Abstract
BACKGROUND: Women with prior gestational diabetes mellitus (GDM) are at a significantly increased risk of developing type 2 diabetes after childbirth. However, studies on the impact of dietary factors on the postpartum endocrine metabolism of women with prior GDM, as well as the underlying mechanisms, remain relatively limited. This study aims to investigate the association and underlying pathways between dietary inflammatory index (DII) and the subsequent development of type 2 diabetes in women with prior GDM, and to help identify high-risk populations. METHODS: The sample included 788 participants from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018. Multivariate logistic regression was utilized to examine the correlation of DII with diabetes and adiposity indices, such as body mass index (BMI) and relative fat mass (RFM) in participants with prior GDM. Mediation analysis was conducted to examine the effects of adiposity indices as potential mediators between DII and diabetes. Spearman correlation analysis was conducted to assess the relationship between the 26 dietary components of the DII on adiposity indices and the occurrence of diabetes in participants with prior GDM. RESULTS: Among participants with prior GDM, higher DII scores were associated with the occurrence of diabetes after variable adjustment. Mediation analysis disclosed that adiposity indices mediated a substantial portion of the relationship between DII and diabetes, with BMI (12.19%) and RFM (11.84%) showing significant mediating effects. Spearman correlation analysis indicated that different dietary components exhibited varying degrees of correlation with adiposity indices and diabetes among participants with prior GDM. CONCLUSIONS: Higher DII scores were associated with the occurrence of diabetes in women with prior GDM, partly mediated by adiposity indices, emphasizing the role of diet in diabetes risk. Additionally, the findings suggested that these adiposity indices should be more broadly utilized to improve early diabetes prevention and treatment strategies among women with prior GDM. CLINICAL TRIAL NUMBER: Not applicable.