Dietary macronutrient substitutions and cardiometabolic outcomes in children with and without gestational diabetes exposure: a cross-sectional analysis.

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.