孕期加工型饮食模式与炎症相关疾病及抑郁关联

Association of processed diet pattern with inflammatory diseases and depression during pregnancy: a clinic-based voluntary survey

目的 探讨孕期加工食物饮食模式与抑郁发生风险的关联,分析炎症相关疾病在其中的作用。方法 于2015年3月-2020年6月,在安徽省合肥市3家医院招募定期产检的孕18~27周孕妇6 313人,采用问卷调查方式收集孕期基本人口学特征、饮食摄入频率、疾病发生情况和抑郁状态,利用探索性因子分析法得到孕期饮食模式,采用logistic回归模型分析加工食物和炎症相关疾病与孕晚期抑郁风险的关联。结果 孕晚期重度抑郁率为13.4%(844/6 313)。只有加工型饮食模式高分组(≥P75)孕妇发生牙龈出血、口腔溃疡、阴道炎等炎症相关疾病风险升高(P <0.05)。孕妇炎症相关疾病与血清白细胞水平呈正相关(r=0.066,P <0.001)。与加工型低分组且无炎症相关疾病相比,低分组且有炎症相关疾病的孕妇孕晚期轻度抑郁(OR=1.343,95%CI=1.174~1.536)和重度抑郁(OR=1.275,95%CI=1.062~1.531)发生风险显著上升(均P <0.01);加工型高分组且无炎症相关疾病的孕妇孕晚期轻度抑郁发生风险(OR=1.417,95%CI=1.156~1.736)升高,孕晚期重度抑郁发生风险未观察到统计学意义(P=0.141);加工型高分组且有炎症相关疾病的孕妇孕晚期轻度抑郁(OR=1.778,95%CI=1.490~2.123)和重度抑郁(OR=2.209,95%CI=1.766~2.763)风险均显著增加。中介分析发现,炎症相关疾病在加工食物和孕晚期抑郁之间发挥部分中介作用,中介效应占总效应的7.54%。结论 孕中期加工型饮食模式且伴有炎症相关疾病的孕妇,孕晚期抑郁风险显著上升;加工型饮食模式可能通过促进炎症相关疾病增加抑郁发生风险。

Objective To investigate the association between processed food pattern and the risk of depression during pregnancy and the role of inflammation-related diseases on the association. Methods Totally 6 313 pregnant women at18 – 27 weeks of gestation were recruited in clinics of 3 hospitals in Hefei city, Anhui province from March 2015 through June 2020. An interview was conducted at the enrollment and two follow-up surveys were carried out at 32 – 36 weeks of gestation and at the delivery. A self-designed questionnaire, Edinburgh Postnatal Depression Scale(EPDS), and Food Frequency Questionnaire(FFQ) were used to collect information on demographics, frequency of food consumption, and diseases/depression. Exploratory factor analysis was adopted to discriminate dietary patterns and binary logistic regression models were used to analyze associations of processed food and inflammation-related diseases with depression risk in third trimester. Results Of all the pregnant women, 13.4%(n = 844) were assessed as having severe depression at the third trimester. The pregnant women with high scores( ≥ 75th percentile) for processed diet pattern had an increased risk of gingival bleeding, oral ulcers, vaginitis and other inflammation-related diseases(all P < 0.050). The inflammation-related disease score was positively correlated with serum leukocyte count(r = 0.066, P < 0.001). The results of logistic regression analysis showed that(1) for the pregnant women with low scores(< 75th percentile) of processed diet pattern, those suffering from inflammation-related diseases were at a significantly increased risk of mild depression(odds ratio [OR] = 1.343, 95%confidence interval [95% CI]: 1.174 – 1.536) and severe depression(OR = 1.275, 95% CI: 1.062 – 1.531) in the third trimester of pregnancy compare with the pregnant women without the diseases;(2) the pregnant women with high processed diet pattern scores but without inflammation-related diseases were at an increased risk of mild depression in the third trimester(OR = 1.417, 95% CI: 1.156 – 1.736), while no significantly increased risk of severe depression was identified(P =0.141);(3) and the pregnant women with both high processed diet pattern scores and inflammation-related diseases were at a significantly increased risk of mild depression(OR = 1.778, 95% CI: 1.490 – 2.123) and severe depression(OR = 2.209,95% CI: 1.766 – 2.763). Mediation analysis revealed that inflammation-related disease exerted a mediation effect on the correlation between processed diet and depression in the third trimester and the mediation effect accounted for 7.54% of the total effect. Conclusion The pregnant women with both processed diet pattern and inflammation-related disease in the second trimester could have a significantly increased risk of depression in the third trimester and processed diet may increase depression risk through promoting the incidence of inflammation-related diseases.