had high school or less education (OR=1·88; 95% CI 1·22, 2·89) or were unemployed (OR=1·89; 95% CI 1·15, 3·12) were significantly more likely to report high stress than women who were younger, had at least some college education or were employed/homemakers. However, race and smoking status were not associated with level of stress. Women with high stress reported significantly lower fruit and vegetable intakes but not fat intake than women with low stress. Women aged 35 years or older reported significantly higher vegetable but not fat or fruit intake than women who were 18-24 years old. Black women reported significantly higher fat but not fruit or vegetable intake than white women. Education, employment and smoking status were not significantly associated with dietary intake of fat, fruits and vegetables.

CONCLUSIONS

Nutrition counselling on reducing fat and increasing fruit and vegetable intakes may consider targeting women who are black or younger or who report high stress, respectively.

Dietary patterns and Helicobacter pylori infection in a group of Chinese adults ages between 45 and 59 years old: An observational study

Limited studies have reported the association between dietary patterns and the risk of Helicobacter pylori (H pylori) infection. The purpose of this study was to evaluate the relationship between dietary patterns and H pylori infection in a Chinese population ages from 45 to 59 years. We performed a cross-sectional examination of the associations between dietary patterns and H pylori infection in 3014 Chinese adults ages between 45 and 59 years from Hangzhou city, Zhejiang province, China. Dietary intake was assessed through a semi-quantitative food frequency questionnaire (FFQ). H pylori infection was diagnosed using the C-urea breath test. Multivariable logistic regression analyses were used to determine the associations between dietary patterns and the risk of H pylori infection. The prevalence of H pylori infection was 27.5%. Four major dietary patterns were identified by means of factor analysis: health-conscious, Western, grains-vegetables and high-salt patterns. After adjustment for the potential confounders, participants in the highest quartile of the "grains-vegetables" pattern scores had a lower odds ratio (OR) for H pylori infection (OR = 0.82; 95% confidence interval [CI]: 0.732-0.973; P = .04) than did those in the lowest quartile. Compared with those in the lowest quartile, participants in the highest quartile of the "high-salt" pattern scores had a greater OR for H pylori infection (OR = 1.13; 95%CI: 1.004-1.139; P = .048). Besides, no significant associations were found between the "health-conscious" and "Western" dietary patterns and the risk of H pylori infection.Our findings demonstrate that the "grains-vegetables" pattern is associated with a decreased risk, while "high-salt" pattern is associated with an increased risk of H pylori infection.

A Vitamin Pattern Diet Is Associated with Decreased Risk of Gestational Diabetes Mellitus in Chinese Women: Results from a Case Control Study in Taiyuan, China

Identification of modifiable dietary factors, which are involved in the development of gestational diabetes mellitus (GDM), could inform strategies to prevent GDM. Therefore, we examined the dietary nutrient patterns and evaluated their relationship with GDM risk in a Chinese population using a case control study design. A total of 1,464 GDM cases and 8,092 non-GDM controls were included in the final analysis. Dietary intake was assessed using a 33-item food frequency questionnaire, and nutrients were estimated using the Chinese Standard Tables of Food Consumption. Dietary nutrient patterns were identified using factor analysis, and their associations with GDM risk were evaluated using unconditional logistic regression models adjusting for total energy intake, maternal age, high blood pressure, education, maternal body mass index (BMI), parity, and family history of diabetes. A "vitamin" nutrient pattern was characterized as the consumption of diet rich in vitamin A, carotene, vitamin B2, vitamin B6, vitamin C, dietary fiber, folate, calcium, and potassium. For every quartile increase in the vitamin factor score during one year prior to conception, the first trimester, and the second trimester of pregnancy, the GDM risk decreased by 9% (OR: 0.91, 95%CI: 0.86-0.96), 9% (OR: 0.91, 95%CI: 0.86-0.96), and 10% (OR: 0.90, 95%CI: 0.85-0.95), respectively. The significant reduced GDM risk was seen in women regardless of age and parity, and slightly stronger effect was found in women whose age ≤ 30 and women who are nulliparous across the three time periods. The significant association was also found in women whose BMI ≤ 24 with similar effect size across the three time periods. Our study suggests that the vitamin nutrient pattern diet is associated with decreased GDM risk. Additional studies are necessary to explore the underlying mechanism of this relationship.

Associations of dietary patterns with hypertension among adults in Jilin Province, China: a structural equation modelling approach

OBJECTIVE

To explore the direct and indirect associations of dietary patterns with hypertension using structural equation modelling (SEM).

DESIGN

Factor analysis with varimax rotation was used to classify different dietary patterns and SEM was employed to investigate the associations of dietary patterns with hypertension. Total cholesterol to HDL-cholesterol (TC:HDL-C) ratio and LDL-cholesterol to HDL-cholesterol (LDL-C:HDL-C) ratio were used as observed indicator variables of the lipid latent variable. Waist circumference, body fat percentage and BMI, which were associated with hypertension, were used as observed indicator variables of the obesity latent variable.

SETTING

International Chronic Disease Cohort (ICDC) that began in 2005 with the purpose of describing the frequency and determinants of chronic diseases in Jilin Province, China.ParticipantsA total of 1492 adults (40-79 years) were enrolled in the baseline study from August 2010 to August 2011.

RESULTS

Hypertension prevalence in our study population was 34·9 %. It was found that the wine pattern, condiment pattern, obesity latent variable, lipid latent variable, glucose, age and family history of hypertension were factors that had an association with hypertension via SEM, and the corresponding coefficients were 0·056, 0·011, 0·230, 0·281, 0·098, 0·232 and 0·116, respectively.

CONCLUSIONS

The wine pattern and lipid latent variable had positive direct associations with hypertension. The condiment pattern had a positive indirect association with hypertension via the obesity latent variable. The vegetables pattern, modern pattern and snack pattern were not associated with hypertension.

Dietary patterns during pregnancy and risk of gestational diabetes: a prospective cohort study in Western China

BACKGROUND

Previous research has demonstrated the association between maternal dietary patterns and gestational diabetes (GDM), but evidence in Asian populations remains limited and inconsistent. This study investigated the association between dietary patterns during early pregnancy and the risk of GDM among pregnant women in Western China.

METHODS

A prospective cohort study was conducted among 1337 pregnant women in Western China. Dietary intakes were assessed at 15-20 weeks of gestation using a validated food frequency questionnaire. GDM was diagnosed by oral glucose tolerance tests at 24-28 weeks of gestation. Exploratory factor analysis was performed to derive dietary patterns, and logistic regression models were used to examine the association between dietary patterns and GDM.

RESULTS

A total of 199 women (14.9%) developed GDM. Three dietary patterns were identified, namely, a plant-based pattern, a meat-based pattern and a high protein-low starch pattern. Notwithstanding a lack of association between dietary patterns and GDM risk in the whole cohort, there was a significant reduction in GDM risk among overweight women (BMI ≥24 kg/m²); the odds ratio being 0.29 (95% confidence interval 0.09 to 0.94) when comparing the highest versus the lowest score of the high protein-low starch pattern.

CONCLUSIONS

There was no significant association between early pregnancy dietary patterns and GDM risk later in pregnancy for women in Western China, but high protein-low starch diet was associated with lower risk for GDM among women who were overweight at pre-pregnancy.

In utero exposure to extra vitamin D from food fortification and the risk of subsequent development of gestational diabetes: the D-tect study

Background

The primary aim of this study was to assess whether exposure during fetal life to extra vitamin D from food fortification was associated with a reduction in the risk of subsequently developing gestational diabetes mellitus (GDM). Furthermore, we examined whether the effect of the vitamin D from fortification differed by women’s season of birth.

Methods

This semi-ecological study is based on the cancellation in 1985 of the mandatory policy to fortify margarine with vitamin D in Denmark, with inclusion of entire national adjacent birth cohorts either exposed or unexposed to extra vitamin D in utero. The identification of GDM cases later in life among both exposure groups was based on the Danish national health registers. Logistic regression analyses generating odds ratios (ORs) and 95% confidence intervals (95% CIs) were performed.

Results

Women who were prenatally exposed to the extra vitamin D from fortification tended to have a lower risk of subsequently developing GDM than unexposed women (OR 0.87, 95%CI 0.74,1.02, P = 0.08). When analyses were stratified by women’s season of birth, exposed women born in spring had a lower risk of developing GDM compared to unexposed subjects (OR 0.68, 95%CI 0.50,0.94, p = 0.02).

Conclusion

This study suggests that prenatal exposure to extra vitamin D from mandatory fortification may lower the risk of developing gestational diabetes among spring-born women.

Trial registration

This study is part of the D-tect project, which is registered on clinicaltrials.gov: NCT03330301.

Electronic supplementary material

The online version of this article (10.1186/s12937-018-0403-5) contains supplementary material, which is available to authorized users.

The Pathophysiology of Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is a serious pregnancy complication, in which women without previously diagnosed diabetes develop chronic hyperglycemia during gestation. In most cases, this hyperglycemia is the result of impaired glucose tolerance due to pancreatic β-cell dysfunction on a background of chronic insulin resistance. Risk factors for GDM include overweight and obesity, advanced maternal age, and a family history or any form of diabetes. Consequences of GDM include increased risk of maternal cardiovascular disease and type 2 diabetes and macrosomia and birth complications in the infant. There is also a longer-term risk of obesity, type 2 diabetes, and cardiovascular disease in the child. GDM affects approximately 16.5% of pregnancies worldwide, and this number is set to increase with the escalating obesity epidemic. While several management strategies exist-including insulin and lifestyle interventions-there is not yet a cure or an efficacious prevention strategy. One reason for this is that the molecular mechanisms underlying GDM are poorly defined. This review discusses what is known about the pathophysiology of GDM, and where there are gaps in the literature that warrant further exploration.

Maternal dietary patterns and risk of adverse pregnancy (hypertensive disorders of pregnancy and gestational diabetes mellitus) and birth (preterm birth and low birth weight) outcomes: a systematic review and meta-analysis

OBJECTIVE

Epidemiological studies have indicated that dietary patterns during pregnancy are associated with adverse pregnancy and birth outcomes such as hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), preterm birth (PTB) and low birth weight (LBW). However, the results of these studies are varied and inconsistent. The present study aimed to assess the association between dietary patterns and the risk of adverse pregnancy and birth outcomes.

DESIGN

Systematic review and meta-analysis. Seven databases were searched for articles. Two reviewers performed the study selection and data extraction. A random-effects model was used to estimate pooled effect sizes of eligible studies.

SETTING

Studies conducted all over the world were incorporated.

SUBJECTS

The review focused on pregnant women.

RESULTS

A total of twenty-one studies were identified. Adherence to a healthy dietary pattern (intake of vegetables, fruits, legumes, whole grains) was significantly associated with lower odds (OR; 95 % CI) of pre-eclampsia (0·78; 0·70, 0·86; I2=39·0 %, P=0·178), GDM (0·78; 0·56, 0·99; I2=68·6 %, P=0·013) and PTB (0·75; 0·57, 0·93; I2=89·6 %, P=0·0001).

CONCLUSIONS

Our review suggests that dietary patterns with a higher intake of fruits, vegetables, legumes, whole grains and fish are associated with a decreased likelihood of adverse pregnancy and birth outcomes. Further research should be conducted in low-income countries to understand the impact of limited resources on dietary intake and adverse pregnancy and birth outcomes.

Diet quality as assessed by the Healthy Food Intake Index and relationship with serum lipoprotein particles and serum fatty acids in pregnant women at increased risk for gestational diabetes

The importance of overall diet in modifying circulating lipoprotein particles and fatty acids during pregnancy is unclear. We examined the relationships of diet quality as assessed by the validated Healthy Food Intake Index (HFII) with serum HDL, LDL and VLDL particle concentrations and sizes and proportions of serum fatty acids in pregnant women at high risk for gestational diabetes mellitus (GDM). Overall, 161 women with a BMI of ≥30 kg/m2 and/or a history of GDM were drawn from the Finnish Gestational Diabetes Prevention Study, which is a dietary and exercise intervention trial to prevent GDM. At baseline, the HFII score was inversely related to concentrations of HDL particles (P=0·010) and MUFA (P=0·010) and positively related to concentrations of n-3 (P<0·001) and n-6 (P=0·003) PUFA. The significance for MUFA disappeared after adjustments. An increase in the HFII score from the first to second trimester of pregnancy correlated with reduced VLDL particle size (r −0·16, 95 % CI −0·31, −0·01), decreased MUFA concentrations (r −0·17, 95 % CI −0·31, −0·01) and elevated n-6 PUFA concentrations (r 0·16, 95 % CI 0·01, 0·31). In the maximum-adjusted model, the results remained significant except for VLDL particle size. These findings suggest that higher diet quality as defined by the HFII is related to a more favourable serum fatty acid profile, whereas the relationship with serum lipoprotein profile is limited in pregnant women at increased GDM risk.

Dietary Patterns Prior to Pregnancy and Associations with Pregnancy Complications

Few studies have explored pre-pregnancy diet and its relationship with pregnancy outcomes. The objectives of this study were to: (1) derive pre-pregnancy dietary patterns for women enrolled in a prospective cohort in the province of Alberta, Canada; (2) describe associations between dietary patterns and socio-demographic characteristics; and (3) describe associations between dietary patterns and pregnancy complications. Upon enrolment into the Alberta Pregnancy Outcomes and Nutrition (APrON) study (median age of gestation, 17 weeks), women (n = 1545) completed a validated 142-item food frequency questionnaire recording food and beverages consumed “in the 12 months prior to pregnancy”. Other assessments included pre-pregnancy body mass index (BMI), gestational weight gain, gestational hypertension, gestational diabetes, and socio-demographic characteristics. Dietary patterns were derived using principal components analysis. Scores were calculated to represent adherence with each dietary pattern retained. Four dietary patterns were retained, accounting for 22.9% of the variation in the overall diet. Dietary patterns were named the “healthy”, “meat and refined carbohydrate”, “beans, cheese and salad” or “tea and coffee” patterns. Higher “healthy” pattern scores prior to pregnancy were associated with lower odds of developing gestational hypertension during pregnancy (adjusted Odds Ratio (OR): 0.6, 95% Confidence Intervals (CI): 0.4, 0.9). Diet prior to pregnancy is an important target for interventions and may reduce the likelihood of developing complications such as gestational hypertension during pregnancy.

Trimester-specific phthalate concentrations and glucose levels among women from a fertility clinic

BACKGROUND

Subfertile women are at increased risk of glucose intolerance in pregnancy. Based on epidemiologic studies, exposure to certain phthalates is associated with diabetes, elevated glucose, and increased insulin resistance.

OBJECTIVES

To evaluate the association between urinary phthalate metabolites and pregnancy glucose levels in women seeking medically assisted reproduction.

METHODS

We evaluated 245 women participating in a prospective cohort study based at a large fertility clinic who delivered live births and had data on pregnancy urinary phthalate metabolite concentrations and blood glucose levels. Urinary phthalate metabolite concentrations were from single spot urine samples collected in 1st and 2nd trimesters. Blood glucose data was abstracted from medical records for non-fasting 50-g glucose challenge tests at 24-28 weeks gestation. Multivariable linear regression models were used to evaluate associations between 7 urinary phthalate metabolites in quartiles and mean glucose adjusted for potential confounders.

RESULTS

Eighteen percent of women had glucose levels ≥ 140 mg/dL. Second trimester monoethyl phthalate (MEP) concentrations were positively associated with glucose levels, with adjusted mean (95%CI) glucose levels of 121 mg/dl (114, 128) vs. 109 mg/dL (103, 116) for women in highest and lowest quartiles, respectively. Women in the highest quartile of second trimester mono-isobutyl phthalate (MiBP) concentrations had a mean glucose level 14 mg/dL lower compared to women in the lowest quartile. No other urinary phthalate metabolites were associated with glucose levels.

CONCLUSIONS

MEP and MiBP-metabolites of diethyl phthalate and dibutyl phthalate, respectively-were associated with higher pregnancy glucose in subfertile women-a population at high risk of glucose intolerance in pregnancy.

Associations of Diet and Physical Activity with Risk for Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis

Rising rates of gestational diabetes mellitus (GDM) and related complications have prompted calls to identify potentially modifiable risk factors that are associated with gestational diabetes mellitus (GDM). We systematically reviewed the scientific literature for observational studies examining specific dietary and/or physical activity (PA) factors and risk of GDM. Our search included PubMed, Medline, CINAHL/EBSCO, Science Direct and EMBASE, and identified 1167 articles, of which 40 met our inclusion criteria (e.g., singleton pregnancy, reported diet or PA data during pre-pregnancy/early pregnancy and GDM as an outcome measure). Studies were assessed for quality using a modified Quality Criteria Checklist from American Dietetic Association. Of the final 40 studies, 72% obtained a positive quality rating and 28% were rated neutral. The final analysis incorporated data on 30,871 pregnant women. Dietary studies were categorised into either caffeine, carbohydrate, fat, protein, calcium, fast food and recognized dietary patterns. Diets such as Mediterranean Diet (MedDiet), Dietary Approaches to Stop Hypertension (DASH) diet and Alternate Healthy Eating Index diet (AHEI) were associated with 15–38% reduced relative risk of GDM. In contrast, frequent consumption of potato, meat/processed meats, and protein (% energy) derived from animal sources was associated with an increased risk of GDM. Compared to no PA, any pre-pregnancy or early pregnancy PA was associated with 30% and 21% reduced odds of GDM, respectively. Engaging in >90 min/week of leisure time PA before pregnancy was associated with 46% decreased odds of GDM. We conclude that diets resembling MedDiet/DASH diet as well as higher PA levels before or in early pregnancy were associated with lower risks or odds of GDM respectively. The systematic review was registered at PROSPERO (www.crd.york.ac.uk/PROSPERO) as CRD42016027795.

Pre-pregnancy dietary carbohydrate quantity and quality, and risk of developing gestational diabetes: the Australian Longitudinal Study on Women's Health

Carbohydrate quantity and quality affect postprandial glucose response, glucose metabolism and risk of type 2 diabetes. The aim of this study was to examine the association of pre-pregnancy dietary carbohydrate quantity and quality with the risk of developing gestational diabetes mellitus (GDM). We used data from the Australian Longitudinal Study on Women's Health that included 3607 women aged 25-30 years without diabetes who were followed up between 2003 and 2015. We examined carbohydrate quantity (total carbohydrate intake and a low-carbohydrate diet (LCD) score) and carbohydrate subtypes indicating quality (fibre, total sugar intake, glycaemic index, glycaemic load and intake of carbohydrate-rich food groups). Relative risks (RR) for development of GDM were estimated using multivariable regression models with generalised estimating equations. During 12 years of follow-up, 285 cases of GDM were documented in 6263 pregnancies (4·6 %). The LCD score, reflecting relatively high fat and protein intake and low carbohydrate intake, was positively associated with GDM risk (RR 1·54; 95 % CI 1·10, 2·15), highest quartile v. lowest quartile). Women in the quartile with highest fibre intake had a 33 % lower risk of GDM (RR 0·67; 95 % CI 0·45, 0·96)). Higher intakes of fruit (0·95 per 50 g/d; 95 % CI 0·90, 0·99) and fruit juice (0·89 per 100 g/d; 95 % CI 0·80, 1·00)) were inversely associated with GDM, whereas cereal intake was associated with a higher risk of GDM (RR 1·05 per 20 g/d; 95 % CI 1·01, 1·07)). Thus, a relatively low carbohydrate and high fat and protein intake may increase the risk of GDM, whereas higher fibre intake could decrease the risk of GDM. It is especially important to take the source of carbohydrates into account.

Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health

A woman who is healthy at the time of conception is more likely to have a successful pregnancy and a healthy child. We reviewed published evidence and present new data from low-income, middle-income, and high-income countries on the timing and importance of preconception health for subsequent maternal and child health. We describe the extent to which pregnancy is planned, and whether planning is linked to preconception health behaviours. Observational studies show strong links between health before pregnancy and maternal and child health outcomes, with consequences that can extend across generations, but awareness of these links is not widespread. Poor nutrition and obesity are rife among women of reproductive age, and differences between high-income and low-income countries have become less distinct, with typical diets falling far short of nutritional recommendations in both settings and especially among adolescents. Several studies show that micronutrient supplementation starting in pregnancy can correct important maternal nutrient deficiencies, but effects on child health outcomes are disappointing. Other interventions to improve diet during pregnancy have had little effect on maternal and newborn health outcomes. Comparatively few interventions have been made for preconception diet and lifestyle. Improvements in the measurement of pregnancy planning have quantified the degree of pregnancy planning and suggest that it is more common than previously recognised. Planning for pregnancy is associated with a mixed pattern of health behaviours before conception. We propose novel definitions of the preconception period relating to embryo development and actions at individual or population level. A sharper focus on intervention before conception is needed to improve maternal and child health and reduce the growing burden of non-communicable diseases. Alongside continued efforts to reduce smoking, alcohol consumption, and obesity in the population, we call for heightened awareness of preconception health, particularly regarding diet and nutrition. Importantly, health professionals should be alerted to ways of identifying women who are planning a pregnancy.

Dietary pattern in pregnancy and risk of gestational diabetes mellitus (GDM)

AIM

Among the most common metabolic disorders during pregnancy is gestational diabetes mellitus (GDM). This research was conducted to examine the dietary pattern in women with GDM.

MATERIAL AND METHODS

In this case-study, 204 pregnant women (104 cases and 100 control women) were chosen through convenient sampling and random sampling. The subjects' food intakes were assessed using semi-quantitative food frequency questionnaire, while their activities evaluated by physical activity questionnaire. Anthropometric indices were measured based on standard instructions, and the body mass index was calculated. The dietary patterns were determined using principal component analysis and its relationship with preeclampsia was tested using logistic regression method.

RESULTS

Unhealthy and healthy dietary patterns were found among the pregnant women. In the unhealthy group, after modifying the effect of confounding variables, a significant relationship was observed between dietary pattern and having gestational diabetes (OR = 2.838,95% CI:1.039-7.751). In the healthy group, on the other hand, the people in the fourth quartile had 149% and 184% higher chance not to catch gestational diabetes before and after modification with confounders, respectively (OR = 0.284,95% CI:0.096-0.838), when compared with people in the first quartile.

CONCLUSION

The findings indicated that selection of foods including fruits, vegetables, low-fat dairies, etc. as healthy dietary pattern is associated with diminished risk of GDM among pregnant women. Determining healthy dietary pattern during pregnancy, considering the foods consumed among pregnant women, as a useful and practical guide during this period can be publicized for training and nutritional interventions.

Evaluating pre-pregnancy dietary diversity vs. dietary quality scores as predictors of gestational diabetes and hypertensive disorders of pregnancy

Background

Dietary diversity scores (DDS) are considered as metrics for monitoring the implementation of the UN’s Sustainable Development Goals, but they need to be rigorously evaluated.

Objective

To examine two DDS, the Food Groups Index (FGI), and the Minimum Dietary Diversity-Women (MDD-W), alongside two dietary quality scores, the Alternate Healthy Eating Index (AHEI-2010) and the Prime Diet Quality Score (PDQS), with risks of gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDPs).

Design

The analysis included 21,312 (GDM) and 19,917 (HDPs) singleton births reported in the Nurses’ Health Study II cohort (1991–2001), among women without major chronic disease or GDM/HDPs. Scores were derived using prepregnancy diet collected by a comprehensive food frequency questionnaire. Multivariable models were utilized to calculate relative risks (RR) and confidence intervals (95%CIs).

Results

Incident GDM (n = 916) and HDPs (n = 1,421) were reported. The MDD-W and FGI were not associated with risk of GDM or HDPs, but the AHEI-2010 and PDQS were associated with a lower risk of GDM and marginally lower risk of HDP. The RR’s of GDM comparing the highest vs. lowest quintiles were 1.00 (95%CI: 0.79, 1.27; p-trend = 0.82) for MDD-W, 0.96 (95%CI: 0.76, 1.22; p-trend = 0.88) for FGI, 0.63 (95%CI: 0.50, 0.81; p-trend <0.0001) for the AHEI-2010 and 0.68 (95%CI: 0.54, 0.86; p-trend = 0.003) for the PDQS. Similarly, the RR’s of HDPs were 0.92 (95%CI: 0.75, 1.12, p-trend = 0.94) for MDD-W, 0.97 (95%CI: 0.79, 1.17; p-trend = 0.83) for FGI, 0.84 (95%CI: 0.70, 1.02; p-trend = 0.07) for AHEI-2010 and 0.89 (95%CI: 0.74, 1.09; p-trend = 0.07) for PDQS.

Conclusions

MDD-W and FGI did not predict the risk of GDM and HDPs. These DDS should not be widely used as metrics for achieving dietary goals in their present form. The Prime Diet Quality Score warrants further testing as a promising measure of a sustainable and healthy diet on a global scale.

Association between dietary patterns and depressive symptoms among middle-aged adults in China in 2016-2017

The purpose of this study was to explore the associations of dietary patterns with depressive symptoms in middle-aged Chinese adults. The cross-sectional study participants were 1360 Chinese adults (45-59 years, 659 males and 701 females) who participated in a Health Survey at the time of periodic checkup. Dietary intakes were assessed via a semi-quantitative food frequency questionnaire (FFQ). Binary logistic regression analysis was used to estimate odds ratio(OR) and 95% confidence interval(CI) for depressive symptoms according to quartiles of each dietary pattern score. Four major dietary patterns were identified by factor analysis: traditional Chinese, Western, grains-vegetables and high-salt patterns. After controlling for potential confounders, participants in the highest quartile of the Western pattern scores had greater odds of depressive symptoms than those in the lowest quartile. In contrast, participants in the highest quartile of the grains-vegetables pattern had lower odds of depressive symptoms than those in the lowest quartile. Nevertheless, no significant associations were observed between the traditional Chinese and high-salt patterns and the risk of depressive symptoms, even after adjusting for potential confounders. The findings indicate that the Western pattern is associated with an increased risk, and the grains-vegetables pattern is associated with a reduced risk of depressive symptoms.

Gestational diabetes from A to Z

Gestational diabetes mellitus (GDM) is defined as any degree of hyperglycaemia that is recognized for the first time during pregnancy. This definition includes cases of undiagnosed type 2 diabetes mellitus (T2DM) identified early in pregnancy and true GDM which develops later. GDM constitutes a greater impact on diabetes epidemic as it carries a major risk of developing T2DM to the mother and foetus later in life. In addition, GDM has also been linked with cardiometabolic risk factors such as lipid abnormalities, hypertensive disorders and hyperinsulinemia. These might result in later development of cardiovascular disease and metabolic syndrome. The understanding of the different risk factors, the pathophysiological mechanisms and the genetic factors of GDM, will help us to identify the women at risk, to develop effective preventive measures and to provide adequate management of the disease. Clinical trials have shown that T2DM can be prevented in women with prior GDM, by intensive lifestyle modification and by using pioglitazone and metformin. However, a matter of controversy surrounding both screening and management of GDM continues to emerge, despite several recent well-designed clinical trials tackling these issues. The aim of this manuscript is to critically review GDM in a detailed and comprehensive manner, in order to provide a scientific analysis and updated write-up of different related aspects.

Dietary patterns are associated with type 2 diabetes mellitus among middle-aged adults in Zhejiang Province, China

Background

Although some studies have shown the associations between dietary patterns and the risk T2DM in a general population, the associations in middle-aged Chinese have been rarely studied to date. In this study, we aimed to characterize dietary patterns in Chinese adults aged 45-59y (n = 1918) and to evaluate the relationship between dietary patterns and the risk of T2DM.

Methods

The study population was a part of the population-based the Nutrition and Health Study conducted in the city of Hangzhou, Zhejiang Province, China. Dietary intake was assessed by using a validated food frequency questionnaire (FFQ). Multivariate logistic regression analyses were used to estimate the associations between dietary patterns and the risk of T2DM, adjusting for potential confounders.

Results

Three major dietary patterns were identified using factor analysis, including the traditional southern Chinese, the Western, and the grains-vegetables patterns. After adjusting for the potential confounders, subjects in the highest quartile of the Western dietary pattern scores had greater odds ratio(OR) for T2DM(OR = 1.28; 95% confidence interval (CI): 1.103–1.697; P = 0.02) than did those in the lowest quartile. Compared with those in the lowest quartile, subjects in the highest quartile of the grains-vegetables dietary pattern scores had a lower OR for T2DM (OR = 0.72; 95% CI:0.596–0.952; P = 0.04). Moreover, no significant association was found between the traditional southern Chinese dietary pattern and risk of developing T2DM.

Conclusions

Our findings indicated that the Western dietary pattern was associated with an elevated risk, whereas the grains-vegetables dietary pattern was associated with a reduced risk of T2DM. Further researches are needed to confirm these findings.

Effect of gene-lifestyle interaction on gestational diabetes risk

We hypothesized that the association of certain lifestyle parameters with gestational diabetes mellitus (GDM) risk would depend on susceptibility loci. In total, 278 Russian women with GDM and 179 controls completed questionnaires about lifestyle habits (food consumption, physical activity and smoking). GDM was diagnosed according to the criteria of the International Association of Diabetes and Pregnancy Study Groups. Maternal blood was sampled for genotyping single-nucleotide polymorphisms (SNPs) in MTNR1B (rs10830963 and rs1387153), GCK (rs1799884), KCNJ11 (rs5219), IGF2BP2 (rs4402960), TCF7L2 (rs7903146 and rs12255372), CDKAL1 (rs7754840), IRS1 (rs1801278) and FTO (rs9939609). Binary logistic regression revealed an interaction effect of sausage intake and the number of risk alleles of two SNPs (rs10830963 in MTNR1B and rs1799884 in GCK) on GDM risk (P < 0.001). Among women without risk alleles of these two SNPs, sausage consumption was positively associated with GDM risk (P trend = 0.045). This difference was not revealed in women carrying 1 or more risk alleles. The risk of GDM increased as the number of risk alles increased in participants with low and moderate sausage consumption (P trend <0.001 and 0.006, respectively), while the risk of GDM in women with high sausage consumption remained relatively high, independent of the number of risk alleles. These findings indicate that the association of sausage consumption with GDM risk can be determined based on the number of risk alleles of rs10830963 in MTNR1B and rs1799884 in GCK.

Dietary patterns associated hyperuricemia among Chinese aged 45 to 59 years: An observational study

In our literature research, we have not found any study reporting the association between the major dietary patterns and the risk of hyperuricemia in a middle-aged Chinese population. Herein, the present study aimed to evaluate the association of dietary patterns with the risk of hyperuricemia in the city of Hangzhou, Zhejiang Province, East China. We included 1204 participants (743 males and 461 females) aged 45 to 59 years in the present cross-sectional study. Dietary intake was assessed using a semiquantitative food frequency questionnaire in 2014 to 2016. All biochemical data and anthropometric measurements were collected following standardized procedures. Dietary patterns were determined by using factor analysis. We examined the associations between major dietary patterns and hyperuricemia risk by log-binominal regression analysis, and the results are presented as prevalence ratio (PR) and confidence interval (CI). Three major dietary patterns were identified by means of factor analysis: traditional Chinese, meat food, and mixed food patterns. After controlling for potential confounders, subjects in the highest quartile of the traditional Chinese pattern scores had a lower PR for hyperuricemia (PR = 0.82; 95%CI: 0.426-0.922), in comparison to those from the lowest quartile, while compared with the lowest quartile of the meat food pattern, the highest quartile had a greater PR for hyperuricemia (PR = 1.48; 95%CI: 1.120-2.097). Besides, no association was observed between mixed food pattern and the risk of hyperuricemia.Our findings indicate that the traditional Chinese pattern is associated with a decreased risk of hyperuricemia, and the meat food pattern is associated with an increased risk of hyperuricemia, whereas the mixed food pattern shows no association with the risk of hyperuricemia. Further large prospective studies are warranted to confirm our findings.

Dietary iron intake, iron status, and gestational diabetes

Pregnant women are particularly vulnerable to iron deficiency and related adverse pregnancy outcomes and, as such, are routinely recommended for iron supplementation. Emerging evidence from both animal and population-based studies, however, has raised potential concerns because significant associations have been observed between greater iron stores and disturbances in glucose metabolism, including increased risk of type 2 diabetes among nonpregnant individuals. Yet, the evidence is uncertain regarding the role of iron in the development of gestational diabetes mellitus (GDM), a common pregnancy complication which has short-term and long-term adverse health ramifications for both women and their children. In this review, we critically and systematically evaluate available data examining the risk of GDM associated with dietary iron, iron supplementation, and iron status as measured by blood concentrations of several indicators. We also discuss major methodologic concerns regarding the available epidemiologic studies on iron and GDM.

Pre-pregnancy adherences to empirically derived dietary patterns and gestational diabetes risk in a Mediterranean cohort: the Seguimiento Universidad de Navarra (SUN) project

The aim of this study was to investigate the association between the adherence to empirically derived dietary patterns and gestational diabetes mellitus (GDM) risk and of healthy lifestyles with the prevention of GDM defining an overall healthy score. The Seguimiento Universidad de Navarra project is a Mediterranean cohort of university graduates started in 1999. We included 3455 pregnant women. During a mean follow-up of 10·3 (sd 3·3) years, we identified 173 incident GDM cases. Two major dietary patterns were identified using principal component analysis: the Western dietary pattern (WDP) (characterised by a high consumption of meat-based products and processed foods) and the Mediterranean dietary pattern (MDP) (characterised by a high consumption of vegetables, fruits, fish and non-processed foods). A low-risk score for GDM was defined taking into account important risk factors (age, BMI and unhealthy dietary pattern) for GDM. Positive association was found in the multivariable model between the highest quartile of adherence to WDP and GDM incidence compared with the lowest quartile (OR 1·56; 95 % CI 1·00, 2·43). No association was found between adherence to the MDP and GDM incidence (OR 1·08; 95 % CI 0·68, 1·70 for the highest quartile compared with the lowest). Women who adhered to all three low-risk factors had a 76 % lower risk of GDM (OR 0·24; 95 % CI 0·10, 0·55) compared with women who did not adhere to any factor before pregnancy. In conclusion, our results reinforce the importance of dietary recommendations and other two factors (low BMI and young age at pregnancy) in pre-gravid women.

Socio-economic status and risk of gestational diabetes mellitus among Chinese women

AIMS

The relationship between socio-economic status and gestational diabetes mellitus has received little attention. The purpose of this study was to investigate the association between socio-economic status and risk of gestational diabetes.

METHODS

Data were obtained from the ongoing Healthy Baby Cohort study in Hubei Province, China, in 2012-2014. Information on educational level and household income was collected using standard questionnaires during face-to-face interviews. Gestational diabetes was defined based on the International Association of Diabetes and Pregnancy Study Group's criteria. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for gestational diabetes in relation to socio-economic status.

RESULTS

Among 6886 participants, 1005 (14.6%) pregnant women were diagnosed with gestational diabetes. Higher educational level was inversely associated with risk of gestational diabetes (OR, 0.74; 95% CI, 0.58, 0.95 for high school and OR, 0.62; 95% CI, 0.50, 0.76 for college or above). After adjustment for potential confounders, the ORs for gestational diabetes were 0.77 (95% CI, 0.59, 1.00) and 0.65 (95% CI, 0.51, 0.83) for women with high school and college or above education, respectively, compared with women with less than high school education. No significant association between household income and gestational diabetes was observed after adjustment for potential confounders. Subgroup analysis showed that the reduced risk of gestational diabetes with higher educational level was more evident among women with a pre-pregnancy BMI < 24 kg/m² (P for interaction = 0.022).

CONCLUSIONS

Our findings suggested that educational level was a more robust predictor of gestational diabetes than household income among Chinese women.

Healthy Lifestyle During Early Pregnancy and Risk of Gestational Diabetes Mellitus

Previous studies have found associations between individual healthy behaviors and reduced risk of gestational diabetes mellitus (GDM); however, the association of composite healthy lifestyle during pregnancy with GDM has not been examined. Participants in the Omega Study (n = 3,005), a pregnancy cohort study conducted in Washington State (1996-2008), reported information on diet, physical activity, smoking, and stress during early pregnancy. Lifestyle components were dichotomized into healthy/unhealthy and then combined into a total lifestyle score (range, 0-4). Regression models were used to determine relative risk of GDM (n = 140 cases) in relation to healthy lifestyle. Twenty percent of participants had a healthy diet, 66% were physically active, 95% were nonsmokers, and 55% had low stress. Each 1-point increase in lifestyle score was associated with a 21% lower risk of GDM (95% confidence interval: 0.65, 0.96) after adjustment for age, race, and nulliparity. Adjustment for prepregnancy body mass index, prepregnancy physical activity, and prepregnancy smoking attenuated the associations slightly. Associations were similar in normal-weight and overweight/obese women. In this study, a composite measure of healthy lifestyle during early pregnancy was associated with substantially lower GDM risk. Public health messaging and interventions promoting multiple aspects of a healthy lifestyle during early pregnancy should be considered for GDM prevention.

Maternal dietary intakes of refined grains during pregnancy and growth through the first 7 y of life among children born to women with gestational diabetes

Background: Refined grains, a major source of dietary carbohydrates, have been related to impaired glucose homeostasis and obesity. Emerging animal data suggest that in utero exposure to dietary refined carbohydrates may predispose offspring to an obese phenotype, indicating a potential role for nutritional programming in the early origins of obesity, but intergenerational human data are lacking.Objective: We prospectively investigated refined-grain intake during pregnancy in association with offspring growth through age 7 y among high-risk children born to women with gestational diabetes mellitus (GDM).Design: The analysis included 918 mother-singleton child dyads from the Danish National Birth Cohort. Offspring body mass index z scores (BMIZs) were calculated by using weight and length or height measured at birth, 5 and 12 mo, and 7 y. Overweight or obesity was defined by WHO cutoffs. Linear and Poisson regressions were used, with adjustment for maternal demographic, lifestyle, and dietary factors.Results: Refined-grain intake during pregnancy was positively associated with offspring BMIZ (adjusted β per serving increase per day: 0.09; 95% CI: 0.02, 0.15) and risk of overweight or obesity at age 7 y [adjusted RR (aRR) comparing the highest with the lowest quartile: 1.80; 95% CI: 1.09, 2.98; P-trend = 0.032]. The association appeared to be more pronounced among children who were breastfed <6 mo. The substitution of 1 serving refined grains/d with an equal serving of whole grains during pregnancy was related to a 10% reduced risk of offspring overweight or obesity at 7 y of age (aRR: 0.90; 95% CI: 0.82, 0.98). No associations were observed between refined-grain intake and infant growth.Conclusions: Higher maternal refined-grain intake during pregnancy was significantly related to a greater BMIZ and a higher risk of overweight or obesity at age 7 y among children born after pregnancies complicated by GDM. The findings highlight pregnancy as a potential window of susceptibility associated with offspring growth and obesity risk among this high-risk population. Data with longer follow-up are warranted.