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Cited by 47Gestational Diabetes Research and ManagementNutritional Studies and DietDiet, Metabolism, and Disease

Higher Maternal Dietary Protein Intake Is Associated with a Higher Risk of Gestational Diabetes Mellitus in a Multiethnic Asian Cohort

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Pang, Wei Wei, Colega, Marjorelee, Cai, Shirong, Chan, Yiong Huak, Padmapriya, Natarajan, Chen, Ling-Wei, Soh, Shu-E, Han, Wee Meng +8 more·2017·The Journal of Nutrition
DOI 10.3945/jn.116.243881PMC PMC5382972
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Abstract

Background: Dietary protein may affect glucose metabolism through several mechanisms, but results from studies on dietary protein intake and risk of gestational diabetes mellitus (GDM) have been inconsistent.Objective: We examined the cross-sectional associations of dietary protein intake from different food sources during pregnancy with the risk of GDM in a multiethnic Asian population.Methods: We included 980 participants with singleton pregnancies from the Growing Up in Singapore Toward healthy Outcomes (GUSTO) cohort. Protein intake was ascertained from 24-h dietary recall and 3-d food diaries at 26-28 wk gestation. GDM was defined as fasting glucose ≥7.0 mmol/L and/or 2-h postload glucose ≥7.8 mmol/L at 26-28 wk gestation. We evaluated the association of dietary protein intake with GDM risk by substituting carbohydrate with protein in an isocaloric model with the use of multivariable logistic regression analysis.Results: The prevalence of GDM was 17.9% among our participants. After adjustment for potential confounders, a higher total dietary protein intake was associated with a higher risk of GDM; the OR comparing the highest with the lowest quartile of intake was 2.15 (95% CI: 1.27, 3.62; P-trend = 0.016). Higher intake levels of both animal protein (OR: 2.87; 95% CI: 1.58, 5.20; P-trend = 0.001) and vegetable protein (OR: 1.78; 95% CI: 0.99, 3.20; P-trend = 0.009) were associated with a higher risk of GDM. Among the animal protein sources, higher intake levels of seafood protein (OR: 2.17; 95% CI: 1.26, 3.72; P-trend = 0.023) and dairy protein (OR: 1.87; 95% CI: 1.11, 3.15; P-trend = 0.017) were significantly associated with a higher GDM risk.Conclusion: Higher intake levels of both animal and vegetable protein were associated with a higher risk of GDM in Asian women. This trial was registered at clinicaltrials.gov as NCT01174875.

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  • High protein diets are associated with GDM independently of meat consumption.

    “Interestingly, even independently of meat consumption, high protein diets are associated with GDM [46,47,48].”

    From The Pathophysiology of Gestational Diabetes Mellitus (2018) · cites this paper as [48]

    The Results section reports a higher GDM risk with higher total and vegetable protein intake, and the Discussion concludes that protein intake itself may be associated with GDM risk rather than only components of high-protein foods. However, the paper does not report an analysis showing that the total-protein association persists after adjustment for meat consumption, so that specific meaning of “independently” is not established. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Specific animal protein sources, such as seafood and dairy proteins, are associated with a higher risk of GDM, with odds ratios of 2.17 (95% CI 1.26-3.72) for seafood and 1.87 (95% CI 1.11-3.15) for dairy proteins.

    “Notably, specific animal protein sources, such as seafood and dairy proteins, were also linked with a higher risk of GDM, with odds ratios of 2.17 (95% CI 1.26–3.72) and 1.87 (95% CI 1.11–3.15) [96].”

    From Medical Nutrition Therapy for Women with Gestational Diabetes: Current Practice and Future Perspectives (2025) · cites this paper as [96]

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Research works printed but not linked: 37

  1. [2]Catalano PM Kirwan JP Haugel-de Mouzon S King J Gestational diabetes and insulin resistance: role in short- and long-term implications for mother and fetus J Nutr 2003 133 1674S 83S 12730484
  2. [3]Bellamy L Casas JP Hingorani AD Williams D Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis Lancet 2009 373 1773 9 19465232
  3. [4]Saldana TM Siega-Riz AM Adair LS Effect of macronutrient intake on the development of glucose intolerance during pregnancy Am J Clin Nutr 2004 79 479 86 14985225
  4. [6]Ley SH Hanley AJ Retnakaran R Sermer M Zinman B O'Connor DL Effect of macronutrient intake during the second trimester on glucose metabolism later in pregnancy Am J Clin Nutr 2011 94 1232 40 21955650
  5. [8]Promintzer M Krebs M Effects of dietary protein on glucose homeostasis Curr Opin Clin Nutr Metab Care 2006 9 463 8 16778578
  6. [9]Krebs M Amino acid-dependent modulation of glucose metabolism in humans Eur J Clin Invest 2005 35 351 4 15948894
  7. [10]Tremblay F Lavigne C Jacques H Marette A Role of dietary proteins and amino acids in the pathogenesis of insulin resistance Annu Rev Nutr 2007 27 293 310 17666010
  8. [11]van Nielen M Feskens EJ Mensink M Sluijs I Molina E Amiano P Ardanaz E Balkau B Beulens JW Boeing H Dietary protein intake and incidence of type 2 diabetes in Europe: the EPIC-InterAct Case-Cohort Study Diabetes Care 2014 37 1854 62 24722499
  9. [12]Ericson U Sonestedt E Gullberg B Hellstrand S Hindy G Wirfalt E Orho-Melander M High intakes of protein and processed meat associate with increased incidence of type 2 diabetes Br J Nutr 2013 109 1143 53 22850191
  10. [13]Halton TL Liu S Manson JE Hu FB Low-carbohydrate-diet score and risk of type 2 diabetes in women Am J Clin Nutr 2008 87 339 46 18258623 PMC2760285
  11. [17]Ley SH Hamdy O Mohan V Hu FB Prevention and management of type 2 diabetes: dietary components and nutritional strategies Lancet 2014 383 1999 2007 24910231 PMC4751088
  12. [18]He JR Yuan MY Chen NN Lu JH Hu CY Mai WB Zhang RF Pan YH Qiu L Wu YF Maternal dietary patterns and gestational diabetes mellitus: a large prospective cohort study in China Br J Nutr 2015 113 1292 300 25821944
  13. [19]Karamanos B Thanopoulou A Anastasiou E Assaad-Khalil S Albache N Bachaoui M Slama CB El Ghomari H Jotic A Lalic N Relation of the Mediterranean diet with the incidence of gestational diabetes Eur J Clin Nutr 2014 68 8 13 24084515
  14. [20]Radesky JS Oken E Rifas-Shiman SL Kleinman KP Rich-Edwards JW Gillman MW Diet during early pregnancy and development of gestational diabetes Paediatr Perinat Epidemiol 2008 22 47 59 18173784 PMC2650816
  15. [21]Chong YS Cai S Lin H Soh SE Lee YS Leow MK Chan YH Chen L Holbrook JD Tan KH Ethnic differences translate to inadequacy of high-risk screening for gestational diabetes mellitus in an Asian population: a cohort study BMC Pregnancy Childbirth 2014 14 345 25273851 PMC4190487
  16. [22]Sacks DA Hadden DR Maresh M Deerochanawong C Dyer AR Metzger BE Lowe LP Coustan DR Hod M Oats JJ Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Diabetes Care 2012 35 526 8 22355019 PMC3322716
  17. [23]Soh SE Tint MT Gluckman PD Godfrey KM Rifkin-Graboi A Chan YH Stunkel W Holbrook JD Kwek K Chong YS Cohort profile: Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study International journal of epidemiology 2014 43 1401 9 23912809
  18. [24]Chong MF Chia AR Colega M Tint MT Aris IM Chong YS Gluckman P Godfrey KM Kwek K Saw SM Maternal Protein Intake during Pregnancy Is Not Associated with Offspring Birth Weight in a Multiethnic Asian Population J Nutr 2015 145 1303 10 25948786
  19. [25]Conway JM Ingwersen LA Vinyard BT Moshfegh AJ Effectiveness of the US Department of Agriculture 5-step multiple-pass method in assessing food intake in obese and nonobese women Am J Clin Nutr 2003 77 1171 8 12716668
  20. [27]Cross AJ Harnly JM Ferrucci LM Risch A Mayne ST Sinha R Developing a heme iron database for meats according to meat type, cooking method and doneness level Food Nutr Sci 2012 3 905 13 23459329 PMC3583546
  21. [28]Pourkhalili A Mirlohi M Rahimi E Heme iron content in lamb meat is differentially altered upon boiling, grilling, or frying as assessed by four distinct analytical methods Scientific World Journal 2013 2013 1 5 Article ID 374030 PMC3662193 23737716
  22. [29]Padmapriya N Shen L Soh SE Shen Z Kwek K Godfrey KM Gluckman PD Chong YS Saw SM Muller-Riemenschneider F Physical Activity and Sedentary Behavior Patterns Before and During Pregnancy in a Multi-ethnic Sample of Asian Women in Singapore Matern Child Health J 2015 19 2523 35 26140834
  23. [30]Hutcheon JA Platt RW Abrams B Himes KP Simhan HN Bodnar LM A weight-gain-for-gestational-age z score chart for the assessment of maternal weight gain in pregnancy Am J Clin Nutr 2013 97 1062 7 23466397 PMC3625243
  24. [31]Wong L Tan AS The glucose challenge test for screening gestational diabetes in pregnant women with no risk factors Singapore Med J 2001 42 517 21 11876377
  25. [32]Alberti KG Zimmet PZ Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation Diabet Med 1998 15 539 53 9686693
  26. [33]Willett WC Howe GR Kushi LH Adjustment for total energy intake in epidemiologic studies Am J Clin Nutr 1997 65 1220S 8S discussion 9S-31S 9094926
  27. [37]Chia AR de Seymour JV Colega M Chen LW Chan YH Aris IM Tint MT Quah PL Godfrey KM Yap F A vegetable, fruit, and white rice dietary pattern during pregnancy is associated with a lower risk of preterm birth and larger birth size in a multiethnic Asian cohort: the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort study Am J Clin Nutr 2016 104 1416 23 27733407
  28. [38]de Seymour J Chia A Colega M Jones B McKenzie E Shirong C Godfrey K Kwek K Saw SM Conlon C Maternal Dietary Patterns and Gestational Diabetes Mellitus in a Multi-Ethnic Asian Cohort: The GUSTO Study Nutrients 2016 8 PMC5037559 27657116
  29. [39]Daniel CR Cross AJ Koebnick C Sinha R Trends in meat consumption in the USA Public Health Nutr 2011 14 575 83 21070685 PMC3045642
  30. [40]Villegas R Xiang YB Elasy T Li HL Yang G Cai H Ye F Gao YT Shyr Y Zheng W Fish, shellfish, and long-chain n-3 fatty acid consumption and risk of incident type 2 diabetes in middle-aged Chinese men and women Am J Clin Nutr 2011 94 543 51 21677058 PMC3142729
  31. [41]Kaushik M Mozaffarian D Spiegelman D Manson JE Willett WC Hu FB Long-chain omega-3 fatty acids, fish intake, and the risk of type 2 diabetes mellitus Am J Clin Nutr 2009 90 613 20 19625683 PMC2728645
  32. [42]Patel PS Forouhi NG Kuijsten A Schulze MB van Woudenbergh GJ Ardanaz E Amiano P Arriola L Balkau B Barricarte A The prospective association between total and type of fish intake and type 2 diabetes in 8 European countries: EPIC-InterAct Study Am J Clin Nutr 2012 95 1445 53 22572642 PMC3623039
  33. [43]Zhang M Picard-Deland E Marette A Fish and marine omega-3 polyunsatured Fatty Acid consumption and incidence of type 2 diabetes: a systematic review and meta-analysis Int J Endocrinol 2013 2013 Article ID 501015:1-11 PMC3781842 24089611
  34. [44]Wallin A Di Giuseppe D Orsini N Patel PS Forouhi NG Wolk A Fish consumption, dietary long-chain n-3 fatty acids, and risk of type 2 diabetes: systematic review and meta-analysis of prospective studies Diabetes Care 2012 35 918 29 22442397 PMC3308304
  35. [45]Zhou Y Tian C Jia C Association of fish and n-3 fatty acid intake with the risk of type 2 diabetes: a meta-analysis of prospective studies Br J Nutr 2012 108 408 17 22857650
  36. [47]Turner KM Keogh JB Clifton PM Red meat, dairy, and insulin sensitivity: a randomized crossover intervention study Am J Clin Nutr 2015 25809854
  37. [50]Gijsbers L Ding EL Malik VS de Goede J Geleijnse JM Soedamah-Muthu SS Consumption of dairy foods and diabetes incidence: a dose-response meta-analysis of observational studies Am J Clin Nutr 2016 103 1111 24 26912494

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Authors
Pang, W. W., Colega, M., Cai, S., Chan, Y. H., Padmapriya, N., Chen, L.-W., Soh, S.-E., Han, W. M., Tan, K. H., Lee, Y. S., Saw, S.-M., Gluckman, P. D., Godfrey, K. M., Chong, Y.-S., van Dam, R. M., & Chong, M. F.
Affiliations
  • National University of Singapore (SG)
  • Agency for Science, Technology and Research (SG)
  • KK Women's and Children's Hospital (SG)
  • National Health Service (GB)
ORCID
Venue
The Journal of Nutrition
Publisher
Elsevier BV
Published
2017-04
Volume
147
Issue
4
Pages
653-660
ISSN
0022-3166 (ISSN-L)
DOI
10.3945/jn.116.243881
PMC
PMC5382972
OpenAlex
W2592471527
Cited by
47
References
13
Citations by year
2026: 6 · 2025: 1 · 2024: 10 · 2023: 8 · 2022: 2 · 2021: 6 · 2020: 1 · 2019: 6 · 2018: 7
FWCI
4.38
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Nutrition (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • ePrints Soton (University of Southampton) (acceptedVersion)
  • National University of Singapore (submittedVersion)
Funders
  • National Institute for Health and Care Research (NF-SI-0515-10042)
  • British Heart Foundation (RG/15/17/31749)
  • National Research Foundation (NMRC/TCR/012-NUHS/2014, NMRC/TCR/004-NUS/2008)
  • Singapore Institute for Clinical Sciences (NMRC/TCR/004-NUS/2008, NMRC/TCR/012-NUHS/2014)
  • National Research Foundation Singapore (NMRC/TCR/004‐NUS/2008, NMRC/TCR/012-NUHS/2014)
  • National University Health System
  • Nestec
  • Medical Research Council (NMRC/TCR/004-NUS/2008, MC_UU_12011/4, NMRC/TCR/012-NUHS/2014)
  • National Medical Research Council (TCR/004, NMRC/TCR/004- NUS /2008, NMRC/TCR/004, NMRC/TCR/012-NUHS/2014)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
Keywords
gestational diabetes mellitus, protein intake, animal protein, plant proteins, seafood proteins, milk protein, pregnancy, glucose metabolism, Asian women, GUSTO cohort, multi-ethnic population, maternal nutrition
MeSH terms
Adolescent, Adult, Dietary Proteins, Female, Humans, Middle Aged, Pregnancy, Risk Factors, Odds Ratio, Diabetes, Gestational, Asian People, Young Adult

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