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

The association between ultra-processed food and common pregnancy adverse outcomes: a dose-response systematic review and meta-analysis

OBJECTIVES

Given the increasing incidence of negative outcomes during pregnancy, our research team conducted a dose-response systematic review and meta-analysis to investigate the relationship between ultra-processed foods (UPFs) consumption and common adverse pregnancy outcomes including gestational diabetes mellitus (GDM), preeclampsia (PE), preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) infants. UPFs are described as formulations of food substances often modified by chemical processes and then assembled into ready-to-consume hyper-palatable food and drink products using flavors, colors, emulsifiers, and other cosmetic additives. Examples include savory snacks, reconstituted meat products, frozen meals that have already been made, and soft drinks.

METHODS

A comprehensive search was performed using the Scopus, PubMed, and Web of Science databases up to December 2023. We pooled relative risk (RR) and 95% confidence intervals (CI) using a random-effects model.

RESULTS

Our analysis (encompassing 54 studies with 552,686 individuals) revealed a significant association between UPFs intake and increased risks of GDM (RR = 1.19; 95% CI: 1.10, 1.27; I2 = 77.5%; p < 0.001; studies = 44; number of participants = 180,824), PE (RR = 1.28; 95% CI: 1.03, 1.59; I2 = 80.0%; p = 0.025; studies = 12; number of participants = 54,955), while no significant relationships were found for PTB, LBW and SGA infants. Importantly, a 100 g increment in UPFs intake was related to a 27% increase in GDM risk (RR = 1.27; 95% CI: 1.07, 1.51; I2 = 81.0%; p = 0.007; studies = 9; number of participants = 39,812). The non-linear dose-response analysis further indicated a positive, non-linear relationship between UPFs intake and GDM risk Pnonlinearity = 0.034, Pdose-response = 0.034), although no such relationship was observed for PE (Pnonlinearity = 0.696, Pdose-response = 0.812).

CONCLUSION

In summary, both prior to and during pregnancy, chronic and excessive intake of UPFs is associated with an increased risk of GDM and PE. However, further observational studies, particularly among diverse ethnic groups with precise UPFs consumption measurement tools, are imperative for a more comprehensive understanding.

Consumption of red and processed meat during early pregnancy and risk of gestational diabetes: a prospective birth cohort study

To investigate the association of red and processed meat intake with the risk of gestational diabetes (GDM) in Iranian mothers. A total of 635 pregnant mothers were included. Dietary intake was assessed by a 90-item food frequency questionnaire during the first trimester of pregnancy. Intakes of total red meat, unprocessed red meat, and processed meat were calculated and then, Cox proportional hazard model was used to calculate the hazard ratios (HR) and 95%CIs of GDM across tertiles of red meat intake while controlling for age, occupation, pre-pregnancy body mass index, physical activities, history of cardiovascular disease, hypertension, hypothyroidism, hyperthyroidism, and pregnancy hypertension, order of pregnancy, nausea during current pregnancy, multivitamin use during current pregnancy, weight gain during current pregnancy and total energy intake. The average age of the mothers was 28.80 ± 5.09 years, the average pre-pregnancy body mass index was 25.13 ± 4.43 kg/m2, and the average weight gain during pregnancy was 13.50 ± 5.03 kg. The multivariable-adjusted HRs of GDM for the third tertiles of red and processed meat, red meat, and processed meat intake were, respectively, 1.92 (95% CI 1.06, 3.49), 1.52 (95% CI 0.85, 2.72) and 1.31 (95% CI 0.73, 2.34) when compared to the first tertiles. Our prospective cohort study suggested that there was a positive association between the consumption of red and processed meat and with risk of GDM in a small sample of Iranian mothers with low red meat intake. More large-scale cohort studies in the Iranian population are needed to present more robust evidence in this regard.

Association between protein intake and risk of gestational diabetes mellitus: A systematic review and dose-response meta-analysis of cohort studies

BACKGROUND

Gestational diabetes mellitus (GDM) is a common condition in pregnancy, the prevalence of which has increased. Identifying modifiable risk factors for GDM, such as dietary factors, could prevent or delay the onset of the condition. Our goal was to perform a comprehensive meta-analysis of cohort studies, to summarize the current evidence on the relationship between total, animal, and plant protein intake during pregnancy, as well as pre-pregnancy protein intake, and the risk of GDM.

METHODS

A literature search was completed using Scopus, PubMed, Web of Science, and Google Scholar up to January 2023 and references of retrieved relevant articles. Observational studies examining the association between the consumption of dietary protein from different sources in pre-pregnancy or/and during pregnancy and the risk of GDM were included. To combine effect sizes for the comparison between the highest and lowest categories of protein intake, a random effects model was utilized. Dose-response relationships were investigated using a 1-stage random-effects model.

RESULTS

8 observational studies were included in the systematic review and 5 prospective cohort studies in the meta-analysis, involving a total of 24,160 participants and 2450 cases of GDM. The analysis revealed a significant association between total protein intake during pregnancy and an elevated risk of GDM (relative risk (RR): 2.24, 95 % confidence interval (CI): 1.67-3.00, P = 0.000). Conversely, no significant association was found between total protein intake before pregnancy and the risk of GDM. Both animal protein intake before pregnancy (RR: 1.47, 95 % CI: 1.06-2.03, P = 0.021) and during pregnancy (RR; 2.31, 95 % CI: 1.43-3.73, P = 0.001) showed a significant association with GDM. Interestingly, there was no significant association between the consumption of plant protein both before and during pregnancy and the risk of GDM. Further analysis revealed that an additional 5 % energy from total protein and animal protein per day was associated with a 24 % and 32 % before and 114 % and 67 % increased risk of GDM during pregnancy respectively.

CONCLUSION

In conclusion, consumption of animal protein and total protein before pregnancy is associated with an increased risk of GDM, although the association is not significant for total protein. Conversely, plant protein intake is linked to a decreased risk of GDM, however, the results are not significant. The intake of any protein type (plant/animal/total) during pregnancy is associated with an elevated risk of GDM, with this association being statistically insignificant for plant protein. Further cohort studies are required to validate the findings presented in this study.

REGISTRATION

PROSPERO (CRD42023396215).

Dietary protein in early pregnancy and gestational diabetes mellitus: a prospective cohort study

PURPOSE

The relationship between dietary protein intake and the risk of gestational diabetes mellitus (GDM) remains inconsistent and unclear. Here, we examined the correlation between the various sources of protein intake among Chinese pregnant women and GDM.

METHODS

This prospective cohort study included 1060 pregnant women at 6-13+6 weeks of gestation from Guangdong Provincial Hospital for Women and Children, South China. The participants' intake of dietary protein was assessed using a validated quantitative food frequency questionnaire during the early trimester. GDM was diagnosed via an oral glucose tolerance test performed at 24-28 gestational weeks. Logistic regression analysis was used to evaluate the association between dietary protein intake during pregnancy and GDM. Furthermore, we applied restricted cubic splines to determine their linear relationship.

RESULTS

About 26.3% (n = 279) of pregnant women were diagnosed with GDM. Animal protein intake was revealed to have a positive correlation with GDM risk (Q4 vs. Q1: OR, 2.78; 95% CI, 1.46-5.34; P = 0.015), whereas high intake levels of dietary plant protein were linked to reduced GDM risk (Q4 vs. Q1: OR, 0.43; 95% CI, 0.25-0.73). In stratified analysis, the relationship between protein and GDM was stronger during early pregnancy in women with obesity. However, total protein intake did not show a significant association with GDM.

CONCLUSIONS

Our study findings suggest that a plant protein-based diet was associated with reduced GDM risk, whereas the dietary intake of animal protein was positively associated with GDM risk among Chinese women during early pregnancy.

The relation of dietary protein intake before and during the pregnancy with gestational diabetes mellitus (GDM): A GRADE-assessed systematic review and dose-response meta-analysis of epidemiologic studies

BACKGROUND

Although previous studies investigated the relation of protein intake and gestational diabetes mellitus (GDM), their findings were controversial. Therefore, we aimed to summarize this association, through a comprehensive systematic review and dose-response meta-analysis.

METHODS

Electronic databases including MEDLINE (PubMed), ISI Web of Science, Scopus and motor engineering of Google Scholar were systematically searched up to April 2023. Observational studies which investigated odds of GDM in relation to protein intake were included.

RESULTS

A total of 31,005 participants with 3451 cases of GDM from 13 eligible investigations were included in the systematic review and meta-analysis. Comparing the highest and lowest intakes of total, animal, and plant proteins revealed the summary RRs of 1.82 (95% CI: 1.42, 2.33), 1.79 (95% CI: 1.50, 2.14), and 0.98 (95% CI: 0.81, 1.20), respectively, indicating a significant positive association between total and animal protein intake and GDM. In the dose-response analyses, each 5% increment in energy intake from total protein during pregnancy was related to 20% increased odds of GDM (RR = 1.20; 95% CI: 1.09, 1.33). In the non-linear dose-response analyses, we found a non-linear association for animal protein intake during pregnancy (P for non-linearity <0.001); so that, a risk increase was seen from zero to 10% of energy intake from animal proteins, however, a risk reduction was seen after 10% of energy intake. However, there was not any significant non-linear trend between plant protein intake during pregnancy and risk of GDM. Based on the GRADE assessment, the quality of evidence for total, animal and plant protein was rated as "moderate", "moderate" and "very low", respectively.

CONCLUSION

We found a significant positive association between total protein intake and GDM; however, the associations of animal and plant protein intake with GDM were dose-dependent.

The Effect of Dietary Protein Intake on the Risk of Gestational Diabetes

Background. The results of epidemiological studies on the association between dietary protein intake and gestational diabetes mellitus (GDM) are controversial. Thus, this systematic review and meta-analysis of cohort studies were established to attain comprehensive findings regarding the association between dietary protein and the risk of GDM. Methods. Bibliographic databases including PubMed, Scopus, Web of Science, and Google Scholar were searched to discover papers related to dietary protein and the risk of GDM. The summary relative risks with 95% confidence intervals (CIs) were estimated through a random effect model for the analysis of the highest versus the lowest categories of dietary proteins. Results. A significantly increased risk of GDM among women who consumed the highest amount of animal protein was observed (summarized risk estimate: 1.52; 95% CI: 1.07, 2.17; I2 = 50.8%). No significant associations were identified regarding vegetable protein (summarized risk estimate:0.99, 95% CI: 0.80 to 1.23, I2 = 63.8%) and total protein (summarized risk estimate: 1.12; 95% CI: 0.88, 1.41; I2 = 35.4%). Conclusion. This review revealed that total protein intake had no relationship with the risk of GDM, while animal protein increases this risk. Further larger prospective cohort studies are required to confirm our results.

The role of nutrition in the development and management of gestational diabetes among Iranian women: a systematic review and meta-analysis

Purpose

We aimed to review existing evidence on nutrition associations with gestational diabetes mellitus (GDM) development and management among Iranian women.

Methods

Web of Science, PubMed, Scopus, SID, and Magiran were searched up to August 2020. Observational studies on associations between circulatory markers of vitamins and minerals, dietary intakes, and GDM and clinical trials of the effects of nutritional supplementations or dietary modifications on management or prevention of GDM among Iranian women were selected.

Results

We reviewed 49 publications. Pooled analyses revealed that GDM women had lower serum vitamin D (-8.31 nmol/l (95% CIs= -14.4, -2.19), higher serum iron (26.2 μg/dl (95% CIs= 2.52, 49.8), ferritin (24.1 ng/ml (95% CIs= 15.0, 33.4), and haemoglobin (1.14 g/dl (95% CIs: 0.32, 1.96) levels than non-GDM women. Single studies found the inverse associations of the Mediterranean diet, dietary approaches to stop hypertension diet, plant-based dietary index, and the direct associations of dietary acid load and dietary inflammatory index with the odds of GDM. Vitamin D supplementation early in pregnancy prevented GDM in two clinical trials. In two studies, iron supplementation's effect on GDM in non-anemic women was inconsistent. Pooled analyses of probiotic supplementation in women with GDM showed no significant impact on maternal glycemia.

Conclusions

Vitamin D supplementation early in pregnancy may reduce the incidence of GDM. There is no compelling evidence that vitamin D or probiotics can help with GDM management. There is currently inadequate data to recommend a specific dietary pattern to prevent GDM in Iranian women.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-021-00944-7.

Association between White Blood Cells Count and Diabetes Mellitus in Tabari Cohort Study: A Case-Control Study

BACKGROUND

White Blood Cells (WBC) can be a useful marker to predict diabetes. In this study, we aimed to investigate the association between WBC count with type 2 diabetes in a large-scaled population-based cohort study.

METHODS

In the present study we used a subset of data collected in enrolment phase of Tabari cohort study. Participants with fasting blood glucose ≥126 or those who report as having diabetes or taking glucose-lowering medications were selected as case group (1765 participants) and control group included participants who did not report as having diabetes (1765 participants) and they randomly selected from the baseline population. Hematology indices were measured for all participants using Celltac Alpha MEK-6510 K. Chi-squared and independent t-test were used to compare categorical and continuous variables, respectively.

RESULTS

The mean of WBC in diabetic patients and control group was 6.89 ± 1.67 and 6.37 ± 1.49 respectively (P ≤ 0.001). The odds of diabetes based on WBC count in crud model was 1.23 [CI 95% 1.181.28] and after adjustment for all possible confounding factor was 1.17 [CI 95% 1.111.23].

CONCLUSIONS

Results of the present study showed a significant association between WBC count and diabetes. This association remained significant after adjustment for all possible confounders.