Associations between the dietary patterns of pregnant Malaysian women and ethnicity, education, and early pregnancy waist circumference:A prospective cohort study

BACKGROUND/OBJECTIVES: Little is known about the dietary patterns (DPs) of women during pregnancy. The present study aimed to identify the DPs of pregnant Malaysian women and their associations with socio-demographic, obstetric, and anthropometric characteristics.SUBJECTS AND METHODS: This prospective cohort study included 737 participants enrolled in Seremban Cohort Study between 2013 and 2015. Food consumption was assessed using a validated 126-food item semi-quantitative food frequency questionnaire (SFFQ) at four time-points, namely, pre-pregnancy and at each trimester (first, second, and third). Principal component analysis (PCA) was used to identify DPs.RESULTS: Three DPs were identified at each time point and designated DP 1-3 (pre-pregnancy), DP 4-6 (first trimester), DP 7-9 (second trimester) and DP 10-12 (third trimester). DP 1, 4, and 7 appeared to be more prudent diets, characterized by higher intakes of nuts, seeds &amp; legumes, green leafy vegetables, other vegetables, eggs, fruits, and milk &amp; dairy products. DP 2, 5, 8, and 11 had greater loadings of condiments &amp; spices, sugar, spreads &amp; creamer, though DP 2 had additional sweet foods, DP 5 and 8 had additional oils &amp; fats, and DP 11 had additional tea &amp; coffee, respectively. DP 3 and 6 were characterized by high protein (poultry, meat, processed, dairy, eggs, and fish), sugars (mainly as beverages and sweet foods), and energy (bread, cereal &amp; cereal products, rice, noodles &amp; pasta) intakes. DP 9 had additional fruits. However, DP 12 had greater loadings of energy foods (bread, cereal &amp; cereal products, rice, noodles &amp; pasta), sugars (mainly as beverages, and sweet foods), and good protein sources (eggs, nuts, seeds &amp; legumes). Malays were more likely to have lower adherence (LA) for DP 1 and 10 than non-Malays. DP 2, 8, and 11 were more prevalent among Malays than non-Malays. Women with a higher education were more likely to have LA for DP 10, and women with a greater waist circumference at first prenatal visit were more likely to show LA for DP 11.CONCLUSIONS: DPs observed in the present study were substantially different from those reported in Western populations. Information concerning associations between ethnicity, waist circumference and education with specific DPs before and throughout pregnancy could facilitate efforts to promote healthy dietary behavior and the overall health and well-being of pregnant women.</p

Beverage Intake and the Risk of Gestational Diabetes Mellitus:The SECOST

The contribution and impact of beverage intake to total nutrient and energy intake may be substantial. Given the link between lifestyle, diet, and the risk of pregnancy complications, this study investigated the association between the quantity and types of beverages with gestational diabetes mellitus (GDM) risk. The study included 452 women from the Seremban Cohort Study (SECOST). The mean energy by beverage intake was 273 ± 23.83 kcal/day (pre-pregnancy), 349 ± 69.46 kcal/day (first trimester) and 361 ± 64.24 kcal/day (second trimester). Women significantly increased intake of maternal milks and malted drinks, but significantly reduced the intake of carbonated drinks and other drinks from before until the second trimester of pregnancy. For chocolate drinks, carbonated drinks, and soy milk, women increased intake from pre-conception to the first trimester, but reduced their intake from the first to the second trimester. While higher intake of cultured-milk drinks was associated with an increased risk of GDM, higher fruit juice intake was associated with a lower risk of GDM. However, these associations were only observed for intake prior to pregnancy and during the first trimester. Further research is needed to corroborate these findings and investigate the contributions of different beverages to overall diet quality as well as adverse health outcomes during pregnancy

Early pregnancy body mass index and gestational weight gain:A mediating or moderating factor for short stature and risk of gestational diabetes mellitus?

This study examined the association between height and the risk of Gestational Diabetes Mellitus (GDM), and whether this association was mediated or moderated by early pregnancy body mass index (BMI) and gestational weight gain (GWG) that are known independent risk factors for GDM. Data of a retrospective cohort of pregnant women (N = 1,945) were extracted from antenatal clinic cards. The cut-off values of height in relation to risk of GDM were identified using receiver operating characteristic analysis and four categories of height were derived: 160cm. Mediation analysis was performed using the Preacher and Hayes bootstrapping method while the moderation effect was tested with multiple regression analysis with interaction terms. Although there was no mediation effect of BMI and GWG on the association between height and risk of GDM, both factors moderated this association with a significant association between shorter height and risk of GDM was observed in overweight / obese women (height < 150 cm: AOR = 1.41, 95% CI = 1.03-2.44; height 156-160 cm: AOR = 1.48, 95% CI = 1.03-2.14). Overweight / obese women with height < 150 cm and excessive GWG at the end of the second trimester (AOR = 2.25, 95% CI = 1.45-4.17) had significantly higher risk of GDM than those without these factors. Short stature (< 150 cm) was significantly associated with GDM risk among OW/OB women with excessive gestational weight gain at the end of second trimester. This finding underscores the importance of maintaining a healthy BMI during reproductive age and gaining weight in recommended range during pregnancy

Independent and combined effects of age, body mass index and gestational weight gain on the risk of gestational diabetes mellitus

This study aimed to identify the independent and combined effects of age, BMI at first prenatal visit and GWG on the risk of GDM. A retrospective cohort study of 1,951 pregnant women in Seremban district, Negeri Sembilan, Malaysia. GDM was defined as fasting plasma glucose (FPG)>= 5.6mmol/l and/or 2-hour postprandial plasma glucose (2hPPG) >= 7.8mmol/l. A higher percentage of women with GDM had 2 risk factors (29.0%) or >2 risk factors (8.6%) compared to non-GDM women (2 risk factors: 25.5%; >2 risk factors: 5.0%). In general, women with >= 2 risk factors were respectively 1.36-2.06 times more likely to have GDM compared to those without risk factors. Older maternal age and being overweight/obese were significantly associated with risk of GDM. Overweight/obese women with age >= 35 years had 2.45 times higher risk of GDM and having excessive GWG at second trimester further increased the risk of GDM. Age and BMI are independent risk factors for GDM but not GWG in the first and second trimester. The findings emphasize the need to focus on a healthy BMI before pregnancy and optimal GWG during pregnancy to improve pregnancy outcomes

The association between dietary patterns before and in early pregnancy and the risk of gestational diabetes mellitus (GDM):Data from the Malaysian SECOST cohort

Generally, dietary patterns (DP)s have been linked to the risk of diabetes mellitus, however, only few studies examined the associations between DPs in early pregnancy and the risk of gestational diabetes mellitus (GDM). This study aims to determine the association between DPs before and during pregnancy and risk of GDM in Malaysian pregnant women. DPs were derived using principal component analysis of consumed 126 food and beverage items assessed using a validated semi-quantitative food frequency questionnaire collecting data retrospectively for pre-pregnancy, but prospectively for the first and second trimester. Three different DPs were identified at each time point and labelled as DP 1-3 (pre-pregnancy), DP 4-6 (first trimester), and DP 7-9 (second trimester). About 10.6% (n = 48) of pregnant women were diagnosed with GDM in our cohort. Women with high adherence (HA) to DP 2 (adjusted OR: 0.45, 95% CI: 0.20-0.91) and DP 5 (adjusted OR: 0.28, 95% CI: 0.11-0.68) showed a significantly reduced risk of GDM compared to women with low adherence (LA). Other DPs were not significantly associated with GDM risk. Compared to women with GDM, non-GDM women showed HA scores for all DPs throughout pregnancy. Overall, a relative low percentage of women with GDM was found in this cohort. The risk was lower in women with HA to a relatively unhealthy dietary pattern, i.e. DP 2 and DP 5. The lower body mass index (BMI) status and energy intake of women showing a HA to DP 2 in the first trimester may underlie the observed association with a lower GDM risk. Additionally, genetic variance might explain the less susceptibility to GDM despite HA to unhealthy DPs among non-GDM women

Higher Animal Protein Intake During the Second Trimester of Pregnancy Is Associated With Risk of GDM

Background and Aims: This study aimed to examine the associations between the total protein intake as well as types and sources of proteins with the gestational diabetes mellitus (GDM) risk.Method and Results: This was a prospective cohort study of the pregnant women in Malaysia. In this study, the total, animal, and plant protein intakes were assessed using a semi-quantitative food frequency questionnaire. Of the 452 women, 48 (10.62%) were diagnosed with GDM. From pre-pregnancy to second trimester, most of the women had 10–20% of energy intake from protein (88.9–90.3%) and ≥75% of recommended protein intake (74.6–86.5%). The women in the highest tertile (T3) of total animal protein intake [adjusted odds ratio (AOR) = 2.76, 95% CI = 1.27–6.04] and red meat protein (AOR = 2.69, 95% CI = 1.27–5.70), specifically in the second trimester, had significantly higher GDM risk compared with the women in the middle tertile of intake (T2). Interestingly, the women in the T3 of egg protein in the second trimester were significantly at lower GDM risk (AOR = 0.43, 95% CI = 0.18–0.91) compared with those in T2.Conclusion: The highest tertile of animal protein (≥42.15 g/day) intake, particularly red meat protein in the second trimester was positively associated with the GDM risk, whereas the highest tertile of egg protein was inversely associated with the GDM risk. Protein intake before or during early pregnancy was not associated with the GDM risk. These findings underscore the importance of sources and types of protein intake, particularly after the first trimester of pregnancy, in relation to GDM risk

The effect of early nutritional supplementation with a mixture of probiotic, prebiotic, fiber and micronutrients in infants with acute diarrhea in Indonesia

A randomized double blind clinical trial was conducted to assess the efficacy of a special infant formula containing Lactobacillus rhamnosus LMG P-22799 (probiotic: 5 x 10 8 CFU/100mL), inulin (prebiotic: 0.15 g/100mL), dietary fiber (soy polysaccharides: 0.2 g/100mL) and increased amounts of zinc+iron (+0.4 and +0.6 mg/100mL, respectively) as active ingredients for the early dietary management of 58 Indonesian well-nourished male infants aged 3-12 months suffering from acute diarrhea with moderate dehydration. After adequate oral rehydration, the patients were randomly assigned to receive either a low lactose infant formula supplemented with added precooked rice (1.5 g/100mL) with the above active ingredients (study group) or a low lactose infant formula with added precooked rice without the above active ingredient supplement (control group). No antibiotic, anti-secretory drug or antiemetic was given at all. Both study and control groups showed similar outcomes for weight gain and stool weight. The duration of diarrhea was significantly shorter in the study group than in the control group (1.63 versus 2.45 days; p&lt;0.05; for the study and control group, respectively). No treatment failure or other side effects were observed during the course of the study. The present study supports the evidence for the efficacy of a special anti-diarrhea infant formula containing probiotic, prebiotic, fiber and iron+zinc after oral rehydration by shortening the duration of infantile diarrhea in developing countries. However, from the results of our study we cannot discern the individual contribution of the active ingredients and also not whether they may act independent from each other or in a synergistic way

Higher parity, pre-pregnancy BMI and rate of gestational weight gain are associated with gestational diabetes mellitus in food insecure women

Food insecurity may exacerbate adverse maternal health outcomes during pregnancy, however, this association has not been well established, particularly in the context of developing countries. This study aimed to identify the associations between household food insecurity and gestational diabetes mellitus (GDM) risk among urban pregnant women. Household food insecurity was assessed using the translated 10-item Radimer/Cornell hunger scale. Logistic regression models were used to estimate the associations between food insecurity status and GDM risk. About 35.6% of women experienced food insecurity, with 25.2% reported household food insecurity, 8.0% individual food insecurity, and 2.4% child hunger. Food insecure women were at significantly higher risk of developing GDM compared to food secure women (AOR = 16.65, 95% CI = 6.17–24.98). The significant association between food insecurity and GDM risk was influenced by pre-pregnancy BMI, parity and rate of GWG at second trimester. Food insecure women with parity ≥ 2 (AOR = 4.21, 95% CI = 1.98–8.92), overweight/obese BMI prior to pregnancy (AOR = 12.11, 95% CI = 6.09–24.10) and excessive rate of GWG in the second trimester (AOR = 9.66, 95% CI = 4.27–21.83) were significantly more likely to develop GDM compared to food secure women. Food insecurity showed strong association with GDM risk in that the association was influenced by maternal biological and physical characteristics. Multipronged interventions may be necessary for food insecure pregnant women who are not only at risk of overweight/obesity prior to pregnancy but also may have excessive gestational weight gain, in order to effectively reduce GDM risk