Dietary pattern, gestational weight gain and risk of gestational - PowerPoint PPT Presentation

Dietary pattern, gestational weight gain and risk of gestational diabetes mellitus Zalilah Mohd Shariff Department of Nutrition and Dietetics Faculty of Medicine and Health Sciences Universiti Putra Malaysia, Serdang 1

Presentation Outline • Gestational weight gain (GWG) • Gestational diabetes mellitus (GDM) • Dietary patterns (DP) in pregnancy – Gestational weight gain – Gestational diabetes mellitus 2

GLOBAL NUTRITION TARGETS 2025 WHO STUNTING CHILDHOOD OVERWEIGHT • TARGET: 40% reduction in the number of • TARGET: No increase in childhood children under-5 who are stunted overweight ANAEMIA BREASTFEEDING • TARGET: 50% reduction of anaemia in • TARGET: Increase the rate of women of reproductive age exclusive breastfeeding in the first 6 months up to at least 50% LOW BIRTH WEIGHT WASTING • TARGET: 30% reduction in low birth • TARGET: Reduce and maintain weight childhood wasting to less than 5%

Role of gestational programming in population shifts towards obesity and metabolic syndrome (Desai et al., 2015) 4

The stunting syndrome (Prendergast & Humphrey, 2014) 5

National Plan of Action for Nutrition of Malaysia (NPANM) 2016 - 2025 1. Promoting maternal, infant and young child nutrition Infants and Pregnant Neonates Young Women Children 2. Promoting healthy eating and active living 3. Preventing and controlling nutritional deficiencies 4. Preventing and controlling obesity and % with anemia other diet-related NCDs 5. Sustaining food systems to promote % with recommended GWG healthy diets 6. Supporting efforts to promote food safety and quality % with GDM 6

More women are entering pregnancy with higher body weights ……… Overweight and Obesity 80 67.2 70 60.8 58.4 60 55.7 53.4 Prevalence (%) 50 40.3 38.6 40 28.8 30 20.2 17.7 20 10 0 18-19 20-29 30-39 40-49 50-59 Age (years) MANS 2003 MANS 2014

Gestational Weight Gain Recommendation (IOM, 2009) Pre-pregnancy Total weight gain, Mean (range) rate of weight gain** in 2 nd and 3 rd trimester, BMI kg kg / week  Development of placenta, 12.5 – 18 Underweight 0.51 (0.44-0.58) uterus and breasts (<18.5)  Increase in blood supply 11.5 – 16 Normal weight 0.42 (0.35-0.50) (18.5 – 24.9) and fluid volume  A healthy ~ 3 kg infant 7 – 11.5 Overweight 0.28 (0.23-0.33) (25.0 – 29.9) 5 – 9 Obese (> 30.0) 0.22 (0.17-0.27) **0.5 – 2.2 kg weight gain in 1 st trimester

 High income setting – 20-50% of pregnant women gain more than the recommended GWG 70 Mean= 17.39 ± 7.22kg Mean= 13.08 ± 6.08kg 57.5 60 53.7 50 41 40 37.2 36.2 34.5 34.5 34.3 % 31 28.5 30 26.1 25 22.8 20.1 17.5 20 10 0 Brazil (N=1052) (Godoy China (N=6341) (Yang et Thailand (N=378) India (N=1279) Indonesia (N=29) et al., 2014)* Obese al. 2015) (Pongcharoen et al., (Bhavadharini et al., (Soltani et al., 2017) women 2016) 2017) *Obese women *Obese women Inadequate Adequate Excesssive 9

Malaysia ….. 60 54.5 Mean= 10.96 ± 0.28kg Mean =10.10 ± 4.45kg 50 45.1 43.8 42.9 38 40 36 35.2 32.5 29.4 % 27.8 30 21 18.9 20 13 10 0 Kuala Lumpur (N= 436) Kelantan (N= 422) (Noor MOH (2016) (clinic data) Selangor & Negeri SECOST (N= 1951) (Rozlan et al., 2012) Farhana et al., 2015) Sembilan (N=589) (Yong (unpublished) et al. 2016) Inadequate Adequate Excesssive 10

 Women tend to retain some weight (2-5 kg) with each successive pregnancy  Excess GWG --- higher postpartum weight retention --- increased risk of OW /OB & metabolic risk profile in long run (Gilmore et al., 2015) 11

10 Mean GWG : 15.9 kg 9.15 9 Mean PPWR : 5.1 kg 7.63 8 % with excessive GWG : 43.2% Mean weight (kg) 7 % with PPWR > 5kg : 53.3% 5.42 6  Excessive – 70.2% 5.0 5  Adequate – 49.1% 3.92 4  Inadequate – 29.3% 2.86 3 1.96 2.93 2 1.31 1 0 1-2 mth 3-5 mth 6-11 mth Postpartum (month) Inadequate Adequate Excessive (Ma et al., 2014)

Hyperglycemia in pregnancy (20 – 49 years) by IDF region, 2017 30 Estimated 21.3 million of live births to women had some form of 26.6 25 hyperglycemia in pregnancy 20 Percentage (%) • 86.4% GDM 17.9 • 7.4% other types of 15 diabetes (type 1 or 13.7 type 2) first detected 12.3 12 11.6 10 in pregnancy 9.5 • 6.2% due to diabetes 5 detected before pregnancy 0 Africa Europe Middle East North South & South East Western & North America & Central Asia Pacific Africa Carribean Africa 13

GDM in various settings …… 20 20 19.7 18 18 18.9 16 16 14 14 Percentage (%) Percentage (%) 13.2 12 12 12.4 10 10 10.2 10.1 9.4 8 8 6 6 6.2 5.5 4 4 2 2 2.7 0 0 China Taiwan Thailand Vietnam Korea Singapore Japan Ireland UK (N=1375) Germany (N=2987) Zhu (n=3641) (N=25255) (N=2772) (N=5212) (N=1136) (N=5424) (N=6105) (Ali et al., (N=567191) et al., 2017 (Hung et al. (Srichumchit (Tran et al., (Heo et al. (Chong et al. (Shimodaira (Altantic DIP 2014) (Melchior et 2015) et al. 2015) 2013) 2015) 2014) et al. 2016) study) al., 2017) 14

GDM in Malaysia …. 30 27.9 25 20 Percentage (%) 15 13.5 13.1 10 10.6 7.9 7.6 5 0 NOR* (2011) NOR* (2012) NHMS* (2016) Logakodie et al (2017) SECOST SECOST (prospective) (retrospective) 15

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Gestational weight gain and risk of GDM - SECOST AOR=1.08 [95% CI 0.57 – 2.06], p= 0.82] Excessive vs Non-excessive AOR=2.94 [95% CI 1.26 – 6.87], p< 0.05 Inadequate vs Adequate AOR=2.13 [95% CI 0.87 – 5.18], p= 0.10] Excessive vs Adequate 0 1 2 3 4 5 6 7 8 Odd ratio Note. The reference category is non GDM. Adjusted for clinic and gestational week at OGTT, maternal age, pre-pregnancy BMI and parity 17

 Energy & Nutrients GWG  Non-nutrients  Foods / food groups  Diet quality index  Glycemic index / load  Dietary patterns Diet GDM 18

Dietary pattern in pregnancy (non-Asian countries) 1. Meats, snacks and sweets red and processed meat, cakes, sweet biscuits, fruit juice, chocolate and pizza 2. Mediterranean vegetables, legumes, nuts, tofu, rice, pasta, rye bread, red wine and fish Schoenaker et al. (2015) - Australia 3. Fruit and low-fat dairy fruits and low-fat dairy including yoghurt, low-fat cheese and skimmed milk 4. Cooked vegetables carrots, peas, cooked potatoes, cauliflower and pumpkin 1. High refined grains, fats, oils and fruit juice Shin et al. (2015) - US 2. High nuts, seeds, fat and soybean; low milk and cheese 3. High added sugar and organ meats; low fruits, vegetables and seafood 1. Western meat-based products and processed foods Donazar-Ezcurra et al. (2017) -Spain 2. Mediterranean vegetables, fruits, fish and non-processed foods non-white bread, bran- and oat-based breakfast cereals, crispbreads/crackers, poultry, fish, eggs, 1. Fruit and vegetables cheese, meat substitutes, pulses, nuts, potatoes (not fried), pasta, rice, vegetables, fruit, fruit juice, herbal tea, low-fat milk and alcohol Freitas-Vilela et al. (2017) - UK fried potatoes, roast potatoes, potatoes (not fried), poultry, red meat, meat pies and sausages/burgers, 2. Meat and potatoes in addition to white bread, other breakfast cereal, biscuits, puddings, cakes/buns, fried foods, pizza, eggs, baked beans, peas, cola, tea, sweets, chocolates, snacks and full-fat milk 3. White bread and coffee white bread, coffee, cola and full-fat milk beans, rice, processed meat, fats, refined grains, rice, pasta & pastries, soft drinks, sugar and sweets, 1. Brazilian pattern Carvalho et al. cookies & crackers (2017) - Brazil 2. Energy rich pattern salty deep-fried snacks, popcorn, packaged snacks, instant noodles, tubers and chicken 3. Healthy fruits and fruit juices, vegetables, whole grains, seafood, dairy products)

Dietary pattern in pregnancy (Asian countries) 1. Healthy fish & other seafood, fruit, dairy products, vegetables, nuts & legumes Loy & Jan Mohamed (2013) - Malaysia 2. Less Healthy confectioneries, condiments, oils and fats, tea and coffee, cereals, meat and offal 1. Carbohydrate and f ruits, rice & cereals, salted vegetables, noodles, meat vegetable Shin et al (2015) - Korea p oultry & eggs, processed meat & seafood, snack & dessert, fast food, deep fried food, coffee 2. Western & beverages, seaweeds vegetables, fruit, white rice, bread, low-fat meat and fish, and low in fried potatoes, burgers, 1. Vegetable-fruit-rice carbonated and sugar-sweetened beverages Deseymour et al. soup, fish and seafood products, noodles, low-fat meat, seafood, and low in ethnic bread, (2016) - Singapore 2. Seafood-noodle legumes and pulses, white rice, and curry-based gravies 3. Pasta, cheese and processed pasta, cheese, processed meats, tomato-based and cream-based gravies meat 1. Western dairy, baked/fried food and white meat 2. Traditional light-colored vegetables, fine grain, red meat and tubers Du et al. (2016) - China 3. Mixed edible fungi, shrimp/shellfish and red meat 4. Prudent dark-colored vegetables and deep-sea fish sweets, jams, mayonnaise, soft drinks, salty snacks, solid fat, high-fat dairy products, 1. Western potatoes, organ meat, eggs, red meat, processed foods, tea, and coffee Sedaghat et al. (2017) - Iran liquid oils, legumes, nuts and seeds, fruits and dried fruits, fish and poultry whole, and 2. Prudent refined grains