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

Abstract

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; Ptrend=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; Ptrend=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.

Association between dietary patterns and prediabetes risk in a middle-aged Chinese population

“…Participants with prediabetes were signi cantly younger(50.67±7.92 vs 52.82± 8.06), smoker(27.4% vs 17.5%), higher educational level(18.9% vs 3.4%) and income(17.8% vs 11.1%), and higher prevalence of obesity(12.0% vs 6.3%) than those without prediabetes. Moreover, in our previous study [16], three major dietary patterns were identi ed, naming the traditional southern Chinese, western and grains-vegetables patterns, which explained 10.3%, 8.5% and 6.8% of the dietary intake variance, respectively. The factor-loading matrixes for these dietary patterns are shown in Table S2.…”

“…Consequently, dietary pattern analysis is now widely accepted in the realm of nutritional epidemiology as a more recognizable approach for assessing the relationship between diet and diseases, because it takes into account the complexity of whole-diet and potentially facilitates nutritional recommendations [10]. Up until now, considerable attentions have been focused in medical research on the association between overall dietary patterns and the risk of diabetes [11][12][13][14][15][16][17][18][19]. A recent meta-analysis by Jannasch et al, indicated that diets according to the Mediterranean diet, Dietary Approaches to Stop Hypertension(DASH), and Alternative Healthy Eating Index (AHEI) had a strong potential for preventing diabetes [20].…”

“…Therefore, studying the relationship between dietary patterns and prediabetes can be of value. To date, many epidemiological studies have examined dietary patterns in relation to T2DM and gestational diabetes mellitus (GDM) in China [11][12][13][14][15][16][17][18][19]. Only two published studies, however, have been reported on the association of dietary patterns with prediabetes in Chinese population [24][25].…”

Association between dietary patterns and prediabetes risk in a middle-aged Chinese population

“…Participants with prediabetes were significantly younger (50.67 ± 7.92 vs 52.82 ± 8.06), smoker (27.4% vs 17.5%), higher educational level (18.9% vs 3.4%) and income (17.8% vs 11.1%), and higher prevalence of obesity (12.0% vs 6.3%) than those without prediabetes. Moreover, in our previous study [ 16 ], three major dietary patterns were identified, naming the traditional southern Chinese, western and grains-vegetables patterns, which explained 10.3, 8.5 and 6.8% of the dietary intake variance, respectively. The factor-loading matrixes for these dietary patterns are shown in Table S 2 .…”

The Role of Dietary Carbohydrates in Gestational Diabetes

“…Whether the type of CHO (low-GI or slowly digesting and low-GI) or additional factors are necessary to offset the rapidly changing and complex pathophysiology that occurs during pregnancy are unknown. Additional insight into the role of CHO can be gained from observational studies that have investigated nutritional intakes and/or patterns before or during pregnancy and GDM; these studies [68,69] show GDM is higher in those having higher intakes of meat and a lower intake of whole grain carbohydrates, fruits, vegetables, and fish. These studies suggest that CHO along with other dietary components are likely involved.…”