Applied nutritional investigationAdherence to the DASH and Mediterranean diets is associated with decreased risk for gestational diabetes mellitus
Introduction
Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance first recognized during pregnancy [1]. It affects 1−14% of all pregnancies worldwide [2]. The prevalence of GDM is 4.7% in Iran [3]. It is positively related to short- and long-term complications for both mothers and their newborns [4], including increased risk for diabetes, hypertension, and cardiovascular diseases in later life [5]. Several strategies including dietary counseling, lifestyle modification, moderate hypocaloric diet, dietary intervention, and glucose-lowering agents have been used to manage GDM and to improve pregnancy outcomes [6], [7], [8], [9], [10], [11]. Although diet therapy focusing on fatty acids, micronutrient supplementation, and low-glycemic load diets are considered cornerstone approaches to manage GDM [6], [7], [11], [12], [13], according to a recent meta-analysis no strong conclusions can be drawn as to the best intervention for managing GDM [11]. Because of the interactions between foods and nutrients, it is optimal to study dietary patterns together than to study them separately [4]. Also, due to differences in dietary patterns between Western and Eastern societies, epidemiologic studies in both contexts should be conducted.
The Dietary Approaches to Stop Hypertension (DASH) diet is a low-glycemic index and low-energy dense dietary pattern, which contains high quantities of phytoestrogens, magnesium, potassium, and dietary fiber [2]. The DASH diet was initially suggested for hypertensive patients [5], but it is an effective approach for improving cardiovascular risks, diabetes, and metabolic syndrome [2], [5]. The Mediterranean (MED) diet, emphasizes consumption of fruits, vegetables, legumes, whole grains, and foods rich in monounsaturated fatty acids (MUFAs), and is associated with lower risk for many chronic diseases [14], [15].
Most available research on this topic has been focused on Western populations. However, due to substantial differences in dietary patterns between Middle-Eastern and Western populations, it is useful to examine the overall effects of these dietary patterns in epidemiologic studies conducted in diverse settings [2], [4], [16], [17]. This is of particular importance given that the consumption patterns of different components of the DASH and MED diets in Iranian populations differ from those in other countries. Also, most research has examined this association in women with a prior history of GDM [16], [18]. Therefore, evaluating the association between adherence to healthy dietary patterns, such as the DASH or MED diets, and incidence of GDM in Iranians might add to current knowledge. The aim of the present study was to evaluate the association between the two dietary patterns and the prevalence of GDM.
Section snippets
Participants
This hospital-based case–control study was conducted in the Azzahra Hospital, Nutrition Clinic of Isfahan and Shahid Beheshti Hospital with 463 pregnant women carrying singleton fetuses. The women were ages 22 to 44 y and between 5 and 28 wk pregnant. Of the women, 263 healthy and 200 had GDM. For every pregnant woman with GDM selected in a specific week of the pregnancy, another woman in the same week of pregnancy was chosen for the control group. Pregnant women having abnormal fasting glucose
Results
We found that cases had lower adherence to the DASH diet than the controls (22.73 ± 4.06 versus 25.03 ± 4.92; P < 0.0001), but observed no significant differences in adherence to the MED diet (4.01 ± 1.57 versus 4.92 ± 1.49; P = 0.81). Additionally, serum levels of FBG, HbA1c, LDL-C, and TGs were significantly higher in cases than controls. No differences were observed between cases and controls for demographic variables. Characteristics of participants across the tertiles of dietary patterns
Discussion
Our results indicated that adherence to the DASH and MED diets was associated with decreased risk for GDM. We analyzed a priori DASH and MED dietary patterns to investigate correlations observed in the present study. This type of study contributes to furthering the understanding of the associations between diet and diseases in specific regions of the world, where social factors and dietary patterns may be distinct. Epidemiologic studies in the field of nutrition are rare in Iran and
Conclusion
Based on the present case–control study, pregnant women who followed the DASH or MED dietary patterns were at lower risk for GDM. Future studies are needed in the context of countries with non-Western diets to confirm these results and to investigate the relation between dietary patterns and risk for GDM longitudinally.
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Funding for this study was granted by the Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.