The American journal of clinical nutrition · 2026
Dietary macronutrient substitutions and cardiometabolic outcomes in children with and without gestational diabetes exposure: a cross-sectional analysis.
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Alves Jasmin M, Belcher Britni Ryan, Luo Yue, Chow Ting, Xiang Anny H, Page Kathleen A
Аннотация
BACKGROUND: Prenatal exposure to gestational diabetes mellitus (GDM) increases offspring cardiometabolic risk, underscoring the need for preventive interventions.
OBJECTIVES: We used isocaloric substitution to investigate the associations between dietary macronutrients and cardiometabolic outcomes in children with and without GDM exposure.
METHODS: Data are from 192 participants aged 7-11 y (53% GDM-exposed, 40% male) from the longitudinal BrainChild cohort. Assessments included a 24-h dietary recall, a fasting blood sample, anthropometrics, and blood pressure measurements. In a cross-sectional analysis, linear regression was used to test the effects of substituting primary macronutrients (protein, MUFA/PUFA, SFA/trans-fatty acids, mono/disaccharides, and polysaccharides) on fasting plasma glucose, insulin, HOMA-IR, total body fat, waist circumference, and systolic/diastolic blood pressure.
RESULTS: Unexposed children were older (mean ± SD: unexposed, 8.9 ± 1.0; GDM-exposed: 8.6 ± 1.0), had higher fasting insulin (mean ± SD: unexposed, 5.0 ± 6.7; GDM-exposed: 4.0 ± 5.2), HOMA-IR values (mean ± SD: unexposed, 1.1 ± 1.3; GDM-exposed: 0.81 ± 1.0), and consumed fewer monosaccharides/disaccharides compared with GDM-exposed children (mean ± SD: unexposed, 345.6 ± 125.2; GDM-exposed: 396.6 ± 159.1). In GDM-exposed children, substituting 5% of daily calories from carbohydrates or fat with protein was associated with lower fasting glucose [polysaccharides: β = -13.12, 95% confidence interval (CI): -23.9, -2.33; monosaccharides/disaccharides: β = -13.35, 95% CI: -24.16, -2.54; MUFA and PUFA: β = -12.18, 95% CI: -22.76, -1.6; SFA and trans-fatty acids: β = -11.07, 95% CI: -21.55, -0.6], whereas substituting SFAs/trans-fatty acids with protein was associated with lower diastolic blood pressure: β = -7.86, 95% CI: -15.51, -0.2). In unexposed children, substituting 5% of daily calories from mono/disaccharides and protein for polysaccharides was associated with lower fasting glucose (monosaccharides/disaccharides: β = -1.09, 95% CI: -2.07, -0.12; protein: β = -4.58, 95% CI: -9.04, -0.11). Associations did not remain after adjusting for social and lifestyle factors.
CONCLUSIONS: These findings reveal exposure-specific differences in how macronutrient composition influences cardiometabolic outcomes and highlight distinct intervention targets for children exposed and unexposed to GDM.
OBJECTIVES: We used isocaloric substitution to investigate the associations between dietary macronutrients and cardiometabolic outcomes in children with and without GDM exposure.
METHODS: Data are from 192 participants aged 7-11 y (53% GDM-exposed, 40% male) from the longitudinal BrainChild cohort. Assessments included a 24-h dietary recall, a fasting blood sample, anthropometrics, and blood pressure measurements. In a cross-sectional analysis, linear regression was used to test the effects of substituting primary macronutrients (protein, MUFA/PUFA, SFA/trans-fatty acids, mono/disaccharides, and polysaccharides) on fasting plasma glucose, insulin, HOMA-IR, total body fat, waist circumference, and systolic/diastolic blood pressure.
RESULTS: Unexposed children were older (mean ± SD: unexposed, 8.9 ± 1.0; GDM-exposed: 8.6 ± 1.0), had higher fasting insulin (mean ± SD: unexposed, 5.0 ± 6.7; GDM-exposed: 4.0 ± 5.2), HOMA-IR values (mean ± SD: unexposed, 1.1 ± 1.3; GDM-exposed: 0.81 ± 1.0), and consumed fewer monosaccharides/disaccharides compared with GDM-exposed children (mean ± SD: unexposed, 345.6 ± 125.2; GDM-exposed: 396.6 ± 159.1). In GDM-exposed children, substituting 5% of daily calories from carbohydrates or fat with protein was associated with lower fasting glucose [polysaccharides: β = -13.12, 95% confidence interval (CI): -23.9, -2.33; monosaccharides/disaccharides: β = -13.35, 95% CI: -24.16, -2.54; MUFA and PUFA: β = -12.18, 95% CI: -22.76, -1.6; SFA and trans-fatty acids: β = -11.07, 95% CI: -21.55, -0.6], whereas substituting SFAs/trans-fatty acids with protein was associated with lower diastolic blood pressure: β = -7.86, 95% CI: -15.51, -0.2). In unexposed children, substituting 5% of daily calories from mono/disaccharides and protein for polysaccharides was associated with lower fasting glucose (monosaccharides/disaccharides: β = -1.09, 95% CI: -2.07, -0.12; protein: β = -4.58, 95% CI: -9.04, -0.11). Associations did not remain after adjusting for social and lifestyle factors.
CONCLUSIONS: These findings reveal exposure-specific differences in how macronutrient composition influences cardiometabolic outcomes and highlight distinct intervention targets for children exposed and unexposed to GDM.