Dietary Quality and Cardiometabolic Risk after Gestational Diabetes Pubblico
Ferranti, Erin (2013)
Abstract
Background : Women with previous gestational diabetes mellitus (pGDM) are at significant risk for the development of type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS). Healthy diets, particularly the Alternate Healthy Eating Index (AHEI) dietary pattern is protective for disease development, but women with pGDM have suboptimal diet quality. Few studies have investigated the influences of diet quality in women with pGDM.
Purpose : This study examined individual, family, and social-level influences of diet quality. An exploratory focus assessed cardiometabolic risk status in relationship to AHEI diet quality.
Sample and Design : This was a cross-sectional descriptive study guided by a synthesis of the Health Belief Model and the ecological framework for eating behavior. Women aged 18-45 years, within five years of their pGDM pregnancy, completed questionnaires about demographic factors, individual perceptions of risk, benefits and barriers to healthy eating, dietary self-efficacy, general social support, components of family functioning, and habitual dietary intake. A basic cardiometabolic health assessment was performed to determine the presence of MetS or T2DM risk defined by abnormal hemoglobin A1C values. Analyses included descriptive, bivariate, multivariate linear and logistic regression.
Results : Participants (n = 75) included women (55% Minority) who were within a mean of 2.6 years since their pGDM pregnancy. AHEI diet quality was suboptimal (M = 47.6, SD = 14.3). Individual factors that significantly predicted better AHEI diet quality were higher levels of education status and dietary self-efficacy (R2 = .36, F(6, 66) = 6.19, p = <.0001). No social or family-level factor predicted diet quality beyond the individual factors. Nearly half (47%) had abnormal hemoglobin A1C levels, and 19% were at risk for MetS. AHEI diet quality was not associated with risk for either T2DM or MetS.
Discussion : These findings highlight the prevalence of cardiometabolic risk factors, the suboptimal AHEI diet quality, and the modifiable influences that contribute to AHEI dietary quality in women with pGDM. Interventions designed to improve diet quality in women with pGDM should incorporate enhancing dietary self-efficacy. This study provides a foundation to further investigate dietary influences in a longitudinally designed study to assess the causal direction of the associations.
Table of Contents
Chapter 1 - Introduction.....................................................................................................................................................................1
Figure 1.1 Synthesis of the Health Belief Model and the
Ecological Framework for Eating Influences
.............................................................8
Table 1.2 AHEI Scoring
Criteria..........................................................................................................................................................40
Table 1.3 Variables, Instruments and
Reliability...................................................................................................................................43
Figure 2.1 Intrapersonal Influences of Diet Quality in
Women with
pGDM...............................................................................................116
Table 2.1 Characteristics of the
Sample.............................................................................................................................................117
Table 2.2 AHEI Scoring Method and Total
Scores................................................................................................................................118
Table 2.3 Participant Scores on Intrapersonal
Measures.......................................................................................................................119
Table 2.5 Multiple Linear Regression Analyses Summary
for IntrapersonalVariables and AHEI Diet
Quality.................................................121
Figure 3.1 Inter- and Intrapersonal Influences of Diet
Quality in Women with
pGDM................................................................................152
Table 3.1 Characteristics of the Sample.............................................................................................................................................153
Table 3.2 AHEI Scoring Method and Total Scores................................................................................................................................154
Table 3.3 Participant Scores on Individual, Family,
and Social
Measures................................................................................................155
Table 3.4 Summary of Bivariate Associations with AHEI
Diet
Quality.....................................................................................................156
Table 3.5 Multiple Linear Regression Analyses Summary for Family
and Social Influences on AHEI Diet
Quality...........................................157
Table 3.6 What is
New?...................................................................................................................................................................158
Additional
Tables............................................................................................................................................................................159
Chapter 4 - Diet Quality and Cardio-metabolic Risk in Women with a
Recent History of Gestational
Diabetes..............................................162
Table 4.1 Characteristics of the
Sample.............................................................................................................................................200
Table 4.2 Clinical Characteristics of
Participants..................................................................................................................................201
Table 4.3 AHEI Scoring Method and Total
Scores................................................................................................................................202
Table 4.4 Summary of Bivariate Associations with AHEI
Diet
Quality.....................................................................................................203
Table 4.5 Logistic Regression Analysis for AHEI Diet Quality
and Metabolic
Syndrome.............................................................................204
Table 4.6 Logistic Regression Analysis for AHEI Diet Quality and
T2DM
Risk...........................................................................................205
Appendix A - Institutional Review Board Documents
Emory IRB Approval Letter
Written Informed Consent
HIPAA Authorization Spanish-version Verbal Informed Consent Spanish-version Written Informed Consent Spanish-version HIPAA Authorization Appendix B - Recruitment Strategies General Flyer Spanish-version General Flyer Tabbed Flyer Spanish-version Tabbed Flyer Trifold FlyerSpanish-version Trifold Flyer
Emory Healthcare Phone-Wait Script
Emory Clinic Letter of Study Invitation Grady Health System Letter of Study Invitation Medical Chart FlyerSpanish-version Medical Chart Flyer Facebook Survey Monkey Questionnaire Email Response for Survey Monkey Study Appointment Letter
Appendix C - Permissions
Permission for Figure Use and Adaptation
Permission for use of Barriers to Healthy Eating Scale
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