Zhao Rui, Zhou Leilei, Lei Gang, Wang Shanshan, Li Yan, Yang Xuefeng, Xiong Guoping, Hao Liping
Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
The Central Hospital of Wuhan, Wuhan, China.
Front Nutr. 2022 May 26;9:892698. doi: 10.3389/fnut.2022.892698. eCollection 2022.
Growing evidence suggests that dietary acid load plays an important role in the development of type 2 diabetes. However, prospective studies on the relationship between dietary acid load and gestational diabetes mellitus (GDM) are limited in the pregnant population. This study aimed to investigate the effect of dietary acid load during early pregnancy on the risk of GDM in Chinese pregnant women.
A total of 1,327 pregnant women were enrolled from an ongoing prospective study of the Tongji Birth cohort (TJBC) in Wuhan, China. Dietary intake was assessed before 20 weeks using a 74-item semiquantitative food frequency questionnaire (FFQ). The dietary acid load was estimated using potential renal acid load (PRAL), net endogenous acid production (NEAP), and animal protein to potassium ratio (A:P ratio). A 75g 2-h oral glucose tolerance test (OGTT) was performed at 24-28 gestational weeks to diagnose GDM.
The mean (standard deviation) values for PRAL score, NEAP score, and A:P ratio were 0.8 ± 11.3 mEq/day, 45.3 ± 16.5 mEq/day, and 9.8 ± 6.0, respectively. There was a significant positive correlation of dietary acid load with the intake of red meat, poultry, fish, and eggs, and a negative correlation with the intake of vegetables, fruits, nuts, and legumes (all < 0.05). Compared to the lowest tertile, the highest tertile of dietary acid load, including PRAL score (odds ratio [OR]: 2.26, 95% confidence interval [CI] = 1.38-3.71, -trend = 0.002), NEAP score (OR: 2.02, 95% CI = 1.25-3.27, -trend = 0.009), and A:P ratio (2.08, 95% CI = 1.30-3.31, -trend = 0.005), significantly increased the risk of GDM. In addition, the dietary acid load was also significantly associated with an increase in 1-h and 2-h post-load blood glucose concentrations (all -trend < 0.05).
We found a significant positive association between dietary acid load during early pregnancy and the risk of GDM in a Chinese population, suggesting that the reduction of food sources of dietary acid load may be an effective strategy for preventing the risk of GDM.
越来越多的证据表明，膳食酸负荷在2型糖尿病的发生发展中起重要作用。然而，关于膳食酸负荷与妊娠期糖尿病（GDM）之间关系的前瞻性研究在孕妇群体中较为有限。本研究旨在探讨孕早期膳食酸负荷对中国孕妇发生GDM风险的影响。
从中国武汉正在进行的一项同济出生队列（TJBC）前瞻性研究中纳入了1327名孕妇。在孕20周前使用一份包含74个条目的半定量食物频率问卷（FFQ）评估膳食摄入量。膳食酸负荷通过潜在肾酸负荷（PRAL）、净内源性酸生成（NEAP）和动物蛋白与钾的比值（A:P比值）来估算。在孕24 - 28周进行75g 2小时口服葡萄糖耐量试验（OGTT）以诊断GDM。
PRAL评分、NEAP评分和A:P比值的平均值（标准差）分别为0.8±11.3 mEq/天、45.3±16.5 mEq/天和9.8±6.0。膳食酸负荷与红肉、家禽、鱼类和蛋类的摄入量呈显著正相关，与蔬菜、水果、坚果和豆类的摄入量呈负相关（均P<0.05）。与膳食酸负荷最低三分位数相比，最高三分位数，包括PRAL评分（比值比[OR]：2.26，95%置信区间[CI]=1.38 - 3.71，P趋势=0.002）、NEAP评分（OR：2.02，95% CI = 1.25 - 3.27，P趋势=0.009）和A:P比值（2.08，95% CI = 1.30 - 3.31，P趋势=0.005），显著增加了GDM的风险。此外，膳食酸负荷还与负荷后1小时和2小时血糖浓度的升高显著相关（均P趋势<0.05）。
我们在中国人群中发现孕早期膳食酸负荷与GDM风险之间存在显著正相关，提示减少膳食酸负荷的食物来源可能是预防GDM风险的有效策略。
