Correlation Between Dietary N-6/n-3 Polyunsaturated Fatty Acid Ratio And Gestational Diabetes Mellitus In Pregnant Women

Background Gestational diabetes mellitus(GDM)refers to hyperglycemia caused by impaired glucose tolerance for the first time during pregnancy,and is a common complication of pregnancy.Due to changes in dietary patterns and other factors,the incidence of GDM is increasing year by year.Dietary n-6 polyunsaturated fatty acids(n-6 PUFA)and dietary n-3 polyunsaturated fatty acids(n-3 PUFA)are important nutrients.Its ratio has the effect of regulating the level of inflammation in the body.With the changes in the dietary structure of residents,the dietary intake of n-6 PUFAs increased and the intake of n-3 PUFAs decreased,resulting in an increase in the dietary n-6/n-3 PUFA ratio.Too much dietary n-6/n-3 PUFA ratio can easily promote chronic low-grade inflammation in the body,thereby affecting insulin sensitivity and insulin resistance(IR).The current research mainly focuses on the general population,and there is still a lack of research on the relationship between the n-6/n-3 PUFA ratio and GDM in pregnant women,especially during pregnancy.Therefore,this study aims to understand the intake of n-6/n-3 PUFA ratios and influencing factors in three different pregnancy diets of Chinese pregnant women through a cross-sectional study;to explore the relationship between dietary n-6/n-3 PUFA ratios and GDM through a cohort study.The association provides a basis for medical staff to provide targeted pregnancy dietary nutrition guidance to pregnant women,so as to promote healthy diet during pregnancy.Part Ⅰ The ratio of n-6/n-3 PUFA intake of pregnant women during different pregnancy periods and its influencing factorsObjective To understand the dietary n-6/n-3 PUFA intake of pregnant women in the first trimester,the second trimester,and the third trimester;analyze the influencing factors of the diet n-6/n-3 PUFA ratio.Methods A cross-sectional study was used to select 100 pregnant women in the first trimester,100 pregnant women in the second trimester,and 100 pregnant women in the third trimester who were undergoing regular birth check-ups in a community and a hospital in Hefei City,Anhui Province from September 2019 to January 2021.The general situation questionnaire is used to investigate the age,height,pre-pregnancy weight,pre-pregnancy BMI,family disease history,diet and other data;The dietary intake of three pregnant women was measured by a 3-day 24-hour(3d24h)diet review method.Food ingredients are calculated using the Chinese Food Ingredient List(Standard Edition)(6th Edition).Collect pregnancy outcome and other data of pregnant women.Use the chi-square test and analysis of variance to analyze the basic data of the three groups of survey subjects,the single factor analysis of diet n-6/n-3PUFA,the non-parametric test for the measurement data and grade data that do not conform to the normal distribution,and the chi-square for the count data Test,Logistic regression analysis of independent variables with statistical significance in univariate analysis.Results(1)The daily dietary energy and nutrient intake in the second trimester were higher than the first trimester and the third trimester.The difference between the three groups was statistically significant(P<0.05);the carbohydrate energy supply ratio during the three trimesters was lower than the recommended standard,and the fat energy supply ratio Higher than the recommended standard,protein energy supply ratio is within the recommended standard;(2)The daily intake of dietary sources is basically within the recommended range of the diet pagoda: cereals,poultry meat,eggs,soybeans and their products,and nuts;the daily intake of dietary sources is less than the recommended intake of the diet pagoda including: potatoes,fruits,vegetables,fish and shrimp,milk;(3)The intakes of PUFA,linoleic acid(ALA),eicosapentaenoic acid(EPA),PUFA n-3,linoleic acid(LA),arachidonic acid(AA)and PUFA n-6 in the three groups during different gestational periods were p > 0.05,with no significant difference.Dietary intake of docosahexaenoic acid(DHA),monounsaturated fatty acid(MUFA),saturated fatty acid(SFA)and fatty acid was significantly higher than that of the three groups(p <0.05);(4)The first trimester diet n-6/n-3 PUFA ratio is5.72±2.73,the second trimester diet n-6/n-3 PUFA ratio is 5.66±2.38,and the third trimester diet n-6/n-3 PUFA ratio is 6.11±2.43.Slightly higher than the recommended ratio of the general population(4-6),the difference between the three groups was not statistically significant(P>0.05);(5)Edible oils,poultry and livestock and cereals are the main sources of n-6 PUFA for pregnant women’s diet,while edible oils,poultry and livestock and nuts are the main sources of n-3 PUFA for pregnant women’s diet;(6)The dietary preferences of pregnant women,n-3 PUFA supplements,dietary SFA and dietary n-3 PUFA intake are factors that influence the ratio of dietary n-6/n-3 PUFA,supplements of n-3 PUFA supplements,dietary intake of n-3 PUFA is a protective factor for the ratio n-6/n-3 PUFA.Fatty diet and excessive intake of dietary SFA may lead to an increase in the ratio of dietary n-6/n-3 PUFA in pregnant women.Part Ⅱ A cohort study on the association between the ratio of dietary n-6/n-3polyunsaturated fatty acids and gestational diabetesObjective To investigate the association between dietary n-6/n-3 PUFA ratio and gestational diabetes mellitusMethods The cohort study selected 100 cases of pregnant women with a gestational13 before the weekend from September 2019 to January 2021 in a community in Hefei City,Anhui Province,and included them in the cohort study.After enrollment,the general situation questionnaire was used to investigate the general demography of pregnant women Characteristics and eating behaviors,the pure food intake and nutritional supplement intake of pregnant women were collected using a 3d 24 h questionnaire from 16 to 18 weeks gestation.Analyze the basic conditions of pregnant women in the GDM group and non-GDM group using t test and chi-square test,and refer to the "Chinese Resident Dietary Guidelines 2016" to divide the dietary n-6/n-3PUFA ratio into diet n-6/n-3 PUFA ratio ≤ 6 and dietary n-6/n-3 PUFA ratio> 6 groups,using t-test and chi-square test to analyze the difference between the two groups,at the same time,the n-6/n-3 PUFA ratio of pure food sources and the total diet n-6including supplements were included in the binary logistic regression analysis.The odds ratio(OR)and the 95% confidence interval(95% CI)were calculated after adjusting for possible confounding factors,to explore the relationship between the n-6/n-3 PUFA ratio and the risk of GDM.Results(1)This study included 100 pregnant women for analysis,of which 22 were diagnosed with GDM,the incidence rate was 22.0%,the ratio of n-6/n-3 PUFA in the control group was 6.11±2.64,and the ratio of n-6/n-3PUFA in the GDM group was pure food.3 The PUFA ratio was 9.52±4.54,the proportion of GDM was significantly higher than that of the control group(p <0.05),the proportion of n-6/n-3 PUFA in the control group was 5.63 ± 2.12,the proportion of n-6/n-3 PUFA in the GDM group was 8.35 ± 3.45,the proportion of GDM was higher than that of the control group(p<0.05);(2)After the binary logistic regression model was used to adjust the age of pregnant women,pre-pregnancy BMI,primipara,family history of diabetes,passive smoking,physical activity during pregnancy and dietary energy,the results showed that the ratio of n-6/n-3 PUFA and GDM of pure food before and after adjustment,there is no statistical correlation with the risk of occurrence.Compared with the group with pure food n-6/n-3 PUFA ratio ≤6,the OR value and 95% CI of the group with pure food n-6/n-3 PUFA ratio> 6 were 2.143(95%CI 0.788 ～ 5.830),2.258(95%CI 0.806 ～ 6.321),2.876(95%CI 0.944 ～ 8.767);(3)After using the binary logistic regression model to adjust the age of pregnant women,pre-pregnancy BMI,whether primiparous,family history of diabetes,passive smoking,physical activity during pregnancy,and dietary energy,the results show that: Compared with the diet n-6/n-3 PUFA ratio ≤ 6 group,the diet n-6/n-3 PUFA ratio> 6 groups have an OR value of 3.579(95%CI 1.201～10.661),3.588(95%CI 1.175～10.958),4.290(95%CI 1.303～14.124).Further taking the dietary n-6/n-3 PUFA ratio as a continuous independent variable,and GDM as the dependent variable analysis showed that the diet n-6/n-3 PUFA ratio is a risk factor for GDM(OR=1.495,95%CI: 1.204～1.857,P<0.05).Conclusion(1)There is no difference in dietary n-6/n-3 PUFA ratio in the first trimester,second trimester,and third trimester;(2)Edible oil and poultry meat are the main sources of diet n-6 PUFA and n-3 PUFA,and nuts are the main food sources of diet n-3 PUFA;(3)Pregnant women’s dietary preferences are greasy and excessive intake of dietary SFA may increase the ratio of n-6/n-3 PUFA in pregnant women’s diet.Supplementation of n-3 PUFA supplements and dietary n-3 PUFA intake may reduce the ratio;(4)The proportion of n-6/n-3 PUFA in GDM group was higher than that of non-GDM pregnant women;(5)The high ratio of n-6/n-3 PUFA in the total diet increases the risk of GDM.