Dietary Fiber Intake, Dietary Glycemic Load, and the Risk for Gestational Diabetes Mellitus

Abstract

OBJECTIVE -We aimed to examine whether pregravid dietary fiber consumptions from cereal, fruit, and vegetable sources and dietary glycemic load were related to gestational diabetes mellitus (GDM) risk.RESEARCH DESIGN AND METHODS -This study was a prospective cohort study among 13,110 eligible women in the Nurses' Health Study II. GDM was self-reported and validated by medical record review in a subsample.RESULTS -We documented 758 incident GDM cases during 8 years of follow-up. After adjustment for age, parity, prepregnancy BMI, and other covariates, dietary total fiber and cereal and fruit fiber were strongly associated with GDM risk. Each 10-g/day increment in total fiber intake was associated with 26% (95% CI 9 -49) reduction in risk; each 5-g/day increment in cereal or fruit fiber was associated with a 23% (9 -36) or 26% (5-42) reduction, respectively. Dietary glycemic load was positively related to GDM risk. Multivariate relative risk for highest versus lowest quintiles was 1.61 (1.02-2.53) (P for trend 0.03). The combination of highglycemic load and low-cereal fiber diet was associated with 2.15-fold (1.04 -4.29) increased risk compared with the reciprocal diet.CONCLUSIONS -These findings suggested that prepregnancy diet might be associated with women's GDM risk. In particular, diet with low fiber and high glycemic load was associated with an increased risk. Future clinical and metabolic studies are warranted to confirm these findings. Diabetes Care 29:2223-2230, 2006G estational diabetes mellitus (GDM) is among the most common complications of pregnancy. GDM complicates ϳ7% of all pregnancies, resulting in Ͼ200,000 cases annually (1). Recent data have shown a substantial rise in the incidence of GDM from 1991 to 2000 (2) and a doubling from 1994 to 2002 (3). Women with GDM experience increased risk for prenatal morbidity and a considerably elevated risk for impaired glucose tolerance and type 2 diabetes in the years following pregnancy (1). Children of women with GDM are more likely to be obese and have impaired glucose tolerance and diabetes in early adulthood (1). Few modifiable risk factors for GDM have been identified. Obesity is the major recognized modifiable risk factor thus far. High prepregnancy BMI has been consistently associated with an increased risk of GDM (1,4).Substantial evidence from epidemiologic and clinical studies supports the thesis that diet influences glucose homeostasis and that modification of diet can lower the risk of diabetes. Dietary fiber and types of carbohydrate have received particular interest due to their impact on postprandial glucose and insulin responses. Associations of dietary fiber (5-10) and dietary glycemic index and load (5-9) with type 2 diabetes among men and nonpregnant women have been extensively studied in large epidemiological studies. Studies on the role of these dietary factors in the development of GDM are sparse. In a large prospective cohort of U.S. women of reproductive age, we examined whether pregravid intakes of dietary fiber and dietary glycemi...

Glycaemic load is associated with insulin resistance in older Australian women

“…Other observational studies with small s.d. have not reported significant associations with GI Zhang et al, 2006). Sahyoun et al (2008), who did not find significant associations between GI, GL or development of type II diabetes, also noted that the homogeneity of glycaemic intake values within their Table 3 Comparison of glycaemic intake and other characteristics between subjects who were and who were not classified as insulin resistant a 26.1 ± 4.4 31.7 ± 6.6 o0.01 26.5 ± 4.8 Waist-to-hip ratio 0.80 ± 0.1 0.84 ± 0.0 o0.01 0.80 ± 0.1 HOMA 1.6 ± 0.8 5.4 ± 1.5 o0.01 1.9 ± 1.3…”

Risk factors for gestational diabetes: is prevention possible?

“…A recent study using the NHS-II data reported that greater potato consumption was related to an increased GDM risk [22]. Potential beneficial factors include a prudent diet, characterised by a high intake of fruit, green leafy vegetables, poultry and fish [21], a Mediterranean diet [23], as well as nut [19] and fibre consumption [24]. Findings from the investigation of joint effects of diet and physical activity, cigarette smoking and BMI indicated that more than 45% of GDM cases might have been prevented if women adopted an overall healthy diet and lifestyle and maintained a healthy body weight before pregnancy [25].…”

Impact of maternal diet during pregnancy and breastfeeding on infant metabolic programming: a prospective randomized controlled study

“…of proinflammatory cytokines (Cani et al, 2007), causally linked to insulin resistance (Shoelson et al, 2006). Further, higher fibre consumption, by reducing the risk of gestational diabetes mellitus (Zhang et al, 2006) or by facilitating maternal weight control (Howarth et al, 2001), was presupposed to benefit the infant's metabolic programming. These previous data are in agreement with our findings that maternal intake of fat and specific fat-containing food products affected metabolic markers in infancy.…”

“…In these demonstrations, low birth weight is the main risk factor, taken to reflect a poor intrauterine nutritional environment. In well-nourished women, again, child birth weight, low or high, and a suboptimal intrauterine environment have been linked to maternal intake of single dietary factors (Godfrey et al, 1996;Mikkelsen et al, 2006;Moses et al, 2006;Zhang et al, 2006). However, a fact not previously properly addressed, but not to be ignored, is that the diet is always a mixture of several nutrients with possible complex interactions.…”