Elsevier

Nutrition

Volume 32, Issue 10, October 2016, Pages 1092-1096
Nutrition

Applied nutritional investigation
Adherence to the DASH and Mediterranean diets is associated with decreased risk for gestational diabetes mellitus

https://doi.org/10.1016/j.nut.2016.03.006Get rights and content

Highlights

  • Greater adherences to Dietary Approaches to Stop Hypertension (DASH) and Mediterranean (MED) diets were associated with reduced risk for gestational diabetes mellitus.

  • Participants in higher tertiles of the DASH and MED diets had lower fasting blood glucose and hemoglobin A1c.

  • Greater adherence to the DASH and MED diets were associated with better lipid profiles.

Abstract

Objectives

Few studies have examined the association between adherence to the Dietary Approaches to Stop Hypertension (DASH) or Mediterranean (MED) diets and prevalence of gestational diabetes mellitus (GDM). The aim of the present study was to evaluate the association between the two diets and GDM.

Methods

In a case–control hospital-based study, pregnant women with (n = 200) and without (n = 260) GMD were recruited. An average of three 24-h dietary records were used to assess participants’ dietary intakes. DASH scores were calculated based on the Fung method and MED scores were calculated using the Trichopoulou method. GDM was defined as fasting glucose >95 mg/dL or 1-h postprandial glucose >140 mg/dL for the first time in the pregnancy. The risk for GDM was assessed across tertiles of DASH and MED scores.

Results

DASH and MED diets were negatively related to fasting blood glucose, hemoglobin A1c, and serum triacylglycerol concentrations. High-density lipoprotein cholesterol was significantly higher for those in the top tertile of the DASH diet but not the MED diet in comparison with the lowest tertile. Total serum cholesterol level was lower in the third tertile of the MED diet but not in the DASH diet. Participants in the highest tertile of the MED diet had 80% lower risk for GDM compared with those in the lowest tertile (Ptrend = 0.006). Greater adherence to the DASH eating plan was associated with 71% reduced risk for GDM (Ptrend = 0.006) after adjustment for potential confounders.

Conclusion

Adherence to either the DASH or Mediterranean diet is associated with decreased risk for GDM.

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.

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