Dietary Glycemic Index during Pregnancy Is Associated with Biomarkers of the Metabolic Syndrome in Offspring at Age 20 Years

Objective
Growing evidence indicates that metabolic syndrome is rooted in fetal life with a potential key role of nutrition during pregnancy. The objective of the study was to assess the possible associations between the dietary glycemic index (GI) and glycemic load (GL) during pregnancy and biomarkers of the metabolic syndrome in young adult offspring.
Methods
Dietary GI and GL were assessed by questionnaires and interviews in gestation week 30 and offspring were clinically examined at the age of 20 years. Analyses based on 428 mother-offspring dyads were adjusted for maternal smoking during pregnancy, height, pre-pregnancy body mass index (BMI), education, energy intake, and the offspring’s ambient level of physical activity. In addition, possible confounding by gestational diabetes mellitus was taken into account.
Outcome Measures
Waist circumference, blood pressure, HOMA insulin resistance (HOMA-IR) and plasma levels of fasting glucose, triglycerides, HDL cholesterol, LDL cholesterol, total cholesterol, insulin, and leptin were measured in the offspring.
Results
Significant associations were found between dietary GI in pregnancy and HOMA-IR (the relative increase in HOMA-IR per 10 units’ GI increase was 1.09 [95% CI: 1.01, 1.16], p = 0.02), insulin (1.09 [95% CI: 1.02, 1.16], p = 0.01) and leptin (1.21 [95% CI: 1.06, 1.38], p = 0.01) in the offspring; whereas no associations were detected for GL.
Conclusions
Our data suggests that high dietary GI in pregnancy may affect levels of markers for the metabolic syndrome in young adult offspring in a potentially harmful direction.

研究目的
越来越多的证据表明，代谢综合征（metabolic syndrome）起源于胎儿期，孕期营养可能发挥关键作用。本研究旨在探讨孕期膳食血糖生成指数（glycemic index, GI）、膳食血糖负荷（glycemic load, GL）与年轻成年子代代谢综合征生物标志物之间的潜在关联。

研究方法
于妊娠第30周通过问卷与访谈评估受试者的膳食GI与GL，并在子代20岁时对其进行临床检查。本研究基于428对母子对进行分析，校正了母亲孕期吸烟、身高、孕前体重指数（body mass index, BMI）、教育水平、能量摄入以及子代日常体力活动水平等混杂因素；此外，还考虑了妊娠糖尿病（gestational diabetes mellitus）带来的潜在混杂影响。

结局指标
对子代的腰围、血压、稳态模型评估胰岛素抵抗（homeostatic model assessment of insulin resistance, HOMA-IR）以及血浆空腹血糖、甘油三酯、高密度脂蛋白胆固醇（high-density lipoprotein cholesterol, HDL-C）、低密度脂蛋白胆固醇（low-density lipoprotein cholesterol, LDL-C）、总胆固醇、胰岛素与瘦素水平进行了检测。

研究结果
研究发现，孕期膳食GI与子代的HOMA-IR（每升高10个单位GI，HOMA-IR相对升高1.09 [95%置信区间：1.01, 1.16]，p=0.02）、胰岛素（1.09 [95%置信区间：1.02, 1.16]，p=0.01）以及瘦素（1.21 [95%置信区间：1.06, 1.38]，p=0.01）存在显著关联；未检测到GL与上述指标存在关联。

研究结论
本研究数据提示，孕期高膳食GI可能以潜在有害的方式影响年轻成年子代的代谢综合征标志物水平。