Dietary fiber intake, dietary glycemic load, and the risk for gestational diabetes mellitus.

OBJECTIVE — We aimed to examine whether pregravid dietary fiber consumptions from cereal, fruit, and vegetable sources and dietary glycemic load were related to gestational diabetes mellitus (GDM) risk. RESEARCH DESIGN AND METHODS — This study was a prospective cohort study among 13,110 eligible women in the Nurses’ Health Study II. GDM was self-reported and validated by medical record review in a subsample. RESULTS — We documented 758 incident GDM cases during 8 years of follow-up. After adjustment for age, parity, prepregnancy BMI, and other covariates, dietary total fiber and cereal and fruit fiber were strongly associated with GDM risk. Each 10-g/day increment in total fiber intake was associated with 26% (95% CI 9 – 49) reduction in risk; each 5-g/day increment in cereal or fruit fiber was associated with a 23% (9 –36) or 26% (5– 42) reduction, respectively. Dietary glycemic load was positively related to GDM risk. Multivariate relative risk for highest versus lowest quintiles was 1.61 (1.02–2.53) (P for trend 0.03). The combination of high– glycemic load and low– cereal fiber diet was associated with 2.15-fold (1.04 – 4.29) increased risk compared with the reciprocal diet. CONCLUSIONS — These findings suggested that prepregnancy diet might be associated with women’s GDM risk. In particular, diet with low fiber and high glycemic load was associated with an increased risk. Future clinical and metabolic studies are warranted to confirm these findings.

[1]  D. Couper,et al.  Dietary fiber intake and glycemic index and incidence of diabetes in African-American and white adults: the ARIC study. , 2002, Diabetes care.

[2]  M. Wolf,et al.  First-trimester C-reactive protein and subsequent gestational diabetes. , 2003, Diabetes care.

[3]  C. Khoo,et al.  The dietary glycemic index during pregnancy: influence on infant birth weight, fetal growth, and biomarkers of carbohydrate metabolism. , 2004, American journal of epidemiology.

[4]  Meir J. Stampfer,et al.  Total energy intake: implications for epidemiologic analyses. , 1986, American journal of epidemiology.

[5]  M. Thompson,et al.  Maternal Plasma Ascorbic Acid (Vitamin C) and Risk of Gestational Diabetes Mellitus , 2004, Epidemiology.

[6]  J. Miller,et al.  Importance of glycemic index in diabetes. , 1994, The American journal of clinical nutrition.

[7]  J. Manson,et al.  Variability in Diagnostic Evaluation and Criteria for Gestational Diabetes , 1996, Diabetes Care.

[8]  T. Wolever,et al.  Dietary glycemic index and glycemic load, carbohydrate and fiber intake, and measures of insulin sensitivity, secretion, and adiposity in the Insulin Resistance Atherosclerosis Study. , 2005, Diabetes care.

[9]  W. Willett,et al.  Changes in dietary intake from the first to the second trimester of pregnancy. , 2006, Paediatric and perinatal epidemiology.

[10]  A. Mokdad,et al.  Dietary fiber and C-reactive protein: findings from national health and nutrition examination survey data. , 2004, The Journal of nutrition.

[11]  R. Knopp.  Hormone‐mediated Changes in Nutrient Metabolism in Pregnancy: A Physiological Basis for Normal Fetal Development a , 1997, Annals of the New York Academy of Sciences.

[12]  J. Manson,et al.  Dietary glycemic load assessed by food-frequency questionnaire in relation to plasma high-density-lipoprotein cholesterol and fasting plasma triacylglycerols in postmenopausal women. , 2001, The American journal of clinical nutrition.

[13]  S. Amini,et al.  Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus. , 1999, American journal of obstetrics and gynecology.

[14]  E. Reece,et al.  Insulin secretion during and after pregnancy in patients with gestational diabetes mellitus. , 2001, The Journal of clinical endocrinology and metabolism.

[15]  Walter C Willett,et al.  Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women. , 2004, The American journal of clinical nutrition.

[16]  E. Rimm,et al.  Dietary Fiber, Glycemic Load, and Risk of NIDDM in Men , 1997, Diabetes Care.

[17]  G A Colditz,et al.  Food-based validation of a dietary questionnaire: the effects of week-to-week variation in food consumption. , 1989, International journal of epidemiology.

[18]  W. Horwitz.  Official Methods of Analysis , 1980 .

[19]  A. Ferrara,et al.  An Increase in the Incidence of Gestational Diabetes Mellitus: Northern California, 1991–2000 , 2004, Obstetrics and gynecology.

[20]  R. Hamman,et al.  Increasing prevalence of gestational diabetes mellitus (GDM) over time and by birth cohort: Kaiser Permanente of Colorado GDM Screening Program. , 2005, Diabetes care.

[21]  G. Boden,et al.  Fuel metabolism in pregnancy and in gestational diabetes mellitus. , 1996, Obstetrics and gynecology clinics of North America.

[22]  T. Sellers,et al.  Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. , 2000, The American journal of clinical nutrition.

[23]  G. Paolisso,et al.  Meal modulation of circulating interleukin 18 and adiponectin concentrations in healthy subjects and in patients with type 2 diabetes mellitus. , 2003, The American journal of clinical nutrition.

[24]  J. Clapp.  Effect of dietary carbohydrate on the glucose and insulin response to mixed caloric intake and exercise in both nonpregnant and pregnant women. , 1998, Diabetes care.

[25]  W. Willett,et al.  Cigarette smoking, relative weight, and menopause. , 1983, American journal of epidemiology.

[26]  Plasma Adiponectin Concentrations in Early Pregnancy and Subsequent Risk of Gestational Diabetes Mellitus , 2004 .

[27]  J. Manson,et al.  A prospective study of pregravid determinants of gestational diabetes mellitus. , 1997, JAMA.

[28]  T. Buchanan,et al.  Gestational diabetes mellitus. , 2005, The Journal of clinical investigation.

[29]  G A Colditz,et al.  Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals. , 1992, American journal of epidemiology.

[30]  D Feskanich,et al.  Reproducibility and validity of food intake measurements from a semiquantitative food frequency questionnaire. , 1993, Journal of the American Dietetic Association.

[31]  W. Willett,et al.  Reproducibility and validity of a semiquantitative food frequency questionnaire. , 1985, American journal of epidemiology.

[32]  S. Colagiuri,et al.  Physiological validation of the concept of glycemic load in lean young adults. , 2003, The Journal of nutrition.

[33]  S. Virtanen,et al.  Associations of dietary fiber with glucose metabolism in nondiabetic relatives of subjects with type 2 diabetes: the Botnia Dietary Study. , 2003, Diabetes care.

[34]  T. Wolever,et al.  Metabolic effects of a low-glycemic-index diet. , 1987, The American journal of clinical nutrition.

[35]  C. Miller,et al.  A diet containing food rich in soluble and insoluble fiber improves glycemic control and reduces hyperlipidemia among patients with type 2 diabetes mellitus. , 2009, Nutrition reviews.

[36]  J. Miller,et al.  International tables of glycemic index. , 1995, The American journal of clinical nutrition.

[37]  Simin Liu.  Whole-grain foods, dietary fiber, and type 2 diabetes: searching for a kernel of truth. , 2003, The American journal of clinical nutrition.

[38]  T. Buchanan,et al.  Multiple metabolic defects during late pregnancy in women at high risk for type 2 diabetes. , 1999, Diabetes.

[39]  A. Mainous,et al.  Fiber and C-reactive protein in diabetes, hypertension, and obesity. , 2005, Diabetes care.

[40]  T. Wolever,et al.  The glycemic index: methodology and clinical implications. , 1991, The American journal of clinical nutrition.

[41]  G A Colditz,et al.  Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. , 1997, JAMA.

[42]  Paul Knekt,et al.  Whole-grain and fiber intake and the incidence of type 2 diabetes. , 2003, The American journal of clinical nutrition.