Diet quality and its association with gestational diabetes

Research output: ThesisDoctoral ThesisCollection of Articles

Abstract

Gestational diabetes mellitus (GDM) is increasing globally and it causes pregnancy complications and later type 2 diabetes (T2D) for the mother and offspring. Studies of the association between diet in Nordic populations and GDM, as well as the effect of observed dietary change on the risk is scanty. The thesis was based on data from the Finnish Gestational Diabetes Prevention Study RADIEL, a randomized controlled trial with diet and physical-activity counselling. The participants were either obese (body mass index, BMI ≥30 kg/m2) or had a history of GDM, and they were recruited either before pregnancy or at early pregnancy. Based on 3-day diet records, at the 1st trimester of pregnancy the pregnant women had fat intake of 33 (standard deviation (SD) 6) % from total energy (E%), intake of saturated fatty acids higher than recommended (12, SD 3 E%), and low intake of carbohydrate (46, SD 6 E%). Average intakes of vitamins D (mean 7 µg, SD 4) and A (724 µg, SD 357), folate (282 µg, SD 85), and iron (12 mg, SD 3) from food sources were below the Nordic Nutrition Recommendations (NNR), but mean total intakes (from foods and supplements), excluding vitamin A, were above the recommended lower level. The proportion of users of any dietary supplements was 77%. The purpose of developing a diet quality index (Healthy Food Intake Index) was to study the level of adherence to the NNR in pregnant women at high risk of GDM. The 11 components of the HFII reflected the food guidelines of the NNR, intakes of relevant nutrients, and characteristics known to vary with diet quality. The HFII showed reproducibility. High scores in the HFII, and thus, high adherence to the NNR at 1st trimester was associated with 2nd trimester’s lower glucose concentrations 2 hours after 75 g oral glucose tolerance test. Dietary changes towards the food guidelines of the NNR during pregnancy were associated with a lower risk of GDM. A diet adherent to the NNR may lower the risk of GDM in high-risk women. This highlights the need for adequate NNR-based dietary intervention in early pregnancy of obese women and women with a history of GDM. Guidance should emphasize importance of quality of fats and safe sources of vitamin A. Vitamin A status of Finnish pregnant women warrants further investigations. With minor adjustments, the HFII is a promising instrument for maternity clinics for quick screening of pregnant women’s diet quality.
Original languageEnglish
Place of PublicationHelsinki
Publisher
Print ISBNs978-951-51-3517-9
Electronic ISBNs978-951-51-3518-6
Publication statusPublished - 2017
MoE publication typeG5 Doctoral dissertation (article)

Fields of Science

  • 3121 Internal medicine
  • 3123 Gynaecology and paediatrics

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