Master of Public Health-Global Nutrition & Active Living Solution Sample


Students will be given a variety of topics (Nutrition and Physical activity) to choose from to undertake a systematic review. Students will be expected to formulate a research question, develop a search strategy, apply study inclusion and exclusion criteria, data extraction, assessment of risk of bias, and analysis of study results.

A minimum of 10 full-length original articles or current available evidence published in peer-reviewed epidemiologic and other scientific journals in the chosen topic area will identified, summarized, and organised.

The word length for this written assignment is a maximum of 2000 words excluding reference and tables. The quality of review paper is expected to be closer to publication. Once students have completed this course they will have sufficient knowledge to participate in a systematic review.

Further instructions will be covered in the coming lectures and tutorials about systematic review approaches and outputs. In the meantime, additional readings can be found in VU Collaborate the content section entitled: Supporting materials for systematic review: Assignment 2.

Please choose one of the topics below:


1. Lifestyle, cultural and social and risk factors for Type 2 Diabetes among South Asians

2. Chamomile tea intake for improving glycaemic index in T2D

3. Nutrition interventions to improve oral health and chronic disease (AMI, Stroke, Diabetes, Arthritis)

4. High protein diet and the risk of type 2 diabetes

5. Fat diet in the prevention of diabetes

6. Risk factors for gestational diabetes among South Asians

Physical activity

1. Walk to school in the prevention of childhood obesity

2. 10000 steps to improve CVD/diabetes/mental health

3. Prolonged sitting and risk of chronic disease-Intervention

4. Physical activity determinants among low SES community

5. Physical activity interventions for migrants in Australia

6. Barriers to participating in physical activity among migrant women in Australia



Table of Contents


The occurrence of Gestational Diabetes nowadays is a very common occurrence among the expectant mothers of South Asia. Many a countries including India, Pakistan, China, Singapore has witnessed the same trend. The condition of the situation is going severe as the women of reproductive age are suffering from many gynaecological problems. As per the already relevant materials available about the situation, it is evident that the problem of Gestational Diabetes is widely prevalent not only in the countries of South Asia but also in a global perspective. Rationale

A prospective systematic literature review was done for the proper assessment on the Gestational Diabetes review of the women of South Asian Countries. The prevalence of the condition is very high and the consequence of the same is not good for the population. The review will help in the understanding of the underlying causes behind such a development.


The main objective behind the systematic review of risk factors of gestational diabetes is

  • To increase awareness of the situation

  • To understand the underlying causes

  • To know the proper perspective of the scenario in the South Asian countries

  • To evaluate the precautions from the risk factors for improved health scenario

  • To understand the causes of initiation of Gestational Diabetes


Eligibility Criteria

Specific study characteristics

The materials which are chosen for the systematic review are the ones which can be properly analysed on the basis of PICO can be followed as per other requirements.

PICO Analysis

The materials which are eligible for the selection should be able to answer the following question statements.

Question Statements

  • Risk Factors of Gestational Diabetes in South Asians

  • Prevalence of the condition is due to clinical negligence

  • Study should be focused only on people of South Asians

  • Ethnic and genetic factors are also considered as risk factors for the occurrence of Gestational Diabetes Mellitus.

Length of Follow up

The major time period span eligible for the selection of relevant study materials range from a few moths’ research to some years’ span (12 years).

Analysis Framework

Patient Problem or Population

Gestational Diabetes among women of reproductive age in countries of South Asia



Comparison or Control

Diet, weight control, smoking,


Reduced cases of prevalence of Gestational Diabetes Mellitus

Table 1: Table showing the PICO Analysis

(Source: Cuisset et al. 2018 p.167)

Report Characteristics

Years Considered – Journals and Articles published from the year 2015.

Rationale behind year consideration: As the topic of risk for gestational diabetes is much discussed and well researched one, current development can only be studied by the inclusion of recently published journals.

Language– English.

Rationale: Widely acceptable journals are published in English.

Publication Status– Published. Relevant journals are open access.

Information Sources

The main information sources used for the relevant systematic studies of the given topic are electronic databases such as PubMed, BMJ, NCBI as well as Google Scholar.

Date Last Searched: 16/04/2019


The search strategy use for the given topic of Gestational diabetes among women of reproductive age done from electronic database Google Scholar included keywords searching from the year 2015. The same was done by searching the key words as presented below

Search Strategy

(Refer to appendix)


  • Study selection









Figure: PRISMA Flow Diagram

(Source: Moher et al. 2015 p.4)

Study Characteristics

The main characteristics used for the relevant materials of study were the s6ynchronocity of the material with aims and objects of the given systematic review.

  • Qualities of Study Assessment

The quality assessment for the relevant materials was done on the basis of the result outcomes of the reviews and whether these are relevant to the aims of the topic.



Study: As per the views of Zhu and Zhang (2016 p.7), increased cases of Gestational diabetes has been observed in the populations affecting different age groups in the varied populations of people all across the globe .However, a recent rise in the cases of Gestational Diabetes is also seen in many an areas. The study has followed various methodological and screening approaches for the proper assessment of the cases. The studies revealed that epidemic of diabetes in the recent case have also increased the number of gestational cases of Diabetes. The causes include perinatal morbidity and development of Type 2 Diabetes Mellitus in the later stage of life. The case of Gestational Diabetes has become a more common complication in pregnancies. Another factor responsible for the proper assessment of the condition in various countries is the divergence of local and regional practices regarding the Gestational Diabetes Mellitus screening process.

Review 2:

Study: As influenced by the views of Kampmann et al. (2015, p.1060), management and diagnosis and of the condition of gestational diabetes is a tough task. The consequences of the pathophysiology of the condition along with long and short term consequences can cause the effect to both the child and the mother. The following study done on the basis of the findings of American Diabetes Association on the citizens of various south Asian countries such as Nepal, Bhutan, Pakistan , South Korea along with others , finds that there is a high increase on the cases of Gestational diabetes increasing the complexity of pregnancies in women.

The main reason as identified by the study along with the normal issues of overweight and obesity includes that Adipose tissue are found to be producing large amounts of diabetogenic adipokines increasing the overall sensitivity of the tissue towards the insulin fluctuation. The study than discusses about the long term consequences of the disease including the conditions of macrosomia, hypertensive disorders and foetal hyperinsulinemia. These conditions are fatal both to the child as well as to the mother in a long term span. Various metabolic disorders and cardiovascular syndrome can also occur due to this. The study also mentions that a large number of severities of the cases are involved with ethnicity as well.

Review 3:

Study: As per the study of Lee et al. (2015, P.496) regarding the prevalence of Gestational Diabetes gives a through overview of the situational analysis for the condition in south Asia Countries. The systematic review done on the same topic includes reviews from different medical conditions such as history of stillbirth, history of Polycystic Ovarian Syndrome, history of abortions and pregnancy induced Hypertension. The following systematic analysis done on the main south Asian countries show that the prevalence of the condition in the pool destination is about 11.5%.

The major risk factors as identified by the study included cases of multiparity cases greater than 2, previous history of Gestational Diabetes Mellitus, congenital Anomalies, stillbirth, abortion, preterm delivery, macrosomia, Polycystic Ovarian Syndrome in ages equal or above 25 years and a family history Diabetes. The limitations of the study included that the sample size used in the study from India only included a small pool as compare to the 1.3 billion populations in India. Thus, the main risk factors are again the same s identified in the last two studies and their respective reviews.

Review 4:

The studies conducted on the increased prevalence of Gestational Diabetes Mellitus as per the statistics of WHO standards reveal that risk factor mentioned in the section of Tianjin for a 12 year period the studies were conducted on women who have been registered under 12 weeks of pregnancy as Gestational Diabetes Mellitus, included the sample size of 18589 women. The results reveal that out of the total sample pool the prevalence case has increased by 9.3%. The studies revealed that it is a common condition of pregnancy associated with short term and long term effects for both expectant mothers and their offspring (Leng et al. 2015, p.121).

Various risk factors have been identified for the condition in the 12 year long study. The main risk factors as identified for the increased prevalence of the case in China are social urbanization and weight gain issues from pre- pregnancy. However, the major risk factors as identified by the study are Obesity or Overweight. According to the 12 year long study, proportion of obesity or overweight conditions in the given sample of population increased from 14.8% to 26.8% causing an increment of Gestational Diabetes Mellitus condition in the region. Another important risk factor, only second to Obesity is the increase Blood pressure of the person. Increased Blood Pressure causes Hypertension or Prehypertension which is also an important risk factor for the same. The other risk factors as identified by the study is Smoking. As p0er the study, habitual smoking patterns in the pre pregnancy as well as during the pregnancies contribute a lot to the increase in the case of Gestational Diabetes Mellitus in the region.

Review 5:

The study by Nanditha et al. (2016, p.480) is based on the increased chances of Diabetes occurrences and the reasons behind the same. According to the study, many reasons mainly lifestyle changes and rapid urbanisation in the regions of South Asian Countries. The study in its focus on the disease determining the view that of the total 16% of pregnancies that are prevalent globally, 11.8% is based on the region of South Asia. The reasons behind the same have been attributed to ethnicity, population and diagnostic criteria as well.

Review 6:

The following study done by Arora et al. (2015, p.260) describes the condition and scenario of prevalence of Gestational Diabetes Mellitus cases in the area of Punjab, North India. As per the study, the prevalence scenario is assessed by the changed WHO criteria of diagnosis of Gestational Diabetes Mellitus in the year 2013. The population screening programme done on randomly chosen 5100 North Indian pregnant women using cross sectional questionnaire and results of Glucose Tolerance test performed. The outcome of the study has revealed that there is almost a fourfold difference in between the prevalence of GDM in the areas of North India. Many a reasons can be attributed for such a pattern such as high Body Mass Index, education and Illiteracy and vegetarian diet.

Review 7:

Study : As per the study of Gadgil et al. (2017, p.289) done on the topic of gestational Diabetes Mellitus in the women of South Asian ethnicity residing in the U.S explores about the possibility of risk of Type 2 Diabetes in cases of the disease. The studies found that approx a majority women aged 40-84 years who suffered from Gestational Diabetes Mellitus are found to be suffering from Type 2 Diabetes. The studies also revealed that women with the higher Body Mass Index and higher levels of Fasting glucose are found to be more vulnerable for developing Type 2 Diabetes along with Gestational Diabetes Mellitus. This also proves the works of other researchers as the risk factors of the condition are again attributed to Higher BMI.

Review 8:

As per the views of Lamri et al. (2019, p.574) the Gestational Diabetes Mellitus is an important condition having strong genetic history. The study done by Genome Wide Association Studies by comparing the genome sequences with those of European women of the same situation founded that participants having higher values of Polygenic Risk Scores are more prone to the occurrence of this particular disease. The study proves that along with all the important risk factors mentioned above, the genetic aspect of the condition plays a pivotal role in the occurrence of the same.

Review 9:

The study done by Bhavadharini et al. (2017, p.23) is done with the aim of gaining an insight of the risk factors among other in the case of Gestational Diabetes Mellitus. The study reveals that lack of awareness of the occurrence of Gestational Diabetes Mellitus among the rural women of the region of South Tamil Nadu is the major reason behind the increased prevalence of the same in the region. Along with this, poor literacy rates and lack of proper nutrition is the major reason of the occurrence of the disease in the region.

Review 10:

Study: The study done by Greenhalgh et al. (2015, p.121) reveals that diabetes in pregnant women is a very common occurrence especially with women from low income backgrounds. The studies further reveal that of the total 45 women selected of various origins from the South Asian Region effect of behavioural patterns had a huge influence on the perceiving nature of the women about Gestational Diabetes Mellitus. Some preferred exercises while others did not. These kinds of beliefs are somewhere related to the increase in cases of Gestational Diabetes Mellitus in the women of South Asia.


The study is only based on the reviews selected and the sample size of the reviews is not similar. Hence, the results can be erroneous in some cases.


From the above systematic review it can be analysed that the main reasons for the occurrence of Gestational Diabetes Mellitus are overweight and obesity issues. High levels of BMI are also responsible for the same. Prevalence of the condition is very high in these regions that the study has highlighted with appropriate evidence.

Reference List

Arora, G.P., Thaman, R.G., Prasad, R.B., Almgren, P., Brøns, C., Groop, L.C. and Vaag, A.A., 2015. Prevalence and risk factors of gestational diabetes in Punjab, North India: results from a population screening program. European journal of endocrinology173(2), pp.257-267.

Bhavadharini, B., Deepa, M., Nallaperumal, S., Anjana, R.M. and Mohan, V., 2017. Knowledge about gestational diabetes mellitus amongst pregnant women in South Tamil Nadu. Journal of Diabetology8(1), pp.22-24.

Cuisset, T., Aponte, Z., Paek, D., del Aguila, M., Girotra, S. and Sibbing, D., 2018. Comparing Patient Profiles of Clopidogrel versus Ticagrelor: A Systematic Literature Review and Meta-Analysis. Circulation138(Suppl_1), pp.A14761-A14761.

Gadgil, M.D., OzaFrank, R., Kandula, N.R. and Kanaya, A.M., 2017. Type 2 diabetes after gestational diabetes mellitus in South Asian women in the United States. Diabetes/metabolism research and reviews33(5), pp.e2891-2893.

Greenhalgh, T., Clinch, M., Afsar, N., Choudhury, Y., Sudra, R., Campbell-Richards, D., Claydon, A., Hitman, G.A., Hanson, P. and Finer, S., 2015. Socio-cultural influences on the behaviour of South Asian women with diabetes in pregnancy: qualitative study using a multi-level theoretical approach. BMC medicine13(1), pp.120-125.

Hemsley, B., Bryant, L., Schlosser, R.W., Shane, H.C., Lang, R., Paul, D., Banajee, M. and Ireland, M., 2018. Systematic review of facilitated communication 2014–2018 finds no new evidence that messages delivered using facilitated communication are authored by the person with disability. Autism & Developmental Language Impairments3, p.2396941518821570.

Kampmann, U., Madsen, L.R., Skajaa, G.O., Iversen, D.S., Moeller, N. and Ovesen, P., 2015. Gestational diabetes: a clinical update. World journal of diabetes6(8), pp.1065-1071.

Lamri, A., Mao, S., Desai, D., Gupta, M., Paré, G. and Anand, S.S., 2019. Genome-Wide Polygenic Risk Scores and prediction of Gestational Diabetes in South Asian Women. bioRxiv, p.574616.

Lee, K.W., Ching, S.M., Ramachandran, V., Yee, A., Hoo, F.K., Chia, Y.C., Sulaiman, W.A.W., Suppiah, S., Mohamed, M.H. and Veettil, S.K., 2018. Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis. BMC pregnancy and childbirth18(1), pp.494-496.

Leng, J., Shao, P., Zhang, C., Tian, H., Zhang, F., Zhang, S., Dong, L., Li, L., Yu, Z., Chan, J.C. and Hu, G., 2015. Prevalence of gestational diabetes mellitus and its risk factors in Chinese pregnant women: a prospective population-based study in Tianjin, China. PloS one10(3), p.e0121029.

Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P. and Stewart, L.A., 2015. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic reviews4(1), pp.1-15.

Nanditha, A., Ma, R.C., Ramachandran, A., Snehalatha, C., Chan, J.C., Chia, K.S., Shaw, J.E. and Zimmet, P.Z., 2016. Diabetes in Asia and the Pacific: implications for the global epidemic. Diabetes care39(3), pp.472-485.

Zhu, Y. and Zhang, C., 2016. Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global perspective. Current diabetes reports16(1), pp.7-15.


Search Strategy

Key Words






Risk Factors of Gestational Diabetes


Prevalence and risk factors of gestational diabetes in Punjab, North India: results from a population screening program. .

Gestational diabetes: a clinical update. 

Gestational Diabetes among South Asian

Gestational Diabetes among women


Knowledge about gestational diabetes mellitus amongst pregnant women in South Tamil Nadu. 

Genome-Wide Polygenic Risk Scores and prediction of Gestational Diabetes in South Asian Women. 

Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis. 

Gestational Diabetes risk factors

Global Perspective of Gestational Diabetes


Diabetes in Asia and the Pacific: implications for the global epidemic. 

Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global perspective. 

Gestational Diabetes risk factors in south asians

Prevalence of Gestational Diabetes


Prevalence of gestational diabetes mellitus and its risk factors in Chinese pregnant women: a prospective population-based study in Tianjin, China

Prevalence of Gestational Diabetes in South Asian women.


Type 2 diabetes after gestational diabetes mellitus in South Asian women in the United States. 

Knowledge about gestational diabetes mellitus amongst pregnant women in South Tamil Nadu

TABLE 2: Table showing the search strategy

(Source: Hemsley et al. 2018, p.17)


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