孕期妇女膳食指南依从性指数的建立和评价

ESTABLISHMENT AND APPLICATION OF THE CHINESE DIETARY GUIDELINES COMPLIANCE INDEX FOR PREGNANT WOMEN

目的依据《中国居民膳食指南(2016)》中孕期妇女膳食原则,建立和评价适用于基层孕期营养门诊工作的简便、有效膳食评估工具——孕期妇女膳食指南依从性指数。方法全面梳理《中国居民膳食指南(2016)》体系中《中国孕期妇女膳食指南》的核心条目,结合《中国孕期妇女平衡膳食宝塔》中膳食原则和推荐食物量建议,根据专家意见,确定该指数的关键考核点及相应赋值,建立该指数的评分计算体系。从"同济母婴健康队列"中随机抽取160名孕期妇女,对其孕早、中、晚三期膳食资料进行指数评分,评价该指数对膳食指南的依从性,并与妊娠期高血压的风险进行关联分析。结果建立的指数由13个考核点组成,赋值总分100。纳入研究的160名孕妇膳食指数评分为:孕早期(72.6±8.5)、孕中期(72.0±6.8)、孕晚期(75.1±7.6)分。该指数评分越高,孕妇各类食物摄入量达到推荐量范围内的比例越高,低于推荐量范围的比例越低。随着评分增加(每+10分),孕妇患妊娠高血压的风险越低,[OR (95%CI)]孕早期0.36(0.14,0.93),孕中期0.14 (0.03,0.60)。结论本研究建立的孕期妇女膳食指南依从性指数是一种简便、有效的膳食状况初筛工具,对中国孕期妇女膳食指南具有较好的依从性,可快速筛查出需要接受膳食教育和指导的重点孕妇,未来可用于基层孕期营养门诊工作。

Objective To establish and evaluate a dietary assessment tool, namely the Chinese dietary guidelines compliance index for pregnant women. Methods Based on Chinese Dietary Guidelines(2016) for pregnant women and Chinese Balanced Dietary Pagoda for pregnant women, we defined the key assessment points and corresponding value assignment of the index, and established the scoring system of the index. As an application example, 160 pregnant women were randomly selected from the "Tongji Maternal and Child Health Cohort", and their dietary data of the first, second and third trimesters of the pregnancy were scored by the index. The compliance of the index to dietary guidelines was evaluated,and the association between the index score and gestational hypertension was quantified using logistic regression analyses.Results The index consisted of 13 scoring components, ranged from 0 to 100 points. The mean index scores of 160 pregnant women in the 1st, 2nd and 3rd trimesters were 72.6±8.5, 72.0±6.8 and 75.1±7.6, respectively. The higher the score of the index,the higher the proportion of pregnant women had reported food intake within the recommendation. Furthermore, better adherence to the index(per 10-point increment) was associated with lower risks of gestational hypertension of pregnant women [OR(95% CI): 0.36(0.14, 0.93) in the 1st trimester, 0.14(0.03, 0.60) in the 2nd trimester]. Conclusions The Chinese dietary guidelines compliance index for pregnant women established in this study is a simple and effective tool for preliminary screening of dietary status. It has good compliance with Chinese Dietary Guidelines for pregnant women, and can quickly screen out pregnant women who need to receive dietary education and guidance, so it can be used in the maternity nutrition clinics of Chinese primary hospitals in the future.