Mediterranean-style diet has ‘strong potential’ to reduce gestational diabetes risk
medwireNews: Findings from the ESTEEM trial suggest that consuming a Mediterranean-style diet may reduce gestational weight gain and lower the risk for gestational diabetes among pregnant women with metabolic risk factors.
However, the dietary intervention did not reduce the risk for the primary composite maternal outcome of gestational diabetes and preeclampsia, nor the primary composite infant outcome of stillbirth, small for gestational age fetus, and admission to the neonatal care unit, report Shakila Thangaratinam (Queen Mary University London, UK) and colleagues in PLOS Medicine.
The trial included 1138 multi-ethnic (60% Black or Asian) inner-city pregnant women with less than 18 weeks of gestation and at least one metabolic risk factor (BMI ≥30 kg/m2, serum triglycerides ≥1.7 mmol/L, systolic blood pressure ≥140 mmHg, or diastolic blood pressure ≥90 mmHg) who were randomly assigned to undertake a Mediterranean-style diet or receive usual care.
Women in the intervention arm were advised to consume high amounts of nuts, extra-virgin olive oil, fruits and vegetables, legumes, and nonrefined grains, along with moderate-to-high amounts of fish, low-to-moderate amounts of poultry and dairy products, and low amounts of red and processed meat. Participants were provided with mixed nuts and olive oil, and were advised to avoid sugar-sweetened drinks, fast food, and products rich in animal fat.
Over the intervention period, lasting from the time of enrolment until the final dietary assessment at 36 weeks of gestation, the 553 women assigned to follow the Mediterranean-style diet were significantly more likely than the 585 receiving usual care to consume at least three servings of nuts per week (70.1 vs 22.9%), use olive oil as their main source of fat (93.2 vs 49.0%), eat at least three portions of fish per week (36.6 vs 22.6%), and consume no more than one serving of red or processed meat (85.5 vs 56.1%) and butter, margarine, or cream (61.2 vs 39.5%) per day
Therefore, “[i]t is feasible to deliver a Mediterranean-style diet to inner-city pregnant women and increase their uptake of relevant dietary components,” say the ESTEEM (Effect of Simple, Targeted Diet in Pregnant Women With Metabolic Risk Factors on Pregnancy Outcomes) investigators.
Thangaratinam et al found numerically lower, but not significantly different, rates of the composite maternal and infant outcomes in the intervention versus control groups, at 22.8% versus 28.6% and 17.3% versus 20.9%, respectively.
Nonetheless, when the component parts of the maternal outcome were analyzed separately, women in the intervention group had significantly lower rates of gestational diabetes than those in the control group (17.6 vs 24.9%). Participants given the dietary intervention also experienced significantly less average weight gain during pregnancy (6.8 vs 8.3 kg).
And when these results were combined with previous study results in a meta-analysis, consuming a Mediterranean-style diet was associated with a 33% reduction in the risk for gestational diabetes.
These findings indicate that a Mediterranean-style diet “can lower gestational weight gain and has strong potential to minimise risk of gestational diabetes,” say Thangaratinam et al.
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