(PO22-66-22) Dietary Approach to Stop Hypertension (DASH) Diet, Physical Activity, and Renal Function Among Women With a History of Gestational Diabetes Mellitus

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Presenting Author(s)

Jiaxi Yang, PhD
– Research Fellow, National University of Singapore, Singapore, Singapore

Co-Author(s)

Jorge E. Chavarro, ScD, MD
– Associate Professor of Medicine, Harvard Medical School, Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
Frank Hu, MD, PhD
– Professor, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
RM

Ronald Ma, MD
– Hong Kong Institute of Diabetes and Obesity Department of Medicine and Therapeutics, CUHK, Hong Kong, Guangdong, China (People's Republic)
Deirdre K. Tobias, ScD
– Assistant Professor, Brigham and Women's Hospital Division of Preventive Medicine, Department of Medicine; Harvard TH Chan School of Public Health, Boston, Massachusetts, United States
JW

Jing Wu, MD, MS
– Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States
CZ

Cuilin Zhang, MD, PhD
– Senior Investigator, National Intitute of Child and Human Development, NIH, Bethesda, Maryland, United States
Shristi Rawal, PhD
– Assistant Professor, Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, New Jersey, United States

Disclosure(s):

Jiaxi Yang, PhD: No relevant financial relationship(s) with ineligible companies to disclose.

Objectives: To examine individual and joint associations of long-term diet quality and physical activity with sub-clinical measures of renal dysfunction in a longitudinal female cohort with a history of gestational diabetes mellitus (GDM).

Methods: This was a retrospective study of women who had reported a physician-diagnosed GDM in the Nurses' Health Study II between 1989-2009. Dietary Approach to Stop Hypertension (DASH) diet score was derived from validated food frequency questionnaires administered every 4 years. Physical activity and other health-related factors were self-reported every 2-4 years. Fasting blood and urine samples were collected in 2012-2014 in a sub-sample (median age: 57 years). Analysis included 646 women who were free of diabetes at the time of biospecimen collection. Renal outcomes included elevated urinary albumin-to-creatinine ratio UACR; ≥20 mg/g) and glomerular hyperfiltration (eGFR ≥95^th percentile [107.3 mL/min/1.73m²]). We used logistic regression to estimate the odds ratios (OR) and 95% confidence intervals (CI) for the associations of habitual diet quality and physical activity with the two subsequently measured renal outcomes, adjusting for major risk factors.

Results: Women with a higher DASH score were less likely to have elevated UACR or glomerular hyperfiltration, but the association was only significant for the latter (p-trend=0.009; OR for tertile 3 vs. tertile 1: 0.14, 95% CI: 0.03-0.66). No evidence of association was seen for elevated UACR with physical activity. Women who were more physically active (≥150 min/week moderate-intensity or ≥75 min/week vigorous-intensity) had a lower risk of glomerular hyperfiltration (OR=0.48, 95% CI: 0.23-1.00), compare with those who were less active. Examination of joint associations revealed that women with a higher binary DASH-diet score and higher physical activity had 80% lower risk of glomerular hyperfiltration (OR, 95% CI: 0.20, 0.07-0.54), compared with those who had lower levels of diet quality and physical activity.

Conclusions: Our study suggests women with a history of GDM with overall higher diet quality and physical activity have a more favorable renal function profile in midlife. Larger prospective studies in diverse populations are warranted to confirm these findings.

Funding Sources: National Institutes of Health, American Diabetes Association