孕妇孕早期膳食维生素A摄入量与妊娠期糖尿病的相关性研究

Association between dietary vitamin A intake and gestational diabetes mellitus in the first trimester

目的探讨孕妇孕早期膳食维生素A摄入量及其来源与妊娠期糖尿病(GDM)的关联。方法采用前瞻性队列研究,选取2017年成都市某三甲妇幼医疗机构产前门诊孕6~14周妇女作为研究对象。采用3 d 24 h膳食回顾法收集孕妇孕早期摄入的所有食物种类及数量,参照《中国食物成分表(2018)》计算膳食维生素A摄入量,并按其来源分为动物性及植物性维生素A摄入量。按孕早期维生素A平均需要量(EAR)、推荐摄入量(RNI)将膳食维生素A摄入量分为低水平组(<EAR)、中水平组(EAR~RNI)和高水平组(>RNI),按四分位数法分别将动物性及植物性维生素A摄入量由低到高分为4组(Q1~Q4)。采用log-binomial回归模型分析孕早期膳食维生素A摄入量及其来源与GDM的相关性。结果共纳入1298例研究对象。孕妇孕早期膳食维生素A摄入量中位数和四分位数间距为341.1(227.8,501.0)μgRAE/d,动物性及植物性维生素A摄入量分别为139.3(69.6,195.3)μgRAE/d、184.2(99.4,301.1)μgRAE/d。调整混杂因素后,log-binomial回归分析显示,膳食维生素A摄入量高水平组孕妇GDM发生风险较低水平组降低[RR(95%CI):0.53(0.36~0.80)];动物性维生素A摄入量在Q4组孕妇GDM发生风险较Q1组降低[RR(95%CI):0.66(0.47~0.95)]。未发现植物性维生素A摄入量对GDM的影响。结论孕妇孕早期膳食维生素A摄入量及其来源与GDM发生有关,膳食维生素A尤其是动物性维生素A摄入充足可能降低GDM发生风险。

Objective To investigate the relationship between dietary vitamin A intake and its sources in the first trimester and gestational diabetes mellitus(GDM).Methods A prospective study was conducted to select women at 6-14 weeks of gestation in an obstetric clinic of a maternal and child health care medical institution in Chengdu in 2017.The types and quantities of food during the first trimester were collected by 3-day 24-hour dietary recalls.Dietary vitamin A intake was calculated based on the Chinese Food Composition Table(2018),and it was divided into animal and plant vitamin A intakes according to its food sources.An oral glucose tolerance test was performed at 24-28 weeks of gestation to diagnose GDM according to the Chinese guidelines for diagnosis and treatment of gestational diabetes mellitus(2014).According to the estimated average requirement(EAR)and recommended nutrient intake(RNI),dietary vitamin A intake was divided into low-level group(<EAR),medium-level group(EAR-RNI)and high-level group(>RNI).Animal and plant vitamin A intakes were divided into four groups(Q1-Q4)according to the quartile method,respectively.The association between dietary vitamin A intake,its different sources of vitamin A intake and GDM in the first trimester was analyzed by log-binomial regression models.Results A total of 1298 valid samples were finally included.The average dietary vitamin A intake,animal and plant vitamin A intakes in the first trimester were 341.1(227.8-501.0)μgRAE/d,139.3(69.6-195.3)μgRAE/d and 184.2(99.4-301.1)μgRAE/d,respectively.After adjusting for confounding factors,log-binomial regression analysis showed that the risk of GDM in high-level group of dietary vitamin A intake was lower than that in low-level group[RR(95%CI):0.53(0.36-0.80)].Pregnant women in the highest quartile of animal vitamin A intake had a lower risk of GDM than those in the lowest quartile[RR(95%CI):0.66(0.47-0.95)].No relationship between plant vitamin A intake and GDM was found.Conclusion Dietary vitamin A intake in the first trimester is associated with the occurrence of GDM,and higher intake than RNI may reduce the risk of GDM.Higher vitamin A intake from animal-derived food is associated with decreased risk of GDM.