title: Prepregnancy dietary protein intake, major dietary protein sources, and the risk of gestational diabetes mellitus: a prospective cohort study.
abstract: OBJECTIVE
  Dietary protein is an important modulator of glucose metabolism. However, studies regarding the association between dietary protein intake and gestational diabetes mellitus (GDM) risk are sparse. This study was to examine the association.
  
  
  METHODS
  Our study included 21,457 singleton pregnancies reported among 15,294 participants of the Nurses' Health Study II cohort between 1991 and 2001. Included pregnancies were free of chronic diseases before pregnancy or previous GDM. Generalized estimating equations were used to estimate the relative risks (RRs) and 95% CIs.
  
  
  RESULTS
  After adjustment for age, parity, nondietary and dietary factors, and BMI, multivariable RRs (95% CIs) comparing the highest with lowest quintiles were 1.49 (1.03-2.17) for animal protein intake and 0.69 (0.50-0.97) for vegetable protein intake. The substitution of 5% energy from vegetable protein for animal protein was associated with a 51% lower risk of GDM (RR [95% CI], 0.49 [0.29-0.84]). For major dietary protein sources, multivariable RRs (95% CIs) comparing the highest with the lowest quintiles were 2.05 (1.55-2.73) for total red meat and 0.73 (0.56-0.95) for nuts, respectively. The substitution of red meat with poultry, fish, nuts, or legumes showed a significantly lower risk of GDM.
  
  
  CONCLUSIONS
  Higher intake of animal protein, in particular red meat, was significantly associated with a greater risk of GDM. By contrast, higher intake of vegetable protein, specifically nuts, was associated with a significantly lower risk. Substitution of vegetable protein for animal protein, as well as substitution of some healthy protein sources for red meat, was associated with a lower risk of GDM.
authors: Epidemiology Branch, Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland, USA.
authors: Wei
authors: W
authors: Bao
authors: Katherine
authors: K
authors: Bowers
authors: Deirdre K
authors: DK
authors: Tobias
authors: Frank B
authors: FB
authors: Hu
authors: Cuilin
authors: C
authors: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000453:epidemiology*; D004044:Dietary Proteins / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008460:Meat; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D004044:Dietary Proteins
references: Amino Acids. 2012 Jul;43(1):171-81
references: 21984377
references: Arch Intern Med. 2006 Mar 13;166(5):543-8
references: 16534041
references: JAMA. 2002 Nov 27;288(20):2554-60
references: 12444862
references: Diabetes Care. 2004 Jan;27 Suppl 1:S88-90
references: 14693936
references: Diabetologia. 2006 Nov;49(11):2604-13
references: 16957814
references: J Nutr. 2009 Oct;139(10):1956-63
references: 19710161
references: Epidemiology. 1990 Nov;1(6):466-73
references: 2090285
references: Stat Med. 1997 Jul 15;16(13):1515-27
references: 9249922
references: Br J Nutr. 2010 Aug;104(4):465-73
references: 20441672
references: N Engl J Med. 1997 Nov 20;337(21):1491-9
references: 9366580
references: Public Health Nutr. 2011 Apr;14(4):575-83
references: 21070685
references: N Engl J Med. 2008 May 8;358(19):1991-2002
references: 18463375
references: Diabetes Care. 2006 Oct;29(10):2223-30
references: 17003297
references: Nat Rev Endocrinol. 2012 Nov;8(11):639-49
references: 22751341
references: N Engl J Med. 2011 Jun 23;364(25):2392-404
references: 21696306
references: Int J Epidemiol. 1994 Oct;23(5):991-9
references: 7860180
references: Circulation. 2010 Aug 31;122(9):876-83
references: 20713902
references: Diabetes Care. 2010 Jan;33(1):43-8
references: 19825820
references: Am J Clin Nutr. 2011 Oct;94(4):1088-96
references: 21831992
references: Lancet. 2009 May 23;373(9677):1773-9
references: 19465232
references: Am J Clin Nutr. 2008 Jan;87(1):162-7
references: 18175751
references: Lancet. 2009 May 23;373(9677):1789-97
references: 19465234
references: Am J Epidemiol. 1999 Mar 15;149(6):531-40
references: 10084242
references: Cell Metab. 2009 Apr;9(4):311-26
references: 19356713
references: Annu Rev Nutr. 2007;27:293-310
references: 17666010
references: Diabetologia. 2010 Apr;53(4):757-67
references: 20076942
references: Arch Intern Med. 2012 Apr 9;172(7):555-63
references: 22412075
references: Int J Epidemiol. 1989 Dec;18(4):858-67
references: 2621022
references: Am J Epidemiol. 1985 Jul;122(1):51-65
references: 4014201
references: Nutrition. 2006 Nov-Dec;22(11-12):1162-70
references: 16979322
references: Nat Med. 2011 Apr;17(4):448-53
references: 21423183
references: Diabetologia. 2000 Oct;43(10):1257-65
references: 11079744
references: Am J Clin Nutr. 1999 Aug;70(2):221-7
references: 10426698
references: JAMA. 1997 Oct 1;278(13):1078-83
references: 9315766
references: Am J Clin Nutr. 2011 Dec;94(6 Suppl):1975S-1979S
references: 21613563
references: Stroke. 2012 Mar;43(3):637-44
references: 22207512
references: Eur J Clin Nutr. 2006 Mar;60(3):364-71
references: 16340954
references: Diabetes Care. 2006 Apr;29(4):948-9
references: 16567851
references: Am J Epidemiol. 1988 Jan;127(1):188-99
references: 3337073
references: Am J Clin Nutr. 2012 Feb;95(2):446-53
references: 22218158