Nutritional Correlates of Women with a History of Gestational Diabetes and Insulin Resistance in the National Health and Nutrition Examination Survey (NHANES) 2000-2010

Abstract

Objective: To evaluate the associations of gestational diabetes (GDM) history with dietary intake,nutritional status, insulin resistance, demographic, and anthropometrical data. Materials & Methods:This cross-sectional study used data from the National Health and Nutrition ExaminationSurvey for the years 2000-2010. Data analysis was based on 290 women who reported a history ofGDM compared to 4239 women who denied a GDM history. Insulin resistance [HOMA_IR = (fastinginsulin in mU/mL × fasting glucose in mmol/L)/405] was calculated. Pearson correlation, Wilcoxonrank sum tests, Student’s t-tests, and chi-square analysis were used while linear regression assessedindependent associations. Results: The median time-lapse from the diagnosis of GDM was15 years. Women with a GDM history had significantly higher body mass index (BMI), other anthropometricmeasurements, diastolic blood pressures and insulin resistance. They were also morelikely to be Hispanic, have delivered macrosomic infants, and delivered via cesarean. PreviousGDM history compared to non-GDM subjects had significantly higher dietary intakes of energycalories, protein, total fat, saturated fatty acids, mono-saturated fatty acids, and cholesterol.Within the entire cohort, increasing insulin resistance was also associated with lower income, lesscollege education, Hispanic or African American ethnicity, obesity, higher systolic and diastolicblood pressures, and with higher dietary cholesterol but lower intake of dietary fiber and micronutrients. Regression analyses showed that GDM history, Hispanic ethnicity, BMI, dietary intake ofcholesterol and decreasing income were independently predictive of insulin resistance. Conclusion:The data confirm that even many years after a pregnancy associated with GDM, women witha history of GDM still report significantly higher dietary intakes of energy calories, protein, and fatwith no corresponding increase in consumption of dietary fiber or minerals and vitamins. Consequently,the increased calorie and food consumption of women with previous GDM are associatedwith obesity, insulin resistance and higher blood pressures. These observations may suggest theneed to target high-risk groups who may need more resources and awareness of the benefits ofquality nutrition.