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Polyphenol-rich foods and risk of gestational diabetes: a systematic review and meta-analysis

European Journal of Clinical Nutrition volume 73, pages 647–656 (2019)Cite this article

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Abstract

Animal studies have demonstrated anti-diabetic properties of several food-derived polyphenols, but data in humans remains unclear. This study aimed to review and meta-analyse evidence concerning the effect of the intake of several polyphenol-rich foods on gestational diabetes (GDM) risk. A systematic literature search was conducted in PubMed, Web of Science and Embase databases for observational studies on the association between dietary intake of foods/diets rich in polyphenols and GDM risk. Inclusion criteria were original research articles with full texts published in peer-reviewed English language journals, which investigated foods within the top 100 richest dietary sources of polyphenols and reported odds ratio/relative risk with their corresponding 95% confidence intervals. The quality of included studies was assessed using the Newcastle-Ottawa Scale. The intake of polyphenol-rich foods and dietary patterns in relation to GDM were pooled with fixed- and random-effects models. In total, 12 (10 cohort, 1 cross-sectional and 1 case-control) studies were included for the final systematic review, comprising 124,959 participants and including 5,786 women with GDM. Five studies found a significant, inverse association between the intake of polyphenol-rich foods or Mediterranean diet and GDM, whereas five studies reported no association and two exhibited a positive association. Meta-analyses further showed that the risk of GDM was about halved amongst women with the highest score of Mediterranean diet compared to those with the lowest score. The results suggest that dietary patterns rich in polyphenols may reduce the risk of GDM despite inconclusive evidence for polyphenol-rich food groups.

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References

  1. Buchanan TA, Xiang A, Kjos SL, Watanabe R. What is gestational diabetes? Diabetes Care. 2007;30:S105–11.

    Article  CAS  PubMed  Google Scholar 

  2. Guariguata L, Linnenkamp U, Beagley J, Whiting DR, Cho NH. Global estimates of the prevalence of hyperglycaemia in pregnancy. Diabetes Res Clin Pract. 2014;103:176–85.

    Article  CAS  PubMed  Google Scholar 

  3. Marchetti D, Carrozzino D, Fraticelli F, Fulcheri M, Vitacolonna E. Quality of life in women with gestational diabetes mellitus: a systematic review. J Diabetes Res. 2017;2017:7058082.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Wendland EM, Torloni MR, Falavigna M, Trujillo J, Dode MA, Campos MA, et al. Gestational diabetes and pregnancy outcomes--a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria. BMC Pregnancy Childbirth. 2012;12:23.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Yogev Y, Xenakis EM, Langer O. The association between preeclampsia and the severity of gestational diabetes: the impact of glycemic control. Am J Obstet Gynecol. 2004;191:1655–60.

    Article  PubMed  Google Scholar 

  6. Rayanagoudar G, Hashi AA, Zamora J, Khan KS, Hitman GA, Thangaratinam S. Quantification of the type 2 diabetes risk in women with gestational diabetes: a systematic review and meta-analysis of 95,750 women. Diabetologia. 2016;59:1403–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373:1773–9.

    Article  CAS  PubMed  Google Scholar 

  8. Xu Y, Shen S, Sun L, Yang H, Jin B, Cao X. Metabolic syndrome risk after gestational diabetes: a systematic review and meta-analysis. PLoS ONE. 2014;9:e87863.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Billionnet C, Mitanchez D, Weill A, Nizard J, Alla F, Hartemann A, et al. Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia. 2017;60:636–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Radesky JS, Oken E, Rifas-Shiman SL, Kleinman KP, Rich-Edwards JW, Gillman MW. Diet during early pregnancy and development of gestational diabetes. Paediatr Perinat Epidemiol. 2008;22:47–59.

    Article  PubMed  PubMed Central  Google Scholar 

  11. He JR, Yuan MY, Chen NN, Lu JH, Hu CY, Mai WB, et al. Maternal dietary patterns and gestational diabetes mellitus: a large prospective cohort study in China. Br J Nutr. 2015;113:1292–300.

    Article  CAS  PubMed  Google Scholar 

  12. Tsao R. Chemistry and biochemistry of dietary polyphenols. Nutrients. 2010;2:1231–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Bao W, Bowers K, Tobias DK, Hu FB, Zhang C. Prepregnancy dietary protein intake, major dietary protein sources, and the risk of gestational diabetes mellitus: a prospective cohort study. Diabetes Care. 2013;36:2001–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Tryggvadottir EA, Medek H, Birgisdottir BE, Geirsson RT, Gunnarsdottir I. Association between healthy maternal dietary pattern and risk for gestational diabetes mellitus. Eur J Clin Nutr. 2016;70:237–42.

    Article  CAS  PubMed  Google Scholar 

  15. Huang WQ, Lu Y, Xu M, Huang J, Su YX, Zhang CX. Excessive fruit consumption during the second trimester is associated with increased likelihood of gestational diabetes mellitus: a prospective study. Sci Rep. 2017;7:43620.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hoffman R, Gerber M. Constituents and physiological effects of Mediterranean plant foods. The Mediterranean Diet: Health and Science. Chichester: Wiley-Blackwell; 2012. pp. 31–66.

    Google Scholar 

  17. Delgado AM, Almeida MDV, Parisi S. Chemistry of the Mediterranean Diet. Springer: Basel; 2017.

    Book  Google Scholar 

  18. Davis C, Bryan J, Hodgson J, Murphy K. Definition of the Mediterranean diet; a literature review. Nutrients. 2015;7:9139–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Dinu M, Pagliai G, Casini A, Sofi F. Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials. Eur J Clin Nutr. 2018;72:30–43.

    Article  CAS  PubMed  Google Scholar 

  20. Nguyen CL, Pham NM, Binns CW, Duong DV, Lee AH. Prevalence of gestational diabetes mellitus in Eastern and Southeastern Asia: a systematic review and meta-analysis. J Diabetes Res. 2018;2018:6536974.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Martin B, Sacks DA. The global burden of hyperglycemia in pregnancy - trends from studies in the last decade. Diabetes Res Clin Pract 2018. https://doi.org/10.1016/j.diabres.2018.04.003.

  22. Kim Y, Keogh JB, Clifton PM. Polyphenols and glycemic control. Nutrients. 2016;8:1–27.

    Google Scholar 

  23. Pe´rez-Jime´nez J, Neveu V, Vos F, Scalbert A. Identification of the 100 richest dietary sources of polyphenols: an application of the Phenol-Explorer database. Eur J Clin Nutr. 2010;64:S112–20.

    Article  CAS  Google Scholar 

  24. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.

  25. Herzog R, Alvarez-Pasquin MJ, Diaz C, Del Barrio JL, Estrada JM, Gil A. Are healthcare workers’ intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health. 2013;13:154.

    Article  PubMed  PubMed Central  Google Scholar 

  26. McPheeters ML, Kripalani S, Peterson NB, Idowu RT, Jerome RN, Potter SA et al. Closing the quality gap: revisiting the state of the science (vol. 3: quality improvement interventions to address health disparities). Evid Rep Technol Assess (Full Rep) 2012:208.3;1–475.

  27. Borensteina M, Larry VH, Higginsc JPT, Rothsteind HR. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Syn Meth. 2010;1:97–111.

    Article  Google Scholar 

  28. Adeney KL, Williams MA, Schiff MA, Qiu C, Sorensen TK. Coffee consumption and the risk of gestational diabetes mellitus. Acta Obstet Gynecol Scand. 2007;86:161–6.

    Article  CAS  PubMed  Google Scholar 

  29. Chen L, Hu FB, Yeung E, Tobias DK, Willett WC, Zhang C. Prepregnancy consumption of fruits and fruit juices and the risk of gestational diabetes mellitus: a prospective cohort study. Diabetes Care. 2012;35:1079–82.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Tobias DK, Zhang C, Chavarro J, Bowers K, Rich-Edwards J, Rosner B, et al. Prepregnancy adherence to dietary patterns and lower risk of gestational diabetes mellitus. Am J Clin Nutr. 2012;96:289–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Karamanos B, Thanopoulou A, Anastasiou E, Assaad-Khalil S, Albache N, Bachaoui M, et al. Relation of the Mediterranean diet with the incidence of gestational diabetes. Eur J Clin Nutr. 2014;68:8–13.

    Article  CAS  PubMed  Google Scholar 

  32. Hinkle SN, Laughon SK, Catov JM, Olsen J, Bech BH. First trimester coffee and tea intake and risk of gestational diabetes mellitus: a study within a national birth cohort. BJOG. 2015;122:420–8.

    Article  CAS  PubMed  Google Scholar 

  33. Schoenaker DA, Soedamah-Muthu SS, Callaway LK, Mishra GD. Pre-pregnancy dietary patterns and risk of gestational diabetes mellitus: results from an Australian population-based prospective cohort study. Diabetologia. 2015;58:2726–35.

    Article  CAS  PubMed  Google Scholar 

  34. Bao W, Tobias DK, Hu FB, Chavarro JE, Zhang C. Pre-pregnancy potato consumption and risk of gestational diabetes mellitus: prospective cohort study. BMJ. 2016;352:h6898.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Izadi V, Tehrani H, Haghighatdoost F, Dehghan A, Surkan PJ, Azadbakht L. Adherence to the DASH and Mediterranean diets is associated with decreased risk for gestational diabetes mellitus. Nutrition. 2016;32:1092–96.

    Article  CAS  PubMed  Google Scholar 

  36. Hanhineva K, Torronen R, Bondia-Pons I, Pekkinen J, Kolehmainen M, Mykkanen H, et al. Impact of dietary polyphenols on carbohydrate metabolism. Int J Mol Sci. 2010;11:1365–402.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Scalbert A, Manach C, Morand C, Remesy C, Jimenez L. Dietary polyphenols and the prevention of diseases. Crit Rev Food Sci Nutr. 2005;45:287–306.

    Article  CAS  PubMed  Google Scholar 

  38. Pandey KB, Rizvi SI. Plant polyphenols as dietary antioxidants in human health and disease. Oxid Med Cell Longev. 2009;2:270–8.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Yang H, Wei Y, Gao X, Xu X, Fan L, He J, et al. Risk factors for gestational diabetes mellitus in Chinese women-a prospective study of 16 286 pregnant women in China. Diabet Med. 2009;26:1099–104.

    Article  CAS  PubMed  Google Scholar 

  40. Xiao JB, Hogger P. Dietary polyphenols and type 2 diabetes: current insights and future perspectives. Curr Med Chem. 2015;22:23–38.

    Article  CAS  PubMed  Google Scholar 

  41. Trichopoulou A, Bamia C, Trichopoulos D. Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study. BMJ. 2009;338:b2337.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Bach-Faig A, Berry EM, Lairon D, Reguant J, Trichopoulou A, Dernini S, et al. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr. 2011;14:2274–84.

    Article  PubMed  Google Scholar 

  43. Jannasch F, Kroger J, Schulze MB. Dietary patterns and type 2 diabetes: a systematic literature review and meta-analysis of prospective studies. J Nutr. 2017;147:1174–82.

    Article  CAS  PubMed  Google Scholar 

  44. Kaaja R, Ronnemaa T. Gestational diabetes: pathogenesis and consequences to mother and offspring. Rev Diabet Stud. 2008;5:194–202.

    Article  PubMed  Google Scholar 

  45. Law KP, Zhang H. The pathogenesis and pathophysiology of gestational diabetes mellitus: Deductions from a three-part longitudinal metabolomics study in China. Clin Chim Acta. 2017;468:60–70.

    Article  CAS  PubMed  Google Scholar 

  46. Guasch-Ferré M, Merino J, Sun Q, Fit M, Salas-Salvad J. Dietary polyphenols, Mediterranean diet, prediabetes, and type 2 diabetes: a narrative review of the evidence. Oxid Med Cell Longev. 2017;2017:1–16.

    Article  CAS  Google Scholar 

  47. Hernandez-Alonso P, Camacho-Barcia L, Bullo M, Salas-Salvado J. Nuts and dried fruits: an update of their beneficial effects on type 2 diabetes. Nutrients. 2017;9:1–34.

    Article  CAS  Google Scholar 

  48. Salas-Salvado J, Guasch-Ferre M, Lee CH, Estruch R, Clish CB, Ros E. Protective effects of the Mediterranean diet on type 2 diabetes and metabolic syndrome. J Nutr. 2016;146:920S–927S.

    Article  CAS  PubMed Central  Google Scholar 

  49. Georgoulis M, Kontogianni MD, Yiannakouris N. Mediterranean diet and diabetes: prevention and treatment. Nutrients. 2014;6:1406–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Dominguez Avila JA, Rodrigo Garcia J, Gonzalez Aguilar GA, de la Rosa LA. The antidiabetic mechanisms of polyphenols related to increased glucagon-like peptide-1 (GLP1) and insulin signaling. Molecules. 2017;22:1–16.

    Article  CAS  Google Scholar 

  51. Muraki I, Imamura F, Manson JE, Hu FB, Willett WC, van Dam RM, et al. Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies. BMJ. 2013;347:f5001.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Johnson RJ, Segal MS, Sautin Y, Nakagawa T, Feig DI, Kang DH, et al. Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease. Am J Clin Nutr. 2007;86:899–906.

    CAS  PubMed  Google Scholar 

  53. Davis JN, Ventura EE, Weigensberg MJ, Ball GD, Cruz ML, Shaibi GQ, et al. The relation of sugar intake to beta cell function in overweight Latino children. Am J Clin Nutr. 2005;82:1004–10.

    Article  CAS  PubMed  Google Scholar 

  54. Neveu V, Perez-Jimenez J, Vos F, Crespy V, du Chaffaut L, Mennen L, et al. Phenol-Explorer: an online comprehensive database on polyphenol contents in foods. Database. 2010;2010:bap024.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Grosso G, Godos J, Galvano F, Giovannucci EL. Coffee, caffeine, and health outcomes: an umbrella review. Annu Rev Nutr. 2017;37:131–56.

    Article  CAS  PubMed  Google Scholar 

  56. Yang J, Mao QX, Xu HX, Ma X, Zeng CY. Tea consumption and risk of type 2 diabetes mellitus: a systematic review and meta-analysis update. BMJ Open. 2014;4:e005632.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Shi X, Xue W, Liang S, Zhao J, Zhang X. Acute caffeine ingestion reduces insulin sensitivity in healthy subjects: a systematic review and meta-analysis. Nutr J. 2016;15:103.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Ter Horst KW, Schene MR, Holman R, Romijn JA, Serlie MJ. Effect of fructose consumption on insulin sensitivity in nondiabetic subjects: a systematic review and meta-analysis of diet-intervention trials. Am J Clin Nutr. 2016;104:1562–76.

    Article  CAS  PubMed  Google Scholar 

  59. Muraki I, Rimm EB, Willett WC, Manson JE, Hu FB, Sun Q. Potato consumption and risk of type 2 diabetes: results from three prospective cohort studies. Diabetes Care. 2016;39:376–84.

    Article  CAS  PubMed  Google Scholar 

  60. McGill CR, Kurilich AC, Davignon J. The role of potatoes and potato components in cardiometabolic health: a review. Ann Med. 2013;45:467–73.

    Article  PubMed  Google Scholar 

  61. Cai W, Ramdas M, Zhu L, Chen X, Striker GE, Vlassara H. Oral advanced glycation endproducts (AGEs) promote insulin resistance and diabetes by depleting the antioxidant defenses AGE receptor-1 and sirtuin 1. Proc Natl Acad Sci USA. 2012;109:15888–93.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Cahill LE, Pan A, Chiuve SE, Sun Q, Willett WC, Hu FB, et al. Fried-food consumption and risk of type 2 diabetes and coronary artery disease: a prospective study in 2 cohorts of US women and men. Am J Clin Nutr. 2014;100:667–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Shim JS, Oh K, Kim HC. Dietary assessment methods in epidemiologic studies. Epidemiol Health. 2014;36:e2014009.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The first author, NMP, is supported by a Training and Research Fellowship awarded by the Nestle Nutrition Institute, Switzerland.

Authors contribution

NMP and AHL conceived and designed the study. VVD conducted a literature search and contributed to the interpretation of results and discussion. NMP reviewed the searched articles, analysed data and wrote the manuscript. AHL critically reviewed, revised and edited the manuscript. Three authors approved the final version prior to submission.

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  1. School of Public Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia

    Ngoc Minh Pham & Andy H. Lee

  2. Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam

    Ngoc Minh Pham

  3. Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam

    Vuong Van Do

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Pham, N.M., Do, V.V. & Lee, A.H. Polyphenol-rich foods and risk of gestational diabetes: a systematic review and meta-analysis. Eur J Clin Nutr 73, 647–656 (2019). https://doi.org/10.1038/s41430-018-0218-7

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