Establishment and verification of the diet balance index for midgestational women in Lanzhou City
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摘要:
目的 建立兰州市孕中期妇女膳食平衡指数(diet balance index, DBI)并加以验证，以期能够快速、准确评价该人群膳食质量。 方法 依据《中国居民膳食指南(2016)》《中国妇幼人群膳食指南(2016)》，建立孕中期DBI。选取在兰州市妇幼机构常规产检的孕中期妇女为研究对象，评价该人群膳食营养质量，进一步评估建立的孕中期DBI指标体系的信效度。 结果 孕中期妇女DBI指标体系与中国膳食平衡指数(diet balance index-16, DBI-16)指标体系基本一致，但基于地域性人群膳食结构特点，在亚组方面新增海藻类蔬菜、加工类蔬菜和动物血/肝脏。膳食能量及营养素摄入与DBI的负端分(low bound score, LBS)、膳食质量距(diet quality distance, DQD)呈负相关，与正端分(high bound score, HBS)呈正相关，差异有统计学意义(均P < 0.05)。推荐食谱的HBS、LBS、DQD评分结果均为较适宜，孕中期膳食质量距均值为34.08，仅0.26%的孕妇膳食摄入较均衡。 结论 初步建立的兰州市孕中期妇女DBI可快速、准确评价该人群膳食质量。进一步优化后可推广使用。 Abstract:Objective This study aimed to develop and validate a Dietary Balance Index (DBI) that allows for a swift, precise, and user-friendly assessment of dietary quality among second-trimester pregnant women in Lanzhou. Methods The DBI for the second-trimester was formulated based on the Dietary Guidelines for Chinese Residents (2016) and the Dietary Guidelines for Women and Children in China (2016). The nutritional quality of diets among second-trimester women undergoing routine obstetric examinations in Lanzhou Maternal and Child Institutions was evaluated. This served to further assess the reliability and validity of the newly established DBI index system for the second-trimester. Results The DBI index system for second-trimester women aligns closely with the Diet Balance Index (DBI-16) system in China, with the addition of seaweed vegetables, processed vegetables, and animal blood/liver to the subgroup, reflecting the dietary structure characteristics of the regional population. Dietary energy and nutrient intake showed a significant negative correlation with the low bound score (LBS) and diet quality distance (DQD), but a positive correlation with the high bound score (HBS) (all P < 0.05). The HBS, LBS, and DQD of the recommended diet were all found to be appropriate. The mean dietary quality distance was calculated to be 34.08, with only 0.26% of pregnant women achieving a balanced dietary intake. Conclusions The initial development of the dietary balance index for second-trimester pregnant women in Lanzhou enables a rapid, accurate, and convenient evaluation of dietary quality in this population. Following further optimization, this method has potential for widespread application. -
Key words:
- Second-trimester /
- Diet balance index /
- Dietary quality evaluation
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表 1 孕中期DBI的指标及取值方法
Table 1. Indicators and scoring methods of DBI during second-trimester
指标
Indicators分值/分
Score/points亚组
Subgroup分值/分
Range/points取值方法
Scoring methodsC1谷薯类
Cereal-12~12 C1-1谷薯类
Cereal-12~12 0 g=-12分，分数每增加1分，摄入量增加25 g，275~ < 325 g=0分，≥600 g=12分
0 g=-12 points，for each 1-point increase in the score, intake increased by 25 g，275~ < 325 g=0 point，≥600 g=12 pointsC2蔬菜水果类
Vegetable and fruit-12~4 C2-1新鲜蔬菜
Vegetable-4~0 0 g=-4分，>0~ < 150 g=-3分，150~ < 300g=-2分，300~ < 400 g=-1分，≥400 g=0分
0 g=-4 points，>0~ < 150 g=-3 points，150~ < 300g=-2 points，300~ < 400 g=-1 points，≥400 g=0 pointC2-2海藻类蔬菜
Seaweed vegetable-2~0 摄入相当于110 g碘的海藻类蔬菜=0分，摄入小于110 g碘的海藻类蔬菜=-2分
Intake of Seaweed vegetables equivalent to 110 g iodine =0 point, intake of Marine algae vegetables less than 110 g iodine =-2 pointsC2-3加工类蔬菜
Processed vegetable0~4 0 g=0分，>0~ < 25 g=2分，≥25 g=4分
0 g=0 point，>0~ < 25 g=2 points，≥25 g=4 pointsC2-4水果
Fruit-6~0 ≥300 g=0分，240~ < 300 g=-1分，分值每减少1分，摄入量减少60
g≥300 g=0 point，240~ < 300 g=-1 points, for each 1-point decrease in the score, intake was reduced by 60 gC3动物性食品
Animal food-12~6 C3-1瘦畜禽肉
Meat and poultry-4~4 0 g=-4分，>0~ < 15 g=-3分，15~ < 30 g=-2分，30~ < 45 g=-1分，45~ < 60 g=0分，60~ < 75 g=1分，75~ < 90 g=2分，90~ < 105 g=3分，≥105 g=4分
0 g=-4 points，>0~ < 15 g=-3 points，15~ < 30 g=-2 points，30~ < 45 g= -1 points，45~ < 60 g=0 point，60~ < 75 g=1 points，75~ < 90 g=2 points，90~ < 105 g=3 points，≥105 g=4 pointsC3-2鱼虾类
Fish and shrimp-4~0 < 5 g=-4分，5~ < 20 g=-3分，20~ < 35 g=-2分，35~ < 50 g=-1分，≥50 g=0分
< 5 g=-4 points，5~ < 20 g=-3 points，20~ < 35 g=-2 points，35~ < 50 g= -1 points，≥50 g=0 pointC3-3蛋类
Egg-2~2 < 5 g=-2分，5~ < 45 g=-1分，45~ < 55 g=0分，55~ < 65 g=1分，65~ < 80 g=2分
< 5 g=-2 points，5~ < 45 g=-1 points，45~ < 55 g=0 point，55~ < 65 g=1 points，65~ < 80 g=2 pointsC3-4动物血/肝脏
Animal blood/liver-2~0 0 g=-2分，>0~ < 25 g= -1分，≥25 g=0分
0 g=-2 points, >0~ < 25 g= -1 point, ≥25 g=0 pointC4奶类大豆坚果
Dairy, soybean and nut-12~0 C4-1奶类及其制品
Dairy-6~0 0 g=-6分，>0~80 g=-5分，分值每增加1分，摄入量增加80 g；≥400 g=0分
0 g=-6 points，>0~80 g=-5 points, for each 1-point decrease in the score, intake was reduced by 80 g; ≥400 g=0 points0 g=-4分，≥30 g=0分0 g=-4 points，≥30 g=0 pointC4-2大豆/坚果类
Soybean and nut-6~0 0 g=-6分，>0~80 g=-5分，分值每增加1分，摄入量增加80 g；≥400 g=0分
0 g=-6 points，>0~80 g=-5 points, for each 1-point decrease in the score, intake was reduced by 80 g; ≥400 g=0 points0 g=-4分，≥30 g=0分0 g=-4 points，≥30 g=0 pointC5纯能量食物
Empty energy food0~6 C5-1烹调油
Cooking oil0~6 ≤25 g=0分，>25~ < 30 g=1分，分值每增加1分，摄入量增加5 g；≥50 g=6分
≤25 g=0 point，>25~ < 30 g=1 points，for each 1-point decrease in the score, intake was reduced by 5 g；≥50 g=6 pointsC6调味品
Condiments0~12 C6-1添加糖
Addible sugar0~6 ≤25 g=0分，>25~ < 30 g=1分，分值每增加1分，摄入量增加5 g；≥50 g=6分
≤25 g=0 point，>25~ < 30 g=1 points，for each 1-point decrease in the score, intake was reduced by 5 g；≥50 g=6 pointsC6-2食盐
Salt0~6 < 6 g=0分，6~ < 8 g=1分，8~ < 10 g=2分，分值每增加1分，摄入量增加2 g；≥18 g=6分
< 6 g=0 point，6~ < 8 g=1 points，8~ < 10 g=2 points，for each 1-point decrease in the score, intake was reduced by 2 g；≥18 g=6 pointsC7饮用水
Drinking water-12~0 C7饮用水
Drinking water-12~0 < 160 mL=-12分，分值每增加1分，摄入量增加140 mL；≥1 700 mL=0分
< 160 mL=-12 points，for each 1-point decrease in the score, intake was reduced by 140 mL；≥1 700 mL=0 pointC8食物多样性
Diet variety-12~0 C8食物种类
Diet variety-12~0 包括米及制品、面及制品、粗粮及薯类、新鲜蔬菜、海藻类蔬菜、水果、奶类、大豆及坚果类、瘦畜禽肉、鱼虾类、蛋类、动物血/肝脏； < 25 g(大豆及坚果 < 5 g)=-1分，≥25 g(大豆及坚果≥5 g)=0分
Including rice and products, noodles and products, whole grains and tubers, fresh vegetables, sea algae vegetables, fruits, milk, soybeans and nuts, lean livestock and poultry meat, fish and shrimp, eggs, animal blood/liver; < 25 g(soy and nuts < 5 g=-1 point, ≥25 g (soy and nuts ≥5 g)=0 point注：DBI, 膳食平衡指数。
Note: DBI, diet balance index.
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表 2 孕中期DBI评价指标的计算与结果评价
Table 2. Results calculation and evaluation of DBI evaluating indicators during second-trimester
项目
Items分值范围/分
Range/points无摄入过量/不足/失衡
No problem较适宜
Almost no problem低度摄入量/不足/失衡
Low level中度摄入过量/不足/失衡
Moderate level高度摄入过量/不足/失衡
High levelHBS 0~40 0~ < 1 1~ < 8 8~ < 16 16~ < 24 24~≤40 LBS 0~72 0~ < 1 1~ < 14 14~ < 28 28~ < 43 43~≤72 无饮水数据 No drinking water 0~60 0~ < 1 1~ < 12 12~ < 24 24~ < 36 36~≤60 DQD 0~90 0~ < 1 1~ < 18 18~ < 36 36~ < 54 54~≤90 无饮水数据 No drinking water 0~78 0~ < 1 1~ < 15 15~ < 31 31~ < 46 46~≤78 注：DBI, 膳食平衡指数; HBS, 正端分；LBS, 负端分；DQD, 膳食质量距。
Note: DBI, diet balance index; HBS, high bound score; LBS, low bound score; DQD, diet quality distance.
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表 3 兰州市孕中期妇女能量及营养素摄入量与DBI指标的相关性
Table 3. Correlations between energy and nutrient intake and DBI indicators in women during second-trimester in Lanzhou City
项目
Items能量
Energy蛋白质
Protein脂肪
Fat碳水化合物
Carbohydrate膳食纤维
Dietary fiber胆固醇
Cholesterol维生素
AVitamin A维生素
DVitamin D维生素
EVitamin E维生素
B1Vitamin B1碘
Iodine锌
ZincHBS r 0.485 ① 0.381 ① 0.292 ① 0.430 ① 0.139 ① 0.169 ① 0.109 ① 0.096 ① 0.087 ② 0.131 ① 0.140 ① 0.142 ① P值value < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 0.003 0.008 0.017 < 0.001 < 0.001 < 0.001 LBS r -0.506 ① -0.614 ① -0.539 ① -0.202 ① -0.389 ① -0.393 ① -0.333 ① -0.353 ① -0.454 ① -0.327 ① -0.350 ① -0.579 ① P值value < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 DQD r -0.068 ② -0.225 ① -0.227 ① -0.134 ① -0.202 ① -0.195 ① -0.217 ① -0.314 ① -0.173 ① -0.423 ① -0.179 ① -0.374 ① P值value 0.041 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 注：DBI, 膳食平衡指数; HBS, 正端分; LBS, 负端分; DQD, 膳食质量距。
①相关性在0.01水平上显著(双侧)。②相关性在0.05水平上显著(双侧)。
Note: DBI, diet balance index; HBS, high bound score; LBS, low bound score; DQD, diet quality distance.
①Correlations were significant at the 0.01 level (two-sided). ②Associations were significant at the 0.05 level (two-sided).
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表 4 兰州市孕中期妇女膳食状况的DBI评分分布
Table 4. Distribution of DBI scores on dietary status of women in the second-trimester of pregnancy in Lanzhou
项目
Items分数/分(x±s)
Score/points(x±s)DBI评分结果[人数(占比/%)] DBI score result [Number (proportion/%)] 无摄入过量/不足/失衡
No problem较适宜
Almost no problem低度摄入量/不足/失衡
Low level中度摄入过量/不足/失衡
Moderate level高度摄入过量/不足/失衡
High levelHBS 8.70±5.23 39(5.14) 290(38.21) 371(48.88) 58(7.64) 1(0.13) LBS 25.38±6.10 0(0) 9(1.19) 288(37.94) 427(56.26) 35(4.61) DQD 34.08±7.56 0(0) 2(0.26) 244(32.15) 463(61.00) 50(6.59) 注：DBI, 膳食平衡指数; HBS, 正端分; LBS, 负端分; DQD, 膳食质量距。
Note: DBI, diet balance index; HBS, high bound score; LBS, low bound score; DQD, diet quality distance.
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