Diet Quality and Its Association with Gestational Diabetes Mellitus

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.Raskausdiabetes (engl. gestational diabetes mellitus, lyh. GDM) ja lihavuus lisääntyvät maailmanlaajuisesti, mikä lisää sekä äitien että lasten tyypin 2 diabeteksen esiintyvyyttä. Pohjoismaisessa väestössä ruokavalion ja GDM:n yhteyttä on tutkittu vähän ja mitatun ruokavaliomuutoksen yhteydestä GDM:n riskiin ei ole tietoa. Väitöskirjan aineisto on peräisin Raskausdiabeteksen ehkäisy elämäntapamuutoksin RADIEL -tutkimuksesta, joka on vuonna 2008 aloitettu satunnaistettu kontrolloitu ravitsemus- ja liikuntainterventiotutkimus. Tutkittavat olivat suurentuneessa GDM:n riskissä lihavuuden (painoindeksi ≥30 kg/m2) tai aikaisemmassa raskaudessa sairastetun GDM:n takia. Rekrytoitaessa tutkittavat joko suunnittelivat raskautta tai olivat raskautensa alussa. Ruokapäiväkirjaan (3 päivää) perustuen, odottavat äidit saivat 1. raskauskolmanneksella rasvaa 33 % kokonaisenergiansaannista (E%) (SD 6), tyydyttynyttä rasvaa Pohjoismaista ravitsemussuositusta (engl. Nordic Nutrition Recommendations, lyh. NNR) enemmän (12 E%, SD 3), ja vähänlaisesti hiilihydraatteja (46 E%, SD 6). Ruoasta saatu D-vitamiinin (7 µg, SD 4), A-vitamiinin (724 µg, SD 357), folaatin (282 µg, SD 85), ja raudan saanti (12 mg, SD 3) keskimäärin alitti suositukset (NNR), mutta lukuun ottamatta A-vitamiinia, ravintoaineiden kokonaissaannit (ruoasta ja ravintoainevalmisteista) ylsivät suositukseen. Vitamiini- ja kivennäisainevalmisteita käytti 77%. Ruokavalioindeksi, nimeltään Healthy Food Intake Index (HFII), kehitettiin tutkimaan NNR:n ruoankäyttösuositusten toteutumista GDM:n riskissä olevien odottavien äitien ruokavalioissa. Validiteettianalyysit osoittivat, että HFII:n 11 komponenttia kuvastivat ruoankäyttösuosituksia, olivat yhteydessä tärkeimpien ravintoaineiden saantiin, ja tutkittavien ominaisuuksiin, joiden tiedetään olevan yhteydessä ruokavalion terveellisyyteen. HFII:n toistettavuus oli kohtuullinen. Korkeat HFII pisteet (toisin sanoen NNR:n mukainen ruokavalio) 1. raskauskolmanneksella olivat yhteydessä myöhempään 2 tuntia glukoosirasituksesta mitattuun plasman glukoosipitoisuuteen. Lisäksi raskauden 1. ja 2. kolmanneksen välinen ruokavalion muutos kohti NNR:a oli yhteydessä pienempään GDM:n riskiin. NNR:n mukainen ruokavalio saattaa olla yhteydessä pienempään GDM:n riskiin. Suuressa GDM:n riskissä oleville tuleekin tarjota NNR:n pohjautuvaa ruokavalioneuvontaa painottaen rasvan laadun ja turvallisten A-vitamiinin saantilähteiden merkitystä. Suomalaisten raskaana olevien A-vitamiinin saantia tulisi tutkia tarkemmin. Pienillä muokkauksilla HFII:a voitaisiin käyttää neuvoloissa odottavien äitien ruokavalion laadun arviointiin

Longitudinal Branched-Chain Amino Acids, Lifestyle Intervention, and Type 2 Diabetes in the Finnish Diabetes Prevention Study

Context Circulating branched-chain amino acids (BCAAs) are associated with the risk of type 2 diabetes (T2D). Objective We examined to what extent lifestyle intervention aiming to prevent T2D interacts with this association and how BCAA concentrations change during the intervention. Methods We computed trajectory clusters by k-means clustering of serum fasting BCAAs analyzed annually by mass spectrometry during a 4-year intervention. We investigated whether baseline BCAAs, BCAA trajectories, and BCAA change trajectories predicted T2D and whether BCAAs predicted T2D differently in the intervention (n = 198) and control group (n = 196). Results Elevated baseline BCAAs predicted the incidence of T2D in the control group (hazard ratio [HR] 1.05 per 10 mu mol/L, P = 0.01), but not in the intervention group. BCAA concentration decreased during the first year in the whole cohort (mean -14.9 mu mol/L, P < 0.001), with no significant difference between the groups. We identified 5 BCAA trajectory clusters and 5 trajectory clusters for the change in BCAAs. Trajectories with high mean BCAA levels were associated with an increased HR for T2D compared with the trajectory with low BCAA levels (trajectory with highest vs lowest BCAA, HR 4.0; P = 0.01). A trajectory with increasing BCAA levels had a higher HR for T2D compared with decreasing trajectory in the intervention group only (HR 25.4, P < 0.001). Conclusion Lifestyle intervention modified the association of the baseline BCAA concentration and BCAA trajectories with the incidence of T2D. Our study adds to the accumulating evidence on the mechanisms behind the effect of lifestyle changes on the risk of T2D.Peer reviewe

Incorporation of novel foods in European diets can reduce global warming potential, water use and land use by over 80%

Global food systems face the challenge of providing healthy and adequate nutrition through sustainable means, which is exacerbated by climate change and increasing protein demand by the world's growing population. Recent advances in novel food production technologies demonstrate potential solutions for improving the sustainability of food systems. Yet, diet-level comparisons are lacking and are needed to fully understand the environmental impacts of incorporating novel foods in diets. Here we estimate the possible reductions in global warming potential, water use and land use by replacing animal-source foods with novel or plant-based foods in European diets. Using a linear programming model, we optimized omnivore, vegan and novel food diets for minimum environmental impacts with nutrition and feasible consumption constraints. Replacing animal-source foods in current diets with novel foods reduced all environmental impacts by over 80% and still met nutrition and feasible consumption constraints. The environmental impacts of more sustainable diets vary across regions. Using linear optimization, this study compares the reductions of global warming potential, water use and land use associated with the replacement of animal-sourced foods with novel or plant-based foods in European diets. Three diet types were considered to meet nutritional adequacy and consumption constraints.Peer reviewe

Macronutrient intake during pregnancy in women with a history of obesity or gestational diabetes and offspring adiposity at 5 years of age

Background/objectives The impact of maternal macronutrient intake during pregnancy on offspring childhood adiposity is unclear. We assessed the associations between maternal macronutrient intake during and after pregnancy with offspring adiposity at 5 years of age. Additionally, we investigated whether gestational diabetes (GDM), BMI, or breastfeeding modified these associations. Subjects/methods Altogether, 301 mother-child dyads with maternal prepregnancy BMI >= 30 and/or previous GDM participated in the Finnish Gestational Diabetes Prevention Study (RADIEL) and its 5 years follow-up. Macronutrient intakes (E%) were calculated from 3-day food records collected at 5-18 weeks' gestation, in the third trimester, and at 12 months and 5 years after pregnancy. Offspring body fat mass (BFM) and fat percentage (BF%) at 5 years were measured by bioimpedance. Statistical analyses were multivariate linear regression. Results Mean (SD) prepregnancy BMI was 33(4) kg/m(2). GDM was diagnosed in 47%. In normoglycemic women, higher first half of pregnancy n-3 PUFA intake was associated with lower offspring BFM (g) (ss -0.90; 95% CI -1.62, -0.18) and BF% (ss -3.45; 95% CI -6.17, -0.72). In women with GDM, higher first half of pregnancy n-3 PUFA intake was associated with higher offspring BFM (ss 0.94; 95% CI 0.14, 1.75) and BF% (ss 3.21; 95% CI 0.43, 5.99). Higher SFA intake in the third trimester and cumulative intake across pregnancy (mean of the first half and late pregnancy) was associated with higher BFM and BF% (across pregnancy: ss 0.12; 95% CI 0.03, 0.20 and ss 0.44; 95% CI 0.15, 0.73, respectively). Higher carbohydrate intake across pregnancy was associated with lower BFM (ss -0.044; 95% CI -0.086, -0.003), and borderline associated with BF% (ss -0.15; 95% CI -0.31, 0.00). Conclusions The macronutrient composition of maternal diet during pregnancy is associated with offspring BFM and BF% at 5 years. GDM modifies the association between prenatal n-3 PUFA intake and offspring anthropometrics.Peer reviewe

Lifestyle and glycemic health 5 years postpartum in obese and non-obese high diabetes risk women

Aim Women with prior gestational diabetes (GDM) are at increased diabetes risk. This study aimed to assess whether lifestyle is associated with glycemic health of high-risk women 5 years postpartum, taking into account the pre-pregnancy BMI. Methods The RADIEL study enrolled before or in early pregnancy 720 women with pre-pregnancy BMI >= 30 kg/m(2)and/or prior GDM. The follow-up visit 5 years postpartum included questionnaires and measurements of anthropometrics, blood pressure, and physical activity (PA) as well as analyses of glucose metabolism, lipids, and inflammatory markers. We measured body composition (Inbody) and calculated a Healthy Food Intake Index (HFII) from Food Frequency Questionnaires (FFQ). ArmBand measured PA, sedentary time, and sleep. To take into account the diverse risk groups of GDM, we divided the women based on pre-pregnancy BMI over/under 30 kg/m(2). Results Altogether 348 women attended the follow-up. The obese and non-obese women showed similar prevalence of glycemic abnormalities, 13% and 19% (p = 0.139). PA levels were higher among the non-obese women (p <0.05), except for step count, and their HFII was higher compared to the obese women (p = 0.033). After adjusting for age, education, and GDM history, PA and HFII were associated with glycemic health only among obese women. When both lifestyle factors were in the same model, only PA remained significant. PA associated with other markers of metabolic health also among the non-obese women, excluding HbA1c. Conclusion Lifestyle 5 years postpartum was associated with better glycemic health only among the obese high-risk women. PA, however, is essential for the metabolic health of all high-risk women.Peer reviewe

A slow road from meat dominance to more sustainable diets: An analysis of purchase preferences among Finnish loyalty-card holders

Achieving a sustainable and healthy diet requires increased replacement of red meat with more sustainable foods. There is a call for novel methodologies to assess the potential of different interventions and policies in enhancing the transition from the current to more sustainable choices. We aimed to characterize consumer clusters with similar preferences in protein sources, to compare the purchase prices of these foods, and to identify ongoing transitions from one protein source to another. Grocery purchase data with individual attributes on 29,437 consenting loyalty card holders were analyzed over 2.3 year period. We designed a sequence analysis to group participants to clusters with similar purchase preferences over the follow-up period and to estimate transition probabilities between preferences. We studied the determinants of prevalent purchase profiles by ordinal logistic models. We identified six participant profiles with similar preferences in four protein sources: red meat, poultry, fish, and plant-based foods. Red meat dominated the purchase preferences and showed the highest persistence over time. The majority (70%) of the participants demonstrated somewhat mixed purchase profiles. A step-by-step transition from red meat towards plant-based food preference seems most likely via poultry and fish. Overall, low income was not a barrier to a more sustainable purchase profile, while price may deter the purchase of fish. The most important resources in choosing more sustainable profiles were education and stage of family life. Societal incentives for sustainable food choices seem most crucial at transition stages of life course and for the less educated. Here, we also demonstrate that grocery purchase data offer a valuable tool for monitoring the progressive transition towards a healthy and sustainable food system.Peer reviewe

Ascending Growth is Associated with Offspring Adiposity in Pregnancies Complicated with Obesity or Gestational Diabetes

Context: Early growth is associated with childhood adiposity, but the influence of lifestyle remains unknown. Objective: This work aimed to investigate the association of growth profiles from high-risk pregnancies with adiposity at age 5 years, taking into account lifestyle and several antenatal/postnatal exposures. Methods: This prospective cohort study included 609 children born during the Finnish Gestational Diabetes Prevention Study (RADIEL), recruiting women with body mass index (BMI) greater than or equal to 30 and/or prior gestational diabetes mellitus (GDM) (2008-2013). Altogether 332 children attended the 5-year follow-up (2014-2017). Main outcome measures included growth profiles based on ponderal index (PI = weight/height(3)), investigated using latent class mixed models. Adiposity was assessed with anthropometrics and body composition (InBody720). Results: We identified 3 growth profiles: ascending (n = 82), intermediate (n = 351), and descending (n = 149). Children with ascending growth had a higher body fat percentage, ISO-BMI, and waist circumference (P Conclusion: Accelerated early growth was associated with higher adiposity in 5-year-old children from high-risk pregnancies, even when adjusted for lifestyle. Reducing cesarean deliveries and promoting breastfeeding may be beneficial for postnatal growth.Peer reviewe

Parents’ Reports of Preschoolers’ Diets: Relative Validity of a Food Frequency Questionnaire and Dietary Patterns

The accurate assessment of food consumption is crucial in nutritional studies. Since modern nutrition science has become more interested in diet as a whole, studies validating food frequency questionnaires (FFQs) and exploratory dietary patterns are needed. We aimed at examining the relative validity of a 47-item FFQ against three-day food records among three- to six-year-old Finnish children, as well as investigating the consistency of the dietary patterns derived using the principal component analysis (PCA), with food record and FFQ data as inputs. We conducted the PCA without forcing the food record data to match the FFQ items. Altogether, 75% or more of the participants were classified into the same or adjacent quarter of vegetables and fruits as well as sugary food consumption. Furthermore, the intake of folate and vitamin C increased linearly in the quarters of vegetable and fruit consumption, as did the intake of sucrose in quarters of sugary food consumption. Three fairly similar dietary patterns were identified from food records and FFQ data. Concerning the patterns, more than 70% of the participants were classified into the same or adjacent quarter. However, the Spearman correlation coefficients between the respective pattern scores were low (0.25–0.33). The FFQ showed acceptable validity when ranking food group consumption compared to food records. Additionally, the FFQ-derived dietary patterns were consistent with those derived using food record data

Food purchase behaviour in a Finnish population : patterns, carbon footprints and expenditures

Objective: To identify food purchase patterns and to assess their carbon footprint and expenditure. Design: Cross-sectional. Setting: Purchase patterns were identified by factor analysis from the annual purchases of 3435 product groups. The associations between purchase patterns and the total purchases' carbon footprints (based on life-cycle assessment) and expenditure were analysed using linear regression and adjusted for nutritional energy content of the purchases. Participants: Loyalty card holders (n 22 860) of the largest food retailer in Finland. Results: Eight patterns explained 55 % of the variation in food purchases. The Animal-based pattern made the greatest contribution to the annual carbon footprint, followed by the Easy-cooking, and Ready-to-eat patterns. High-energy, Traditional and Plant-based patterns made the smallest contribution to the carbon footprint of the purchases. Animal-based, Ready-to-eat, Plant-based and High-energy patterns made the greatest contribution, whereas the Traditional and Easy-cooking patterns made the smallest contribution to food expenditure. Carbon footprint per euros spent increased with stronger adherence to the Traditional, Animal-based and Easy-cooking patterns. Conclusions: The Animal-based, Ready-to-eat and High-energy patterns were associated with relatively high expenditure on food, suggesting no economic barrier to a potential shift towards a plant-based diet for consumers adherent to those patterns. Strong adherence to the Traditional pattern resulted in a low energy-adjusted carbon footprint but high carbon footprint per euro. This suggests a preference for cheap nutritional energy rather than environment-conscious purchase behaviour. Whether a shift towards a plant-based pattern would be affordable for those with more traditional and cheaper purchase patterns requires more research.Peer reviewe