Grand Rounds

Does a Mediterranean Diet with Extra Olive Oil Decrease Risk of Gestational Diabetes Mellitus?

BACKGROUND AND PURPOSE:

Thus far, effective lifestyle prevention measures to prevent gestational diabetes mellitus (GDM) have been limited
A Mediterranean Diet (MedDiet), with additional extra virgin olive oil (EVOO) and nuts, prevents type 2 DM and cardiovascular disease
Retrospective data indicate that MedDiet is associated with a decreased risk for GDM
Assaf-Balut et al. (PLoS One, 2017) report on their RCT that examined whether eating a Mediterranean diet with increased intake of EVOO and nuts decreases the risk for GDM

Prospective, randomized controlled trial (RCT)
Inclusion: Normoglycemic pregnant women were invited to join the study at 12-14 weeks at first ultrasound
Both Intervention and Control Group received basic MedDiet
- ≥ 2 servings/day of vegetables, ≥ 3 servings/day of fruit, 3 servings/day of skimmed dairy products, wholegrain cereals, 2-3 servings of legumes/week, moderate to high consumption of fish
- Low consumption of red and processed meat
- Avoidance of refined grains, processed baked goods, pre-sliced bread, soft drinks and fresh juices, fast foods and precooked meals
- All participants were encouraged to walk ≥ 30 minutes/day
Women were randomized to
- Intervention Group: MedDiet plus ≥ 40 mL EVOO and handful of pistachios (20-30g)
- Control Group: Standard diet with limited fat intake, including EVOO and nuts
Primary outcome
- GDM incidence at 24-28 weeks
Secondary outcomes
- Gestational weight gain (GWG), pregnancy-induced hypertension, caesarean section (CS), preterm delivery, perineal trauma, small and large for gestational age (SGA and LGA) and admissions to neonatal intensive care unit
Analysis was by intention-to-treat

Data was collected from 874 women (440 controls/434 intervention arm)
23.4% of the control group and 17.1% of the intervention group (IG) were diagnosed with GDM
Comparing the intervention to the control group
- Crude relative risk (RR) for GDM was 0.73 (95% CI 0.56-0.95; p = 0.020)
- adjusted multivariable analysis, RR 0.75 (95% CI 0.57-0.98; p = 0.039)
Intervention group also had reduced rates of insulin-treated GDM, prematurity, GWG at 24-28 and 36-38 weeks, emergency CS, perineal trauma, and SGA and LGA newborns (all p<0.05)

A MedDiet diet supplemented with EVOO and pistachio nuts reduces the incidence of GDM and improves several maternal and neonatal outcomes

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