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Epidemiology and Population Health

Healthful dietary patterns and long-term weight change among women with a history of gestational diabetes mellitus

International Journal of Obesity volume 40, pages 1748–1753 (2016)Cite this article

Subjects

Abstract

Background/Objective:

Diet represents a key strategy for the prevention of obesity and type 2 diabetes among women with a history of gestational diabetes mellitus (GDM), although effective dietary patterns to prevent weight gain in the long term are largely unknown. We sought to evaluate whether improvement in overall diet quality is associated with less long-term weight gain among high-risk women with prior GDM.

Subjects/Methods:

Women with a history of GDM (N=3397) were followed from 1991 to 2011, or until diagnosis of type 2 diabetes or other chronic disease. Usual diet was assessed via food frequency questionnaire every 4 years from which we calculated the Alternative Healthy Eating Index (aHEI-2010), Alternate Mediterranean Diet (AMED) and Dietary Approaches to Stop Hypertension (DASH) dietary pattern scores. Weight, lifestyle and health-related outcomes were self-reported every 2 years. We estimated the change in dietary score with change in body weight using linear regression models adjusting for age, baseline body mass index (BMI), baseline and simultaneous change in physical activity and smoking status and other risk factors.

Results:

Women were followed up to 20 years, gaining an average 1.9 kg (s.d.=7.0) per 4-year period. Women in the highest quintile (Q5) of diet change (most improvement in quality) gained significantly less weight per 4-year period than the lowest quintile (Q1; decrease in quality), independent of other risk factors (4-year weight change, aHEI-2010: Q5=1.30 kg vs Q1=3.27 kg; AMED: Q5=0.94 kg vs Q1=2.56 kg, DASH: Q5=0.64 kg vs Q1=2.75 kg). Significant effect modification by BMI (p-interactions <0.001) indicated a greater magnitude of weight change among women with a higher baseline BMI for all three patterns.

Conclusions:

Increased diet quality was associated with less weight gain, independent of other lifestyle factors. Post-partum recommendations on diet quality may provide one strategy to prevent long-term weight gain in this high-risk group.

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Acknowledgements

This work was supported by the National Institutes of Health (HL60712, UM1 CA176726, DK58845, HSN275201000020C, P30 DK46200, 1K01DK103720) and the American Diabetes Association (7-12-MN-34). Drs Zhang and Bao are supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health.

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Authors and Affiliations

  1. Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    D K Tobias & J E Manson

  2. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    D K Tobias, J Chavarro, S Olsen, T T Fung & F B Hu

  3. Division of Intramural Population Health Research, Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD, USA

    C Zhang & W Bao

  4. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA

    J Chavarro & F B Hu

  5. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    J Chavarro & F B Hu

  6. Department of Epidemiology Research, Centre for Fetal Programming, Statens Serum Institut, Copenhagen, Denmark

    S Olsen & A A Bjerregaard

  7. Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA

    W Bao

  8. Department of Nutrition, Simmons College, Boston, MA, USA

    T T Fung

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  1. D K Tobias
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Correspondence to D K Tobias.

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Tobias, D., Zhang, C., Chavarro, J. et al. Healthful dietary patterns and long-term weight change among women with a history of gestational diabetes mellitus. Int J Obes 40, 1748–1753 (2016). https://doi.org/10.1038/ijo.2016.156

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