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A Daily Snack Containing Leafy Green Vegetables, Fruit, and Milk before and during Pregnancy Prevents Gestational Diabetes in a Randomized, Controlled Trial in Mumbai, India.

ABSTRACT: Prospective observational studies suggest that maternal diets rich in leafy green vegetables and fruit may help prevent gestational diabetes mellitus (GDM).Our objective was to test whether increasing women's dietary intake of leafy green vegetables, fruit, and milk before conception and throughout pregnancy reduced their risk of GDM.Project SARAS ("excellent") (2006-2012) was a nonblinded, individually randomized, controlled trial in women living in slums in the city of Mumbai, India. The interventions included a daily snack made from leafy green vegetables, fruit, and milk for the treatment group or low-micronutrient vegetables (e.g., potato and onion) for the control group, in addition to the usual diet. Results for the primary outcome, birth weight, have been reported. Women were invited to take an oral-glucose-tolerance test (OGTT) at 28-32 wk gestation to screen for GDM (WHO 1999 criteria). The prevalence of GDM was compared between the intervention and control groups, and Kernel density analysis was used to compare distributions of 120-min plasma glucose concentrations between groups.Of 6513 women randomly assigned, 2291 became pregnant; of these, 2028 reached a gestation of 28 wk, 1008 (50%) attended for an OGTT, and 100 (9.9%) had GDM. In an intention-to-treat analysis, the prevalence of GDM was reduced in the treatment group (7.3% compared with 12.4% in controls; OR: 0.56; 95% CI: 0.36, 0.86; P = 0.008). The reduction in GDM remained significant after adjusting for prepregnancy adiposity and fat or weight gain during pregnancy. Kernel density analysis showed that this was explained by the fact that fewer women in the treatment group had a 2-h glucose concentration in the range 7.5-10.0 mmol/L.In low-income settings, in which women have a low intake of micronutrient-rich foods, improving dietary micronutrient quality by increasing intake of leafy green vegetables, fruit, and/or milk may have an important protective effect against the development of GDM. This trial was registered at www.controlled-trials.com as ISRCTN62811278.

SUBMITTER: Sahariah SA

PROVIDER: S-EPMC4926846 | biostudies-literature | 2016 Jul

REPOSITORIES: biostudies-literature

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A Daily Snack Containing Leafy Green Vegetables, Fruit, and Milk before and during Pregnancy Prevents Gestational Diabetes in a Randomized, Controlled Trial in Mumbai, India.

Sahariah Sirazul A SA Potdar Ramesh D RD Gandhi Meera M Kehoe Sarah H SH Brown Nick N Sane Harshad H Coakley Patsy J PJ Marley-Zagar Ella E Chopra Harsha H Shivshankaran Devi D Cox Vanessa A VA Jackson Alan A AA Margetts Barrie M BM Fall Caroline Hd CH

The Journal of nutrition 20160608 7

<h4>Background</h4>Prospective observational studies suggest that maternal diets rich in leafy green vegetables and fruit may help prevent gestational diabetes mellitus (GDM).<h4>Objective</h4>Our objective was to test whether increasing women's dietary intake of leafy green vegetables, fruit, and milk before conception and throughout pregnancy reduced their risk of GDM.<h4>Methods</h4>Project SARAS ("excellent") (2006-2012) was a nonblinded, individually randomized, controlled trial in women li ...[more]

PMID: 27281802

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Project description:BACKGROUND:Different diets during pregnancy might have an impact on the health, reflected in the birthweight of newborns. The consumption of fruits and vegetables during pregnancy and the relationship with newborn health status have been studied by several authors. However, these studies have shown inconsistent results. PURPOSE:We assessed whether certain foods were related to the risk of small for gestational age (SGA). METHODS:A matched by age (± 2?years) and hospital 1:1 case-control study of 518 pairs of pregnant Spanish women in five hospitals was conducted. The cases were women with an SGA newborn at delivery (neonates weighting less than the 10th percentile, adjusted for gestational age at delivery and sex, were diagnosed as SGA). The control group comprised women giving birth to babies adequate for gestational age (AGA). Mothers who gave birth to babies large for gestational age (LGA) were excluded. Data were gathered concerning demographic characteristics, socioeconomic status, toxic habits and diet. A food frequency questionnaire (FFQ) comprising 137 items was completed by all participants. The intake of vegetables, legumes and fruits was categorized in quintiles (Q1-Q5). Crude values and and adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression. The variables for adjustment were as follows: preeclampsia, education, smoking, weight gain per week during pregnancy, fish intake and previous preterm/low birthweight newborns. RESULTS:Total pulse intake showed an inverse association with the risk of SGA (trend p?=?0.02). Women with an intake of fruits above 420?g/day (Q5), compared with women in Q1 (? 121?g/day) showed a decreased risk of SGA (AOR?=?0.63, 95% CI?=?0.40-0.98). The total consumption of vegetables was not associated with the risk of SGA. The intake of selenium was assessed: a protective association was observed for Q3-5; a daily intake above 60??g was associated with a lower risk of SGA (AOR?=?0.39, 95% CI: 0.22-0.69). CONCLUSIONS:Fruits, pulses and selenium reduce the risk of SGA in Spanish women.

Project description:PurposeSeveral frameworks coincide in the importance of addressing social impacts to ensure sustainability. However, the agri-food sector, regarded as key in sustainable production, still neglects to identify potential social impacts when applying life cycle approaches. This work contributes to understanding the social performance of three agricultural products from a Latin American and Caribbean developing country as Costa Rica while recognising the challenges of Social-Life Cycle Assessment (S-LCA) application in this context.MethodsS-LCA represents a powerful technique to evaluate the potential social impacts of a product. Three case studies were analysed through S-LCA, using the subcategory assessment method (SAM) to characterise the social impacts and detect hotspots in the production of green coffee, raw milk and leafy vegetables. Primary data was collected through questionnaires to relevant informants and observations. In addition to secondary information, these data and information were used to assess eight impact subcategories for the farmer and worker stakeholder groups and nine subcategories for the local community.Results and discussionThe main results suggest that the Costa Rican institutional and market frameworks provide an enabling environment for a generally positive social performance in the studied cases. The assessed stakeholders can fulfil basic needs through access to inputs and services and achieve fair-trading conditions. Child labour, forced labour and evidence of environmental or health risks for the surrounding communities were absent. Important efforts to address the delocalisation, migration and child labour were observed, suggesting the potential development of social handprints in further studies. However, the farm production phase, related to farmers and workers, entails hotspots regarding social security and women's empowerment. Moreover, farmers appear as the most vulnerable group because of their overall social performance.ConclusionsS-LCA helped identify relevant areas of intervention in the context of these particular case studies; however, further research and capacity building are recommended to tackle the detected challenges, both in the agri-food chains and in the use of S-LCA. Furthermore, these findings can aid in future decision and policy-making to improve and safeguard the positive social performance observed in the studied products.Supplementary informationThe online version contains supplementary material available at 10.1007/s11367-021-01964-4.

Dataset Information

A Daily Snack Containing Leafy Green Vegetables, Fruit, and Milk before and during Pregnancy Prevents Gestational Diabetes in a Randomized, Controlled Trial in Mumbai, India.

Publications

A Daily Snack Containing Leafy Green Vegetables, Fruit, and Milk before and during Pregnancy Prevents Gestational Diabetes in a Randomized, Controlled Trial in Mumbai, India.

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