title: The Impact of Macronutrients on Retinal Microvasculature among Singapore Pregnant Women during the Mid-Late Gestation.
abstract: BACKGROUND
  Imbalanced macronutrient intakes can induce impairment of endothelial and vascular function, and further lead to metabolic and cardiovascular disease. However, little is known about the influence of such diets on endothelial and vascular dysfunction in pregnant women, even though high-fat diet is a known risk for pregnancy complications such as gestational diabetes and pre-eclampsia.
  
  
  OBJECTIVE
  We aimed to assess the association between maternal macronutrient intakes (protein, fat and carbohydrates), dietary quality and retinal microvascular changes in a multi-ethnic Asian mother-offspring cohort.
  
  
  METHODS
  Pregnant women (n = 614) with singleton pregnancies were recruited during their first trimester from June 2009 to Sep 2010. Maternal diet quality and macronutrient intakes, expressed as a percentage of total energy during pregnancy, were ascertained using 24 hr recalls and 3 d food diaries at 26-28 weeks gestation. Retinal examination was completed at the same clinic visit. Dietary quality was assessed and scored using the Health Eating Index in Asian Pregnant women (HEI-AP), while macronutrients intakes ware expressed as percentages of total energy and further log transformed for analysis. Associations were examined cross-sectionally by substitution models with the use of multiple linear regression.
  
  
  RESULTS
  In adjusted model, each 20 points decrease in HEI-AP score was associated with a significant increase of 1.70 μm (p<0.05) in retinal venular calibre. Each 0.1 log increase in percentage of total fat intake was associated with a significant increment of 1.84 μm (p<0.05) in retinal venular caliber. Additionally, each 0.1 log increase in percentage of mono-unsaturated fat intake was associated with an increment of 1.84 μm (p<0.01) in retinal venular caliber.
  
  
  CONCLUSIONS
  In this cross-sectional study, we found that women with higher fat and lower protein intakes, and lower diet quality tended to have wider retinal venular caliber, which is suggestive of suboptimal microvasculature.
authors: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.|DUKE-NUS Graduate Medical School, Singapore, Singapore.
authors: Ling-Jun
authors: LJ
authors: Li
authors: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
authors: Peng Guan
authors: PG
authors: Ong
authors: Singapore Institute for Clinical Sciences, Growth, Development & Metabolism, Singapore, Singapore.
authors: Marjorelee T
authors: MT
authors: Colega
authors: Department of Nutrition and Dietetics, Flinders University of South Australia, Adelaide, South Australia, Australia.
authors: Chad Yixian
authors: CY
authors: Han
authors: Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.|Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore.|Khoo Teck Puat- National University Children's Medical Institute, National University Health System, Singapore, Singapore.
authors: Ling Wei
authors: LW
authors: Chen
authors: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
authors: Ryan
authors: R
authors: Man Eyn Kidd
authors: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.|DUKE-NUS Graduate Medical School, Singapore, Singapore.
authors: Ecosse
authors: E
authors: Lamoureux
authors: Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.
authors: Peter
authors: P
authors: Gluckman
authors: KK Women's and Children's Hospital, Singapore, Singapore.
authors: Kenneth
authors: K
authors: Kwek
authors: Singapore Institute for Clinical Sciences, Growth, Development & Metabolism, Singapore, Singapore.|Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors: Yap Seng
authors: YS
authors: Chong
authors: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.|Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
authors: Seang Mei
authors: SM
authors: Saw
authors: Medical Research Council Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
authors: Keith M
authors: KM
authors: Godfrey
authors: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.|DUKE-NUS Graduate Medical School, Singapore, Singapore.
authors: Tien Yin
authors: TY
authors: Wong
authors: Singapore Institute for Clinical Sciences, Growth, Development & Metabolism, Singapore, Singapore.|Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.|Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore.
authors: Mary
authors: M
authors: Chong Foong-Fong
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004032:Diet; D059305:Diet, High-Fat / Q000009:adverse effects; D005260:Female; D006801:Humans; D039382:Maternal Nutritional Physiological Phenomena / Q000502:physiology*; D055806:Microvessels / Q000502:physiology*; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D037841:Pregnant People; D012160:Retina / Q000502:physiology* / Q000503:physiopathology; D012846:Singapore