Relationship between dietary balance index during pregnancy and infant body weight development: a cohort study
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摘要:
目的 前瞻性探究孕中期膳食平衡指数(diet balance index for pregnancy, DBI)与婴幼儿体重发育的纵向关联。 方法 基于出生队列，通过食物频率问卷收集孕中期妇女过去1个月内的摄入膳食情况，并采用经修订的孕妇膳食平衡指数(diet balance index for pregnancy, DBI-P)评价孕妇膳食质量，评分分值越高代表偏离推荐值程度越高。随访其子代至24月龄，分别在1、6、12、18、24月龄测量体重，并计算年龄别体重Z分值和0~24月龄年龄别体重Z分值变化值。分别采用混合线性模型和多重logistic回归分析模型进行关联性分析。 结果 共纳入543对母子对，13.45%的孕妇存在低度以上摄入过量，84.53%的孕妇存在低度以上的摄入不足，88.77%的孕妇存在低度以上膳食不均。孕期水果类摄入评分与婴幼儿0~24月龄年龄别体重呈正相关(β=0.065，P=0.002)；孕期添加糖评分和DBI-P正端分(high bound score, HBS)与0~24月龄年龄别体重变化值呈正相关(β=0.091，P=0.032)；孕期饮酒评分与0~24月龄年龄别体重变化值呈负相关(β=-0.282，P=0.032)。 结论 广州市孕中期妇女膳食摄入不均衡，应强调适宜摄入水果，减少孕期过量摄入水果及添加糖，避免酒类摄入。 Abstract:Objective To prospectively explore the longitudinal association between dietary balance index during pregnancy and infant body weight development. Methods Using food frequency questionnaire, we collected data on the dietary intake of women during the second trimester of pregnancy in the past month based on the birth cohort. The revised dietary balance index for pregnancy (DBI-P) was utilized to evaluate dietary quality of pregnant women. Follow-ups were conducted for offspring up to the age of 2 years, with body weight measurements taken at 1, 6, 12, 18, and 24 months respectively. The Z-score of body weight for age and the Z-score of body weight for age from 0 to 24 months of age were calculated. The mixed linear model and multiple regression were used to analyze the correlation. Results A total of 543 mother-child pairs were included, of which 13.45% of pregnant women had overall low intake, 84.53% had an overall low intake, and 88.77% had an uneven diet. Fruit intake score during pregnancy was positively correlated with the body weight of infants aged 0-24 months (β=0.065, P=0.002). Gestational added sugar score and DBI-P high bound score (HBS) was positively correlated with weight change at 0-24 months of age (β=0.091, P=0.032). Alcohol consumption score during pregnancy was negatively correlated with weight change of age from 0-24 months (β=-0.282, P=0.032). Conclusions There is a significant dietary imbalance among women in the second trimester of pregnancy in Guangzhou. It is crucial to encourage increased fruit intake, reduce excessive and added sugar consumption, and completely avoid alcohol during pregnancy. -
Key words:
- Dietary balance index /
- Infant /
- Weight development
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表 1 孕妇及婴幼儿的基本特征
Table 1. Basic characteristics of pregnant women and their infants
基本特征Basic characteristics 合计[人数(占比/%)] Total [Number of people (proportion/%)] 孕妇Pregant woman 年龄组/岁Age group/years, (x±s) 30.90±4.88 孕前BMI/(kg·m-2)
Preconception BMI/(kg·m-2), (x±s)20.66±2.93 孕期体力活动/(METs·min·w)
Physical activity during pregnancy/(METs·min·w), (x±s)1 869.69±1 659.32 孕期摄入总能量/kcal
Total energy intake during pregnancy/kcal, (x±s)1 812.64±517.14 文化程度Education level 初中及以下Junior high school or below 51(9.39) 高中Senior high school 108(19.89) 专科及本科Colleges and universities 343(63.17) 研究生及以上Postgraduate or above 41(7.55) 职业Occupation 家庭主妇或待业Housewife or unemployed 98(18.05) 企事业单位人员
Personnel of enterprises and public institutions192(35.36) 商业或服务业人员Business or service workers 150(27.62) 其他Others 103(18.97) 家庭人均月收入/元
Per capita monthly household income /yuan＜4 000 89(16.39) 4 000~＜6 000 123(22.65) 6 000~＜10 000 142(26.15) ≥10 000 189(34.81) 孕期被动吸烟(否)
Passive smoking during pregnancy (no)448(82.50) 家族肥胖史(否)
Family history of obesity (no)504(92.82) 分娩方式Delivery mode 顺产Eutocia 343(63.17) 剖宫产Cesarean delivery 184(33.89) 其他Others 16(2.95) 配偶年龄/岁Spouse age/years, (x±s) 33.79±5.71 配偶BMI/(kg·m-2)
Spouse BMI/(kg·m-2), (x±s)23.18±3.27 婴幼儿Infants 出生体重/kg Birth weigh/kg, (x±s) 3.21±0.40 性别(男)Sex(male) 281 (51.75) 
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表 2 孕妇膳食平衡指数指标评价
Table 2. Evaluation of dietary balance index for pregnancy
x±s 膳食摄入① Dietary intake ① 适宜Suitable 较适宜Almost suitable 低度Low level 中度Moderate level 高度Heig level 正端分High bound score 6.28±3.08 10(1.84) 460(84.71) 71(13.08) 2(0.37) 0(0) 负端分Low bound score 24.20±9.17 0(0) 84(15.47) 282(51.83) 170(31.31) 7(1.29) 膳食质量距Diet quality distance 30.48±8.74 0(0) 61(11.23) 378(69.61) 104(19.15) 0(0) 注：①以[人数(占比/%)]表示。
Note: ① [Number of people (proportion/%)].
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表 3 膳食平衡指数与0~24月龄婴幼儿年龄别体重的关联
Table 3. Association between dietary balance index and weight-for-age for infants aged 0-24 months
食物组分
Food component模型1 Model 1 模型2 Model 2 β±s P值value β±s P值value 谷薯类Cereal and potato-based foods -0.003±0.010 0.773 0.010±0.015 0.515 蔬菜类Vegetables 0.014±0.022 0.533 0.011±0.024 0.658 水果类Fruits 0.045±0.019 0.020 0.065±0.021 0.002 奶类Dairy products -0.025±0.019 0.180 -0.027±0.021 0.192 大豆坚果类Soybeans and nuts -0.003±0.016 0.872 -0.003±0.018 0.880 畜禽肉类Livestock and poultry meat -0.016±0.015 0.289 -0.008±0.016 0.623 鱼虾类Fishes and shrimps -0.017±0.025 0.487 -0.010±0.026 0.706 蛋类Eggs 0.001±0.018 0.954 0.000±0.019 0.988 油Edible oil 0.045±0.029 0.127 0.034±0.029 0.237 酒Alcohol -0.038±0.089 0.673 -0.020±0.087 0.818 添加糖Added sugar 0.013±0.027 0.620 0.020±0.027 0.463 盐Salt 0.128±0.043 0.003 0.105±0.043 0.015 食物种类Type of food 0.005±0.017 0.762 0.014±0.021 0.521 饮水量Water intake 0.000±0.011 0.966 -0.002±0.011 0.845 正端分High bound score 0.004±0.010 0.726 0.011±0.012 0.350 负端分Low bound score -0.001±0.003 0.829 -0.004±0.005 0.421 膳食质量距Diet quality distance 0.000±0.004 0.919 -0.002±0.005 0.742 注：1. 模型1未校正混杂因素；模型2校正母亲年龄及孕前BMI、职业、文化程度、家庭人均月收入、孕期被动吸烟、家族肥胖史、分娩方式、孕期体力活动、每日能量摄入量、配偶年龄及BMI、婴幼儿性别。
2. 正端分、负端分和膳食质量距分别代表膳食摄入过量、摄入不足和摄入均衡状况。
Note: 1. Model 1 did not adjust for confounding factors; Model 2 adjusted for maternal age and pre-pregnancy BMI, occupation, degree of education, per capita monthly household income, passive smoking during pregnancy, family history of obesity, delivery mode, physical activity during pregnancy, and daily energy intake, spouse age and BMI, infant sex.
2. High bound score, low bound score and dietary quality distance represent excessive, insufficient and balanced dietary intake, respectively.
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表 4 孕妇膳食平衡指数与0~24月龄婴幼儿年龄别体重变化值的关联性分析
Table 4. Association between dietary balance index for pregnancy and variation of weight-for-age infants for 0-24 months
膳食平衡指数组成成分
Diet balance index components模型1 Model 1 模型2 Model 2 β±s P值value β±s P值value 谷薯类Cereal and potato-based foods 0.000 ± 0.017 0.984 0.007 ± 0.025 0.773 蔬菜类Vegetables -0.033 ± 0.036 0.369 -0.030 ± 0.042 0.472 水果类Fruits 0.040 ± 0.032 0.187 0.053 ± 0.035 0.135 奶类Dairy products -0.043 ± 0.031 0.157 -0.043 ± 0.034 0.200 大豆坚果类Soybeans and nuts -0.012 ± 0.026 0.649 -0.012 ± 0.030 0.686 禽畜肉类Livestock and poultry meat 0.013 ± 0.024 0.580 0.025 ± 0.027 0.366 鱼虾类Fishes and shrimps -0.012 ± 0.040 0.764 -0.003 ± 0.043 0.935 蛋类Eggs -0.002 ± 0.030 0.951 0.001 ± 0.031 0.963 油Edible oil 0.065 ± 0.047 0.161 0.076 ± 0.047 0.107 酒Alcohol -0.291 ± 0.129 0.025 -0.282 ± 0.130 0.032 添加糖Added sugar 0.087 ± 0.041 0.034 0.091 ± 0.043 0.032 盐Salt -0.016 ± 0.069 0.821 -0.012 ± 0.070 0.862 食物种类Type of food -0.011 ± 0.028 0.706 0.002 ± 0.036 0.947 饮水量Water intake -0.015 ± 0.017 0.369 -0.016 ± 0.018 0.386 正端分High bound score 0.025 ± 0.016 0.113 0.041 ± 0.019 0.033 负端分Low bound score 0.004 ± 0.006 0.436 0.006 ± 0.009 0.509 膳食质量距Diet quality distance 0.008 ± 0.006 0.164 0.011 ± 0.008 0.159 注：模型1未校正混杂因素；模型2校正母亲年龄及孕前BMI、职业、文化程度、家庭人均月收入、孕期被动吸烟、家族肥胖史、分娩方式、孕期体力活动、每日能量摄入量、配偶年龄及BMI、婴幼儿性别。
Note：Model 1 did not adjust for confounding factors; Model 2 adjusted for maternal age and pre-pregnancy BMI, occupation, degree of education, per capita monthly household income, passive smoking during pregnancy, family history of obesity, delivery mode, physical activity during pregnancy, and daily energy intake, spouse age and BMI, infant sex.
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