Geiker Nina R W, Magkos Faidon, Zingenberg Helle, Svare Jens, Chabanova Elizaveta, Thomsen Henrik S, Ritz Christian, Astrup Arne
Department of Nutrition, Exercise and Sports, Faculty of Sciences, University of Copenhagen, Frederiksberg, Denmark.
Dietetic and Clinical Nutrition Research Unit, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark.
Am J Clin Nutr. 2022 Mar 4;115(3):970-979. doi: 10.1093/ajcn/nqab405.
Prepregnancy overweight and excessive gestational weight gain (GWG) increase the risk of complications and offspring obesity.
We aimed to investigate the effect of a high-protein low-glycemic index (HPLGI) diet on GWG, birth weight, and risk of gestational complications in pregnant women with obesity.
A total of 279 women with prepregnancy overweight or obesity (BMI: 28-45 kg/m2), between 18 and 45 y old, and in their late first trimester with singleton pregnancies, were randomly assigned to 1 of 2 ad libitum diets: a high-protein low-glycemic index diet (HPLGI: 25%-28% of energy from protein and glycemic index ≤ 55) and a moderate-protein moderate-glycemic index diet (MPMGI: 15%-18% of energy from protein and glycemic index ∼60). Diets were consumed from gestational week 15 and throughout pregnancy. Participants received dietary guidance by a clinical dietician 9 times to facilitate adherence.
Out of 141 and 138 women randomly assigned to the HPLGI and MPMGI diets, 105 and 104 completed the intervention, respectively (75%). In the available case analyses, GWG was 6.8 ± 1.3 kg among women assigned the HPLGI diet and this was significantly lower, by -1.7 kg (95% CI: -2.8, -0.5 kg; P = 0.004), than the GWG of 8.5 ± 1.3 kg among women assigned the MPMGI diet. There were no significant differences between diets on major neonatal outcomes (birth weight and other anthropometric measures). The incidence of composite pregnancy complications was lower for the HPLGI than for the MPMGI diet (35.4% compared with 53.7%, respectively; P = 0.009), including cesarean delivery (15.4% compared with 28.8%, respectively; P = 0.03). There were no reported maternal, fetal, or neonatal deaths. Incidence of miscarriages (1%-2%) did not differ between groups.
A moderate increase in dietary protein in conjunction with a reduction in glycemic index during the last 2 trimesters of pregnancy reduced GWG and limited complications and cesarean deliveries among women with overweight or obesity.
孕前超重和孕期体重过度增加（GWG）会增加并发症和子代肥胖的风险。
我们旨在研究高蛋白低血糖指数（HPLGI）饮食对肥胖孕妇GWG、出生体重和妊娠并发症风险的影响。
总共279名孕前超重或肥胖（BMI：28 - 45kg/m²）、年龄在18至45岁之间且处于孕早期晚期的单胎妊娠女性被随机分配至两种随意饮食中的一种：高蛋白低血糖指数饮食（HPLGI：蛋白质供能占25% - 28%且血糖指数≤55）和中等蛋白中等血糖指数饮食（MPMGI：蛋白质供能占15% - 18%且血糖指数约为60）。从妊娠第15周开始直至整个孕期都采用这些饮食。参与者接受临床营养师9次饮食指导以促进依从性。
在随机分配至HPLGI饮食组的141名女性和MPMGI饮食组的138名女性中，分别有105名和104名完成了干预（75%）。在有效病例分析中，分配至HPLGI饮食组的女性GWG为6.8±1.3kg，这比分配至MPMGI饮食组女性的GWG（8.5±1.3kg）显著低1.7kg（95%CI：-2.8，-0.5kg；P = 0.004）。两种饮食在主要新生儿结局（出生体重和其他人体测量指标）上无显著差异。HPLGI饮食组的复合妊娠并发症发生率低于MPMGI饮食组（分别为35.4%和53.7%；P = 0.009），包括剖宫产（分别为15.4%和28.8%；P = 0.03）。未报告有孕产妇、胎儿或新生儿死亡。两组间流产发生率（1% - 2%）无差异。
在妊娠最后两个孕期适度增加饮食蛋白质并降低血糖指数可减少超重或肥胖女性的GWG，并减少并发症和剖宫产的发生。
