Prevalence of abnormal glucose tolerance and associated dietary patterns, metabolomic profiles, and nutritype signatures in women post-gestational Diabetes Mellitus

Women with a previous history of gestational diabetes (post-GDM) have a higher risk of abnormal glucose tolerance (AGT). However, evidence on tailored Malaysian diets and their link to AGT is limited in these women. Identifying dietary biomarkers using metabolomic techniques is also crucial. The concept of nutritype, connecting dietary patterns with metabolites, is emerging in this context. Hence, this cross-sectional study aimed to identify the prevalence of AGT and the associated dietary patterns, metabolomic profiles, and nutritype signatures in women post-GDM. The study involved 157 Malaysian women aged 18-49 years old (mean age 34.8 ± 5.6 years old, body mass index [BMI] 26.5 ± 5.0 kg/m2 ), post-GDM, who were recruited between six weeks and 15 years postpartum. The study was conducted at Universiti Putra Malaysia (January to April 2021) and Klinik Kesihatan Seri Kembangan (September 2021 to February 2022). According to the Malaysian Clinical Practice Guidelines criteria, participants were categorized into AGT or normal glucose tolerance (NGT) groups based on oral glucose tolerance test or HbA1c results. Food intake was assessed using a food frequency questionnaire and dietary patterns were derived using principal component analysis (PCA). Plasma metabolites were analyzed using one-dimensional proton nuclear magnetic resonance (1H NMR) spectroscopy. Multivariate linear regression of dietary patterns and metabolites was performed to obtain nutritype signatures associated with AGT. Data on covariates (socio-demographic characteristics, obstetric history, nutritional status, and lifestyle practices) were also collected. The prevalence of AGT in this study was 36.3% (n = 57). Compared to the NGT group, participants diagnosed with AGT were characterized by a significantly larger household size; higher gravidity, parity, pre-pregnancy weight and BMI, current weight and BMI, body fat percentage, waist and hip circumference; and were also more likely to have recurrent GDM. Additionally, participants with AGT had significantly higher fasting insulin levels, total cholesterol, triglycerides, low-density lipoprotein (LDL) cholesterol, and lower high-density lipoprotein (HDL) cholesterol levels. The AGT group consumed a significantly lower total energy intake (%TEI) from fat, saturated fat (amount and as %TEI), and riboflavin intake. Five dietary patterns emerged from PCA: ‘Mostly Unhealthy’, ‘Fish-Eggs-Fruits-Vegetables’, ‘Cereals-Confectionaries’, ‘Legumes-Dairy’, and ‘Meat-Sugar-sweetened beverages’. The ‘Cereals-confectionaries’ dietary pattern was significantly associated with increased odds of AGT (adjusted odds ratio 1.708, 95% CI 1.023 – 2.854, p = 0.041). Compared to the NGT group, participants with AGT had significantly higher levels of carnitine, glucose, glycerol, threonine, and valine, while concentrations of creatine, glycylproline, and sn-glycero-3-phosphocholine were reduced. The nutritype signatures obtained were the consumption of ‘Cereals-Confectionaries’ dietary pattern and increased levels of glucose, glycerol, and valine, which were significantly associated with AGT after adjusting for socio-demographic characteristics and TEI. In conclusion, nutritype signatures aided in elucidating the metabolic pathways implicated with AGT development that can be modulated by dietary patterns. Findings from this study could contribute to the scientific evidence particularly in women post-GDM. A prospective study with a targeted metabolomic approach is recommended to validate and expand these insights, thus advancing the efforts to delay or prevent the onset of type 2 diabetes among women post-GDM.

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