综合营养管理对妊娠期糖尿病患者的血糖及妊娠结局的影响

目的 探讨综合营养管理对妊娠期糖尿病(GDM)患者糖脂代谢及妊娠结局的影响。方法 本研究纳入了2021年5月~2021年7月共121名在全国6个分中心医院产科建档的妊娠24~28周的GDM孕妇,随机分为干预组(n=74)和对照组(n=47)。干预组接受综合营养管理,包括至少6次门诊干预、个体化营养管理及妊娠期糖尿病半日规范化门诊宣教,并持续使用动态血糖监测仪和指血血糖监测仪监测血糖,每4周进行糖化白蛋白和尿常规检测,记录体质量、体成分、饮食运动实施、胎儿发育以及并发症发生情况。对照组接受常规营养指导。比较两组孕37周的血糖相关指标、分娩前的体质量增加和部分脂类代谢指标、妊娠结局以及产后42 d口服葡萄糖耐量试验(OGTT)结果的差异。结果 与对照组相比,干预组孕妇的产前空腹血糖(P=0.006)、餐后2 h静脉血浆葡萄糖(P=0.009)、血酮(P=0.044)水平显著降低。两组间体质量增加值与体质量达标率没有显著性差异。干预组孕妇的产后2h OGTT试验结果小于对照组(P=0.006),差异有统计学意义,子痫前期的发生率和产后出血量低于对照组,但两组之间没有统计学差异。对于新生儿来说,干预组的巨大儿(P=0.042)、剖宫产(P=0.048)的发生率略低于对照组,结果有统计学差异。其他不良妊娠结局在两组之间没有统计学差异。结论 强化综合营养管理能够更好地控制孕妇血糖水平,改善GDM妇女的孕产妇和新生儿结局。

血清维生素D对妊娠早期血脂的影响

目的 探讨妊娠早期血清维生素D水平与血脂的关系。方法 选取妊娠早期女性257名,采用面对面问询法收集其年龄、文化程度等一般资料;使用立柱式身高仪测量身高,询问其孕前体质量,并计算孕前体质量指数(BMI);使用软尺测量宫高、腹围,抽取清晨空腹静脉血5 mL测定其血清维生素D,采用罗氏Cobas c702全自动生化分析仪测定其总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)水平;采用logistic回归分析血清维生素D水平与血脂指标之间的相关性。结果 妊娠早期女性血清维生素D中位数水平为43.25(28.88,58.63) nmol/L,血清维生素D缺乏率为59.53%;按血清维生素D水平分为3组,不同血清维生素D水平组间TG、HDL-C的差异有统计学意义(P<0.05),且呈现随血清维生素D水平升高而升高的趋势;以血脂是否异常为因变量,校正年龄、孕前BMI、腹围等因素后进行logistic回归分析,血清维生素D的OR(95%CI)为1.037(1.003~1.071),P=0.031,提示血清维生素D水平是血脂异常的危险因素。结论 妊娠早期女性维生素D缺乏现象普遍,血清维生素D水平可能与血脂异常相关。

中国三地乳母乳汁维生素A营养状况及影响因素

目的:分析中国威海、岳阳、包头三地乳母乳汁维生素A(vitamin A, VitA)水平,评价乳母乳汁VitA的营养状况及其影响因素。方法:2014年5月至7月在山东省威海市、湖南省岳阳市和内蒙古包头市于产后(42±7) d募集乳母403例,通过调查问卷收集乳母和新生儿基本信息及乳母近1个月内鱼类摄入情况,采集乳母乳汁并采用高效液相色谱法检测乳汁视黄醇浓度,以此代表VitA水平。依据视黄醇浓度,将乳母乳汁VitA营养状况分为缺乏(<1.05μmol/L)和充足(≥1.05μmol/L)。采用多因素分位数回归计算调整后的乳汁视黄醇浓度,Kruskal-Wallis H检验和Mann-Whitney U检验评估不同特征人群视黄醇浓度差异情况,Logistic回归模型分析乳汁VitA缺乏的可能影响因素。结果:中国三地乳母乳汁视黄醇M(P_(25),P_(75))为1.15 (0.83, 1.49)μmol/L。多因素分析结果显示,调整后的乳汁视黄醇浓度与乳母居住地区、年龄、民族、受教育程度、体重指数、产次、分娩孕周、分娩方式、哺乳方式、鱼类摄入量和新生儿出生体质量有关。乳母乳汁整体VitA缺乏率为41.9%,威海、岳阳和包头地区的缺乏率分别为34.8%、39.6%和51.5%。与威海地区乳母相比,包头地区乳母乳汁VitA缺乏的调整OR值为1.75 (95%CI:1.05~2.92);与受教育程度为大专及以上乳母相比,初中及以下乳母乳汁VitA缺乏的调整OR值为2.16 (95%CI:1.10~4.24);与鱼类摄入量少的乳母相比,鱼类摄入量多的乳母乳汁VitA缺乏的调整OR值为0.55 (95%CI:0.36~0.84)。结论:调查地区乳母乳汁整体VitA缺乏率为41.9%,提示乳汁VitA缺乏及婴儿VitA摄入不足情况较为普遍。包头地区、受教育程度低和鱼类摄入量少增加乳汁VitA缺乏发生风险,提示宜重点关注欠发达地区乳母的乳汁营养状况,加强健康教育,增加鱼类等含VitA的食物摄入。

母乳低聚糖与婴幼儿健康关系研究进展

母乳低聚糖在促进婴幼儿生长发育上发挥重要作用,目前已报道的母乳低聚糖超过200种。文章综述了母乳低聚糖的种类与结构、对婴幼儿肠道健康的影响、免疫调节作用及促进大脑发育等相关研究成果,总结了母乳低聚糖的应用现状,展望了未来母乳低聚糖工业化生产及其应用的可能性和必要性。

应用哺乳期膳食平衡指数评价中国十城市乳母膳食质量

目的:修订哺乳期膳食平衡指数,并评价我国十城市哺乳期妇女膳食质量,分析影响哺乳期妇女膳食质量的因素。方法:使用自设问卷和膳食频率问卷,于2019年对中国10城市863名乳母开展横断面营养健康调查。在2016年膳食平衡指数的基础上,根据2022年哺乳期妇女膳食指南调整评分标准,并评价乳母膳食质量。结果:乳母膳食摄入不平衡、不足、过量的比例分别为86.7%、85.9%、44.2%。乳母蔬菜类、水果类、奶类、大豆类及水产品类食物摄入不足,食用油和盐摄入过量严重,摄入食物多样性较低。受教育水平、收入、城市类型、体力活动水平、产后抑郁情况和是否参与孕妇学校等多种因素与乳母膳食平衡相关。结论:中国十城市乳母人群的膳食摄入不平衡主要体现为摄入不足,而摄入过量的程度相对较低。应有针对性地加强妇女产后健康教育,提高乳母膳食质量。

6~36月龄婴幼儿膳食多样性与自报患病的相关性分析

目的:探究中国10城市6~36月龄婴幼儿膳食多样性与自报患病情况的相关性。方法:基于2019—2020年在中国10城市开展的横断面调查的数据,通过问卷收集婴幼儿的相关人口学特征、自报患病情况及膳食多样性情况,使用卡方检验、Logistic回归、负二项回归模型分析婴幼儿膳食多样性与自报患病发生率及患病次数之间的相关性。结果:我国城市婴幼儿最低膳食多样性满足率为74.6%,婴幼儿年龄越大、家庭人均月收入越高、父亲教育程度越高其最低膳食多样性满足率更高(P<0.05)。满足最低膳食多样性的婴幼儿其呼吸系统疾病(IRR=0.76,95%CI:0.58~0.98,P=0.035)以及腹泻(IRR=0.65,95%CI:0.48~0.88,P=0.006)发生的次数更低。暂未发现婴幼儿膳食多样性与各自报疾病的发生率之间存在显著相关关系。结论:中国城市6~36月龄婴幼儿膳食多样性与呼吸系统疾病以及腹泻存在一定关联。

凉山州少数民族地区新生儿维生素D水平及影响因素分析

目的:对凉山州少数民族地区新生儿血清维生素D水平进行评估,探讨血清维生素D水平的影响因素。方法:收集2022年1月—2023年9月在西昌市人民医院住院分娩的1705例新生儿为研究对象。采用调查问卷及电子病历收集孕妇及新生儿的一般情况,采用自动电化学发光法检测血清25(OH)D水平,统计新生儿血清25(OH)D水平状况,分析血清维生素D水平的影响因素。结果:凉山州少数民族地区新生儿1705例新生儿中,维生素D营养状况充足者共197例(11.55%),不足/缺乏者1508例(88.45%)。孕妇文化程度为大学及以上(OR=0.906,95%CI:0.820~0.997)、维生素D补充(OR=0.826,95%CI:0.690~0.989)及新生儿出生胎龄高(OR=0.912,95%CI:0.835~0.996)是维生素D营养状况的保护因素;而日照不充足(OR=1.284,95%CI:1.051~1.568)、孕期维生素D缺乏(OR=1.484,95%CI:1.017~2.166)及分娩季节为冬春季(OR=1.316,95%CI:1.017-1.693)是维生素D不足/缺乏的危险因素。结论:凉山州少数民族地区新生儿维生素D不足/缺乏发生率高,应关注此地区新生儿的维生素D营养状况,对可能的影响因素进行及时干预,以保证新生儿健康成长。

上海市青浦区 2015—2023 年孕妇碘营养状况调查

目的了解上海市青浦区2015—2023年孕妇碘营养状况,为制定区域内干预策略提供依据。方法每个街镇随机抽取20~30名共计1152名孕妇,采集其家中食用盐样并检测尿样碘含量,结合统计学方法进行分析。结果调查对象的盐碘含量为24.40 mg/kg,合格碘盐食用率为61.37%,碘盐合格率为84.67%,碘盐覆盖率为72.48%。近年青浦区的碘盐合格率、碘盐覆盖率、合格碘盐食用率均呈现下降趋势(P<0.01)。合格碘盐食用率与碘盐覆盖率之间呈正相关关系(P<0.05)。结论孕妇群体的碘营养状况整体处于适宜水平,但仍有近半数碘营养水平不足。应加强健康宣教,倡导科学补碘、按需补碘。

合肥市孕妇孕早期膳食模式与6月龄婴儿神经心理发育的分析

目的:探讨孕早期膳食模式对婴儿神经心理发育的影响,为引导孕妇调整孕早期膳食结构以及促进婴儿神经心理发育提供科学依据。方法:在合肥市以孕早期(12~12+6周)孕妇作为目标人群,随机抽取496名孕妇作为研究对象,并随访其子代到6月+10天左右。通过问卷调查收集研究对象的基本信息、膳食习惯,并通过膳食频率法记录孕妇的膳食情况;采用因子分析法提取孕早期孕妇膳食模式,并通过多元Logistic回归分析孕早期孕妇不同膳食模式对婴儿神经心理发育的影响。结果:孕早期孕妇共有5种膳食模式,分别为腌制类、水果-奶类、水产-肉类、干坚果-豆类以及饮料-主食类。调整了混杂因素之后在6月龄婴儿智力得分高分组中,腌制类DP中T1与T3相比,增加了婴儿获得更高智力得分的可能性(OR=9.64,95%CI=1.30~71.67);6月龄婴儿运动得分中分组中,水产肉类DP中T2与T3相比,降低了婴儿获得更高运动得分的可能(OR=0.11,95%CI=0.02~0.74)。结论:孕妇孕早期较少的食用腌制类DP对婴儿的神经心理发育有一定的影响,增加婴儿获得智力高分的可能性;水产-肉类DP中,孕妇食用量处于中位水平较食用多者,导致婴儿获得更高运动得分的可能性降低。

澜沧县2021-2023年妊娠期妇女碘营养水平现状调查

目的 对澜沧县孕妇食盐、尿碘进行调查,评价该县孕妇碘营养状况,为科学补碘提供依据。方法 根据《全国碘缺乏病监测方案》要求按辖区方位进行抽样,收集其尿样及家中食用盐,测定尿碘、盐碘含量。结果 共调查290人;该县非碘盐率检出率仅1%;三年碘盐覆盖率均>90%;孕妇MUI为205.41μg/L;勐朗镇(57.5%)、惠民(51.6%)、南岭(50%)等乡镇尿检结果<150μg/L者较多,酒井(25%)、上允(15%)尿碘≥500μg/L者较多,不同乡镇尿碘分布、MUI差异有统计学意义(P<0.05)。结论 该地非碘盐率总体处于较低水平、碘盐覆盖率较好、碘盐合格率总体均达到国家碘缺乏病消除标准;建议对该地实施因地制宜的科学补碘策略。

Iodine Nutrition, Thyroid-stimulating Hormone, and Related Factors of Postpartum Women from three Different Areas in China: A Cross-sectional Survey

Objective Studies on the relationship between iodine,vitamin A(VA),and vitamin D(VD)and thyroid function are limited.This study aimed to analyze iodine and thyroid-stimulating hormone(TSH)status and their possible relationships with VA,VD,and other factors in postpartum women.Methods A total of 1,311 mothers(896 lactating and 415 non-lactating)from Hebei,Zhejiang,and Guangxi provinces were included in this study.The urinary iodine concentration(UIC),TSH,VA,and VD were measured.Results The median UIC of total and lactating participants were 142.00µg/L and 139.95µg/L,respectively.The median TSH,VA,and VD levels in all the participants were 1.89 mIU/L,0.44μg/mL,and 24.04 ng/mL,respectively.No differences in the UIC were found between lactating and non-lactating mothers.UIC and TSH levels were significantly different among the three provinces.The rural UIC was higher than the urban UIC.Obese mothers had a higher UIC and a higher prevalence of excessive TSH.Higher UICs and TSHs levels were observed in both the VD deficiency and insufficiency groups than in the VD-sufficient group.After adjustment,no linear correlation was observed between UIC and VA/VD.No interaction was found between vitamins A/D and UIC on TSH levels.Conclusion The mothers in the present study had no iodine deficiency.Region,area type,BMI,and VD may be related to the iodine status or TSH levels.

Longitudinal investigation of mineral composition in human milk and its correlation with infant anthropometric outcomes among Tibetan mother-infant dyads during the first 6 months postpartum

Nutrients in human milk,including minerals,relate growth and development of breast-fed infants.Tibetan mother-infant dyads possess unique characteristics on early nutrition due to their featured long-lasting lifestyle.This study longitudinally investigated the relationship between the mineral composition in human milk and the Z-scores of infants among Tibetan mother-infant dyads during their first 6 months postpartum through a prospective cohort study.The results show that the minerals of Na,Mg,K,Ca,Cu,Zn,and Se were of higher levels in colostrum than other lactation stages.Several minerals were below the recommended values for infants according to Chinese dietary guidelines.Besides,a large proportion of infant Z-scores were below-2 as lactation period continued.Multivariate statistical analysis revealed that classifications and correlations in varying degrees were observed between minerals in human milk and infant Z-scores.These findings will be advantageous for research upon Chinese early nutrition and progress of tailor-made infant formula.

谷氨酰胺与骨密度、骨转换指标、wnt-7a蛋白间的孟德尔随机分析

目的使用孟德尔随机化分析(MR)方法探索谷氨酰胺(Gln)与骨密度(bone mineral density,BMD)、骨转换指标、wnt-7a蛋白之间的因果关系。方法利用全基因组关联分析(genome-wide association studies,GWAS)研究数据,暴露因素选择Gln,结局变量包括股骨颈骨密度(FN-BMD)、前臂骨密度(FA-BMD)、腰椎骨密度(LS-BMD)、全身骨密度(TB-BMD)、骨转换指标包括血清25-羟基维生素D水平[25(OH)D]、甲状旁腺素(PTH)、骨保护素(OPG)、骨钙素(BGP)、Wnt信号家族成员:wnt-7a。采用逆方差加权法、MR-Egger回归法、加权中位数方法、Simple Mode法和Weighted Mode法,并且进行异质性检验、敏感性分析和多效性分析。结果MR结果显示Gln与wnt-7a蛋白之间差异具有统计学意义,且两者关系呈正相关;Gln与FN-BMD、FA-BMD、LS-BMD、TB-BMD、25(OH)D、PTH、OPG、BGP差异均无统计学意义。本次研究的异质性检验均无异常,敏感性分析结果均显示稳健,且未发现多效性。结论该研究结果为Gln在维持骨稳态及参与成骨分化的作用及预防、治疗骨质疏松症提供了一定理论依据,说明通过摄入Gln预防和治疗骨质疏松症可能具有潜在临床意义。

妊娠期营养研究与临床实践

妊娠期营养既是一个公共营养领域备受关注的问题,也需孕产保健行业参与其中,是一个新兴的交叉学科,研究内容涉及到围孕期营养素评价、管理,也涉及到妊娠相关营养代谢性疾病的处理,是妊娠结局改善的有效保障。本期专题包括2篇关于微量元素与妊娠的综述和1篇关于妊娠糖尿病营养干预的多中心研究报告,从中得窥当前该领域的研究现况和方向。

A cross-sectional study to assess medication safety,knowledge,attitude,and practices regarding nutrition and medication among pregnant women

Objective:To assess pregnant women's knowledge,attitude,and practice regarding nutrition and medication usage,analyse the prescribing pattern,and categorize them based on the Food and Drug Administration(FDA)guidelines.Methods:A cross-sectional study was conducted with 264 pregnant women in the obstetrics and gynaecology department of a tertiary care hospital from October 2022 to August 2023.A knowledge,attitude,and practice(KAP)questionnaire was prepared in English language by the researchers and validated by an expert panel consisting of 12 members.The validated questionnaire was then translated into regional languages,Kannada and Malayalam.The reliability of the questionnaire was assessed with test-retest method with a representative sample population of 30 subjects(10 subjects for each language).The subjects'knowledge,attitude,and practice were evaluated using the validated KAP questionnaire.The safety of the medication was assessed using the FDA drug safety classification for pregnancy.Results:The mean scores for nutritional and medication usage knowledge,attitude,and practice were 4.14±1.15,4.50±1.09,and 3.00±1.47,respectively.Among 30 prescribed medications,3 belong to category A(no risk in human studies),8 belong to category B(no risk in animal studies),18 belong to category C(risk cannot be ruled out)and 1 drug is not classified.A significant association was observed between medication knowledge and practice(r=0.159,P=0.010).Conclusions:Most of the study population knows the need to maintain good dietary and medication practices during pregnancy.Counselling pregnant women regarding diet and medication usage is crucial in maternal care.

Maternal dietary patterns associated with bone density in Chinese lactating women and infants at 6 months postpartum:a prospective study using data from 2018-2019

This cohort study was designed to explore the relationship between maternal dietary patterns(DPs)and bone health in Chinese lactating mothers and infants.We recruited 150 lactating women at 1-month postpartum.The estimated bone mineral density(eBMD)of subjects’calcanei and the information on dietary intake were collected.After 5-month follow-up,the eBMD of mothers and their infants were measured again.Factor analysis was applied to determine maternal DPs.General linear models were used to evaluate the association between maternal DPs and maternal eBMD loss or infants’eBMD.With all potential covariates adjusted,Factor 2(high intake of whole grains,tubers,mixed beans,soybeans and soybean products,seaweeds,and nuts)showed a positive association with the changes of maternal eBMD(β=0.16,95%CI:0.005,0.310).Factor 3(high intake of soft drinks,fried foods,and puffed foods)was inversely correlated with the changes of maternal eBMD(β=-0.22,95%CI:-0.44,0.00).The changes of maternal eBMD were positively associated with 6-month infants’eBMD(β=0.34,95%CI:0.017,0.652).In conclusion,Factor 2 might contribute to the maintenance of eBMD in lactating women,while Factor 3 could exacerbate maternal eBMD loss.Additionally,the changes of maternal eBMD presented a positive correlation with 6-month infants’eBMD.

预后营养指数和改良格拉斯哥预后评分与宫颈癌患者预后的关系

目的探讨预后营养指数(PNI)和改良格拉斯哥预后评分(mGPS)对宫颈癌患者预后的预测价值。方法选取宫颈癌患者120例为研究对象。收集、分析患者完整资料,并随访至2023年6月30日。采用Kaplan-Meier法绘制生存曲线。采用Log-rank检验和Cox回归分析筛选预后的影响因素。结果本研究患者中位随访时间61个月,中位生存时间52个月,随访期内死亡41例(34.17%),患者3年和5年生存率分别为82.50%和66.67%。受试者工作特征(ROC)曲线显示,PNI、mGPS、白蛋白(ALB)、淋巴细胞(LYM)、C反应蛋白(CRP)和中性粒细胞(NEU)预测患者预后的曲线下面积(AUC)分别为0.90、0.81、0.84、0.86、0.82和0.71,最佳截断值分别为41.80、0.50分、34.25 g/L、1.44×10^(9)/L、5.45×10^(9)/L和7.25 mg/L。Cox回归分析显示,PNI(HR=4.18,95%CI:2.83~9.21,P=0.015)、mGPS[HR=1.95,95%CI:1.37~3.59,P<0.001(mGPS=1分);HR=3.07,95%CI:2.38~5.36,P<0.001(mGPS=2分)]和国际妇产科联盟(FIGO)分期[HR=2.03,95%CI:1.34~3.85,P=0.030(FIGO分期=Ⅲ期);HR=3.46,95%CI:2.15~6.62,P=0.003(FIGO分期=Ⅳ期)]是影响宫颈癌患者预后的危险因素。结论PNI、mGPS和FIGO分期是宫颈癌患者预后的重要预测因子,关注患者治疗前PNI和mGPS有利于改善其临床结局。

孕期锌缺乏及对妊娠结局的影响

孕期锌缺乏率较高,迄今研究发现其与自发性早产、复发性流产、低出生体重、小胎龄儿、子痫前期和妊娠期糖尿病等不良妊娠结局存在显著关联。然而,目前缺乏一种特异、灵敏、便于采集和检测的生物标志物用于临床评价锌的营养状况,所幸最新研究发现金属硫蛋白和油酸与二羟甲基γ-亚麻酸的比值(LA/DGLA)具有潜在应用价值。本文重点对孕期锌缺乏与不良妊娠结局、潜在锌生物标志物及锌缺乏治疗的国内外研究进展进行总结与探讨,以期为围产期营养指导提供思路。

Minimum 10-year follow-up outcomes of arthroscopic Bankart’s repair with metallic anchors:Reliable results with low redislocation rates

BACKGROUND With stiff competition from alternative albeit more expensive counterparts,it has become important to establish the applicability of metallic anchors for shoulder instability in the modern era.This can be accomplished,in part,by analysing long-term outcomes.AIM To analyse minimum 10-year outcomes from 30 patients following arthroscopic anterior stabilisation using metallic anchors.METHODS Prospectively collected data from arthroscopic Bankart repairs performed using metal anchors during 2007P-2010 were retrospectively analysed in this singlesurgeon study.Comprehensive data collection included historical and clinical findings,dislocation details,operative specifics,and follow-up radiological and clinical findings including shoulder scores.The primary outcomes were patientreported scores(Constant,American Shoulder and Elbow Surgeons[ASES],and Rowe scores)and pain and instability on a visual analogue scale(VAS).RESULTS A 3% recurrence rate of dislocation was noted at the final follow-up.Total constant scores at 10 years postoperatively measured between 76 and 100(mean 89)were significantly better than preoperative scores(mean 62.7).Congruous improvements were also noted in the Rowe and ASES scores and VAS at the 10-year review.CONCLUSION Reliable long-term outcomes with metallic anchors in surgery for shoulder instability can be expected.Our results provide additional evidence of their continued,cost-effective presence in the modern scenario.

XX市孕妇食用碘盐应用情况和尿碘检测结果分析

目的:选择XX市孕妇为研究对象,测定食用盐碘含量及尿碘水平,评价碘营养情况,为科学补碘提供参考。方法:选择PPS人口抽样方法,按照东南西北中方位抽取、收集2022~2023年共200名孕妇数例,并采集相应孕妇的晨尿及家庭食用盐样。然后通过直接滴定法和砷铈催化分光光度法分别测定碘盐以及尿碘。结果:XX市盐覆盖率为97.5%,碘盐合格率为92.0%;孕妇尿碘中位数为156.1μg·L^(-1),尿碘适宜率为83.5%。结论:XX市需提高孕妇碘营养水平。