© Borgis - New Medicine 2/2007, s. 27-30
*Wojciech Chalcarz, Sylwia Merkiel, Katarzyna Wandelt
ASSESSMENT OF DIETARY INTAKE IN WOMEN WITH GESTATIONAL DIABETES MELLITUS – PRELIMINARY REPORT
Food and Nutrition Department of the Eugeniusz Piasecki
University School of Physical Education in Poznan
Head of the Department: Dr hab. Wojciech Chalcarz, prof. nadzw. AWF
Summary
Summary
The study was carried out on a group of 10 women in the third trimester of pregnancy suffering from gestational diabetes mellitus. Dietary intake was assessed from a seven-day food record. The analysis included the intake of energy, macronutrients, water, vitamins and minerals. The diet of the studied population did not meet the nutritional recommendations. Pregnant women should be educated on nutrition during pregnancy, especially those affected by diabetes mellitus.
INTRODUCTION
Gestational diabetes mellitus is one of the most common metabolic disorders occurring during pregnancy [1]. It is characterized by increased insulin resistance and impaired insulin secretion [2, 3]. Treatment of women with gestational diabetes mellitus is of vital importance not only because of the risk of developing type 2 diabetes mellitus in the mother, but also because of adverse influence on the fetus´ growth and future offspring´s health. Proper diet, aimed at attaining normoglycaemia [4, 5], is the basis of the therapy of women with gestational diabetes mellitus [5, 6]. The most common advice is to decrease energy intake. However, when a calorie-restricted diet is applied in pregnant women, special attention should be paid to sufficient intake of all nutrients in order to ensure proper growth and good health of the fetus.
The aim of this research was to assess dietary intake in women with gestational diabetes mellitus following a calorie-restricted diet.
MATERIAL AND METHODS
The research was carried out on a group of 10 women in the third trimester of pregnancy suffering from gestational diabetes mellitus. The women were patients of a maternity ward and were on a calorie-restricted diet of 1500 kcal. Dietary intake was assessed from a food record. The studied women kept a detailed record of all foods and beverages consumed over seven consecutive days, writing the amounts in grams or using household measurements.
Daily intakes of energy, macronutrients, water, vitamins and minerals were calculated using the Dieta 2.0 computer program. Statistical analysis was carried out by means of the SPSS 12.0 PL for Windows computer program.
The research was approved by the Bioethics Committee of the Poznan University of Medical Sciences.
RESULTS
The studied women were 24 to 38 years of age. Their mean height was 164.2 cm, and mean weight was 73.6 kg. Before getting pregnant their mean weight was 63.2 kg, and mean BMI was 23.5 kg/m2. Before getting pregnant one woman was obese, four were overweight, four were underweight and only one woman had appropriate weight. Of the studied women, 30.0% did not have any children, 30.0% had one child and 40.0% had two children.
Mean daily intake of energy, macronutrients and water in the studied women with gestational diabetes mellitus is presented in Table 1. The mean intake of energy was 1315 kcal and included 16.5% of energy from protein, 28.0% of energy from fat and 55.5% of energy from carbohydrates. Intake of total protein was far lower than the recommended 95 g. Intake of total fat was 41.3 g. In terms of the structure of energy from fatty acids the studied women also failed to meet the recommendations due to excess intake of saturated fatty acids, and too low intake of monounsaturated and polyunsaturated fatty acids. Of a total 200.6 g of carbohydrates, 112.1 g came from starch. Intake of dietary fibre was 20.9 g, and intake of water was 1644.0 g.
Table 1. Mean daily intake of energy, macronutrients and water in the studied women with gestational diabetes mellitus.
| No. | Nutrient | Intake | Recommendations |
| 1. | Energy | [kcal] | 1315?119 | 1500[21] |
| [kJ] | 5503?499 | 6276[21] |
| 2. | Percentage of energy | from protein [%] | 16.5?1.3 | 20.0-25.0[10] |
| from fat [%] | 28.0?1.8 | 30.0-40.0[10] |
| from carbohydrates [%] | 55.5?2.3 | 38.0-45.0[10] |
| 3. | Protein | total [g] | 53.9?6.4 | 75.0-93.8[10] |
| animal [g] | 33.4?5.5 | 35.0-50.0[9] |
| plant [g] | 20.5?2.4 | - |
| 4. | Total fat | [g] | 41.3?3.5 | 50.0-66.7[10] |
| 5. | Fatty acids | saturated [g] | 16.92?3.02 | < 16.67[9] |
| monounsaturated [g] | 14.66?2.15 | 25.00[9] |
| polyunsaturated [g] | 5.86?1.83 | 11.67[9] |
| 6. | Cholesterol | [mg] | 169?33 | < 300[9] |
| 7. | Total carbohydrates | [g] | 200.6?22.7 | 142.5-168.8[10] |
| 8. | Sucrose | [g] | 29.0?5.3 | < 37.5[9] |
| 9. | Lactose | [g] | 7.2?2.9 |
| 10. | Starch | [g] | 112.1?19.6 | - |
| 11. | Dietary fibre | [g] | 20.9?3.1 | 20-35[6] |
| 12. | Water | [g] | 1644.0?209.7 | 2000-2800[9] |
Mean daily intake of vitamins and minerals in the studied women with gestational diabetes mellitus is presented in Table 2. Intake of vitamins was lower than the recommendations for pregnant women, except for vitamins A, C and B12. Intake of vitamins A and C was too high, and intake of vitamin B12 was within the recommended range, that is from 90.0% to 110.0% of the norm. Among minerals, the most inadequate intake was that of calcium, sodium and iron. Only intake of potassium met the recommendations.
Table 2. Mean daily intake of vitamins and minerals in the studied women with gestational diabetes mellitus.
| No. | Nutrient | Intake | Recommendations[9] |
| 1. | Vitamin A (retinol equivalent) | ?g | 1176?313 | 950 ?g |
| 2. | Retinol | ?g | 247?27 | - |
| 3. | ß-carotene | ?g | 5566?1880 | - |
| 4. | Vitamin D | ?g | 2.15?0.58 | 10 ?g |
| 5. | Vitamin E (tocopherol equivalent) | mg | 7.16?1.71 | 8 mg |
| 6. | Vitamin B1 | mg | 0.963?0.175 | 1.7 mg |
| 7. | Vitamin B2 | mg | 1.122?0.126 | 2.2 mg |
| 8. | Vitamin B6 | mg | 1.63?0.24 | 2.6 mg |
| 9. | Folic acid (Vitamin B9) | ?g | 232.7?33.5 | 400 ?g |
| 10. | Vitamin B12 | ?g | 2.14?0.32 | 2.2 ?g |
| 11. | Vitamin PP | mg | 13.07?2.26 | 19 mg |
| 12. | Vitamin C | mg | 122.0?34.8 | 70 mg |
| 13. | Calcium | mg | 472?84 | 1100 mg |
| 14. | Phosphorus | mg | 956?113 | 800 mg |
| 15. | Magnesium | mg | 274?32 | 320 mg |
| 16. | Sodium | mg | 2962?314 | 575 mg |
| 17. | Potassium | mg | 3163?447 | 3500 mg |
| 18. | Iron | mg | 9.2?1.4 | 22 mg |
| 19. | Zinc | mg | 8.09?1.28 | 12 mg |
| 20. | Copper | mg | 1.10?0.16 | 2.0-2.5 mg |
| 21. | Manganese | mg | 4.83?1.41 | - |
DISCUSSION
Energy intake in the studied women was lower than the advised 1500 kcal. Over-restriction of energy intake advice was also observed in Chinese women with gestational diabetes mellitus [7]. Decrease in energy intake in women with gestational diabetes mellitus has a desirable effect which is the decrease of serum glucose concentration. However, because of the risk of intensification of ketogenesis and increase of ketonuria [1, 4], with their detrimental influence on neurophysiolo-gical and cognitive development of the fetus [8], special attention should be paid to strict adherence to the recommendations on energy intake in the studied women, especially as following calorie-restricted diets increases the risk of nutrient deficiencies.
Polish dietary reference values [9] do not include separate recommendations on the structure of energy intake from macronutrients for women with gestational diabetes mellitus. In comparison to the American Diabetes Association´s recommendations [10], the percentages of energy from protein and fat in the diets of the studied women were too low, while the percentage of energy from carbohydrates was too high. The percentage of energy from protein was too low also in the diets of women with gestational diabetes mellitus living in France [11] and the UK [12]; however, the percentage of energy from fat in their diets was in accordance with the recommendations. The diets of women from the UK [12], similarly to the diets of the studied women, provided too much energy from carbohydrates, while the women from France [11] met the recommendations.
Total protein intake, much lower than recommended, has an adverse influence on the growing fetus because of the role of this macronutrient as a building constituent. Much higher, 84.9 g, was total protein intake in the diets of British women [12]. Unfortunately, no data on animal or plant protein intake in women with gestational diabetes mellitus were found. It is noteworthy that while advising the studied women to increase the intake of total protein, special emphasis should be laid on the advantages of deriving this macronutrient mainly from foods of plant origin. Moreover, it is of great importance to give the women practical guidance on combining various plant proteins to make them supplement each other in limiting amino acids.
Total fat intake in the studied women was far lower than in women from France [11] and the UK [12]. Also the intake of all kinds of fatty acids was lower in comparison with the diets of British women [12], whose fatty acids intake was close to the United Kingdom Reference Nutrient Intake. In Australian women with gestational diabetes mellitus, before they received nutritional advice [13], the structure of fatty acids intake was more unfavourable than in the studied women because of the higher percentage of energy from saturated fatty acids and lower percentage of energy from polyunsaturated fatty acids. Meeting the recommendations on unsaturated fatty acids intake is particularly important. It was shown [14] that diets with high content of monounsaturated fatty acids do not have an adverse influence on serum lipid or lipoprotein concentrations and may prevent high blood pressure, a symptom which often accompanies gestational diabetes mellitus. In turn, increased intake of polyunsaturated fatty acids is associated with lower risk of glucose intolerance during pregnancy [15].
It is very favourable that cholesterol intake in the studied women was low because cholesterol is probably involved in the pathogenesis of gestational diabetes mellitus [16].
Intake of total carbohydrates in the studied women was almost the same as in women from France [11], but far lower than in women from the UK [12]. It is very advantageous that sucrose intake in the studied women was in accordance with the recommendations. Starch intake was much lower than in women from the UK [12]. Dietary fibre intake was 6 g higher than in British women [12] and was within the recommended range.
Unfortunately, no data on water intake in women with gestational diabetes mellitus were found. Moreover, there are no separate reference values for water intake for this group of women. In comparison with general recommendations, water intake in the studied women was too low [9].
Vitamin A intake was much higher than safe intake, mainly due to high intake of â-carotene. In Italian women with gestational diabetes mellitus [17] intake of vitamin A was much lower, and intake of vitamin E was higher [17]. In the studied women vitamin C intake was lower than in women from Italy [17] and China [18], but still it was higher than safe intake. Adequate intake of vitamin C in women with gestational diabetes mellitus is essential because it was shown that low intake of this vitamin is associated with increased risk of gestational diabetes mellitus [18].
It is very unfavourable that intake of zinc in the studied women was below safe intake. Similar zinc intake was observed in the diets of Italian women [17]. Zinc deficiency may impair the sensitivity to insulin [19]. Also the very high sodium intake, over five times higher than recommended, is disadvantageous [20].
Nutritional mistakes made by the studied women in their daily diets could be eliminated if an individual nutritional education was introduced. This positive effect of nutritional education in women with gestational diabetes mellitus was proved by Gillen et al. [5].
CONCLUSIONS
1. The diets of the studied women with gestational diabetes mellitus did not meet the norms. They were characterized by incorrect structure of energy and fatty acids intake, too low protein intake, too low intake of vitamins, except for vitamins A, C and B12, excess intake of sodium and phosphorus, and too low intake of the other minerals, except for potassium.
2. In order to eliminate the observed nutritional mistakes made by the studied women, a nutritional education programme and the women´s strict cooperation with the gynaecologist and dietitian are necessary.
Piśmiennictwo
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