成都市孕妇膳食能量摄入及能量密度与孕期增重的关系

Association of dietary energy intake and energy density with gestational weight gain in Chengdu City

目的探讨成都市孕妇膳食能量摄入及能量密度与孕期增重的关系。方法采用前瞻性方法,于2015年选取四川大学华西第二医院进行定期产前体检的503名孕妇为研究对象。采用经有效性验证的24小时膳食回顾法收集调查对象在孕早期、孕中期及孕晚期的膳食信息,并计算各期膳食能量摄入及三种定义下的能量密度(定义一:仅纳入食物;定义二:纳入食物及乳制品;定义三:纳入食物及饮料)。记录孕妇孕前及产前体重,计算孕期增重值,使用2009年美国医学研究所(Institute of Medicine,IOM)孕期增重推荐评价孕期是否过度增重。采用Logistic回归模型分析膳食能量摄入及能量密度与孕期过度增重是否存在相关性。结果孕晚期膳食能量较高者,其孕期过度增重的风险较高(OR=1. 94,95%CI 1. 18～3. 23);纳入食物和乳制品时,在控制混杂因素后,适中的孕晚期膳食能量密度降低了孕期过度增重的风险(OR=0. 56,95%CI 0. 34～0. 93);孕早期、孕中期在控制所有混杂因素后,膳食能量摄入及能量密度与孕期过度增重均未发现相关性。结论孕晚期膳食能量可能是孕期过度增重的危险因素,而孕晚期膳食能量密度保持适度可能会降低孕期过度增重风险。

Objective To determine the association of dietary energy intake and energy density (ED)with gestational weight gain among pregnant women in Chengdu. Methods A total of 503pregnant women who took the prenatal examination in West China Second University Hospital were selected in the prospective study in 2015.ED, computed as the ratio of energy intake (kcal)per weight (g)of foods (kcal/g),was calculated using three methods as follows:(1)ED1 included foods only,excluding all beverages;(2)ED2 included foods and milk;(3)ED3 included foods and beverages.Energy intake were calculated using dietary data respectively collected in the first,second and third trimester of pregnancy by validated 24-hour recalls,in which ED was calculated based on three calculation method.Data on gestational weight gain was calculated by using pre-pregnancy weight and prenatal weight.Excessive gestational weight gain was determined by the 2009 Institute of Medicine (IOM)recommendations for gestational weight gain.Logistic regression analyses were performed to explore the association of energy intake and ED with excessive gestational weight gain.Results The risk of excessive gestational weight gain was higher among pregnant women whose dietary energy intake during the third trimester of pregnancy was higher (OR =1.94,95%CI 1.18- 3.23).After adjusting for covariates,ED based on foods and milk during the third trimester of pregnancy was identified as a protect factor of excessive gestational weight gain (OR =0.56,95%CI O.34-0.93).Dietary energy intake and ED in the first and second trimester of pregnancy were not associated with excessive gestational weight gain after adjustment of all covariates.Conclusion Dietary energy intake in the third trimester of pregnancy might be the risk faetor of excessive gestational weight gain,while moderate ED may be the proteet factor.