NUS study: Breastfeeding lowers cardiovascular risk in women with type 2 diabetes and gestational diabetes; lower gestational diabetes risk with healthy Mediterranean diet with low POP exposure

Singapore, 25 October 2024 – Researchers from the Global Centre for Asian Women’s Health or GloW, based at the NUS Yong Loo Lin School of Medicine (NUS Medicine) and Harvard T.H. Chan School of Public Health found that women who breastfed showed much lower rates of cardiovascular disease (CVD) and longer duration of breastfeeding was associated with lower risk of CVD in women with type 2 diabetes or gestational diabetes (GDM).

Analysing data from 15,146 women in the U.S. with type 2 diabetes and 4,537 with a history of GDM across two significant studies — Nurses’ Health Study I & II — the study revealed that compared with women who never breastfed, breastfeeding for over 18 months was related to a significant reduction in CVD risk by 32% among women who had a history of type 2 diabetes and 51% reduction in CVD risk among women whose pregnancies who were complicated by GDM.

Having previously found that maintaining a healthy lifestyle before pregnancy including being a non-smoker, getting sufficient physical activity, adopting a healthy diet and having a healthy weight before pregnancy can prevent more than 50% of GDM diagnoses, and that optimal lifestyle habits in women with a history of GDM were associated with more than 90% reduction in later diagnosis of type 2 diabetes risk, GloW set out to identify modifiable factors at both molecular and behaviour levels partnering with investigators from Université Paris Cité (UPCité) and others that could influence women’s health outcomes across their life course and beyond. The two institutions announced a new endeavour to encourage Asian women to adopt healthier diet choices through the consumption of a tailored Mediterranean diet at the Women’s Health Conference 2024.

“Nutrition is a fundamental factor for health and there is substantial evidence to show that it plays a critical role in managing the risks of non-communicable diseases. Accumulating evidence has demonstrated that the earlier a healthy diet was adopted, the more years of life expectancy was gained. Meanwhile, it should be noted that optimal dietary patterns and
nutrition intakes are culture sensitive and efforts to improve nutrition and dietary patterns should be customised for the local population, to increase the chances of success. The findings from the new endeavour will provide valuable insights and evidence in developing nutritional interventions that work for Asian women and more importantly, potentially reduce the risk of cardio-metabolic disorders for women and their families,” said Professor Zhang Cuilin, Director of GloW at NUS Medicine.

A follow-up paper to a previous study that links greater adherence to healthy dietary patterns to higher chemical exposure during pregnancy led by Professor Zhang found that amongst a study population of U.S. multi-racial pregnant women, those whom consumed a Mediterranean diet but had a low exposure to persistent organic pollutants (POPs) concentrations had the lowest GDM risk. Greater adherence to Mediterranean dietary pattern can also alleviate the potential harmful effect of POPs.

Malnutrition in Asia is a serious concern that poses significant health risks. While malnutrition has traditionally and frequently been associated with undernutrition, the rise of obesity led by overnutrition is a growing concern in developed countries such as Singapore, given that obesity is an important risk factor for cardiovascular diseases. According to a study which projects the incidence of heart attacks in Singapore from 2025 to 2050, the overall incidence of heart attack is predicted to rise by 194.4%, and females who are overweight / obese is projected to see a higher increase compared to males who are overweight / obese. Nutrition, a key modifiable factor in health and disease prevention, is one of the key themes of the conference, with sessions across all three days (24 – 26 October 2024) exploring of the link between dietary habits, food choices and the impact they have on long-term health outcomes of women.

Cultivating A New Generation of Women Health Advocates
Besides working with women health experts in Singapore and France, GloW and UPCité have also been actively engaging with their respective governments to augment outreach efforts and influence policy. Highlighting the need for international collaboration and dialogue, the conference convened experts from various fields, including Amira Ghouaibi, Head of the Global Alliance for Women’s Health, World Economic Forum, Dr Megan Greenfield, Partner with McKinsey & Company, Helena Hui Wang, Asia Executive Editor of The Lancet, Professor Zaleha Abdullah Mahdy, National University of Malaysia and Professor Chong Yap Seng, Lien Ying Chow Professor in Medicine, Dean of NUS Medicine for the World Economic Forum session that discussed ways to address diverse health challenges faced by women in Asia.

“Too often, the well-being and health of women tend to be overlooked. In addition to women facing a set of distinct risk factors from men, variations in geographic location, ethnicity and lifestyles further distinguishes the impact that these factors have on the health of Asian women compared to their western counterparts. It is thus important for studies to be done in Asian contexts as much of our understanding comes from non-Asian sources. GloW’s work is critical; by collaborating with global partners from diverse backgrounds to advance Asian women’s health, they are accelerating the improvement on all fronts – education, research and advocacy – and that will bring us many steps closer to building a healthier future for Asian women, children, and families globally,” said Professor Chong Yap Seng, Lien Ying Chow Professor in Medicine, Dean of NUS Medicine.