Diabetes Center Hippokration Hospital B. Karamanos 2011 Gestational Diabetes in the Mediterranean Region Risk factors, pregnancy outcome, nutritional contributors.

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Presentation transcript:

Diabetes Center Hippokration Hospital B. Karamanos 2011 Gestational Diabetes in the Mediterranean Region Risk factors, pregnancy outcome, nutritional contributors Nutritional aspects B. Karamanos MD, PhD Athens, Greece 11 April 2011 Morocco

Diabetes Center Hippokration Hospital 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

Diabetes Center Hippokration Hospital B. Karamanos 2011 Comparison of subjects with newly diagnosed diabetes or IFG, by fasting glucose, with matched controls DMpControlIFGpControl Fat %34,70,03530,430,6NS32,1 Diabetes Care 26:302–307, 2003

Diabetes Center Hippokration Hospital B. Karamanos 2011 Aim of the study To explore if GDM incidence is associated with dietary factors

Diabetes Center Hippokration Hospital 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

Diabetes Center Hippokration Hospital B. Karamanos 2011

Diabetes Center Hippokration Hospital B. Karamanos 2011 MGSD Nutrition Study 90 ties MGSD GDM Study 2010 BMI 25,324,8 Kcal/d CHO % 47,449,5 Protein % 16,316,4 Fat % 35,234,0 Plan/Anim Fat 1,531,63

Diabetes Center Hippokration Hospital 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%

Diabetes Center Hippokration Hospital B. Karamanos 2011 GDM +GDM - AGE 32,1 *** 30,0 BMI 26,6 *** 24,5 Kcal/d CHO g/d 262,0281,8 PROTEIN g/d 84,6 ** 92,8 FAT g/d 82,086,6

Diabetes Center Hippokration Hospital B. Karamanos 2011 GDM +GDM - FIBRE g/d 22,223,2 ANIMAL FAT g/d 26,624,5 ANIMAL PROT g/d 33,736,5 SAFA g/d 33,036,0 PUFA g/d 9,3 ** 10,5 RATIO VEG/ANIM 1,71,6 Olive oil g/d 21,1 *** 15,2

Diabetes Center Hippokration Hospital B. Karamanos 2011 GDM +GDM - CHO % 48,749,6 FAT % 35,033,9 PROTEIN % 16,216,5 ANIMAL FAT % 14,314,4 PLANT FAT % 20,018,7 SAFA % 13,713,8

Diabetes Center Hippokration Hospital B. Karamanos 2011 GDM +GDM - FOLATE NIACIN 34,9 * 37,9 RIBOFLAVIN 1,731,84 THIAMINE 1,241,29 VITAMINE A 603 * 693 VITAMINE C 92,487,4

Diabetes Center Hippokration Hospital B. Karamanos 2011 GDM +GDM - AGE 32,1 *** 30,0 BMI 26,6 *** 24,5 Kcal/d CHO g/d 258 * 280 PROTEIN g/d 84,4 * 92,5 FAT g/d 83,985,5 After adjustment for Age and BMI

Diabetes Center Hippokration Hospital B. Karamanos 2011 GDM +GDM - FIBRE 21,723,2 ANIMAL FAT 34,536,6 ANIMAL PROT 55,259,1 SAFA 34,335,0 PUFA 9,510,5 RATIO VEG/ANIM 1,71,6 Olive oil 21,9 *** 15,4 After adjustment for Age and BMI

Diabetes Center Hippokration Hospital B. Karamanos 2011 GDM +GDM - CHO % 48,049,4 FAT % 35,9 * 34,0 PROTEIN % 16,216,5 ANIMAL FAT % 14,614,5 PLANT FAT % 20,518,7 SAFA % 14,213,8 After adjustment for Age and BMI

Diabetes Center Hippokration Hospital B. Karamanos 2011 GDM +GDM - FOLATE NIACIN 34,637,6 RIBOFLAVIN 1,71,8 THIAMINE 1,221,28 VITAMINE A VITAMINE C 94,988,0 After adjustment for Age and BMI

Diabetes Centre Hippokration Hospital Athens, Greece B. KARAMANOS 2011

Diabetes Centre Hippokration Hospital Athens, Greece B. KARAMANOS 2011 Mediterranean Diet Score Plant /Animal Fat ratio Vegetables Alcohol ConsumptionMeat Legumes Dairy products Cereals Fruits Fish Score 0-9 Good > 5 BMJ 311: , 1995

Diabetes Centre Hippokration Hospital Athens, Greece 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, 1990 Diab Nutr Metab 14:119, 2001

Diabetes Centre Hippokration Hospital Athens, Greece B. KARAMANOS years survival of elderly non-diabetics Predictors Age12% decrease per 1 year Sexnot significant Smokingnot significant Mediterranean Diet Score 17% increased survival per unit increase BMJ 311:1457, 1995

Diabetes Center Hippokration Hospital B. Karamanos 2011 GDM +GDM - CHO g/d258 * 280 Protein g/d84,4 * 92,5 Fat %35,9 * 34,0 Olive oil g/d21,9 *** 15,4 Medi Diet Index 5,53 * 5,98 Significant differences after adjustment for Age and BMI

Diabetes Center Hippokration Hospital B. Karamanos 2011 In a model of Logistic Regression, where all variables related to GDM incidence were included: Agep=0,014 BMIp=0,001 Olive oil consumptionp=0,001 Medi Diet Indexp=0,002 (neg) Were related with the incidence of GDM

Diabetes Center Hippokration Hospital B. Karamanos 2011 Incidence of GDM according to Mediterranean Diet Index Med Diet Good p Med Diet Bad GDM Incidence 7,9 %0,0312,6 % Relative Risk 0,60 (CI 0,38 – 0,95)

Diabetes Center Hippokration Hospital 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