孕早期膳食血糖负荷与妊娠期糖尿病关系的前瞻性研究

Association between dietary glycemic load during first trimester and the risk of gestational diabetes mellitus:a prospective study

目的探讨孕早期膳食血糖负荷(GL)与妊娠期糖尿病(GDM)的关系。方法采用前瞻性研究,选取成都市某三甲妇幼医疗机构产前门诊1462名孕8~14周单胎健康孕妇为研究对象。采用3天24小时膳食回顾法收集孕早期摄入的食物种类及数量。参照《中国食物成分表:标准版》及国际血糖生成指数和血糖负荷值表(2008)确定食物血糖生成指数(GI)值,根据食物GI值及其平均每日摄入量中碳水化合物含量计算膳食GL及主食GL。于孕24~28周行口服葡萄糖耐量试验,根据《妊娠合并糖尿病诊治指南(2014)》诊断GDM。按照四分位数分别将膳食GL及主食GL由低到高分为4组(Q1~Q4),采用log-binomial回归模型分析膳食GL及主食GL与GDM的关系。结果研究对象孕早期每日膳食GL和主食GL分别为145.70(113.23~180.85)和121.05(89.08~155.70),米类和薯类GL分别为73.14(43.89~107.50)和3.43(0.00~9.84)。调整年龄、孕前BMI等混杂因素后,log-binomial回归分析显示,膳食GL在Q3、Q4组孕妇GDM发生风险均较Q1组增加(RR=1.47,95%CI:1.20~1.80;RR=1.31,95%CI:1.04~1.64);主食GL在Q3、Q4组孕妇GDM发生风险均较Q1组增加(RR=1.28,95%CI:1.04~1.58;RR=1.27,95%CI:1.02~1.60);米类GL在Q3、Q4组孕妇GDM发生风险均较Q1组增加(RR=1.30,95%CI:1.06~1.59;RR=1.28,95%CI:1.03~1.59);薯类GL在Q4组孕妇GDM发生风险较Q1组增加(RR=1.30,95%CI:1.09~1.54)。未发现面类GL和杂粮GL对GDM发生风险有影响。结论孕早期膳食GL与GDM发生有关,膳食GL较高尤其是米类及薯类GL较高可能增加GDM的发生风险。

Objective To explore the effects of dietary glycemic load(GL)during first trimester on the risk of gestational diabetes mellitus(GDM).Methods A prospective study was conducted among healthy women with singleton pregnancy at 8-14 weeks of gestation in a maternity out-patient clinic of maternal-and-child health care institution in Chengdu,Sichuan province.Information on dietary intake during the first trimester was collected through a 3-day 24-hour dietary recall.Glycemic index(GI)values were obtained from China Food Composition Tables(Standard Edition)and International Tables of Glycemic Index and Glycemic Load Values(2008).Dietary GL and GLs of staple foods were calculated based on GI values and the amount of carbohydrate consumed per day.Diagnostic criteria of GDM was followed the Guidelines for Diagnosis and Treatment of Pregnancy Diabetes in China(2014),and used on participants who underwent an oral glucose tolerant test during 24-28 weeks of gestation.Log-binomial regression models were used to explore the associations between both quartiles of dietary GL,GLs of staple foods and the risks of GDM,respectively.Results The medians of dietary GL and GL of staple foods were 145.70(113.23-180.85)and 121.05(89.08-155.70),respectively.The median GL of both rice and tubers were 73.14(43.89-107.50)and 3.43(0.00-9.84),respectively.After adjusting for the age at pregnancy,pre-pregnancy body mass index and other confounding factors,results of log-binomial regressions analysis showed that when compared with the lowest quartile of dietary GL group,the third and highest quartiles of dietary GL groups increased the risk of GDM(RR=1.47,95%CI:1.20-1.80;RR=1.31,95%CI:1.04-1.64),respectively.Compared with the lowest quartile of GL of staple foods,the third and highest quartiles of GL of staple foods groups also increased the risk of GDM(RR=1.28,95%CI:1.04-1.58;RR=1.27,95%CI:1.02-1.60),respectively.The third and highest quartiles of GL of rice groups increased the risk of GDM(RR=1.30,95%CI:1.06-1.59;RR=1.28,95%CI:1.03-1.59),respectively,than the lowest quartile of GL of rice group.When compared with the lowest quartile of GL of tubers group,the highest quartile of GL of tubers group increased the risk of GDM(RR=1.30,95%CI:1.09-1.54).However,we did not notice the effects of wheat GL and coarse grain GL on the risk of GDM.Conclusions A positive association was found between dietary glycemic load and the risk of GDM.Higher dietary glycemic load,especially in rice and tubers during first trimester,seemed to have increased the risk of GDM.