Shin Dayeon, Lee Kyung Won, Song Won O
Department of Food Science and Human Nutrition, Michigan State University, 469 Wilson Road, Trout FSHN Building, East Lansing, MI 48824, USA.
Nutrients. 2015 Nov 12;7(11):9369-82. doi: 10.3390/nu7115472.
Maternal dietary patterns before and during pregnancy play important roles in the development of gestational diabetes mellitus (GDM). We aimed to identify dietary patterns during pregnancy that are associated with GDM risk in pregnant U.S. women. From a 24 h dietary recall of 253 pregnant women (16-41 years) included in the National Health and Nutrition Examination Survey (NHANES) 2003-2012, food items were aggregated into 28 food groups based on Food Patterns Equivalents Database. Three dietary patterns were identified by reduced rank regression with responses including prepregnancy body mass index (BMI), dietary fiber, and ratio of poly- and monounsaturated fatty acids to saturated fatty acid: "high refined grains, fats, oils and fruit juice", "high nuts, seeds, fat and soybean; low milk and cheese", and "high added sugar and organ meats; low fruits, vegetables and seafood". GDM was diagnosed using fasting plasma glucose levels ≥5.1 mmol/L for gestation <24 weeks. Multivariable logistic regression models were used to estimate adjusted odds ratio (AOR) and 95% confidence intervals (CIs) for GDM, after controlling for maternal age, race/ethnicity, education, family poverty income ratio, marital status, prepregnancy BMI, gestational weight gain, energy intake, physical activity, and log-transformed C-reactive protein (CRP). All statistical analyses accounted for the appropriate survey design and sample weights of the NHANES. Of 249 pregnant women, 34 pregnant women (14%) had GDM. Multivariable AOR (95% CIs) of GDM for comparisons between the highest vs. lowest tertiles were 4.9 (1.4-17.0) for "high refined grains, fats, oils and fruit juice" pattern, 7.5 (1.8-32.3) for "high nuts, seeds, fat and soybean; low milk and cheese" pattern, and 22.3 (3.9-127.4) for "high added sugar and organ meats; low fruits, vegetables and seafood" pattern after controlling for maternal sociodemographic variables, prepregnancy BMI, gestational weight gain, energy intake and log-transformed CRP. These findings suggest that dietary patterns during pregnancy are associated with risk of GDM after controlling for potential confounders. The observed connection between a high consumption of refined grains, fat, added sugars and low intake of fruits and vegetables during pregnancy with higher odds for GDM, are consistent with general health benefits of healthy diets, but warrants further research to understand underlying pathophysiology of GDM associated with dietary behaviors during pregnancy.
孕期前后的孕妇饮食模式在妊娠期糖尿病（GDM）的发展中起着重要作用。我们旨在确定美国孕妇孕期与GDM风险相关的饮食模式。根据2003 - 2012年美国国家健康与营养检查调查（NHANES）中253名孕妇（16 - 41岁）的24小时饮食回忆，基于食物模式等效数据库将食物项目汇总为28个食物组。通过降秩回归确定了三种饮食模式，反应变量包括孕前体重指数（BMI）、膳食纤维以及多不饱和脂肪酸和单不饱和脂肪酸与饱和脂肪酸的比例：“高精制谷物、脂肪、油和果汁”模式、“高坚果、种子、脂肪和大豆；低牛奶和奶酪”模式以及“高添加糖和动物内脏；低水果、蔬菜和海鲜”模式。对于妊娠<24周的孕妇，若空腹血糖水平≥5.1 mmol/L，则诊断为GDM。在控制了孕妇年龄、种族/族裔、教育程度、家庭贫困收入比、婚姻状况、孕前BMI、孕期体重增加、能量摄入、身体活动以及对数转换后的C反应蛋白（CRP）后，使用多变量逻辑回归模型估计GDM的调整优势比（AOR）和95%置信区间（CI）。所有统计分析均考虑了NHANES的适当调查设计和样本权重。在249名孕妇中，34名孕妇（14%）患有GDM。在控制了孕妇社会人口统计学变量、孕前BMI、孕期体重增加、能量摄入和对数转换后的CRP后，“高精制谷物、脂肪、油和果汁”模式的GDM多变量AOR（95%CI）在最高三分位数与最低三分位数比较时为4.9（1.4 - 17.0），“高坚果、种子、脂肪和大豆；低牛奶和奶酪”模式为7.5（1.8 - 32.3），“高添加糖和动物内脏；低水果、蔬菜和海鲜”模式为22.3（3.9 - 127.4）。这些发现表明，在控制潜在混杂因素后，孕期饮食模式与GDM风险相关。孕期高精制谷物、脂肪、添加糖的摄入以及水果和蔬菜的低摄入与GDM较高几率之间的观察联系，与健康饮食对总体健康的益处一致，但需要进一步研究以了解孕期饮食行为与GDM相关的潜在病理生理学。
