Association between maternal dietary intake during postpartum period and infant eczema
-
摘要:
目的 探讨母乳喂养的母亲产褥期各大类食物摄入与婴儿湿疹发生风险的关系。 方法 基于广州市一项队列研究，在孕中期招募孕妇，于产后6~8周进行面对面随访。针对母乳喂养的母亲，由训练有素的调查员采用信效度良好的食物频率问卷调查其产后一个月的膳食摄入情况，并收集婴儿湿疹发病情况。根据2016年中国居民膳食指南划分食物类别，计算各大类食物摄入量，采用多因素Logistic回归分析模型分析母亲产褥期膳食与婴儿湿疹的关系。 结果 共纳入468对母子，产后6~8周湿疹累计发病率为47.44%。湿疹组母亲与非湿疹组母亲的谷薯类、蔬菜、水果、红肉、禽肉、鱼类、蛋、奶制品、大豆以及坚果摄入量差异无统计学意义。多因素Logistic回归分析模型分析结果显示，母亲产褥期鱼类摄入每增加一个标准差，婴儿湿疹的发病风险增加26.4%(OR=1.264, 95% CI: 1.015~1.574, P=0.037)。其中淡水鱼摄入每增加一个标准差，婴儿湿疹发生风险增加27.2%(OR=1.272, 95% CI: 1.019~1.588, P=0.034)，未发现深海鱼摄入与婴儿湿疹发生有关。 结论 母亲产褥期较高的淡水鱼类摄入与婴儿湿疹发生风险增高有关。 Abstract:Objective To explore the association between maternal food group intakes in breastfeeding women during postpartum period and the risk of infant eczema. Methods Participants were from a prospective cohort study in Guangzhou, China. Mothers were recruited in the second trimester and followed up at 6-8 weeks after delivery by a face-to-face interview. Trained investigators collected dietary information of breastfeeding mothers during first month after delivery using a validated food frequency questionnaire, and collected infant eczema information. Food items were aggregated into 10 food groups according to the 2016 Chinese Dietary Guidelines, and the intake of each food group was calculated. The association between maternal dietary intake during postpartum period and infant eczema was tested using multivariate Logistic regression models. Results A total of 468 mother-infant pairs were enrolled. The cumulative incidence of infant eczema at 6-8 weeks postpartum was 47.44%. No statistical differences were observed in maternal intakes of cereals and tubers, vegetables, fruits, red meat, poultry, fish, eggs, dairy, soybean, and nuts and seeds between eczema group and control group. The results of multivariate Logistic regression analysis model showed that the risk of infant eczema increased by 26.4% with the increase of one standard deviation of fish intake during puerperium (OR=1.264, 95% CI: 1.015-1.574, P=0.037). The risk of infant eczema increased by 27.2% for each standard deviation increase of freshwater fish intake (OR=1.272, 95% CI: 1.019-1.588, P=0.034), while no such association was observed for deep-sea fish. Conclusions Maternal higher intake of freshwater fish during postpartum period was associated with an increased risk of infant eczema. -
Key words:
- Maternal diet /
- Postpartum period /
- Infant eczema
-
表 1 研究对象的基本特征[n(%)]
Table 1. Basic characteristics of participants [n(%)]
基本特征 合计
(n=468)湿疹组
(n=222)非湿疹组
(n=246)t/χ2值 P值 母亲基本资料 年龄[岁, (x±s)] 30.50±4.57 30.22±4.82 30.77±4.33 1.301 0.194 孕前BMI[kg/m2, (x±s)] 20.69±2.80 20.70±2.72 20.69±2.87 -0.050 0.960 首次怀孕 180(39.05) 96(43.85) 84(34.71) 4.022 0.045 产后吸烟 10(2.16) 6(2.73) 4(1.64) 0.649 0.420 产褥期摄入含酒精食物 137(29.98) 71(32.42) 66(27.73) 1.195 0.274 食物过敏史 96(20.82) 42(19.18) 54(22.31) 0.686 0.408 文化程度 4.091 0.252 初中及以下 56(12.25) 28(12.84) 28(11.72) 高中或中专 93(20.35) 36(16.51) 57(23.85) 大学或大专 275(60.18) 139(63.76) 136(56.90) 研究生及以上 33(7.22) 15(6.88) 18(7.53) 家庭人均月收入(元) 1.558 0.669 ＜4 000 77(16.96) 32(14.88) 45(18.83) 4 000~ 117(25.77) 59(27.44) 58(24.27) 6 000~ 109(24.01) 53(24.65) 56(23.43) ≥10 000 151(33.26) 71(33.02) 80(33.47) 婴儿基本资料 性别(男) 216(47.26) 92(42.40) 124(51.67) 3.929 0.048 出生体重[kg, (x±s)] 3.22±0.40 3.24±0.40 3.19±0.40 -1.279 0.202 喂养方式 < 0.001 >0.999 纯母乳喂养 234(50.00) 111(50.00) 123(50.00) 混合喂养 234(50.00) 111(50.00) 123(50.00) 过敏性疾病家族史 272(58.24) 139(62.90) 133(54.07) 3.733 0.053 
下载: 导出CSV
表 2 湿疹组与非湿疹组母亲总能量及各类食物摄入量比较[M(P25, P75)]
Table 2. Comparison of maternal intake of total energy and food groups between the eczema group and the control group [M(P25, P75)]
合计(n=468) 湿疹组(n=222) 非湿疹组(n=246) Z值 P值 总能量摄入(Kcal/d) 1 940.58(1 543.32，2 378.80) 1 837.15(1 505.14，2 362.93) 2 003.38(1 618.46，2 387.73) -1.662 0.097 各大类食物摄入(g/d) 谷薯类 188.23(143.64，246.70) 182.96(140.90，232.49) 193.54(151.51，261.22) -1.785 0.074 蔬菜类 199.10(120.99，314.11) 195.39(127.00，321.81) 199.31(116.70，310.26) 0.468 0.640 水果类 103.47(39.00，198.88) 94.26(39.34，190.16) 112.98(33.43，218.17) -1.238 0.216 红肉类 141.83(86.59，232.61) 144.43(90.62，225.00) 140.48(81.36，235.00) 0.130 0.900 禽肉类 75.71(37.71，152.00) 76.75(35.29，152.00) 72.90(37.71，142.00) 0.694 0.488 鱼类 27.38(8.14，55.50) 30.16(8.14，57.12) 24.78(7.60，52.33) 1.273 0.203 淡水鱼 16.29(0.00，32.57) 16.29(0.00，32.57) 12.21(0.00，32.57) 1.267 0.206 深海鱼 0.00(0.00，8.96) 0.00(0.00，8.96) 0.00(0.00，8.96) 0.088 0.930 蛋类 52.80(23.76，105.60) 52.80(22.63，105.60) 52.80(26.40，105.60) -0.455 0.649 奶制品类 23.34(0.00，127.82) 16.67(0.00，125.00) 32.00(0.00，140.67) -0.854 0.393 大豆类 1.61(0.00，6.63) 1.75(0.00，6.91) 1.60(0.00，5.80) 1.137 0.256 坚果类 1.67(0.00，10.71) 1.67(0.00，10.00) 1.67(0.00，10.71) 0.079 0.937
下载: 导出CSV
表 3 母亲各类食物摄入量与婴儿湿疹的关系
Table 3. The associations between maternal dietary intake and infant eczema
食物种类 未校正[OR(95% CI)值] P值 模型1a[OR(95% CI)值] P值 模型2b[OR(95% CI)值] P值 谷薯类 0.863(0.709~1.052) 0.145 0.996(0.678~1.463) 0.983 0.877(0.588~1.308) 0.520 蔬菜类 1.029(0.841~1.259) 0.782 1.036(0.832~1.290) 0.750 1.066(0.838~1.357) 0.601 水果类 0.874(0.718~1.063) 0.177 0.912(0.731~1.136) 0.410 0.928(0.739~1.165) 0.519 红肉类 0.991(0.820~1.198) 0.924 1.097(0.769~1.566) 0.609 0.992(0.682~1.441) 0.965 禽肉类 1.058(0.879~1.273) 0.552 1.248(0.901~1.729) 0.182 1.169(0.835~1.638) 0.363 鱼类 1.260(1.025~1.549) 0.028 1.262(1.014~1.570) 0.037 1.264(1.015~1.574) 0.037 淡水鱼 1.261(1.011~1.574) 0.040 1.243(0.988~1.565) 0.063 1.272(1.019~1.588) 0.034 深海鱼 1.056(0.877~1.271) 0.569 1.015(0.831~1.239) 0.886 0.994(0.811~1.218) 0.952 蛋类 0.986(0.819~1.186) 0.877 1.039(0.806~1.338) 0.769 1.073(0.827~1.392) 0.594 奶制品类 0.874(0.721~1.061) 0.173 0.886(0.705~1.113) 0.297 0.870(0.687~1.103) 0.250 大豆类 1.011(0.834~1.225) 0.915 1.036(0.836~1.285) 0.744 1.014(0.812~1.267) 0.902 坚果类 1.010(0.834~1.223) 0.921 1.055(0.842~1.322) 0.639 1.018(0.803~1.290) 0.883 注：a模型1：校正孕妇年龄、孕前BMI、是否头胎、孕妇文化程度、家庭人均月收入、母亲吸烟、产后摄入含酒精食物及每日总能量摄入；b模型2：在模型1基础上进一步校正母亲食物过敏史、过敏性疾病家族史、婴儿性别、出生体重、出生季节及婴儿喂养方式。
下载: 导出CSV
-
[1] Weidinger S, Novak N. Atopic dermatitis[J]. Lancet, 2016, 387(10023):1109-1122. DOI: 10.1016/S0140-6736(15)00149-X. [2] 胡亚美, 江载芳.诸福棠实用儿科学(第7版)[M].北京:人民卫生出版社, 2005.Hu YM, Jang ZF. Zhu Futang textbook of pediatrics (7 th ed)[M]. Beijing: People's Medical Publishing House, 2005. [3] Illi S, Von Mutius E, Lau S, et al. The natural course of atopic dermatitis from birth to age 7 years and the association with asthma[J]. J Allergy Clin Immunol, 2004, 113(5):925-931. DOI: 10.1016/j.jaci.2004.01.778. [4] Silverberg JI, Paller AS. Association between eczema and stature in 9 US population-based studies[J]. JAMA Dermatol, 2015, 151(4):401-409. DOI: 10.1001/jamadermatol.2014.3432. [5] Huang FQ, Lu CY, Wu SP, et al. Maternal exposure to antibiotics increases the risk of infant eczema before one year of life: a meta-analysis of observational studies[J]. World J of Pediatr, 2020, 16(2):143-151. DOI: 10.1007/s12519-019-00301-y. [6] Rajani PS, Martin H, Groetch M, et al. Presentation and management of food allergy in breastfed infants and risks of maternal elimination diets[J]. J Allergy Clin Immunol Pract, 2020, 8(1):52-67. DOI: 10.1016/j.jaip.2019.11.007. [7] 江宗坦.喂养方式及母亲饮食结构对婴儿湿疹发病率的影响分析[J].临床合理用药杂志, 2018, 11(28):164-165. DOI: 10.15887/j.cnki.13-1389/r.2018.28.095.Jiang ZT. Influences of feeding patterns and maternal diet on the incidence of infant eczema[J]. Chinese Journal of Clinical Rational Drug Use, 2018, 11(28):164-165. DOI: 10.15887/j.cnki.13-1389/r.2018.28.095. [8] Jeurink PV, Knipping K, Wiens F, et al. Importance of maternal diet in the training of the infant's immune system during gestation and lactation[J]. Crit Rev Food Sci Nutr, 2019, 59(8):1311-1319. DOI: 10.1080/10408398.2017.1405907. [9] International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy[J]. Diabetes Care, 2010, 33(3):676-682. DOI: 10.2337/dc09-1848. [10] 崔宇童, 李笑天.孕期贫血与不良妊娠结局[J].中国实用妇科与产科杂志, 2020, 36(5):408-412. DOI: 10.19538/j.fk2020050107.Cui YT, Li TX. Anemia during pregnancy and adverse pregnancy outcomes[J]. Chin J Pract Gynecol Obstetr, 2020, 36(5):408-412. DOI: 10.19538/j.fk2020050107. [11] Zhang CX, Ho SC. Validity and reproducibility of a food frequency questionnaire among Chinese women in Guangdong Province[J]. Asia Pac J Clin Nutr, 2009, 18(2):240-250. [12] 中国营养学会.中国居民膳食指南(2016)[M].北京:人民卫生出版社, 2016.Chinese Nutrition Society. Dietary Guidelines for Chinese Residents (2016)[M]. Beijing: People's Medical Publishing House, 2016. [13] 何宇纳, 房玥晖, 夏娟.中国膳食平衡指数的修订:DBI_16[J].营养学报, 2018, 40(6):526-530. DOI: 10.13325/j.cnki.acta.nutr.sin.2018.06.003.He YN, Fang YH, Xia J. Update of the Chinese diet balance index: DBI_16[J]. Acta Nutrimenta Sinica, 2018, 40(6):526-530. DOI: 10.13325/j.cnki.acta.nutr.sin.2018.06.003. [14] 申春平, 闫琦, 王召阳, 等.低龄婴儿湿疹的流行病学调查与治疗随访[J].临床皮肤科杂志, 2015, 44(8):469-472. DOI:10.16761/j.cnki.1000-496 3.2015.08.017.Shen CP, Yan Q, Wang ZY, et al. Epidemiological investigation and follow-up treatment of young infants with eczema[J]. J Clin Dermatol, 2015, 44(8):469-472. DOI: 10.16761/j.cnki.1000-4963.2015.08.017. [15] 王硕, 蒋竞雄, 王燕, 等.城市0-24月龄婴幼儿过敏性疾病症状流行病学调查[J].中国儿童保健杂志, 2016, 24(2):119-122. DOI: 10.11852/zgetbjzz2016-24-02-03.Wang S, Jiang JX, Wang Y, et al. Survey on prevalence of allergic symptoms among 0 to 24 months old children in Chinese cities[J]. Chin J Child Health Care, 2016, 24(2):119-122. DOI: 10.11852/zgetbjzz2016-24-02-03. [16] 周琴, 古桂雄, 叶侃, 等.婴儿湿疹发病相关因素分析[J].中国儿童保健杂志, 2019, 27(11):1240-1242. DOI: 10.11852/zgetbjzz2017-25-12-14.Zhou Q, Gu GX, Ye K, et al. Review on the influencing factors of infantile eczema[J]. Chin J Child Health Care, 2019, 27(11):1240-1242. DOI: 10.11852/zgetbjzz2017-25-12-14. [17] 沈华, 滕红. 42天婴儿体检伴随疾病情况分析[J].中国妇幼健康研究, 2008, 19(2):170-171. DOI: 10.3969/j.issn.1673-5293.2008.02.034.Shen H, Teng H. An analysis of concomininant diseases of infants aged 42 days old[J]. Chinese Journal of Woman and Child Health Research, 2008, 19(2):170-171. DOI: 10.3969/j.issn.1673-5293.2008.02.034. [18] 汪之顼, 赖建强, 毛丽梅, 等.中国产褥期(月子)妇女膳食建议[J].营养学报, 2020, 42(1):3-6. DOI: 10.13325/j.cnki.acta.nutr.sin.20200402.001.Wang ZX, Lai JQ, Mao LM, et al. Dietary recommendations for Chinese women in the puerperium period[J]. Acta Nutrimenta Sinica, 2020, 42(1):3-6. DOI: 10.13325/j.cnki.acta.nutr.sin.20200402.001. [19] Eriksen KG, Christensen SH, Lind MV, et al. Human milk composition and infant growth[J]. Curr Opin Clin Nutr Metab Care, 2018, 21(3):200-206. DOI: 10.1097/MCO.0000000000000466. [20] Fusaro AE, de Brito CA, Taniguchi EF, et al. Balance between early life tolerance and sensitization in allergy: dependence on the timing and intensity of prenatal and postnatal allergen exposure of the mother[J]. Immunology, 2009, 128(1 Suppl):e541-e550. DOI: 10.1111/j.1365-2567.2008.03028.x. [21] Gochfeld M, Burger J. Good fish/bad fish: a composite benefit-risk by dose curve[J]. Neurotoxicology, 2005, 26(4):511-520. DOI: 10.1016/j.neuro.2004.12.010. [22] Halldorsson TI, Thorsdottir I, Meltzer HM, et al. Linking exposure to polychlorinated biphenyls with fatty fish consumption and reduced fetal growth among Danish pregnant women: a cause for concern?[J]. Am J Epidemiol, 2008, 168(8):958-965. DOI: 10.1093/aje/kwn204. [23] Stølevik SB, Nygaard UC, Namork E, et al. Prenatal exposure to polychlorinated biphenyls and dioxins is associated with increased risk of wheeze and infections in infants[J]. Food Chem Toxicol, 2011, 49(8):1843-1848. DOI: 10.1016/j.fct.2011.05.002. [24] Park H, Kim K. Association of blood mercury concentrations with atopic dermatitis in adults: a population-based study in Korea[J]. Environ Res, 2011, 111(4):573-578. DOI: 10.1016/j.envres.2011.02.003. [25] Gunaratne AW, Makrides M, Collins CT. Maternal prenatal and/or postnatal n-3 long chain polyunsaturated fatty acids (LCPUFA) supplementation for preventing allergies in early childhood[J]. Cochrane Database Syst Rev, 2015, 22(7):CD010085. DOI: 10.1002/14651858.CD010085.pub2. [26] Furuhjelm C, Warstedt K, Larsson J, et al. Fish oil supplementation in pregnancy and lactation may decrease the risk of infant allergy[J]. Acta Paediatr, 2009, 98(9):1461-1467. DOI: 10.1111/j.1651-2227.2009.01355.x. [27] Calder PC, Kremmyda LS, Vlachava M, et al. Is there a role for fatty acids in early life programming of the immune system?[J]. Proc Nutr Soc, 2010, 69(3):373-380. DOI: 10.1017/S0029665110001552. [28] Wong VW, Ng YF, Chan SM, et al. Positive relationship between consumption of specific fish type and n-3 PUFA in milk of Hong Kong lactating mothers[J]. Br J Nutr, 2019, 121(12):1431-1440. DOI: 10.1017/S0007114519000801. [29] 陶鋆, 蔡莉.生命早期多不饱和脂肪酸摄入对儿童过敏性疾病的影响研究进展[J].中华疾病控制杂志, 2017, 21(1):94-98. DOI: 10.16462/j.cnki.zhjbkz.2017.01.022.Tao Y, Cai L. Research advance on the influence of exposure to polyunsaturated fatty acid in early life on childhood allergic diseases[J]. Chin J Dis Control Prev, 2017, 21(1):94-98. DOI: 10.16462/j.cnki.zhjbkz.2017.01.022. [30] Greer FR, Sicherer SH, Burks AW. The effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, hydrolyzed formulas, and timing of introduction of allergenic complementary foods[J]. Pediatrics, 2019, 143(4):e20190281. DOI: 10.1542/peds.2019-0281. -
