孕前植物性饮食与妊娠糖尿病风险：对 14926 名女性的前瞻性队列研究。
Prepregnancy plant-based diets and the risk of gestational diabetes mellitus: a prospective cohort study of 14,926 women.
机构信息
Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.
Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
出版信息
Am J Clin Nutr. 2021 Dec 1;114(6):1997-2005. doi: 10.1093/ajcn/nqab275.
BACKGROUND
Emerging evidence suggests beneficial impacts of plant-based diets on glucose metabolism among generally healthy individuals. Whether adherence to these diets is related to risk of gestational diabetes mellitus (GDM) is unknown.
OBJECTIVES
We aimed to examine associations between plant-based diets and GDM in a large prospective study.
METHODS
We included 14,926 women from the Nurses' Health Study II (1991-2001), who reported ≥1 singleton pregnancy and without previous GDM before the index pregnancy. Prepregnancy adherence to plant-based diets was measured by an overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI) as assessed by FFQs every 4 y. Incident first-time GDM was ascertained from a self-reported physician diagnosis, which was previously validated by review of medical records. We used log-binomial models with generalized estimating equations to calculate RRs and 95% CIs for associations of PDIs with GDM.
RESULTS
We documented 846 incident GDM cases over the 10-y follow-up among 20,707 pregnancies. Greater adherence to the PDI and hPDI was associated with lower GDM risk. For the PDI, the multivariable-adjusted RR (95% CI) comparing the highest and lowest quintiles (Q5 compared with Q1) was 0.70 (0.56, 0.87) (Ptrend = 0.0004), and for each 10-point increment was 0.80 (0.71, 0.90). For the hPDI, the RR (95% CI) of Q5 compared with Q1 was 0.75 (0.59, 0.94) (Ptrend = 0.009) and for each 10-point increment was 0.86 (0.77, 0.95). After further adjustment for prepregnancy BMI, the associations were attenuated but remained significant: for the PDI, the RR (95% CI) for each 10-point increment was 0.89 (0.79, 1.00) and the corresponding RR (95% CI) was 0.89 (0.80, 0.99) for the hPDI. The uPDI was not associated with GDM.
CONCLUSIONS
Our study suggests that greater prepregnancy adherence to a healthful plant-based diet was associated with lower risk of GDM, whereas an unhealthful plant-based diet was not related to GDM risk.
背景
新出现的证据表明，植物性饮食对一般健康人群的葡萄糖代谢有益。但目前尚不清楚这些饮食的依从性与妊娠糖尿病（GDM）的风险是否相关。
目的
我们旨在通过一项大型前瞻性研究来检验植物性饮食与 GDM 之间的关联。
方法
我们纳入了来自护士健康研究 II 期（1991-2001 年）的 14926 名女性，这些女性均报告了≥1 次单胎妊娠，且在指数妊娠前无 GDM 病史。采用每 4 年一次的 FFQ 评估，通过整体植物性饮食指数（PDI）、健康植物性饮食指数（hPDI）和不健康植物性饮食指数（uPDI）来衡量孕前植物性饮食的依从性。通过自我报告的医生诊断来确定首次发生的 GDM 病例，该诊断方法此前已通过对病历的审查进行了验证。我们使用对数二项式模型和广义估计方程来计算 PDI 与 GDM 之间关联的 RR 和 95%CI。
结果
在 20707 次妊娠的 10 年随访期间，我们共记录了 846 例新发 GDM 病例。更高的 PDI 和 hPDI 依从性与较低的 GDM 风险相关。对于 PDI，最高五分位数（Q5）与最低五分位数（Q1）相比，多变量调整后的 RR（95%CI）为 0.70（0.56，0.87）（Ptrend=0.0004），每增加 10 分，RR 为 0.80（0.71，0.90）。对于 hPDI，Q5 与 Q1 相比的 RR（95%CI）为 0.75（0.59，0.94）（Ptrend=0.009），每增加 10 分，RR 为 0.86（0.77，0.95）。进一步调整孕前 BMI 后，相关性减弱但仍有统计学意义：对于 PDI，每增加 10 分的 RR（95%CI）为 0.89（0.79，1.00），相应的 RR（95%CI）为 0.89（0.80，0.99），对于 hPDI。不健康的植物性饮食与 GDM 风险无关。
结论
我们的研究表明，孕前更健康的植物性饮食依从性与较低的 GDM 风险相关，而不健康的植物性饮食与 GDM 风险无关。
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