Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Increased body fat percentage and physical inactivity are independent predictors of gestational diabetes mellitus in South Asian women

European Journal of Clinical Nutrition volume 61, pages 736–742 (2007)Cite this article

Abstract

Objective:

This study aims to identify lifestyle predictors of gestational diabetes mellitus (GDM) in South Asian women. Pre-gravid body mass index, body composition, rate of weight gain during pregnancy, physical activity (PA) and dietary intake were studied.

Design:

Prospective cohort study (n=611) of South Asian women at Aga Khan University Hospital antenatal clinic in Karachi, Pakistan. Weight, height and body fat % were measured and data on PA, diet and socio-economic covariates were collected at baseline. A glucose screen was performed at 29.8±2.6 weeks.

Results:

Using logistic regression analysis for the full cohort, the risk of GDM increased with older maternal age (odds ratio (OR) 1.13, confidence interval (CI) 1.06–1.21), increased body fat % (OR 1.07, CI 1.03–1.13) and the risk was inversely associated with PA (100 kcal) (OR 0.79–0.99, CI 0.89). Using a nested case (n=49) control (n=98) design to study dietary intake, the risk of GDM decreased with increasing protein (% energy) in the diet (OR 0.75, CI 0.60–0.95).

Conclusions:

Body fat %, physical inactivity and, possibly, diet quality are important modifiable risk factors for GDM.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  • American Diabetes Assoication (2004). Gestational diabetes mellitus. Diabetes Care 27, 885–890.

  • Banerji MA, Faridi N, Atluri R, Chaiken RL, Lebovitz HE (1999). Body composition, visceral fat, leptin, and insulin resistance in Asian Indian men. J Clin Endocrinol Metab 84, 137–144.

    CAS  PubMed  Google Scholar 

  • Ben-Haroush A, Yogev Y, Hod M (2004). Epidemiology of gestational diabetes mellitus and its association with type 2 diabetes. Diabet Med 21, 103–113.

    Article  CAS  Google Scholar 

  • Bhasin SK, Chaturvedi S, Gupta P, Aggarwal P (2001). Status of physical exercise and its association with obesity and hypertension in two urban assembly constituencies of East Delhi. J Indian Med Assoc 99, 631–633.

    CAS  PubMed  Google Scholar 

  • Cox-Reijven PL, Van Kreel B, Soeters PB (2002). Bio-electrical impedance spectroscopy: alternatives for the conventional hand-to-foot measurements. Clin Nutr 21, 127–133.

    Article  CAS  Google Scholar 

  • Dempsey JC, Sorensen TK, Williams MA, Lee IM, Miller RS, Dashow EE et al. (2004a). Prospective study of gestational diabetes mellitus risk in relation to maternal recreational physical activity before and during pregnancy. Am J Epidemiol 159, 663–670.

    Article  Google Scholar 

  • Dempsey JC, Sorensen TK, Lee IM, Thompson ML, Miller RS, Frederick IO et al. (2004b). A case control study of maternal recreational physical activity and risk of gestational diabetes mellitus. Diabetes Res Clin Pract 66, 203–215.

    Article  Google Scholar 

  • Demspey JC, Butler CL, Williams MA (2005). No need for a pregnant pause: physical activity may reduce the occurrence of gestational diabetes mellitus and preeclampsia. Exerc Sport Sci Rev 33, 141–149.

    Article  Google Scholar 

  • FAO and US Department of Agriculture A.R.S.2 (1982). Food Composition Tables for the Near East Accessed 1 October 2004.http://www.fao.org/docrep/003/X6879E/X6879E00.html.

  • Field AE, Coakley EH, Must A, Spadano JL, Laird N, Dietz WH et al. (2001) Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med 161, 1581–1586.

    Article  CAS  Google Scholar 

  • Gopalan C, Sastari R, Balasubramanian S (1991). Food composition tables. In: Narasinga Rao BS, Deothale YG, Pant KC (eds). Nutritive Value of Indian Foods revised edn. National Institute of Nutrition: Hyderabad, pp 45–80.

    Google Scholar 

  • Hussain T (2001). Prosimate composition mineral and vitamin content of food. In: Hussain T (ed). Food Composition Table for Pakistan, revised edn. Ministry of Planning and Development, Government of Pakistan: Islamabad, pp 5–38.

    Google Scholar 

  • Iqbal R, Rafique G, Badruddin S, Qureshi R, Gray-Donald K (2006). Validating MOSPA questionnaire for measuring physical activity in Pakistani women. Nutrition Journal 5, 18.

    Article  Google Scholar 

  • Jones D (1997). The Monica Optional Study of Physical Activity (MOSPA). Med Sci Sports Exerc 29 (Suppl), S162–S169. (Cited in ed. Kriska AM and Casperson CJ (1997). A collection of physical activity questionnaires for health related research. Med Sci Sports Exerc 29 (Suppl)).

    Google Scholar 

  • Jovanovic-Peterson L, Peterson CM (1996). Exercise and the nutritional management of diabetes during pregnancy. Obstet Gynecol Clin N Am 23, 75–86.

    Article  CAS  Google Scholar 

  • Judd PA, Kassam-Khamis T, Thomas J (2000). Food composition tables. In: Judd PA, Kassam-Khamis T, Thomas J (eds). The Composition and Nutrient Content of Foods Commonly Consumed by South Asians in the UK. The Aga Khan Health Board for the United Kingdom: Edinburgh, pp 15–64.

    Google Scholar 

  • Khine ML, Winklestein A, Copel JA (1999). Selective screening for gestational diabetes mellitus in adolescent pregnancies. Obstet Gynecol 93, 738–742.

    CAS  PubMed  Google Scholar 

  • Kieffer EC, Carman WJ, Gillespie BW, Nolan GH, Worley SE, Guzman JR (2001). Obesity and gestational diabetes among African-American women and Latinas in Detroit: implications for disparities in women's health. J Am Med Womens Assoc 56, 181–187, 196.

    CAS  Google Scholar 

  • Kjos SL, Peters RK, Xiang A, Thomas D, Schaefer U, Buchanan TA (1998). Contraception and the risk of type 2 diabetes mellitus in Latina women with prior gestational diabetes mellitus. JAMA 280, 533–538.

    Article  CAS  Google Scholar 

  • Laaksonen DE, Lindstrom J, Lakka TA, Eriksson JG, Niskanen L, Wikstrom K et al. (2005). Physical activity in the prevention of type 2 diabetes: the Finnish diabetes prevention study. Diabetes 54, 158–165.

    Article  CAS  Google Scholar 

  • Lindsay RS, Hanson RL, Bennett PH, Knowler WC (2000). Secular trends in birth weight, BMI, and diabetes in the offspring of diabetic mothers. Diabetes Care 23, 1249–1254.

    Article  CAS  Google Scholar 

  • Linne Y, Barkeling B, Rossner S (2002). Natural course of gestational diabetes mellitus: long term follow up of women in the SPAWN study. BJOG 109, 1227–1231.

    Article  Google Scholar 

  • Meltzer S, Leiter L, Daneman D, Gerstein HC, Lau D, Ludwig S et al. (1998). 1998 clinical practice guidelines for the management of diabetes in Canada. Canadian Diabetes Association. Can Med Assoc J 159, S1–S29.

    Google Scholar 

  • Molitch ME, Fujimoto W, Hamman RF, Knowler WC (2003). The diabetes prevention program and its global implications. J Am Soc Nephrol 14, S103–S107.

    Article  Google Scholar 

  • Persson B, Hanson U (1998). Neonatal morbidities in gestational diabetes mellitus. Diabetes Care 21 (Suppl), B79–B84.

    PubMed  Google Scholar 

  • Popkin BM (2002). The shift in stages of the nutrition transition in the developing world differs from past experiences!. Public Health Nutr 5, 205–214.

    PubMed  Google Scholar 

  • Ramachandaran A, Snehalatha C, Shobana R, Vidyavathi P, Vija V (1999). Influence of lifestyle factors in development of diabetes in Indians – scope of primary prevention. J Assoc Physicians India 47, 764–766.

    Google Scholar 

  • Rastogi T, Reddy KS, Vaz M, Spiegelman D, Prabhakaran D, Willett WC et al. (2004). Diet and risk of ischemic heart disease in India. Am J Clin Nutr 79, 582–592.

    Article  CAS  Google Scholar 

  • Saldana TM, Siega-Riz AM, Adair LS (2004). Effect of macronutrient intake on the development of glucose intolerance during pregnancy. Am J Clin Nutr 79, 479–486.

    Article  CAS  Google Scholar 

  • Salmeron J, Manson JE, Stampfer MJ, Colditz GA, Wing AL, Willett WC (1997). Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. JAMA 277, 472–477.

    Article  CAS  Google Scholar 

  • Schulze MB, Liu S, Rimm EB, Manson JE, Willett WC, Hu FB (2004). Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women. Am J Clin Nutr 80, 348–356.

    Article  CAS  Google Scholar 

  • Sermer M, Naylor CD, Farine D, Kenshole AB, Ritchie JW, Gare DJ et al. (1998). The Toronto Tri-Hospital gestational diabetes project. A preliminary review. Diabetes Care 21, B33–B42.

    PubMed  Google Scholar 

  • Shera AS, Rafique G, Khawaja IA, Baqai S, King H (1999a). Pakistan National Diabetes Survey: prevalence of glucose intolerance and associated factors in Baluchistan province. Diabetes Res Clin Pract 44, 49–58.

    Article  CAS  Google Scholar 

  • Shera AS, Rafique G, Khawaja IA, Baqai S, Khan IA, King H (1999b). Pakistan national diabetes survey prevalence of glucose intolerance and associated factors in North West Frontier Province (NWFP) of Pakistan. J Pak Med Assoc 49, 206–211.

    CAS  PubMed  Google Scholar 

  • Sohmiya M, Kanazawa I, Kato Y (2004). Seasonal changes in body composition and blood HbA1c levels without weight change in male patients with type 2 diabetes treated with insulin. Diabetes Care 27, 1238–1239.

    Article  Google Scholar 

  • Solomon CG, Willett WC, Carey VJ, Rich-Edwards J, Hunter DJ, Colditz GA et al. (1997). A prospective study of pregravid determinants of gestational diabetes mellitus. JAMA 278, 1078–1083.

    Article  CAS  Google Scholar 

  • US Department of Agriculture, A.R.S.2 [release 17] (2004). USDA National Nutrient Database for Standard Reference. Accessed 1 October 2004.http://www.nal.usda.gov/fnic/foodcomp.

  • Utter AC, Nieman DC, Ward AN, Butterworth DE (1999). Use of the leg-to-leg bioelectrical impedance method in assessing body-composition change in obese women. Am J Clin Nutr 69, 603–607.

    Article  CAS  Google Scholar 

  • Vierkant R, Terry MT, Kosanke J, James MN (1999). Mcstrat: a SAS macro to analyse data from a matches or finely stratified case control design. [online]. Available: URLhttp://mayoresearch.mayo.edu/mayo/research/biostat/upload/65.pdf(accessed: 01/04/06).

  • Wang Y, Storlien LH, Jenkins AB, Tapsell LC, Jin Y, Pan JF et al. (2000). Dietary variables and glucose tolerance in pregnancy. Diabetes Care 23, 460–464.

    Article  CAS  Google Scholar 

  • WHO (2002). Fact sheet No. 138. Available online, 2002. Available fromhttp://www.who.int/mediacentre/factsheets/fs138/en/(Accessed 12 July 2004).

  • World Health Organization (1999). Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Part 1: Diagnosis and Classification of Diabetes Mellitus. Report of a WHO consultation. World Health Organization, Department of Non communicable Disease Surveillance.

  • Zhang S, Folsom AR, Flack JM, Liu K (1995). Body fat distribution before pregnancy and gestational diabetes: findings from coronary artery risk development in young adults (CARDIA) study. BMJ 311, 1139–1140.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

Research grant for this study was received from the Aga Khan University's Research Council, Pakistan. RI is the recipient of the Canadian Commonwealth Scholarship during her doctoral studies at McGill, Canada. The contributors thank Dr Arriaza at the Centers for Disease Control and Prevention (CDC) for providing the MOSPA algorithm for analysis of our physical activity data. We also thank Dr Fareeha Warsi for data collection and Louise Johnson-Down for help in dietary analysis.

Author information

Authors and Affiliations

  1. Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, Canada

    R Iqbal

  2. Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan

    G Rafique, S Badruddin & R Qureshi

  3. Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan

    G Rafique, S Badruddin & R Qureshi

  4. Department of Animal Science, McGill University, Montreal, Canada

    R Cue

  5. School of Dietetics and Human Nutrition, McGill University, Montreal, Canada

    K Gray-Donald

Authors
  1. R Iqbal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G Rafique
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S Badruddin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R Qureshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R Cue
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. K Gray-Donald
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K Gray-Donald.

Additional information

Guarantors: R Iqbal and K Gray-Donald.

Contributors: RI contributed to the conception and design of the study, coordinated data collection, conducted data analysis and wrote the paper. GR, SB and RQ aided in design and data collection as well as provided comments on the paper. RC provided significant consultation in the statistical analysis and interpretation of results. KGD contributed to the conception, design and analysis of the data, and the writing of the paper.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Iqbal, R., Rafique, G., Badruddin, S. et al. Increased body fat percentage and physical inactivity are independent predictors of gestational diabetes mellitus in South Asian women. Eur J Clin Nutr 61, 736–742 (2007). https://doi.org/10.1038/sj.ejcn.1602574

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1602574

Keywords

This article is cited by

Search

Advanced search

Quick links