The Association Of Maternal Dietary Vegetables,Fruits And Carotenoids,Polyphenols Intake During Mid-trimester With Gestational Diabetes Mellitus

Gestational diabetes mellitus(GDM),defined as glucose intolerance with onset or first recognition during pregnancy,is one of the most common pregnancy complications.In recent years,the prevalence of GDM has been on a rising trend due to the change of dietary patterns and lifestyles and the environment pollution.Balanced diet and exercise has been the important measures to prevent type 2 diabetes mellitus,as well as for GDM.Large numbers of epidemiologic researches have shown that the Mediterranean diet patterns is associated with decreased risk of GDM,which may potentially due to abundant intake of vegetables and fruits(V&F).The high quantities of fiber,magnesium,potassium,vitamin C and phytochemicals contained in V&F are critical factors to improve health.Phytochemicals,non-nutrient bioactive compounds,are widely distributed in plant-based foods,such as fruit,vegetables.Abundant evidence has demonstrated the prospective effects of carotenoids and polyphenols on chronic diseases,which may due to the powerful antioxidant and anti-inflammatory activities.Therefore,the aim of this study was to determine whether increased intake of V&F and carotenoids,polyphenols from V&F is associated with reduced risk of GDM.Part I,we analyzed the association of maternal dietary intake of total vegetables and fruits,and common vegetables and fruits with GDM risk.Part II,we examined the association of dietary intake of carotenoids from vegetables and fruits with GDM risk and blood glucose concentrations,and explored the potential interaction.Part III,we determined the association of dietary intake of polyphenols from vegetables and fruits with GDM risk and blood glucose concentrations,and explored the potential interaction.PartⅠ The association of maternal dietary intake of vegetables and fruits during mid-trimester with gestational diabetes mellitusObjective: To determine whether increased dietary intake of vegetables and fruits and the common ones during mid-trimester is associated with decreased risk of GDM.Methods: This present study population was drawn from the Tongji Maternal and Child Health Cohort(TMCHC)study,a prospective cohort study conducted from 2013 to 2016 at three public hospitals in Wuhan.Dietary data was collected using a researcher-administered semi-quantitative food frequency questionnaire(FFQ),before undertaking an oral glucose tolerance test(OGTT)at 24-28 gestational weeks.Multiple logistic regression analysis was used to estimate the OR(95% CI)of GDM risk,and multiple linear regression analysis was used to obtain the β coefficients of fasting blood glucose(FBG),1-h post-load blood glucose(PBG)and 2-h PBG.Stratified and interaction analyses were used to explore the potential effects modification.Results: A total of 2231 participants were included in this present study,and 185(8.3%)were diagnosed with GDM.The dietary intake of total vegetables and fruits were 399.5 ± 228.6 g/d and 399.4 ± 255.9 g/d,respectively.There was no correlation between total vegetables intake and GDM risk.However,before adjusting for covariates,the OR(95% CI)in the highest quartile of tomatoes intake was 0.61(0.40,0.94)(P for trend = 0.075),compared with the lowest quartile;after adjusting for covariates,the OR(95% CI)was 0.70(0.44,1.11)(P for trend = 0.280).The increased total fruits intake was associated with decreased GDM risk(OR for the highest quartile vs.the lowest quartile: 0.52;95% CI: 0.33,0.82;P for trend= 0.001)after adjusting for covariates,and the relationship was consistent in different subgroups.The OR(95% CI)in the highest quartile of berries intake were 0.63(0.40,0.98)(P for trend= 0.021)and 0.73(0.46,1.16)(P for trend= 0.108),before and after adjusting for covariates.Multiple linear regression analysis suggested an inverse association between total fruit intake and 1-h PBG,2-h PBG concentrations(all P for trend < 0.05).Per 100 g increase in total fruit consumption was associated with 0.028 mmol/L(95%CI: 0.001,0.055)mmol/L decrease in 1-h PBG and 0.023 mmol/L(95% CI: 0.002,0.043)decrease in 2-h PBG,respectively(all P< 0.05).Conclusions: Our findings supported that the increased fruits intake,rather than total vegetables,was inversely associated with GDM risk.The association of dietary tomatoes and berries intake with GDM risk should be determined by further studies.Part Ⅱ The association of maternal dietary intake of carotenoids from vegetables and fruits during mid-trimester with gestational diabetes mellitusObjective: To determine whether increased intake of carotenoids from vegetables and fruits is associated with decreased risk of GDM and glucose concentrations.Methods: Participants recruitment and investigations were consistent with the part I.Dietary intake of carotenoids from vegetables and fruits including α-carotene,β-carotene,β-cryptoxanthin,lycopene and lutein/zeaxanthin was calculated based on the United States Department of Agriculture(USDA)Nutrient Database.Multiple logistic and linear regression models were used to obtain the estimates of GDM risk and blood glucose concentrations.Stratified and interaction analyses were demonstrated to explore the potential effects modification.Results: A total of 2231 participants and 185(8.3%)GDM patients were included,which was consistent with Part I.The intake of total carotenoids was 9.00(5.91-14.04)mg/d,and the intake from vegetables and fruits was 7.36(4.68-11.21)mg/d and 0.80(0.37-1.84)mg/d,respectively.After adjusting for covariates,the OR(95% CI)in the highest quartile of lycopene intake 0.55(0.36,0.85)(P for trend = 0.031),compared with the lowest quartile;each 1 mg increase in lycopene consumption was associated with 4%(95% CI: 0%,8%)(P= 0.030)decrease in GDM risk.Compared with the lowest quartile,the ORs(95% CIs)of GDM risk in the second,third and highest quartile of total carotenoids from fruits intake was 0.61(0.41,0.93),0.62(0.40,0.96)and 0.46(0.28,0.77)(P for trend= 0.008);the ORs(95% CIs)of β-carotene was 0.64(0.42,0.97),0.52(0.33,0.82)and 0.44(0.27,0.70)(P for trend= 0.006);the ORs(95% CIs)of β-cryptoxanthin was 0.52(0.34,0.79),0.62(0.41,0.95)and 0.51(0.30,0.85)(P for trend= 0.033).The multi-adjusted results showed that per 1 mg increase in total carotenoids from fruits consumption,the GDM risk was decreased 35%(11%,52%)(P= 0.007);and per 0.1 mg increase in β-carotene consumption,the GDM risk was decreased 7%(2%,12%)(P= 0.008).Multiple linear regression analysis showed an inverse association between lycopene intake,total carotenoids from fruits and FBG concentrations(all P for trend < 0.05).The multi-adjusted results showed that per 1 mg increase in lycopene consumption and total carotenoids from fruits consumption was associated with 0.012 mmol/L(95%CI: 0.007,0.016)mmol/L and 0.013 mmol/L(95%CI: 0.007,0.018)mmol/L decrease in FBG.Conclusions: The dietary lycopene and total carotenoids intake was mainly assumed via reducing FBG to decrease GDM risk,and the protection of lycopene was relatively increased among primigravid women.Part Ⅲ The association of maternal dietary intake of polyphenols from vegetables and fruits during mid-trimester with gestational diabetes mellitusObjective: To assess whether increased intake of polyphenols from vegetables and fruits is associated with decreased risk of GDM and glucose concentrations.Methods: Participants recruitment and investigations were consistent with the part I.Dietary intake of polyphenols including flavonoids,phenolic acids,lignans,stilbenes and other polyphenols was calculated based on the USDA Nutrient Database and Phenol-Explorer 3.6 database.The flavonoids included flavonols,flavan-3-ols,flavones,flavanones,isoflavone,anthocyanidins and proanthocyanidins.Multiple logistic and linear regression analyses were used to assess the estimates of GDM risk and blood glucose concentrations.Stratified and interaction analyses were demonstrated to explore the potential effects modification.Results: The intake of total polyphenols was 319.85(217.84-427.02)mg/d,and the intake from vegetables and fruits was 63.16(41.09-92.72)mg/d and 201.62(115.30-281.79)mg/d,respectively.No significant association was shown between dietary polyphenols from vegetables and GDM risk.The increased total polyphenols and flavonoids intake from fruits were associated with decreased GDM risk.After adjusting for covariates,the OR(95% CI)in the highest quartile versus the lowest quartile of total polyphenols from fruits intake was 0.52(0.30,0.90)(P for trend= 0.026),and the OR(95% CI)of flavonoids from fruits intake was 0.58(0.33,1.00)(P for trend= 0.049).In further analysis,the OR(95% CI)in the third quartile versus the lowest quartile of flavones from fruits intake was 0.57(0.35,0.93)(P for trend= 0.008),and the OR(95% CI)in the highest quartile versus the lowest quartile of anthocyanidins from fruits intake was 0.62(0.38,1.00)(P for trend= 0.065).In addition,compared with the lowest quartile of total polyphenols from fruits consumption,the concentration of 2-h PBG in the highest quartile was decreased with 0.183(0.031,0.335)mmol/L(P for trend= 0.031);per100 mg increase in total polyphenols from fruits consumption was associated with 0.061(0.012,0.109)mmol/L decrease in 2-h PBG(P= 0.015).Conclusions: The dietary total polyphenols from fruits and flavonoids from fruits was inversely associated with decreased GDM risk,and the anthocyanidins maybe the critical factors.The dietary total polyphenols from fruits was mainly assumed via reducing PBG to decrease GDM risk.