孕期膳食模式对妊娠期糖尿病发生风险的影响

Effect of dietary patterns during pregnancy on the risk of developing gestational diabetes mellitus

目的探讨孕期膳食模式对妊娠期糖尿病(GDM)发生风险的影响。方法为前瞻性队列研究。纳入2018年10月至2019年3月于复旦大学附属妇产科医院产科建卡的1008例孕妇作为研究对象,收集一般资料、膳食记录、活动情况及口服葡萄糖耐量试验(OGTT)数据。采用主成分分析法提取膳食模式,利用多因素logistic回归模型分析各膳食模式得分的四分位数对GDM发生风险的影响,采用多元线性回归分析法分析膳食模式得分与血糖水平的相关性。结果本研究中GDM发生率为9.8%(99/1008)。提取出五种膳食模式,分别为“蔬果-薯类”“菌藻-豆类”“鱼-虾蟹贝类”“精制谷物-红肉内脏”和“添加糖-糕点”。多因素logistic回归分析结果显示,在“鱼-虾蟹贝类”膳食模式下,膳食模式得分处于最高四分位数的孕妇GDM发生风险是最低四分位数的2.64倍,95%可信区间1.17~5.94,Ptrend=0.012;该模式得分与OGTT 1 h和2 h血糖呈正相关(β=0.21,P=0.001;β=0.12,P=0.007)。进一步分析宏量营养素在其中的作用,发现模型中校正碳水化合物供能比、蛋白质供能比或蛋白质/碳水化合物后,“鱼-虾蟹贝类”模式对GDM产生的影响不再显著(P>0.05);同时,在校正碳水化合物供能比或蛋白质/碳水化合物后,该模式对OGTT 1 h和2 h血糖的影响消失(P>0.05)。结论本研究中“鱼-虾蟹贝类”膳食模式以高蛋白质和低碳水化合物摄入为特征,增加了GDM患病率,该模式中宏量营养素供能比是影响OGTT结果至关重要的因素。

Objective To analyze the dietary patterns of pregnant women during pregnancy and their associations with gestational diabetes mellitus(GDM).Methods A cohort of 1008 pregnant women from Department of Obstetrics,Obstetrics and Gynecology Hospital of Fudan University were recruited at their first routine antenatal care from October 2018 to March 2019.Participants′data about their demographic and lifestyle characteristics,dietary intake,physical activity,and oral glucose tolerance test(OGTT)results were collected in this study.Dietary patterns were identified using a principal component analysis.The logistic regression models were used to evaluate the association between dietary pattern scores and GDM.Multivariate linear regression models were performed to assess the association between each dietary pattern and maternal blood glucose levels.Results The occurrence of GDM was 9.8%(99/1008).Five dietary patterns were extracted:vegetables-fruit-tubers,fungi-algae-beans,fish-shrimps-crab-shellfish,refined grains-red meat-organs,and confectionery-sugary beverages dietary pattern.Higher fish-shrimps scores were associated with an increased risk of GDM(odds ratio for highest quartile vs.lowest quartile:2.64;95%confidence interval:1.17-5.94;Ptrend=0.012)and higher OGTT 1 h and 2 h plasma glucose levels(β=0.21,P=0.001;β=0.12,P=0.007).We further analyzed the role of macronutrients in the relationship between fish-shrimps patterns with GDM and glucose levels.The results showed that the association of the fish-shrimps-crab-shellfish score with GDM risk for comparisons of highest with lowest quartiles was no longer significant after additional adjustment for percentage of energy supply from protein or carbohydrate,or ratio of protein to carbohydrate.The association between fish-shrimps-crab-shellfish score and OGTT 1 h and 2 h plasma glucose levels disappeared after further adjusted for percentage of energy from carbohydrate,or ratio of protein to carbohydrate.Conclusions In this study,the fish-shrimp,crab and shellfish dietary pattern is characterized by high protein and low carbohydrate intake,which may increase the prevalence of GDM.In this pattern,the macronutrients energy supply ratio plays a crucial role in the results of OGTT.