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. 2025 Jul 16;17(1):275.
doi: 10.1186/s13098-025-01826-1.

Adiposity indices mediate the association between dietary inflammatory index and type 2 diabetes risk in women with prior gestational diabetes mellitus

Yingni Liang #  1 , Li Hu #  1 , Fuliang Shangguan  1 , E Tan  1 , Jiayu Shen  1 , Anran Dai  1 , Zhuolian Zheng  1 , Yinhua Su  2 , Zhongyu Li  3
Affiliations

Adiposity indices mediate the association between dietary inflammatory index and type 2 diabetes risk in women with prior gestational diabetes mellitus

Yingni Liang et al. Diabetol Metab Syndr. .

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.

Keywords: Adiposity indices; Diabetes; Dietary inflammatory index; Gestational diabetes mellitus; Mediation effect.

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Conflict of interest statement

Declarations. Human ethics and consent to participate: This study adhered to the principles outlined in the Declaration of Helsinki, with approval from the Institutional Review Board of the National Center for Health Statistics for all procedures involving participants. And written informed consent has been obtained from all participants involved in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A detailed flowchart of the study participants recruitment process
Fig. 2
Fig. 2
Dietary intake of each DII component grouped by diabetes status. Abbreviations: MUFA, monounsaturated fatty acid; PUFA, polyunsaturated fatty acid
Fig. 3
Fig. 3
Adiposity indices partially mediates the relationship between DII and diabetes in participants with prior GDM. Abbreviations: DII, dietary inflammation index; BMI, body mass index; RFM, relative fat mass
Fig. 4
Fig. 4
Spearman correlation analysis for identification of key diabetes-related dietary factors in study participants with prior GDM. Abbreviations: BMI, body mass index; RFM, relative fat mass; MUFA, monounsaturated fatty acid; PUFA, polyunsaturated fatty acid; MG, magnesium; ZN, zinc; SE, selenium
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