Higher Maternal Dietary Protein Intake Is Associated with a Higher Risk of Gestational Diabetes Mellitus in a Multiethnic Asian Cohort
Open accessAbstract
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.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
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 measuredSpecific 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]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Pan, A., Sun, Q., Bernstein, A. M., Schulze, M. B., Manson, J. E., Willett, W. C., & Hu, F. B. (2011) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.111.018978 · Cited by 709 · see citing works
Aune, D., Norat, T., Romundstad, P., & Vatten, L. J. (2013) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.113.059030 · Cited by 434 · see citing works
Dairy consumption and risk of type 2 diabetes: 3 cohorts of US adults and an updated meta-analysis
Chen, M., Sun, Q., Giovannucci, E., Mozaffarian, D., Manson, J. E., Willett, W. C., & Hu, F. B. (2014) · BMC Medicine · doi:10.1186/s12916-014-0215-1 · Cited by 370 · see citing works
A Prospective Study of Red Meat Consumption and Type 2 Diabetes in Middle-Aged and Elderly Women
Song, Y., Manson, J. E., Buring, J. E., & Liu, S. (2004) · Diabetes Care · doi:10.2337/diacare.27.9.2108 · Cited by 368 · see citing works
Dairy consumption and risk of type 2 diabetes mellitus: a meta-analysis of cohort studies
Tong, X., Dong, J.-Y., Wu, Z.-W., Li, W., & Qin, L.-Q. (2011) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2011.62 · Cited by 337 · see citing works
Sluijs, I., Beulens, J. W. J., van der A, D. L., Spijkerman, A. M. W., Grobbee, D. E., & van der Schouw, Y. T. (2010) · Diabetes Care · doi:10.2337/dc09-1321 · Cited by 335 · see citing works
A prospective study of dietary patterns, meat intake and the risk of gestational diabetes mellitus
Zhang, C., Schulze, M. B., Solomon, C. G., & Hu, F. B. (2006) · Diabetologia · doi:10.1007/s00125-006-0422-1 · Cited by 266 · see citing works
Baz, B., Riveline, J.-P., & Gautier, J.-F. (2016) · European Journal of Endocrinology · doi:10.1530/eje-15-0378 · Cited by 260 · see citing works
Effect of long-term dietary protein intake on glucose metabolism in humans
Linn, T., Santosa, B., Grönemeyer, D., Aygen, S., Scholz, N., Busch, M., & Bretzel, R. G. (2000) · Diabetologia · doi:10.1007/s001250051521 · Cited by 241 · see citing works
Schoenaker, D. A. J. M., Mishra, G. D., Callaway, L. K., & Soedamah-Muthu, S. S. (2016) · Diabetes Care · doi:10.2337/dc15-0540 · Cited by 206 · see citing works
Bao, W., Bowers, K., Tobias, D. K., Hu, F. B., & Zhang, C. (2013) · Diabetes Care · doi:10.2337/dc12-2018 · Cited by 159 · see citing works
A prospective study of prepregnancy dietary fat intake and risk of gestational diabetes
Bowers, K., Tobias, D. K., Yeung, E., Hu, F. B., & Zhang, C. (2012) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.111.026294 · Cited by 156 · see citing works
Zong, G., Sun, Q., Yu, D., Zhu, J., Sun, L., Ye, X., Li, H., Jin, Q., Zheng, H., Hu, F. B., et al. (2014) · Diabetes Care · doi:10.2337/dc13-0975 · Cited by 85 · see citing works
Flagged first, then by citations
Research works printed but not linked: 37
- [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
- [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
- [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
- [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
- [8]Promintzer M Krebs M Effects of dietary protein on glucose homeostasis Curr Opin Clin Nutr Metab Care 2006 9 463 8 16778578
- [9]Krebs M Amino acid-dependent modulation of glucose metabolism in humans Eur J Clin Invest 2005 35 351 4 15948894
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [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
- [47]Turner KM Keogh JB Clifton PM Red meat, dairy, and insulin sensitivity: a randomized crossover intervention study Am J Clin Nutr 2015 25809854
- [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
Cited by
Sorted by citations
The Pathophysiology of Gestational Diabetes Mellitus
Plows, J. F., Stanley, J. L., Baker, P. N., Reynolds, C. M., & Vickers, M. H. (2018) · International Journal of Molecular Sciences · doi:10.3390/ijms19113342 · Cited by 1,874 · see citing works
Ethnic disparities in gestational diabetes
Yuen, L., Wong, V. W., & Simmons, D. (2018) · Current Diabetes Reports · doi:10.1007/s11892-018-1040-2 · Cited by 88 · see citing works
Cheong, L., Law, L. S.-C., Tan, L. Y. L., Amal, A. A.-A., Khoo, C. M., & Eng, P. C. (2025) · Nutrients · doi:10.3390/nu17071210 · Cited by 14 · see citing works
- 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)
- 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
- bronze
- doi.org
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review