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22-09-2023 | Gestational Diabetes | Original Article

The role of dietary fiber on preventing gestational diabetes mellitus in an at-risk group of high triglyceride-glucose index women: a randomized controlled trial

Authors: Yannan Cao, Jing Sheng, Dongyao Zhang, Li Chen, Ying Jiang, Decui Cheng, Yao Su, Yuexin Yu, Haoyi Jia, Pengyuan He, Li Wang, Xianming Xu

Published in: Endocrine | Issue 3/2023

Abstract

Background

Pregnant women with a high triglyceride-glucose (TyG) index during early pregnancy may increase the risk of gestational diabetes mellitus (GDM), and dietary fiber could play an important role in glucose and lipid metabolism. However, no trials have tested the effects of dietary fiber on preventing GDM in women with a high TyG index. This study aims to investigate whether GDM can be prevented by dietary fiber supplementation in women with a TyG index ≥8.5 during early pregnancy (<20 weeks).

Methods

A randomized clinical trial was performed among 295 women with a TyG index ≥8.5 before 20 weeks of gestation, divided into a fiber group (24 g dietary fiber powder/day) or a control group (usual care). The intervention was conducted from 20 to 24⁺⁶ gestational weeks, and both groups received guidance on exercise and diet. The primary outcomes were the incidence of GDM diagnosed by a 75 g oral glucose tolerance test at 25–28 gestational weeks, and levels of maternal blood glucose, lipids. Secondary outcomes include gestational hypertension, postpartum hemorrhage, preterm birth, and other maternal and neonatal complications.

Results

GDM occurred at 11.2% (10 of 89) in the fiber group, which was significantly lower than 23.7 (44 of 186) in the control group (P = 0.015). The mean gestational weeks increased dramatically in the fiber group compared with the control group (39.07 ± 1.08 vs. 38.58 ± 1.44 weeks, P = 0.006). The incidence of preterm birth was 2.3% (2 of 86) of women randomized to the fiber group compared with 9.4% (17 of 181) in the control group (P = 0.032). The concentrations of 2 h postprandial blood glucose showed statistically higher in the control group compared with the intervention group (6.69 ± 1.65 vs. 6.45 ± 1.25 mmol/L, P = 0.026). There were no other significant differences between groups in lipid profile values, or other secondary outcomes.

Conclusion

An intervention with dietary fiber supplementation during pregnancy may prevent GDM and preterm birth in women with a TyG index ≥8.5 before 20 weeks of gestation.

B.A. Raczkowska, P. Mojsak, D. Rojo et al. Gas chromatography-mass spectroscopy-based metabolomics analysis reveals potential biochemical markers for diagnosis of gestational diabetes mellitus. Front. Pharmacol. 12, 770240 (2021). https://doi.org/10.3389/fphar.2021.770240 CrossRefPubMedPubMedCentral

Y. Guo, X. Xu, W. Xu et al. Subsequent perinatal outcomes of pregnancy with two consecutive pregnancies with gestational diabetes mellitus: a population-based cohort study. J. Diabetes 14(4), 282–290 (2022). https://doi.org/10.1111/1753-0407.13263 CrossRefPubMedPubMedCentral

J.H. Moon, H.C. Jang, Gestational diabetes mellitus: diagnostic approaches and maternal-offspring complications. Diabetes Metab. J. 46(1), 3–14 (2022). https://doi.org/10.4093/dmj.2021.0335 CrossRefPubMedPubMedCentral

A. Wang, X. Tian, Y. Zuo et al. Change in triglyceride-glucose index predicts the risk of cardiovascular disease in the general population: a prospective cohort study. Cardiovasc. Diabetol. 20(1), 113 (2021). https://doi.org/10.1186/s12933-021-01305-7 CrossRefPubMedPubMedCentral

M. Miao, G. Zhou, A. Bao et al. Triglyceride-glucose index and common carotid artery intima-media thickness in patients with ischemic stroke. Cardiovasc. Diabetol. 21(1), 43 (2022). https://doi.org/10.1186/s12933-022-01472-1 CrossRefPubMedPubMedCentral

N.E. Poveda, M.F. Garces, A.E. Darghan et al. Triglycerides/glucose and triglyceride/high-density lipoprotein cholesterol indices in normal and preeclamptic pregnancies: a longitudinal study. Int. J. Endocrinol. 2018, 8956404 (2018). https://doi.org/10.1155/2018/8956404 CrossRefPubMedPubMedCentral

T. Song, G. Su, Y. Chi et al. Triglyceride-glucose index predicts the risk of gestational diabetes mellitus: a systematic review and meta-analysis. Gynecol. Endocrinol. 38(1), 10–15 (2022). https://doi.org/10.1080/09513590.2021.1940932 CrossRefPubMed

P.J. Liu, Y. Liu, L. Ma et al. The predictive ability of two triglyceride-associated indices for gestational diabetes mellitus and large for gestational age infant among Chinese pregnancies: a preliminary cohort study. Diabetes Metab. Syndr. Obes. 13, 2025–2035 (2020). https://doi.org/10.2147/DMSO.S251846 CrossRefPubMedPubMedCentral

Y. Li, Y. Yu, J. Wu et al. (2022) Comparison the structural, physicochemical, and prebiotic properties of litchi pomace dietary fibers before and after modification. Foods 11(3), 428. https://doi.org/10.3390/foods11030248

10.

M.O. Weickert, A.F.H. Pfeiffer, Impact of dietary fiber consumption on insulin resistance and the prevention of type 2 diabetes. J. Nutr. 148(1), 7–12 (2018). https://doi.org/10.1093/jn/nxx008 CrossRefPubMed

11.

B.A. Hannon, S.V. Thompson, C.G. Edwards et al. Dietary fiber is independently related to blood triglycerides among adults with overweight and obesity. Curr. Dev. Nutr. 3(2), nzy094 (2019). https://doi.org/10.1093/cdn/nzy094 CrossRefPubMed

12.

T.A. Zerfu, A. Mekuria, Pregnant women have inadequate fiber intake while consuming fiber-rich diets in low-income rural setting: evidences from analysis of common "ready-to-eat" stable foods. Food. Sci. Nutr. 7(10), 3286–3292 (2019). https://doi.org/10.1002/fsn3.1188 CrossRefPubMedPubMedCentral

13.

F.-L. Liu, Y.-M. Zhang, G.V. Parés et al. Nutrient intakes of pregnant women and their associated factors in eight cities of China: a cross-sectional study. Chin. Med. J. (Engl) 128(13), 1778–1786 (2015) CrossRefPubMed

14.

S.S. Wang, S. Lay, H.N. Yu et al. Dietary guidelines for Chinese residents (2016): comments and comparisons. J. Zhejiang Univ. Sci. B. 17(9), 649–656 (2016). https://doi.org/10.1631/jzus.B1600341 CrossRefPubMedPubMedCentral

15.

L.S. Weinert, International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy: comment to the International Association of Diabetes and Pregnancy Study Groups Consensus Panel. Diabetes Care 33(7), e97 (2010). https://doi.org/10.2337/dc10-0544. author reply e98 CrossRefPubMed

16.

S.L. White, D. Pasupathy, N. Sattar et al. Metabolic profiling of gestational diabetes in obese women during pregnancy. Diabetologia 60(10), 1903–1912 (2017). https://doi.org/10.1007/s00125-017-4380-6 CrossRefPubMedPubMedCentral

17.

M.L. Rahman, Y.A. Feng, O. Fiehn et al. (2021) Plasma lipidomics profile in pregnancy and gestational diabetes risk: a prospective study in a multiracial/ethnic cohort. BMJ Open Diabetes Res. Care 9(1), e001551. https://doi.org/10.1136/bmjdrc-2020-001551

18.

Y. Zhang, X. Lan, C. Cai et al. Associations between maternal lipid profiles and pregnancy complications: a prospective population-based study. Am. J. Perinatol 38(8), 834–840 (2021). https://doi.org/10.1055/s-0039-3402724 CrossRefPubMed

19.

A. Pazhohan, M. Rezaee Moradali, N. Pazhohan, Association of first-trimester maternal lipid profiles and triglyceride-glucose index with the risk of gestational diabetes mellitus and large for gestational age newborn. J. Matern. Fetal Neonatal Med. 32(7), 1167–1175 (2019). https://doi.org/10.1080/14767058.2017.1402876 CrossRefPubMed

20.

H. Fujii, M. Iwase, T. Ohkuma et al. Impact of dietary fiber intake on glycemic control, cardiovascular risk factors and chronic kidney disease in Japanese patients with type 2 diabetes mellitus: the Fukuoka Diabetes Registry. Nutr. J. 12, 159 (2013). https://doi.org/10.1186/1475-2891-12-159 CrossRefPubMedPubMedCentral

21.

S. Cowan, S. Gibson, A.J. Sinclair et al. (2022) Meals that differ in nutrient composition and inflammatory potential do not differentially impact postprandial circulating cytokines in older adults above a healthy weight. Nutrients 14(7), 1470. https://doi.org/10.3390/nu14071470

22.

Y. Wang, H. Zhang, X. Teng et al. Garlic oil alleviates high triglyceride levels in alcohol-exposed rats by inhibiting liver oxidative stress and regulating the intestinal barrier and intestinal flora. Food Sci. Nutr. 10(8), 2479–2495 (2022). https://doi.org/10.1002/fsn3.2854 CrossRefPubMedPubMedCentral

23.

H.K. Wang, D.C. Cheng, Y.M. Yang et al. The role of high-content complex dietary fiber in medical nutrition therapy for gestational diabetes mellitus. Front. Pharmacol. 12, 684898 (2021). https://doi.org/10.3389/fphar.2021.684898 CrossRefPubMedPubMedCentral

24.

N. Hori, M. Shiraishi, R. Harada et al. (2021) Association of lifestyle changes due to the COVID-19 pandemic with nutrient intake and physical activity levels during pregnancy in Japan. Nutrients 13(11), 3799. https://doi.org/10.3390/nu13113799

25.

A.M. Ramos-Levi, N. Perez-Ferre, M.D. Fernandez et al. Risk factors for gestational diabetes mellitus in a large population of women living in Spain: implications for preventative strategies. Int. J. Endocrinol. 2012, 312529 (2012). https://doi.org/10.1155/2012/312529 CrossRefPubMedPubMedCentral

26.

A. Basu, J. Crew, J.L. Ebersole et al. (2021) Dietary blueberry and soluble fiber improve serum antioxidant and adipokine biomarkers and lipid peroxidation in pregnant women with obesity and at risk for gestational diabetes. Antioxidants (Basel) 10(8), 1318. https://doi.org/10.3390/antiox10081318

27.

Q. Xu, Y. Tao, Y. Zhang et al. Dietary fiber intake, dietary glycemic load, and the risk of gestational diabetes mellitus during the second trimester: a nested case-control study. Asia Pac. J. Clin. Nutr. 30(3), 477–486 (2021). https://doi.org/10.6133/apjcn.202109_30(3).0014 CrossRefPubMed

28.

C. Zhang, S. Liu, C.G. Solomon et al. Dietary fiber intake, dietary glycemic load, and the risk for gestational diabetes mellitus. Diabetes Care 29(10), 2223–2230 (2006). https://doi.org/10.2337/dc06-0266 CrossRefPubMed

29.

A. Basu, D. Feng, P. Planinic et al. Dietary blueberry and soluble fiber supplementation reduces risk of gestational diabetes in women with obesity in a randomized controlled trial. J. Nutr. 151(5), 1128–1138 (2021). https://doi.org/10.1093/jn/nxaa435 CrossRefPubMedPubMedCentral

30.

L. Englund-Ogge, B.E. Birgisdottir, V. Sengpiel et al. Meal frequency patterns and glycemic properties of maternal diet in relation to preterm delivery: results from a large prospective cohort study. PLoS One 12(3), e0172896 (2017). https://doi.org/10.1371/journal.pone.0172896 CrossRefPubMedPubMedCentral

31.

E.R. Hillesund, N.C. Overby, S.M. Engel et al. Associations of adherence to the New Nordic Diet with risk of preeclampsia and preterm delivery in the Norwegian Mother and Child Cohort Study (MoBa). Eur. J. Epidemiol. 29(10), 753–765 (2014). https://doi.org/10.1007/s10654-014-9948-6 CrossRefPubMedPubMedCentral

32.

C. Qiu, K.B. Coughlin, I.O. Frederick et al. Dietary fiber intake in early pregnancy and risk of subsequent preeclampsia. Am. J. Hypertens 21(8), 903–909 (2008). https://doi.org/10.1038/ajh.2008.209 CrossRefPubMed

33.

R.A. Pretorius, D.J. Palmer (2020) High-fiber diet during pregnancy characterized by more fruit and vegetable consumption. Nutrients 13(1), 35. https://doi.org/10.3390/nu13010035

34.

S. Fealy, J. Hollis, J. Martin et al. (2022) Modeling the predictive value of evidence-based referral criteria to support healthy gestational weight gain among an Australian pregnancy cohort. Nutrients 14(2), 381. https://doi.org/10.3390/nu14020381

Title: The role of dietary fiber on preventing gestational diabetes mellitus in an at-risk group of high triglyceride-glucose index women: a randomized controlled trial
Authors: Yannan Cao
Jing Sheng
Dongyao Zhang
Li Chen
Ying Jiang
Decui Cheng
Yao Su
Yuexin Yu
Haoyi Jia
Pengyuan He
Li Wang
Xianming Xu
Publication date: 22-09-2023
Publisher: Springer US
Keywords: Gestational Diabetes
Gestational Diabetes
Pre-Eclampsia
Premature Birth
Published in: Endocrine / Issue 3/2023
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-023-03478-5

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Abstract

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