The Effect of a Maternal Mediterranean Diet in Pregnancy on Insulin Resistance is Moderated by Maternal Negative Affect

Abstract

There is inconsistent evidence that healthy dietary interventions can effectively mitigate the risk of adverse outcomes associated with elevated insulin resistance in pregnancy, suggesting that other moderating factors may be at play. Maternal psychological state is an important factor to consider in this regard, because stress/mood state can directly influence glycemia and a bidirectional relationship may exist between nutrition and psychological state. The objective of this study was to examine the interaction between maternal negative affect and diet quality on third trimester insulin resistance. We conducted a prospective longitudinal study of N = 203 women with assessments in early and mid-pregnancy, which included an ecological momentary assessment of maternal psychological state, from which a negative affect score (NAS) was derived, and 24-h dietary recalls, from which the Mediterranean Diet Score (MDS) was computed. The homeostasis model assessment of insulin resistance (HOMA-IR) was computed from third trimester fasting plasma glucose and insulin values. Early pregnancy MDS was inversely associated with the HOMA-IR, but this did not maintain significance after adjusting for covariates. There was a significant effect of the mid-pregnancy MDS*NAS interaction term with the HOMA-IR in the adjusted model, such that a higher negative affect was found to override the beneficial effects of a Mediterranean diet on insulin resistance. These results highlight the need to consider nutrition and affective state concurrently in the context of gestational insulin resistance.

Factors Influencing Dietary Patterns during Pregnancy in a Culturally Diverse Society

“…Recent studies have shown that diets with a higher intake of fruits, vegetables, pulses, and fish lead to positive outcomes during pregnancy [ 18 , 19 ]. Generally speaking, greater adherence to the Mediterranean diet during pregnancy can protect against excessive cardiometabolic risk for offspring [ 20 ].…”

Maternal Adherence to the Mediterranean Diet during Pregnancy: A Review of Commonly Used a priori Indexes

“…In total, 27 observational studies were included in the review: 17 (63.0%) cohort studies [20][21][22][24][25][26][27][28][29][30][31][32][33][34][35][36][37]; 7 (25.9%) cross-sectional studies [38][39][40][41][42][43][44]; 2 (7.4%) case-control studies [23,45]; and, 1 (3.7%) nested case-control study [46]. Table 2 provides a summary of the key characteristics of these 27 studies.…”

“…All studies included fruits as a beneficial component in their index . Seven studies specified the inclusion of fruit juices in the fruit component [20,33,[40][41][42]44,46]. Only one study explicitly excluded fruit juices from inclusion in the fruit component of their index [22].…”

“…Moreover, nine studies grouped fruits and nuts together as a single component [21,22,24,[27][28][29][30]37,39] in line with the original designs of the MDS-2003 [13] and rMed [49] employed by these studies. [20][21][22][23][24][27][28][29][30][32][33][34]36,37,[39][40][41][42][43][44][45][46], including only the PREDIMED score of Martínez-Galiano et al (2018) [23]. Thirteen studies categorized nuts as a separate component from fruits [20,23,[32][33][34]36,[40][41][42][43][44][45][46].…”

Mediterrane Diät vor und während der Schwangerschaft

“…Es existieren zahlreiche nichtdiätetische Modifikatoren dieser Assoziation. Lindsay et al fanden beispielsweise keine Assoziation zwischen MD und Insulinresistenz, aber sie be-richteten von einer Kombination psychologischer Faktoren wie Ängstlichkeit, Trauer, Wut und Stress als möglichem abmildernden Faktor der Assoziation zwischen mütterlicher MD und Insulinresistenz (HOMA-IR)[16].Der BMI ist zusätzlich mit unterschiedlichen Verhältnissen der Fettsäurenzusammensetzung der Muttermilch assoziiert, was wiederum die Gewichtszunahme des Säuglings in den ersten Lebensmonaten beeinflussen könnte[17].…”