Body mass index, prebiotic supplementation during pregnancy and gestational diabetes mellitus risk: an effect modification analysis from a randomised controlled trial.
Rachelle A Pretorius, Thomas R Sullivan, Summer V M Walker, Johan Garssen, Jeffrey A Keelan, Desiree Silva, Susan L Prescott, Debra J Palmer
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引用次数: 0
Abstract
BACKGROUND: Prebiotic dietary supplementation has been shown to improve glucose homeostasis in type 2 diabetes patients. The aim of this analysis was to determine whether pre-pregnancy body mass index (BMI) modifies the effect of prebiotic supplementation from mid-pregnancy on reducing the risk of gestational diabetes mellitus (GDM). METHODS: In a double-blinded, randomised controlled trial, pregnant women < 21 gestational weeks were randomly assigned (1:1) to consume daily prebiotics (14.2 g galacto-oligosaccharides and fructo-oligosaccharides) or placebo (8.7 g maltodextrin) powder. An effect modification analysis was performed to assess the heterogeneity of the effect of prebiotic supplementation in relation to pre-pregnancy BMI on GDM diagnosis. RESULTS: Between June 2016 and November 2021, 329 women were assigned to the prebiotic group (50.4%), and 323 (49.5%) were assigned to the placebo group. Overall, 288 of 652 women (44.2%) were classified as overweight/obese prior to pregnancy (BMI ≥ 25 kg/m2). The distribution was balanced, with 146/329 (44.4%) randomised to the prebiotics group and 142/323 (44.0%) in the placebo group. Pre-pregnancy BMI modified the effect of prebiotic supplementation, with the intervention reducing GDM rates in women with a BMI ≥ 25 kg/m2 (prebiotic group 11.0% vs. control group 21.8%; adjusted relative risk 0.50; 95% confidence interval (CI) 0.28 to 0.89) but not in women with a pre-pregnancy BMI < 25 kg/m2 (7.7–7% vs. 4.4%; adjusted relative risk 1.72; 95% CI 0.70 to 4.19; interaction p = 0.02). CONCLUSION: Pre-pregnancy BMI was found to modify the effect of prebiotic supplementation on GDM rates, with benefits observed in overweight and obese women. Our results highlight a target population for future randomised controlled trials to further investigate the effects of prebiotic supplementation during pregnancy on reducing the risk of GDM. TRIAL REGISTRATION: Primary and secondary infant allergic disease outcomes of this randomised controlled trial have been previously published. The trial was registered with the Australian New Zealand Clinical Trial Registry: ACTRN12615001075572, https://www.anzctr.org.au/on13/10/2015 .
期刊介绍：
Nutrition Journal publishes surveillance, epidemiologic, and intervention research that sheds light on i) influences (e.g., familial, environmental) on eating patterns; ii) associations between eating patterns and health, and iii) strategies to improve eating patterns among populations. The journal also welcomes manuscripts reporting on the psychometric properties (e.g., validity, reliability) and feasibility of methods (e.g., for assessing dietary intake) for human nutrition research. In addition, study protocols for controlled trials and cohort studies, with an emphasis on methods for assessing dietary exposures and outcomes as well as intervention components, will be considered.
Manuscripts that consider eating patterns holistically, as opposed to solely reductionist approaches that focus on specific dietary components in isolation, are encouraged. Also encouraged are papers that take a holistic or systems perspective in attempting to understand possible compensatory and differential effects of nutrition interventions. The journal does not consider animal studies.
In addition to the influence of eating patterns for human health, we also invite research providing insights into the environmental sustainability of dietary practices. Again, a holistic perspective is encouraged, for example, through the consideration of how eating patterns might maximize both human and planetary health.
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