Bao Wei, Bowers Katherine, Tobias Deirdre K, Olsen Sjurdur F, Chavarro Jorge, Vaag Allan, Kiely Michele, Zhang Cuilin
From the Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Rockville, MD (WB, MK, and CZ); the Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (KB); the Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA (DKT and JC); the Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark (SFO); the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (JC); and the Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark (AV).
Am J Clin Nutr. 2014 Jun;99(6):1378-84. doi: 10.3945/ajcn.113.082966. Epub 2014 Apr 9.
Low-carbohydrate diets (LCDs) have been vastly popular for weight loss. The association between a low-carbohydrate dietary pattern and risk of gestational diabetes mellitus (GDM) remains unknown.
We aimed to prospectively examine the association of 3 prepregnancy low-carbohydrate dietary patterns with risk of GDM.
We included 21,411 singleton pregnancies in the Nurses' Health Study II. Prepregnancy LCD scores were calculated from validated food-frequency questionnaires, including an overall LCD score on the basis of intakes of carbohydrate, total protein, and total fat; an animal LCD score on the basis of intakes of carbohydrate, animal protein, and animal fat; and a vegetable LCD score on the basis of intakes of carbohydrate, vegetable protein, and vegetable fat. A higher score reflected a higher intake of fat and protein and a lower intake of carbohydrate, and it indicated closer adherence to a low-carbohydrate dietary pattern. RRs and 95% CIs were estimated by using generalized estimating equations with log-binomial models.
We documented 867 incident GDM pregnancies during 10 y follow-up. Multivariable-adjusted RRs (95% CIs) of GDM for comparisons of highest with lowest quartiles were 1.27 (1.06, 1.51) for the overall LCD score (P-trend = 0.03), 1.36 (1.13, 1.64) for the animal LCD score (P-trend = 0.003), and 0.84 (0.69, 1.03) for the vegetable LCD score (P-trend = 0.08). Associations between LCD scores and GDM risk were not significantly modified by age, parity, family history of diabetes, physical activity, or overweight status.
A prepregnancy low-carbohydrate dietary pattern with high protein and fat from animal-food sources is positively associated with GDM risk, whereas a prepregnancy low-carbohydrate dietary pattern with high protein and fat from vegetable food sources is not associated with the risk. Women of reproductive age who follow a low-carbohydrate dietary pattern may consider consuming vegetable rather than animal sources of protein and fat to minimize their risk of GDM.
低碳水化合物饮食（LCDs）在减肥方面广受欢迎。低碳水化合物饮食模式与妊娠期糖尿病（GDM）风险之间的关联尚不清楚。
我们旨在前瞻性研究孕前三种低碳水化合物饮食模式与GDM风险的关联。
我们纳入了护士健康研究II中的21411例单胎妊娠。孕前LCD评分通过经过验证的食物频率问卷计算得出，包括基于碳水化合物、总蛋白质和总脂肪摄入量的总体LCD评分；基于碳水化合物、动物蛋白和动物脂肪摄入量的动物LCD评分；以及基于碳水化合物、植物蛋白和植物脂肪摄入量的蔬菜LCD评分。分数越高反映脂肪和蛋白质摄入量越高，碳水化合物摄入量越低，表明越严格遵循低碳水化合物饮食模式。使用对数二项模型的广义估计方程估计相对风险（RRs）和95%置信区间（CIs）。
在10年的随访期间，我们记录了867例GDM妊娠病例。总体LCD评分最高四分位数与最低四分位数相比，GDM的多变量调整RRs（95% CIs）为1.27（1.06，1.51）（P趋势 = 0.03），动物LCD评分为1.36（1.13，1.64）（P趋势 = 0.003），蔬菜LCD评分为0.84（0.69，1.03）（P趋势 = 0.08）。年龄、产次、糖尿病家族史、身体活动或超重状态对LCD评分与GDM风险之间的关联没有显著影响。
孕前来自动物性食物来源的高蛋白和高脂肪低碳水化合物饮食模式与GDM风险呈正相关，而孕前来自植物性食物来源的高蛋白和高脂肪低碳水化合物饮食模式与该风险无关。遵循低碳水化合物饮食模式的育龄妇女可能考虑食用植物性而非动物性蛋白质和脂肪来源，以将其GDM风险降至最低。
