目的 探讨孕期膳食模式与增重过多（excessive gestational weight gain,eGWG）的关联。方法 研究对象来自同济母婴健康队列（Tongji Maternal and Child Health Cohort,TMCHC）,孕早期产检时纳入孕妇,测量身高、体重,问卷调查收集孕前体重及其它基本信息,定期随访称量体重,计算孕期总增重,并判定是否为eGWG;采用食物频率问卷（food frequency questionnaire,FFQ）进行膳食调查;用主成分分析法识别孕期膳食模式;Logistic回归估计膳食模式与eGWG风险的关联,计算比值比及95%可信区间（OR,95%CI）;采用贝叶斯核机器回归（Bayesian Kernel Machine regression,BKMR）方法验证膳食模式与eGWG的关联。结果 4815名孕妇中,3010名（62.5%）判定为eGWG;提取的5种主要膳食模式分别为“蔬菜类”“动物肉-米麦类”“蛋奶-坚果类”“大豆-鱼类”和 “粗粮-水果-零食-菌藻类”;与得分最低四分位Q1相比,在“蔬菜类”模式中Q4组孕妇eGWG的OR为0.82 (95% CI:0.68, 0.99,P-trend=0.033), 在“蛋奶-坚果类”模式中Q4组孕妇eGWG的OR为1.46 (95% CI:1.21, 1.75,P-trend<0.001);BKMR模型证实“蛋奶-坚果类”过多是eGWG的独立危险因素,在“蔬菜类”是独立保护因素,奶制品和坚果、特别是酸奶摄入过多,对eGWG起到重要作用;在“蔬菜类”饮食中,橙黄色蔬菜的保护作用最为显著。结论 为避免eGWG,孕妇应遵循平衡膳食原则,适宜摄入坚果、酸奶等高能量密度食物,注意增加蔬菜的摄入量,尤其应增加橙黄色蔬菜的比例。
Abstract
Objective To explore the association between dietary patterns during pregnancy and excessive gestational weight gain (eGWG). Methods All participants were from the Tongji Maternal and Child Health Cohort (TMCHC), which enrolled pregnant women during early pregnancy. Height and weight were measured, and pre-pregnancy weight and other basic information were collected through questionnaires at enrollment. Regular follow-up visits were conducted to monitor participants’ weight. Total eGWG was calculated by subtracting the pre-pregnancy weight from the last weight measured before delivery. Participants were categorized into appropriate, excessive, or insufficient weight gain. Dietary intake was assessed using a food frequency questionnaire (FFQ). Principal component analysis was used to identify dietary patterns during pregnancy, and logistic regression was utilized to estimate the association between dietary patterns and the risk (OR) of eGWG. The Bayesian Kernel Machine Regression (BKMR) method was used to validate the association between dietary patterns and eGWG. Results Among 4815 pregnant women, 3010 (62.5%) experienced eGWG. Five major dietary patterns were identified: Vegetable, Meat-Rice-Wheat, Egg-Dairy-Nut, Bean-Fish, and Grain-Fruit-Snack-Mushroom. Compared to the lowest quartile (Q1), in the Vegetable pattern, the OR for eGWG in the Q4 group was 0.82 (95% CI: 0.68, 0.99, P-trend=0.033), but in the Egg-Dairy- Nut pattern, the OR for eGWG in the Q4 group was 1.46 "Egg-Dairy-Nut" was an (95% CI: 1.21, 1.75, P-trend<0.001) when compared to Q1. The BKMR model confirmed that excessive intake of independent risk factor for eGWG, with dairy and nuts, especially excessive yogurt intake, significant contributing to eGWG. While increased intake of "Vegetable" was an independent protective factor, with the protective effect of orange-colored vegetables being particularly notable. Conclusion Pregnant women should be encouraged to follow a balanced dietary regimen,which includes avoiding excessive nut intake and limiting yogurt consumption, and increasing intake of vegetables, especially orange-colored vegetables in their diet.
关键词
孕期 /
膳食模式 /
孕期体重增长
Key words
pregnancy /
dietary patterns /
gestational weight gain
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基金
国家科技基础性工作专项（No.2019FY101003,2013FY114200）
