Diabetes Metab J.  2020 Dec;44(6):887-896. 10.4093/dmj.2019.0138.

A Vegetable Dietary Pattern Is Associated with Lowered Risk of Gestational Diabetes Mellitus in Chinese Women

• Chen Q
• Wu W
• Yang H
• Zhang P
• Feng Y
• Wang K
• Wang Y
• Wang S
• Zhang Y

• KMID: 2513052
• DOI: http://doi.org/10.4093/dmj.2019.0138

Abstract

Background
Identification of modifiable dietary factors, which are involved in the development of gestational diabetes mellitus (GDM), could inform strategies to prevent GDM.
Methods
We examined the dietary patterns in a Chinese population and evaluated their relationship with GDM risk using a case-control study including 1,464 cases and 8,092 control subjects. Propensity score matching was used to reduce the imbalance of covariates between cases and controls. Dietary patterns were identified using factor analysis while their associations with GDM risk were evaluated using logistic regression models.
Results
A “vegetable” dietary pattern was characterized as the consumption of green leafy vegetables (Chinese little greens and bean seedling), other vegetables (cabbages, carrots, tomatoes, eggplants, potatoes, mushrooms, peppers, bamboo shoots, agarics, and garlic), and bean products (soybean milk, tofu, kidney beans, and cowpea). For every quartile increase in the vegetables factor score during 1 year prior to conception, the first trimester, and the second trimester of pregnancy, the GDM risk lowered by 6% (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.89 to 0.99), 7% (OR, 0.94; 95% CI, 0.88 to 0.99), and 9% (OR, 0.91; 95% CI, 0.86 to 0.96).
Conclusion
In conclusion, our study suggests that the vegetable dietary pattern is associated with lower GDM risk; however, the interpretation of the result should with caution due to the limitations in our study, and additional studies are necessary to explore the underlying mechanism of this relationship.

Keyword

Case-control studies; Diabetes, gestational; Diet; Vegetables

Reference

1. Chiefari E, Arcidiacono B, Foti D, Brunetti A. Gestational diabetes mellitus: an updated overview. J Endocrinol Invest. 2017; 40:899–909.

2. Zhu Y, Zhang C. Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global perspective. Curr Diab Rep. 2016; 16:7.

3. Agha-Jaffar R, Oliver N, Johnston D, Robinson S. Gestational diabetes mellitus: does an effective prevention strategy exist? Nat Rev Endocrinol. 2016; 12:533–46.

4. Matarrelli B, Vitacolonna E, D’Angelo M, Pavone G, Mattei PA, Liberati M, Celentano C. Effect of dietary myo-inositol supplementation in pregnancy on the incidence of maternal gestational diabetes mellitus and fetal outcomes: a randomized controlled trial. J Matern Fetal Neonatal Med. 2013; 26:967–72.

5. Luoto R, Laitinen K, Nermes M, Isolauri E. Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study. Br J Nutr. 2010; 103:1792–9.

6. Schoenaker DA, Mishra GD, Callaway LK, Soedamah-Muthu SS. The role of energy, nutrients, foods, and dietary patterns in the development of gestational diabetes mellitus: a systematic review of observational studies. Diabetes Care. 2016; 39:16–23.

7. Bao W, Bowers K, Tobias DK, Olsen SF, Chavarro J, Vaag A, Kiely M, Zhang C. Prepregnancy low-carbohydrate dietary pattern and risk of gestational diabetes mellitus: a prospective cohort study. Am J Clin Nutr. 2014; 99:1378–84.

8. Tobias DK, Zhang C, Chavarro J, Bowers K, Rich-Edwards J, Rosner B, Mozaffarian D, Hu FB. Prepregnancy adherence to dietary patterns and lower risk of gestational diabetes mellitus. Am J Clin Nutr. 2012; 96:289–95.

9. Izadi V, Tehrani H, Haghighatdoost F, Dehghan A, Surkan PJ, Azadbakht L. Adherence to the DASH and Mediterranean diets is associated with decreased risk for gestational diabetes mellitus. Nutrition. 2016; 32:1092–6.

10. Karamanos B, Thanopoulou A, Anastasiou E, Assaad-Khalil S, Albache N, Bachaoui M, Slama CB, El Ghomari H, Jotic A, Lalic N, Lapolla A, Saab C, Marre M, Vassallo J, Savona-Ventura C; MGSD-GDM Study Group. Relation of the Mediterranean diet with the incidence of gestational diabetes. Eur J Clin Nutr. 2014; 68:8–13.

11. Schoenaker DA, Soedamah-Muthu SS, Callaway LK, Mishra GD. Pre-pregnancy dietary patterns and risk of gestational diabetes mellitus: results from an Australian population-based prospective cohort study. Diabetologia. 2015; 58:2726–35.

12. Tryggvadottir EA, Medek H, Birgisdottir BE, Geirsson RT, Gunnarsdottir I. Association between healthy maternal dietary pattern and risk for gestational diabetes mellitus. Eur J Clin Nutr. 2016; 70:237–42.

13. De Seymour J, Chia A, Colega M, Jones B, McKenzie E, Shirong C, Godfrey K, Kwek K, Saw SM, Conlon C, Chong YS, Baker P, Chong MF. Maternal dietary patterns and gestational diabetes mellitus in a multi-ethnic Asian cohort: the GUSTO study. Nutrients. 2016; 8:E574.

14. He JR, Yuan MY, Chen NN, Lu JH, Hu CY, Mai WB, Zhang RF, Pan YH, Qiu L, Wu YF, Xiao WQ, Liu Y, Xia HM, Qiu X. Maternal dietary patterns and gestational diabetes mellitus: a large prospective cohort study in China. Br J Nutr. 2015; 113:1292–300.

15. Wang Y, Zhao N, Qiu J, He X, Zhou M, Cui H, Lv L, Lin X, Zhang C, Zhang H, Xu R, Zhu D, Dang Y, Han X, Zhang H, Bai H, Chen Y, Tang Z, Lin R, Yao T, Su J, Xu X, Liu X, Wang W, Ma B, Liu S, Qiu W, Huang H, Liang J, Wang S, Ehrenkranz RA, Kim C, Liu Q, Zhang Y. Folic acid supplementation and dietary folate intake, and risk of preeclampsia. Eur J Clin Nutr. 2015; 69:1145–50.

16. Liu X, Lv L, Zhang H, Zhao N, Qiu J, He X, Zhou M, Xu X, Cui H, Liu S, Lerro C, Lin X, Zhang C, Zhang H, Xu R, Zhu D, Dang Y, Han X, Bai H, Chen Y, Tang Z, Lin R, Yao T, Su J, Wang W, Wang Y, Ma B, Huang H, Liang J, Qiu W, Liu Q, Zhang Y. Folic acid supplementation, dietary folate intake and risk of preterm birth in China. Eur J Nutr. 2016; 55:1411–22.

17. International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva Ad, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJ, Omori Y, Schmidt MI. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010; 33:676–82.

18. Gao H, Stiller CK, Scherbaum V, Biesalski HK, Wang Q, Hormann E, Bellows AC. Dietary intake and food habits of pregnant women residing in urban and rural areas of Deyang city, Sichuan province, China. Nutrients. 2013; 5:2933–54.

19. Shin D, Lee KW, Song WO. Dietary patterns during pregnancy are associated with risk of gestational diabetes mellitus. Nutrients. 2015; 7:9369–82.

20. Burris HH, Camargo CA Jr. Vitamin D and gestational diabetes mellitus. Curr Diab Rep. 2014; 14:451.

21. Joergensen JS, Lamont RF, Torloni MR. Vitamin D and gestational diabetes: an update. Curr Opin Clin Nutr Metab Care. 2014; 17:360–7.

22. Zhang MX, Pan GT, Guo JF, Li BY, Qin LQ, Zhang ZL. Vitamin D deficiency increases the risk of gestational diabetes mellitus: a meta-analysis of observational studies. Nutrients. 2015; 7:8366–75.

23. Zhang C, Williams MA, Frederick IO, King IB, Sorensen TK, Kestin MM, Dashow EE, Luthy DA. Vitamin C and the risk of gestational diabetes mellitus: a case-control study. J Reprod Med. 2004; 49:257–66.

24. Zhang C, Williams MA, Sorensen TK, King IB, Kestin MM, Thompson ML, Leisenring WM, Dashow EE, Luthy DA. Maternal plasma ascorbic acid (vitamin C) and risk of gestational diabetes mellitus. Epidemiology. 2004; 15:597–604.

25. Weickert MO, Pfeiffer AF. Metabolic effects of dietary fiber consumption and prevention of diabetes. J Nutr. 2008; 138:439–42.

26. Zhang C, Liu S, Solomon CG, Hu FB. Dietary fiber intake, dietary glycemic load, and the risk for gestational diabetes mellitus. Diabetes Care. 2006; 29:2223–30.

27. Oude Griep LM, Wang H, Chan Q. Empirically-derived dietary patterns, diet quality scores, and markers of inflammation and endothelial dysfunction. Curr Nutr Rep. 2013; 2:97–104.

28. Qiu C, Sorensen TK, Luthy DA, Williams MA. A prospective study of maternal serum C-reactive protein (CRP) concentrations and risk of gestational diabetes mellitus. Paediatr Perinat Epidemiol. 2004; 18:377–84.

29. McIntosh M, Miller C. A diet containing food rich in soluble and insoluble fiber improves glycemic control and reduces hyperlipidemia among patients with type 2 diabetes mellitus. Nutr Rev. 2001; 59:52–5.

30. Galisteo M, Duarte J, Zarzuelo A. Effects of dietary fibers on disturbances clustered in the metabolic syndrome. J Nutr Biochem. 2008; 19:71–84.

31. Lee KW, Ching SM, Ramachandran V, Yee A, Hoo FK, Chia YC, Wan Sulaiman WA, Suppiah S, Mohamed MH, Veettil SK. Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2018; 18:494.