Tobias Deirdre K, Hu Frank B, Chavarro Jorge, Rosner Bernard, Mozaffarian Dariush, Zhang Cuilin
Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
Arch Intern Med. 2012 Nov 12;172(20):1566-72. doi: 10.1001/archinternmed.2012.3747.
Type 2 diabetes mellitus (T2DM) has reached epidemic proportions. Women with gestational diabetes mellitus (GDM) are at high risk for T2DM after pregnancy. Adherence to healthful dietary patterns has been inversely associated with T2DM in the general population; however, whether these dietary patterns are associated with progression to T2DM among a susceptible population is unknown.
Four thousand four hundred thirteen participants from the Nurses' Health Study II cohort with prior GDM were followed up from 1991 to 2005. We derived the alternate Mediterranean diet (aMED), Dietary Approaches to Stop Hypertension (DASH), and alternate Healthy Eating Index (aHEI) dietary pattern adherence scores from a post-GDM validated food-frequency questionnaire, with cumulative average updating every 4 years. Multivariable Cox proportional hazards models estimated the relative risk (hazard ratios) and 95% confidence intervals.
We observed 491 cases of incident T2DM during 52 743 person-years. All 3 patterns were inversely associated with T2DM risk with adjustment for age, total calorie intake, age at first birth, parity, ethnicity, parental diabetes, oral contraceptive use, menopause, and smoking. When we compared participants with the highest adherence (quartile 4) vs lowest (quartile 1), the aMED pattern was associated with 40% lower risk of T2DM (hazard ratio, 0.60 [95% CI, 0.44-0.82; P=.002]); the DASH pattern, with 46% lower risk (0.54 [0.39-0.73; P.001]); and the aHEI pattern, with 57% lower risk (0.43 [0.31-0.59; P.001]). Adjustment for body mass index moderately attenuated these findings.
Adherence to healthful dietary patterns is associated with lower T2DM risk among women with a history of GDM. The inverse associations are partly mediated by body mass index.
2型糖尿病（T2DM）已呈流行态势。患有妊娠期糖尿病（GDM）的女性在产后患T2DM的风险很高。在一般人群中，坚持健康的饮食模式与T2DM呈负相关；然而，这些饮食模式是否与易感人群发展为T2DM有关尚不清楚。
对护士健康研究II队列中的4413名既往患有GDM的参与者进行了1991年至2005年的随访。我们从一份GDM后经过验证的食物频率问卷中得出替代地中海饮食（aMED）、终止高血压饮食方法（DASH）和替代健康饮食指数（aHEI）饮食模式依从性得分，每4年进行累积平均更新。多变量Cox比例风险模型估计相对风险（风险比）和95%置信区间。
在52743人年的随访期间，我们观察到491例新发T2DM病例。在对年龄、总热量摄入、初产年龄、产次、种族、父母糖尿病史、口服避孕药使用情况、绝经状态和吸烟情况进行调整后，所有三种模式均与T2DM风险呈负相关。当我们比较依从性最高（四分位数4）与最低（四分位数1）的参与者时，aMED模式与T2DM风险降低40%相关（风险比，0.60[95%CI，0.44 - 0.82；P = 0.002]）；DASH模式与风险降低46%相关（0.54[0.39 - 0.73；P < 0.001]）；aHEI模式与风险降低57%相关（0.43[0.31 - 0.59；P < 0.001]）。对体重指数进行调整后，这些结果略有减弱。
坚持健康的饮食模式与有GDM病史的女性患T2DM的风险较低有关。这种负相关部分由体重指数介导。
