Relationship of the Frequency, Distribution, and Content of Meals/Snacks to Glycaemic Control in Gestational Diabetes: The myfood24 GDM Pilot Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Setting, Participants, and Data Collection
2.2. Ethical Approval
2.3. Statistical Analysis
- completion of (A) ≥1 myfood24 versus (B) none
- completion of myfood24 and fasting BG readings [2]:
- ○
- (A) achieving fasting BG target (<5.3 mmol/L) and
- ○
- (B) exceeding the target
- completion of myfood24, fasting BG readings, and all postprandial BG readings [2]:
- ○
- (A) achieving BG targets through the day: 1-h postprandial BG target (<7.8 mmol/L) and fasting BG target (<5.3 mmol/L) and
- ○
- (B) exceeding the target
3. Results
3.1. General Characteristics
3.2. Meal Regularity and Glucose Control
4. Discussions
4.1. Supporting Glycaemic Control
4.2. Diet in GDM
4.3. Study Strengths and Weaknesses
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Study Participants | N |
---|---|
All participants | 199 |
myfood24 | |
Completed | 120 |
Did not complete | 79 |
Monitored fasting BG and completed myfood24 | |
Achieved fasting BG target (<5.3 mmol/L) | 88 |
Not achieved fasting BG target | 27 |
Monitored postprandial breakfast BG and completed myfood24 | |
Achieved BG target (<7.8 mmol/L) | 90 |
Not achieved BG target | 23 |
Monitored postprandial lunch BG and completed myfood24 | |
Achieved BG target (<7.8 mmol/L) | 106 |
Not achieved BG target | 9 |
Monitored postprandial evening meal BG and completed myfood24 | |
Achieved BG target (<7.8 mmol/L) | 100 |
Not achieved BG target | 15 |
Monitored all postprandial meals and completed myfood24 | |
Achieved BG target (<7.8 mmol/L) | 80 |
Not achieved BG target | 33 |
Monitored fasting BG and all postprandial meals and completed myfood24 | |
Achieved all BG targets | 68 |
Not achieved all BG targets | 34 |
myfood24 | Monitored Fasting BG and Completed myfood24 | Monitored Fasting BG, All Postprandial Meals BG and Completed myfood24 | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
All (n = 199) | Completed (n = 120) | Did Not Complete (n = 79) | p Value | Achieved Fasting BG Target (n = 88) | Not Achieved Fasting BG Target (n = 27) | p Value | Achieved BG Target (n = 68) | Not Achieved BG Target (n = 34) | p Value | |
Age, years: mean (sd) | 33.3 (5.0) | 33.4 (4.6) | 33.2 (5.6) | 0.8 | 33.1 (4.6)) | 34.2 (4.4) | 0.3 | 32.9 (4.4) | 34.3 (4.9) | 0.2 |
Booking weight, kg (sd) | 78.4 (18.4) a | 77.8 (17.8) | 79.1 (19.3) | 0.7 | 73.9 (16.4) | 89.5 (17.9) | 0.001 | 75.9 (16.8) | 76.9 (19.3) | 0.8 |
Booking BMI, kg/m2 (sd) | 29.7 (6.5) a | 29.4 (6.2) | 30.1 (7.0) | 0.5 | 28.0 (5.5) | 33.8 (6.1) | <0.001 | 28.4 (5.8) | 29.8 (6.8) | 0.3 |
Ethnicity n (%) | <0.001 | 0.3 | 0.05 | |||||||
White | 114 (57.3%) | 79 (65.8%) | 35 (44.3%) | 60 (68.2%) | 16 (59.3%) | 51 (75.0%) | 17 (50.0%) | |||
Asian | 54 (27.1%) | 31 (25.8%) | 23 (29.1%) | 19 (21.6%) | 10 (37.0%) | 11 (16.2%) | 14 (41.2%) | |||
Black | 20 (10.1%) | 3 (2.5%) | 17 (21.5%) | 3 (3.4%) | 0 (0.0%) | 2 (2.9%) | 1 (2.9%) | |||
Mixed, Chinese, Other | 11 (5.5%) | 7 (5.8%) | 4 (5.1%) | 6 (6.8%) | 1 (3.7%) | 4 (5.9%) | 2 (5.9%) | |||
Parity n (%) | 0.02 | 0.4 | 0.3 | |||||||
Primiparous | 73 (36.7%) | 52 (43.3%) | 21 (26.6%) | 39 (44.3%) | 10 (37.0%) | 32 (47.1%) | 12 (35.3%) | |||
Multiparous | 126 (63.3%) | 68 (56.7%) | 58 (73.4%) | 49 (55.7%) | 17 (63.0%) | 36 (52.9%) | 22 (64.7%) | |||
Days completed myfood24 (sd) | 3.8 (1.4) | - | 3.8 (1.4) | 4.0 (1.3) | 0.5 | 3.8 (1.5) | 3.8 (1.3) | 1.0 | ||
Mean fasting BG mmol/L (sd) | 5.0 (0.7) b | 4.9 (0.6) | 5.2 (0.5) | 0.008 | 4.9 (0.6) | 5.8 (0.5) | <0.001 | 4.7 (0.4) | 5.2 (0.8) | <0.001 |
Mean post breakfast BG mmol/L (sd) | 7.2 (1.0) b | 7.1 (1.0) | 7.2 (1.1) | 0.6 | 6.9 (0.8) | 7.9 (1.2) | <0.001 | 6.6 (0.7) | 8.1 (1.0) | <0.001 |
Mean post lunch BG mmol/L (sd) | 6.7 (1.0) b | 6.6 (0.9) | 7.0 (1.0) | 0.02 | 6.5 (0.7) | 7.0 (1.3) | 0.008 | 6.4 (0.6) | 7.2 (1.2) | <0.001 |
Mean post dinner BG mmol/L (sd) | 6.8 (1.0) b | 6.7 (1.0) | 7.1 (1.1) | 0.03 | 6.5 (0.7) | 7.3 (1.3) | <0.001 | 6.4 (0.6) | 7.6 (1.2) | <0.001 |
Monitored Fasting BG and Completed myfood24 | Monitored Fasting BG and All Postprandial Meals BG and Completed myfood24 | ||||||
---|---|---|---|---|---|---|---|
All myfood24 (n = 120) | Achieved (n = 88) | Not Achieved (n = 34) | p Value | Achieved (n = 68) | Not Achieved (n = 34) | p Value | |
Frequency of meal consumption n (%) | 0.04 | 0.05 | |||||
Fewer than three times a day | 13 (10.8%) | 7 (8.0%) | 6 (22.2%) | 7 (10.3%) | 0 (0.0%) | ||
Three times a day | 107 (89.2%) | 81 (92.0%) | 21 (77.8%) | 61 (89.7%) | 34 (100%) | ||
Frequency of snack and drink consumption n (%) | 0.06 | 0.008 | |||||
Fewer than two snacking periods a day | 62 (51.7%) | 39 (44.3%) | 19 (70.4%) | 26 (38.2) | 24 (70.6) | ||
≥twice and < three snacking periods a day | 48 (40.0%) | 40 (45.5%) | 7 (25.9%) | 35 (51.5) | 8 (23.5) | ||
Three snacking periods a day | 10 (8.3%) | 9 (10.2%) | 1 (3.7%) | 7 (10.3) | 2 (5.9) | ||
Distribution of mean energy intake % (sd) | |||||||
Breakfast | 19.6 (7.1) | 19.1 (6.4) | 21.1 (9.5) | 0.5 | 19.1 (6.3) | 20.1 (6.9) | 0.5 |
Morning snack and drinks | 6.2 (7.0) | 6.3 (6.4) | 6.5 (9.0) | 0.4 | 6.0 (6.3) | 6.7 (8.0) | 0.9 |
Lunch | 28.0 (9.7) | 28.1 (9.4) | 27.2 (11.4) | 0.8 | 28.3 (9.5) | 29.3 (10.0) | 0.7 |
Afternoon snack and drinks | 6.5 (5.9) | 6.9 (5.8) | 5.6 (6.0) | 0.2 | 6.9 (5.9) | 6.3 (4.9) | 0.8 |
Dinner | 34.4 (9.0) | 33.4 (8.4) | 36.1 (10.1) | 0.2 | 33.7 (8.8) | 33.2 (8.0) | 1.0 |
Evening snack and drinks | 5.3 (6.0) | 6.0 (6.2) | 3.5 (5.2) | 0.03 | 6.0 (6.6) | 4.4 (4.5) | 0.5 |
Distribution of mean carbohydrate intake % (sd) | |||||||
Breakfast | 20.9 (8.6) | 20.4 (7.3) | 21.6 (11.7) | 0.9 | 20.4 (6.6) | 21.2 (10.5) | 0.9 |
Morning snack and drinks | 7.8 (9.0) | 7.6 (7.9) | 8.7 (12.4) | 0.7 | 7.3 (7.3) | 8.4 (11.6) | 0.7 |
Lunch | 26.8 (9.5) | 27.1 (9.0) | 26.2 (11.9) | 0.7 | 26.7 (9.3) | 29.3 (9.1) | 0.3 |
Afternoon snack and drinks | 7.6 (6.5) | 8.02 (6.6) | 6.9 (6.3) | 0.3 | 8.0 (6.6) | 7.4 (5.5) | 0.8 |
Dinner | 31.4 (11.4) | 30.3 (11.0) | 33.5 (12.2) | 0.1 | 30.9 (12.0) | 29.6 (9.1) | 0.9 |
Evening snack and drinks | 5.6 (7.1) | 6.5 (7.5) | 3.3 (5.5) | 0.01 | 6.7 (8.1) | 4.0 (4.3) | 0.2 |
Percentage (sd) meals between 30 and 50 g | |||||||
carbohydrate at | 41.8 (34.4) | 42.6 (34.4) | 41.4 (37.2) | 0.8 | 43.2 (34.3) | 38.7 (37.0) | 0.5 |
Breakfast | 31.5 (28.0) | 30.6 (27.6) | 35.2 (30.4) | 0.5 | 27.4 (26.0) | 37.9 (28.8) | 0.08 |
Lunch | 20.7 (25.8) | 20.3 (24.1) | 23.8 (32.4) | 1.0 | 19.5 (22.6) | 20.5 (25.2) | 1.0 |
Evening meal | |||||||
Percentage (sd) snack and drink periods >0 to ≤20 g carbohydrate | |||||||
Morning | 73.0 (32.6) | 70.8 (32.8) | 78.4 (32.7) | 0.2 | 70.6 (33.6) | 76.6 (31.0) | 0.4 |
Afternoon | 73.1 (31.1) | 70.9 (32.8) | 76.9 (26.7) | 0.5 | 70.9 (33.0) | 72.9 (29.6) | 1.0 |
Evening | 81.5 (25.7) | 78.1 (27.4) | 90.6 (17.7) | 0.02 | 77.2 (29.4) | 86.4 (18.2) | 0.2 |
Monitored Fasting BG and Completed myfood24 | Monitored Fasting BG and All Postprandial Meals and Completed myfood24 | ||||||
---|---|---|---|---|---|---|---|
All myfood24 (n = 120) | Achieved (n = 88) | Not Achieved (n = 27) | p Value | Achieved (n = 68) | Not Achieved (n = 34) | p Value | |
Energy, kcal mean (sd) | 1449 (389) | 1485 (385) | 1343 (421) | 0.2 | 1468.7 (1382.6) | 1515.6 (439.9) | 0.9 |
Carbohydrate, g (sd) | 170 (49.4) | 174 (50) | 156 (46) | 0.1 | 172.6 (44.1) | 177.3 (59.0) | 0.9 |
Protein, g (sd) | 63.2 (18.6) | 64.1 (16.9) | 61.0 (23.4) | 0.4 | 62.2 (16.3) | 69.5 (19.0) | 0.1 |
Fat, g (sd) | 58.7 (21.6) | 60.2 (21.4) | 53.1 (22.4) | 0.1 | 59.8 (21.7) | 59.4 (19.8) | 0.9 |
Dietary fibre, g (sd) | 16.2 (6.0) | 17.0 (6.1) | 13.7 (5.6) | 0.01 | 16.4 (5.8) | 17.0 (6.5) | 0.8 |
Sugar, g (sd) | 53.9 (26.1) | 56.4(23.5) | 48.0 (33.2) | 0.01 | 58.9 (24.2) | 50.5 (28.3) | 0.03 |
Saturated fat, g (sd) | 19.9 (8.4) | 20.4 (8.6) | 18.3 (8.1) | 0.2 | 20.4 (9.1) | 19.4 (6.8) | 0.7 |
Sodium g (sd) | 2.2 (0.9) | 2.2 (0.8) | 2.2 (0.8) | 0.8 | 2.1 (0.7) | 2.5 (1.1) | 0.4 |
% (sd) Energy from Carbohydrates | 46.9 (8.0) | 47.4 (7.5) | 47.5 (8.7) | 0.8 | 47.6 (7.7) | 46.9 (6.8) | 0.5 |
% (sd) Energy from Fats | 35.4 (6.9) | 35.9 (6.8) | 35.0 (6.7) | 0.5 | 35.9 (7.0) | 35.2 (5.8) | 0.6 |
% (sd) Energy from Proteins | 17.9 (3.5) | 17.5 (3.3) | 18.1 (3.9) | 0.3 | 17.2 (3.3) | 18.6 (3.0) | 0.02 |
Total vegetables g (sd) | 149 (98) | 156 (102) | 121 (82) | 0.08 | 156.1 (108.5) | 142.4 (89.0) | 0.6 |
Total fruit g (sd) | 140 (101 | 145 (100) | 132 (103) | 0.4 | 146.8 (103.9) | 136.2 (91.1) | 0.7 |
Total fruit and vegetables g (sd) | 274 (147) | 285 (144) | 234 (160) | 0.06 | 285.3 (149.7) | 262.6 (145.2) | 0.4 |
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Morris, M.A.; Hutchinson, J.; Gianfrancesco, C.; Alwan, N.A.; Carter, M.C.; Scott, E.M.; Cade, J.E. Relationship of the Frequency, Distribution, and Content of Meals/Snacks to Glycaemic Control in Gestational Diabetes: The myfood24 GDM Pilot Study. Nutrients 2020, 12, 3. https://doi.org/10.3390/nu12010003
Morris MA, Hutchinson J, Gianfrancesco C, Alwan NA, Carter MC, Scott EM, Cade JE. Relationship of the Frequency, Distribution, and Content of Meals/Snacks to Glycaemic Control in Gestational Diabetes: The myfood24 GDM Pilot Study. Nutrients. 2020; 12(1):3. https://doi.org/10.3390/nu12010003
Chicago/Turabian StyleMorris, Michelle A., Jayne Hutchinson, Carla Gianfrancesco, Nisreen A. Alwan, Michelle C. Carter, Eleanor M. Scott, and Janet E. Cade. 2020. "Relationship of the Frequency, Distribution, and Content of Meals/Snacks to Glycaemic Control in Gestational Diabetes: The myfood24 GDM Pilot Study" Nutrients 12, no. 1: 3. https://doi.org/10.3390/nu12010003
APA StyleMorris, M. A., Hutchinson, J., Gianfrancesco, C., Alwan, N. A., Carter, M. C., Scott, E. M., & Cade, J. E. (2020). Relationship of the Frequency, Distribution, and Content of Meals/Snacks to Glycaemic Control in Gestational Diabetes: The myfood24 GDM Pilot Study. Nutrients, 12(1), 3. https://doi.org/10.3390/nu12010003