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The role of dietary fiber on preventing gestational diabetes mellitus in an at-risk group of high triglyceride-glucose index women: a randomized controlled trial

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Abstract

Background

Pregnant women with a high triglyceride-glucose (TyG) index during early pregnancy may increase the risk of gestational diabetes mellitus (GDM), and dietary fiber could play an important role in glucose and lipid metabolism. However, no trials have tested the effects of dietary fiber on preventing GDM in women with a high TyG index. This study aims to investigate whether GDM can be prevented by dietary fiber supplementation in women with a TyG index ≥8.5 during early pregnancy (<20 weeks).

Methods

A randomized clinical trial was performed among 295 women with a TyG index ≥8.5 before 20 weeks of gestation, divided into a fiber group (24 g dietary fiber powder/day) or a control group (usual care). The intervention was conducted from 20 to 24+6 gestational weeks, and both groups received guidance on exercise and diet. The primary outcomes were the incidence of GDM diagnosed by a 75 g oral glucose tolerance test at 25–28 gestational weeks, and levels of maternal blood glucose, lipids. Secondary outcomes include gestational hypertension, postpartum hemorrhage, preterm birth, and other maternal and neonatal complications.

Results

GDM occurred at 11.2% (10 of 89) in the fiber group, which was significantly lower than 23.7 (44 of 186) in the control group (P = 0.015). The mean gestational weeks increased dramatically in the fiber group compared with the control group (39.07 ± 1.08 vs. 38.58 ± 1.44 weeks, P = 0.006). The incidence of preterm birth was 2.3% (2 of 86) of women randomized to the fiber group compared with 9.4% (17 of 181) in the control group (P = 0.032). The concentrations of 2 h postprandial blood glucose showed statistically higher in the control group compared with the intervention group (6.69 ± 1.65 vs. 6.45 ± 1.25 mmol/L, P = 0.026). There were no other significant differences between groups in lipid profile values, or other secondary outcomes.

Conclusion

An intervention with dietary fiber supplementation during pregnancy may prevent GDM and preterm birth in women with a TyG index ≥8.5 before 20 weeks of gestation.

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Data availability

The original data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors thank the contributions of all staff involved in the study within the Shanghai General Hospital, and all patients who volunteered to participate in the trial. The authors are grateful for financial support from the Shanghai Shenkang Hospital Development Center. The authors also acknowledge the Qingdao Nutrasumma Health Technology Co., Ltd for providing dietary fiber powder for at a 40 percent discount in supporting the study.

Funding

Project name: To promote clinical skills and clinical innovation ability of municipal hospitals: three-year action plan project. Project number: SHDC2020CR2060B. Setting: Shanghai Shenkang Hospital Development Center.

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Author notes

  1. These authors contributed equally: Yannan Cao, Jing Sheng, Dongyao Zhang

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, China

    Yannan Cao, Dongyao Zhang, Li Chen, Ying Jiang, Decui Cheng, Yao Su, Yuexin Yu, Haoyi Jia, Pengyuan He, Li Wang & Xianming Xu

  2. Department of Radiology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China

    Jing Sheng

  3. Department of Obstetrics and Gynecology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China

    Dongyao Zhang

  4. Nursing Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, China

    Ying Jiang

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Contributions

X.X. and Y.C. contributed to the concept and design of the study. D.Z., Y.C., L.C., Y.S., Y.J., and L.W. managed the clinical trial. D.C., H.J., P.H., and Y.Y. were responsible for collecting and analyzing the data. J.S. wrote the initial manuscript, and D.Z. contributed to the text revision. All authors read and approved the final version of the article.

Corresponding author

Correspondence to Xianming Xu.

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The authors declare no competing interests.

Ethical approval

This study involving human participants were reviewed and approved by the Ethics Committee of the Shanghai General Hospital of School of Medicine, Shanghai Jiao Tong University. The patients/participants provided their written informed consent to participate in this study.

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Cao, Y., Sheng, J., Zhang, D. et al. The role of dietary fiber on preventing gestational diabetes mellitus in an at-risk group of high triglyceride-glucose index women: a randomized controlled trial. Endocrine 82, 542–549 (2023). https://doi.org/10.1007/s12020-023-03478-5

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