膳食脂肪酸与妊娠期糖尿病的前瞻性研究

A prospective study on relation between dietary fatty acids and gestational diabetes mellitus

目的探讨孕期膳食脂肪酸的摄入类型与妊娠期糖尿病发病及血糖水平间的关系，旨在探索出一套符合本地特点的膳食脂肪干预方案，降低妊娠期糖尿病的患病率，减少产科并发症及早产儿疾病的发生。方法选取妊娠期糖尿病孕妇64例为妊娠期糖尿病组，以同期正常妊娠孕妇64例为正常妊娠组。对饮食治疗前后的两组孕妇进行膳食脂肪酸检查，比较两组孕妇膳食结构中各类脂肪酸供能百分比，连续监测2周孕妇空腹、餐后1小时、餐后2小时血糖的变化以及空腹和餐后胰岛素的变化，并进行分析。结果两组孕妇日总热能摄入比较差异无统计学意义（t=0．594，P=0．536）；妊娠期糖尿病组孕妇饱和脂肪酸供能百分比显著高于正常妊娠组，差异有统计学意义（t=2．139，P=0．028），妊娠期糖尿病组孕妇多不饱和脂肪酸供能百分比显著低于正常妊娠组，差异有统计学意义（t=2．109，P=0．031）；两组孕妇单不饱和脂肪酸供能百分比经比较，差异无统计学意义（t=0．638，P=0．702）。对妊娠期糖尿病组孕妇膳食脂肪酸供能比例进行控制后，与正常妊娠组和未控制膳食脂肪酸妊娠期糖尿病组比较，空腹、餐后1小时、餐后2小时血糖差异均有统计学意义（t=2．675，P=0．015）。结论饱和脂肪酸可能是引起妊娠期糖尿病的独立危险因素，降低膳食饱和脂肪酸的比例，增加含较多多不饱和脂肪酸的食品可能是减少妊娠期糖尿病发病的一个良好方法。

Objective To investigate relationship between intake of different types of dietary fatty acids during pregnancy and incidence of gestational diabetes mellitus （GDM） and blood glucose level of the pregnant woman, so as to explore a dietary fat intervention program for pregnant women with local characteristics to reduce prevalence rate of GDM and obstetric complications and diseases of premature infants. Methods 64 pregnant women with GDM were included in GDM group（ average age： 33.2 years old; average gestational age： 26.7 weeks ; BMI. 18 -25kg/m^2） and other 64 normal pregnant women in the same period were as controls（ with similar age, BMI and gestational age ）. The dietary fatty acids of all pregnant women in the two groups were examined and energy supplying proportions of all types of dietary fatty acids of the pregnant women between the two groups were compared, and their fasting, postprandial 1 hour, 2 hours blood glucose level changes, as well as fasting and postprandial changes in serum insulin level were monitored for consecutive two weeks. The data were analysed statistically. Results ①The total calorie intake per day of the pregnant women in GDM group （ 12 011.2 ± 1 731.3 ） kJ was higher than that in the control group （11 209.8 ± 1 821.5 ）kJ, but there was no significant difference between the two groups （t = 0. 594 ,P = 0. 536） ;②The energy supplying proportion of saturated fatty acid（SFA） （% kJ） in GDM group was significantly higher than that in the control group and the difference was significant （ t = 2. 139, P = 0. 028 ） , while the energy supplying proportion of polyunsaturated fatty acid （PUFA） （% k J） in GDM group was significantly lower than that in the control group and the difference was significant （t = 2. 109, P = 0. 031 ）. In energy supplying proportion of monounsaturated fatty acid （ % kJ） , there was no significant difference between the two groups （t = 0.638, P = 0. 702 ） ;③After alimentary control, the fasting blood glucose, 1 hour postprandial blood glucose, 2 hours postprandial blood glucose of the pregnant women in GDM group were significantly lowered as compared with those of the normal pregnant women and those pregnant women whose intake proportions of dietary fatty acids were not controlled in GDM group （ t = 2. 675, P = 0. 015 ）. Conclusion SFA might be an independent risk factor of GDM. So, reducing the proportion of dietary SFA and increasing the proportion of PUFA in foods, for example, eating more deep-sea fish, nuts, seeds and vegetable oils may be a good way to reduce the incidence of GDM.