Diabetes Center Hippokration Hospital B. Karamanos 2011 Gestational Diabetes in the Mediterranean...

B. Karamanos 2011

Diabetes CenterHippokration Hospital

Gestational Diabetes in the Mediterranean RegionRisk factors, pregnancy outcome, nutritional

contributors

Nutritional aspects

B. Karamanos MD, PhDAthens, Greece

11 April 2011Morocco

B. Karamanos 2011


European Journal of Clinical Nutrition (2002) 56, 983–991

Diabetologia (2004) 47:367–376

European Journal of Clinical Nutrition (2006) 60, 1376–1383

Diabetes Care 26:302–307, 2003

B. Karamanos 2011


Comparison of subjects with newly diagnosed diabetes or IFG, by fasting

glucose, with matched controls

DM p Control IFG p Control

Fat % 34,7 0,035 30,4 30,6 NS 32,1

Diabetes Care 26:302–307, 2003

B. Karamanos 2011


Aim of the study

To explore if GDM incidence is

associated with dietary factors

B. Karamanos 2011


Subjects and Methods

• 1254 pregnant women, in 11 Mediterranean

countries participated to the main study

• 947 pregnant women, in 9 Mediterranean

countries participated to the nutrition part

of the study

• 834 pregnant women had valid dietary

questionnaires and were included in the

present analysis

B. Karamanos 2011


B. Karamanos 2011


MGSD Nutrition Study

90 ties

MGSD

GDM Study 2010

BMI 25,3 24,8

Kcal/d 2279 2224

CHO % 47,4 49,5

Protein % 16,3 16,4

Fat % 35,2 34,0

Plan/Anim Fat 1,53 1,63

B. Karamanos 2011


Evaluation of the OGTT

• Fasting PG > 5,3 mm/L

• 1 Hour PG > 10,0 mm/L

• 2 Hour PG > 8,6 mm/L

• Two abnormal values needed for the diagnosis of GDM

GDM Incidence

9,7%

B. Karamanos 2011


GDM + GDM -

AGE 32,1 *** 30,0

BMI 26,6 *** 24,5

Kcal/d 2093 2238

CHO g/d 262,0 281,8

PROTEIN g/d 84,6 ** 92,8

FAT g/d 82,0 86,6

B. Karamanos 2011


GDM + GDM -

FIBRE g/d 22,2 23,2

ANIMAL FAT g/d 26,6 24,5

ANIMAL PROT g/d 33,7 36,5

SAFA g/d 33,0 36,0

PUFA g/d 9,3 ** 10,5

RATIO VEG/ANIM 1,7 1,6

Olive oil g/d 21,1 *** 15,2

B. Karamanos 2011


GDM + GDM -

CHO % 48,7 49,6

FAT % 35,0 33,9

PROTEIN % 16,2 16,5

ANIMAL FAT % 14,3 14,4

PLANT FAT % 20,0 18,7

SAFA % 13,7 13,8

B. Karamanos 2011


GDM + GDM -

FOLATE 239 244

NIACIN 34,9 * 37,9

RIBOFLAVIN 1,73 1,84

THIAMINE 1,24 1,29

VITAMINE A 603 * 693

VITAMINE C 92,4 87,4

B. Karamanos 2011


GDM + GDM -

AGE 32,1 *** 30,0

BMI 26,6 *** 24,5

Kcal/d 2092 2227

CHO g/d 258 * 280

PROTEIN g/d 84,4 * 92,5

FAT g/d 83,9 85,5

After adjustment for Age and BMI

B. Karamanos 2011


GDM + GDM -

FIBRE 21,7 23,2

ANIMAL FAT 34,5 36,6

ANIMAL PROT 55,2 59,1

SAFA 34,3 35,0

PUFA 9,5 10,5

RATIO VEG/ANIM 1,7 1,6

Olive oil 21,9 *** 15,4


B. Karamanos 2011


GDM + GDM -

CHO % 48,0 49,4

FAT % 35,9 * 34,0

PROTEIN % 16,2 16,5

ANIMAL FAT % 14,6 14,5

PLANT FAT % 20,5 18,7

SAFA % 14,2 13,8


B. Karamanos 2011


GDM + GDM -

FOLATE 235 244

NIACIN 34,6 37,6

RIBOFLAVIN 1,7 1,8

THIAMINE 1,22 1,28

VITAMINE A 602 691

VITAMINE C 94,9 88,0


B. KARAMANOS 2011

Diabetes CentreHippokration HospitalAthens, Greece

B. KARAMANOS 2011


MediterraneanDiet Score

Plant /Animal Fat ratio Vegetables

Alcohol Consumption Meat

Legumes Dairy products

Cereals Fruits

Fish

Score 0-9 Good > 5BMJ 311:1457-60, 1995

B. KARAMANOS 2011


Mediterranean Adequacy Index

• Ratio of the Sum of the percentage contribution to the daily energy intake of the:

• “good” MD food groups (bread,cereals, legumes, potatoes, vegetables, fruits, fish, plant oil, red wine)

• “bad” MD food groups (meat, milk, cheese, eggs, animal fats and margarines, sweet beverages, cakes/pies/cookies, sugar)

Fidanza et al Eur J Clinic Nutr 53:854, 1990Diab Nutr Metab 14:119, 2001

B. KARAMANOS 2011


4 years survival of elderly non-diabetics Predictors

Age 12% decrease per 1 year

Sex not significant

Smoking not significant

Mediterranean

Diet Score

17% increased survival

per unit increase

BMJ 311:1457, 1995

B. Karamanos 2011


GDM + GDM -

CHO g/d 258 * 280

Protein g/d 84,4 * 92,5

Fat % 35,9 * 34,0

Olive oil g/d 21,9 *** 15,4

Medi Diet Index

5,53 * 5,98

Significant differences after adjustment for Age and BMI

B. Karamanos 2011


In a model of Logistic Regression, where all variables related to GDM

incidence were included:

• Age p=0,014• BMI p=0,001• Olive oil consumption p=0,001• Medi Diet Index p=0,002 (neg)

Were related with the incidence

of GDM

B. Karamanos 2011


Incidence of GDMaccording to Mediterranean Diet Index

Med Diet

Goodp

Med Diet

Bad

GDM

Incidence7,9 % 0,03 12,6 %

Relative Risk

0,60 (CI 0,38 – 0,95)

B. Karamanos 2011


Conclusions

The incidence of Gestational diabetes is related with:

• The contribution of Fat to the energy

intake

– even if it is Monounsaturated (olive oil)

• The Mediterranean Diet Index

– the higher the better

Diabetes Center Hippokration Hospital B. Karamanos 2011 Gestational Diabetes in the Mediterranean...

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