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A daily snack containing green leafy vegetables, fruit and milk before and during pregnancy prevented gestational diabetes in a randomized controlled trial in Mumbai

A daily snack containing green leafy vegetables, fruit and milk before and during pregnancy prevented gestational diabetes in a randomized controlled trial in Mumbai
A daily snack containing green leafy vegetables, fruit and milk before and during pregnancy prevented gestational diabetes in a randomized controlled trial in Mumbai
Background: Prospective observational studies suggest that maternal diets rich in leafy green vegetables and fruit may help prevent gestational diabetes mellitus (GDM).

Objective: Our objective was to test whether increasing women's dietary intake of leafy green vegetables, fruit, and milk before conception and throughout pregnancy reduced their risk of GDM.

Methods: Project SARAS (''excellent'') (2006-2012) was a nonblinded, individually randomized, controlled trial in women living in slums in the city of Mumbai, India. The interventions included a daily snack made from leafy green vegetables, fruit, and milk for the treatment group or low-micronutrient vegetables (e.g., potato and onion) for the control group, in addition to the usual diet. Results for the primary outcome, birth weight, have been reported. Women were invited to take an oral-glucose-tolerance test (OGTT) at 28-32 wk gestation to screen for GDM (WHO 1999 criteria). The prevalence of GDM was compared between the intervention and control groups, and Kernel density analysis was used to compare distributions of 120-min plasma glucose concentrations between groups.

Results: Of 6513 women randomly assigned, 2291 became pregnant; of these, 2028 reached a gestation of 28 wk, 1008 (50%) attended for an OGTT, and 100 (9.9%) had GDM. In an intention-to-treat analysis, the prevalence of GDM was reduced in the treatment group (7.3% compared with 12.4% in controls; OR: 0.56; 95% CI: 0.36, 0.86; P = 0.008). The reduction in GDM remained significant after adjusting for prepregnancy adiposity and fat or weight gain during pregnancy. Kernel density analysis showed that this was explained by the fact that fewer women in the treatment group had a 2-h glucose concentration in the range 7.5-10.0 mmol/L.

Conclusions: In low-income settings, in which women have a low intake of micronutrient-rich foods, improving dietary micronutrient quality by increasing intake of leafy green vegetables, fruit, and/or milk may have an important protective effect against the development of GDM.
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Sahariah, S.A.
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Potdar, R.D.
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Gandhi, M.
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Kehoe, S.H.
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Brown, N.
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Sane, H.
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Coakley, P.J.
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Marley-Zagar, E.
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Chopra, H.
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Shivshankaran, D.
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Cox, V.A.
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Jackson, A.A.
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Margetts, B.M.
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Fall, C.H.D.
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Sahariah, S.A.
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Potdar, R.D.
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Gandhi, M.
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Kehoe, S.H.
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Brown, N.
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Sane, H.
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Coakley, P.J.
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Marley-Zagar, E.
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Chopra, H.
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Shivshankaran, D.
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Cox, V.A.
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Jackson, A.A.
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Margetts, B.M.
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Fall, C.H.D.
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Sahariah, S.A., Potdar, R.D., Gandhi, M., Kehoe, S.H., Brown, N., Sane, H., Coakley, P.J., Marley-Zagar, E., Chopra, H., Shivshankaran, D., Cox, V.A., Jackson, A.A., Margetts, B.M. and Fall, C.H.D. (2016) A daily snack containing green leafy vegetables, fruit and milk before and during pregnancy prevented gestational diabetes in a randomized controlled trial in Mumbai. The Journal of nutrition, 146 (7), 1453S-1460S. (doi:10.3945/jn.115.223461).

Record type: Article

Abstract

Background: Prospective observational studies suggest that maternal diets rich in leafy green vegetables and fruit may help prevent gestational diabetes mellitus (GDM).

Objective: Our objective was to test whether increasing women's dietary intake of leafy green vegetables, fruit, and milk before conception and throughout pregnancy reduced their risk of GDM.

Methods: Project SARAS (''excellent'') (2006-2012) was a nonblinded, individually randomized, controlled trial in women living in slums in the city of Mumbai, India. The interventions included a daily snack made from leafy green vegetables, fruit, and milk for the treatment group or low-micronutrient vegetables (e.g., potato and onion) for the control group, in addition to the usual diet. Results for the primary outcome, birth weight, have been reported. Women were invited to take an oral-glucose-tolerance test (OGTT) at 28-32 wk gestation to screen for GDM (WHO 1999 criteria). The prevalence of GDM was compared between the intervention and control groups, and Kernel density analysis was used to compare distributions of 120-min plasma glucose concentrations between groups.

Results: Of 6513 women randomly assigned, 2291 became pregnant; of these, 2028 reached a gestation of 28 wk, 1008 (50%) attended for an OGTT, and 100 (9.9%) had GDM. In an intention-to-treat analysis, the prevalence of GDM was reduced in the treatment group (7.3% compared with 12.4% in controls; OR: 0.56; 95% CI: 0.36, 0.86; P = 0.008). The reduction in GDM remained significant after adjusting for prepregnancy adiposity and fat or weight gain during pregnancy. Kernel density analysis showed that this was explained by the fact that fewer women in the treatment group had a 2-h glucose concentration in the range 7.5-10.0 mmol/L.

Conclusions: In low-income settings, in which women have a low intake of micronutrient-rich foods, improving dietary micronutrient quality by increasing intake of leafy green vegetables, fruit, and/or milk may have an important protective effect against the development of GDM.

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Accepted/In Press date: 4 January 2016
e-pub ahead of print date: 8 June 2016
Published date: 1 July 2016
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 393793
URI: http://eprints.soton.ac.uk/id/eprint/393793
ISSN: 0022-3166
PURE UUID: 43553136-f81d-4cb7-863a-351cb55bf380
ORCID for S.H. Kehoe: ORCID iD orcid.org/0000-0003-2584-7999
ORCID for C.H.D. Fall: ORCID iD orcid.org/0000-0003-4402-5552

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Date deposited: 05 May 2016 09:25
Last modified: 18 Feb 2021 16:54

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Contributors

Author: S.A. Sahariah
Author: R.D. Potdar
Author: M. Gandhi
Author: S.H. Kehoe ORCID iD
Author: N. Brown
Author: H. Sane
Author: P.J. Coakley
Author: E. Marley-Zagar
Author: H. Chopra
Author: D. Shivshankaran
Author: V.A. Cox
Author: A.A. Jackson
Author: B.M. Margetts
Author: C.H.D. Fall ORCID iD

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