European Journal of Nutrition

, Volume 58, Issue 3, pp 1081–1094 | Cite as

Macronutrient composition and food groups associated with gestational weight gain: the GUSTO study

  • Jun S. Lai
  • Shu E. Soh
  • See Ling Loy
  • Marjorelee Colega
  • Michael S. Kramer
  • Jerry K. Y. Chan
  • Thiam Chye Tan
  • Lynnette P. C. Shek
  • Fabian K. P. Yap
  • Kok Hian Tan
  • Keith M. Godfrey
  • Yap Seng Chong
  • Mary F. F. ChongEmail author
Original Contribution



To examine the associations of energy, macronutrient and food intakes with GWG on 960 pregnant women from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) mother-offspring cohort.


Dietary intake was assessed at 26–28 weeks’ gestation with a 24-hour recall and 3-day food diary. GWG z-scores were calculated from first (4–13 weeks’ gestation) and last (30–40 weeks gestation) measured weights; inadequate and excessive GWG were defined using the Institute of Medicine recommendations based on weights between 15 and 35 weeks’ gestation. Associations were examined using substitution models for macronutrient composition, with linear or multinomial logistic regressions.


Mean ± SD daily energy intake was 1868 ± 598 kcal, and percentage energy intakes were 51.8 ± 8.9% from carbohydrate, 15.7 ± 3.9% from protein and 32.6 ± 7.7% from fat. Higher energy intake (per 500 kcal increment) was associated with 0.18 SD higher GWG. In isocaloric diets, higher-carbohydrate and lower-fat intakes (at 5% energy substitution) were associated with 0.07 SD higher GWG, and 14% higher likelihood of excessive GWG. Concordantly, the highest tertile of carbohydrate-rich foods intake was associated with 0.20 SD higher GWG, but the highest tertile of fruit and vegetable intake was independently associated with 60% lower likelihood of inadequate GWG. Additionally, the highest tertile of dairy intake was associated with 0.18 SD lower GWG; and the highest tertile of plant-based protein foods intake was associated with 60% and 34% lower likelihood of inadequate and excessive GWG.


Balancing the proportions of carbohydrates and fat, and a higher intake of plant-based protein foods may be beneficial for achieving optimal GWG.


Energy Macronutrients Food group Pregnancy Gestational weight gain 



This research is supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health’s National Medical Research Council (NMRC), Singapore—NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014. Additional funding is provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), and Nestec. KMG is supported by the National Institute for Health Research through the NIHR Southampton Biomedical Research Centre and by the European Union’s Seventh Framework Programme (FP7/2007–2013), projects Early Nutrition and ODIN under grant agreement numbers 289346 and 613977. We will like to acknowledge the contribution of the GUSTO study group: Allan Sheppard, Amutha Chinnadurai, Anne Eng Neo Goh, Anne Rifkin-Graboi, Anqi Qiu, Arijit Biswas, Bee Wah Lee, Birit F.P. Broekman, Boon Long Quah, Borys Shuter, Chai Kiat Chng, Cheryl Ngo, Choon Looi Bong, Christiani Jeyakumar Henry, Cornelia Yin Ing Chee, Yam Thiam Daniel Goh, Doris Fok, Fabian Yap, George Seow Heong Yeo, Helen Chen, Hugo P S van Bever, Iliana Magiati, Inez Bik Yun Wong, Ivy Yee-Man Lau, Jeevesh Kapur, Jenny L. Richmond, Jerry Kok Yen Chan, Joanna D. Holbrook, Joshua J. Gooley, Keith M. Godfrey, Kenneth Kwek, Kok Hian Tan, Krishnamoorthy Niduvaje, Leher Singh, Lin Lin Su, Lourdes Mary Daniel, Lynette Pei-Chi Shek, Marielle V. Fortier, Mark Hanson, Mary Foong-Fong Chong, Mary Rauff, Mei Chien Chua, Michael Meaney, Mya Thway Tint, Neerja Karnani, Ngee Lek, Oon Hoe Teoh, P. C. Wong, Peter D. Gluckman, Pratibha Agarwal, Rob M. van Dam, Salome A. Rebello, Seang-Mei Saw, Shang Chee Chong, Shirong Cai, Shu-E Soh, Sok Bee Lim, Chin-Ying Stephen Hsu, Victor Samuel Rajadurai, Walter Stunkel, Wee Meng Han, Wei Wei Pang, Yap-Seng Chong, Yin Bun Cheung, Yiong Huak Chan and Yung Seng Lee.

Author contributions

JSL and MFFC designed the research, wrote the manuscript and had primary responsibility of final content. SES, SLL, MC conducted research and contributed to data analysis. JSL performed statistical analysis. LPCS, FKPY, KHT, PDG, KMG and YSC designed and led the GUSTO study. All authors were involved in study conception and data interpretation, critically reviewed the manuscript for intellectual content, read and approved the final manuscript.

Compliance with ethical standards

Ethical standards

The GUSTO study has received ethical approval from the Institutional Review Board of KKH and NUH, and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Written informed consent was obtained from all study participants prior to their inclusion in the study.

Conflict of interest

PDG, KMG and YSC have received reimbursement for speaking at conferences sponsored by companies selling nutritional products. These authors are part of an academic consortium that has received research funding from Abbot Nutrition, Nestec, and Danone. All other authors declare that they have no conflict of interest.

Supplementary material

394_2018_1623_MOESM1_ESM.docx (37 kb)
Supplementary material 1 (DOCX 36 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Jun S. Lai
    • 1
  • Shu E. Soh
    • 1
  • See Ling Loy
    • 2
  • Marjorelee Colega
    • 1
  • Michael S. Kramer
    • 3
    • 4
  • Jerry K. Y. Chan
    • 2
    • 5
  • Thiam Chye Tan
    • 6
  • Lynnette P. C. Shek
    • 1
    • 7
  • Fabian K. P. Yap
    • 5
    • 8
  • Kok Hian Tan
    • 9
  • Keith M. Godfrey
    • 10
  • Yap Seng Chong
    • 1
    • 3
  • Mary F. F. Chong
    • 1
    • 11
    Email author
  1. 1.Singapore Institute of Clinical Sciences, Agency for Science, Technology and ResearchSingaporeSingapore
  2. 2.Department of Reproductive MedicineKK Women’s and Children’s HospitalSingaporeSingapore
  3. 3.Departments of Obstetrics and Gynaecology, Yong Loo Lin School of MedicineNational University of Singapore and National University Health SystemSingaporeSingapore
  4. 4.Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, Faculty of MedicineMcGill UniversityCanadaUSA
  5. 5.Duke-NUS Medical SchoolSingaporeSingapore
  6. 6.Department of Obstetrics and GynaecologyKK Women’s and Children’s HospitalSingaporeSingapore
  7. 7.Department of Paediatrics, Yong Loo Lin School of MedicineNational University of Singapore and National University Health SystemSingaporeSingapore
  8. 8.Department of Paediatric EndocrinologyKK Women’s and Children’s HospitalSingaporeSingapore
  9. 9.Department of Maternal Fetal MedicineKK Women’s and Children’s HospitalSingaporeSingapore
  10. 10.MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
  11. 11.Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore

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