以飲食頻率問卷評估婦女孕前至產後飲食型態對其體重變化與懷孕結果之影響

Abstract

本研究目的為利用飲食頻率問卷評估現今婦女孕前、懷孕期至產後飲食營養攝取變化情形，並以前瞻性研究設計進而探討營養素攝取對懷孕期間體重增加、產後體重保留量及新生兒出生體型（出生體重、身長、頭圍、胸圍）之影響。研究對象係以民國98年11月至99年3月中於台北市立聯合醫院婦幼院區，所招募之151位懷孕20週以內的健康婦女，收集婦女懷孕前(n=151)、懷孕期(n=112)、產後一年(n=61)飲食頻率問卷並分析飲食頻率問卷與24小時飲食回憶之相對效度。利用統計軟體SPSS 19.0及STATA 8.0版進行統計分析。 飲食頻率問卷評估懷孕前、懷孕期至產後一年每日熱量攝取分別為2554、2380、2794大卡，蛋白質為97、88、103公克，脂質為102、91、103公克、醣類為306、297、356公克，蛋白質熱量百分比為15.1%、14.7%、14.7%，脂質熱量百分比為36.0%、34.1%、33.0%，醣類熱量百分比為47.9%、50.3%、51.3%。若以營養素密度呈現數據，相較未懷孕時期（孕前一年及產後一年），婦女懷孕期間攝取膳食纖維及鈣質密度顯著較高，攝取較低咖啡因、維生素B6、維生素B12密度；相較懷孕前，懷孕期間攝取較多水果類、奶類，而攝取較少新鮮蔬菜類、蛋類、豬肉類、植物油類、咖啡因飲料類；相較懷孕前，婦女懷孕期攝取宵夜熱量百分比較高。分析飲食頻率問卷與24小時飲食回憶相對效度，結果發現二種膳食評估法所得到的營養素Kappa值由-0.073（飽和脂肪酸）至0.189 （鈉），營養素密度Kappa值由-0.073（維生素E）至0.189g昇糖指數(Glycemic index, GI)，營養素與營養素密度平均組內相關係數(Intraclass correlation coefficient, ICC)分別為0.11及0.12；相較24小時飲食回憶，斯皮爾曼等級相關營養素達顯著為40%(16/40)，營養素密度為48.57%(17/35)，效度最好的營養素或營養素密度皆為膳食纖維。 在雙變項分析中，婦女孕期體重增加與孕期攝取熱量、GI、昇糖負荷(glycemic load, GL)呈顯著正相關，婦女孕期體重增加量與孕期攝取麵食類、其他主食類、咖啡因飲料類呈正相關；而產後3、6、9、12個月體重保留量皆與米食類攝取呈負相關。多元迴歸分析結果顯示，在線性狀況下，孕期總體重增加與懷孕週數、GL顯著正相關，與米食類攝取重量呈顯著負相關。產後3、6、9、12個月體重保留量與孕期體重增加量顯著正相關，與米食類攝取重量呈顯著負相關。 婦女身高、孕前體重、身體質量指數(body mass index, BMI)及懷孕週數與新生兒體型相關。分析婦女飲食攝取對新生兒出生體型的影響，結果發現出生體重與懷孕期攝取動物性蛋白質、膽固醇、維生素B12密度以及蛋類、禽肉類呈正相關。多元迴歸分析結果顯示，在線性狀況下，懷孕週數、媽媽懷孕前體重、懷孕期攝取動物性蛋白質密度與出生體重呈顯著正相關。出生身長與懷孕週數、孕期蛋白質攝取密度呈正相關，與鋅、泛酸密度呈負相關。出生胸圍與孕期黃豆類攝取克重顯著正相關。 本研究發現飲食頻率問卷與24小時飲食回憶相對效度尚可。婦女孕前、懷孕期至產後飲食營養攝取有所變化，而婦女飲食情況對其體重變化、新生兒出生體型有其相關。The purpose of this study was to examine the diet by food frequency questionnaire (FFQ) from prepregnancy to postpartum by a prospective study. This thesis analyzes the impact of the nutrient and food intakes on gestational weight gain (GWG), postpartum weight retention and birth outcomes including weight, length, head circumference and chest circumference. We recruited 151 health pregnant women within 20 weeks pregnancy from the Taipei City Hospital, Women and Children Branch and collected food frequency questionnaires in pre-pregnancy (n=151), pregnancy (n=112), postpartum (n=61), and compared the relative validity with 24-hour recalls. The statistical analyses were performed by SPSS 19.0 and STATA 8.0. By FFQ, the average daily energy intake for prepregnancy, pregnancy and 1 year after postpartum were 2554, 2380, 2794kcal, daily protein intake were 102, 91, 103 grams, lipid were 102, 91, 103 grams, carbohydrate were 306, 297, 356 grams, respectively. The percentage of energy was 15.1%, 14.7%, 14.7% of protein, 36.0%, 34.1%, 33.0% of lipid, and 47.9%, 50.3%, 51.3% of carbohydrate. We present data by nutrients density per 1000 kcal. Compared to non-pregnant period (prepregnancy and postpartum), during pregnancy, women intake more density of dietary fiber and calcium, and lower intakes density of caffeine, vitamin B6, vitamin B12. Women intake more fruits and dairy products, and less fresh vegetables, eggs, pork, vegetable oil, caffeine beverages during pregnancy than prepregnancy. Pregnant women have higher night snack energy percentage than prepregnancy. Compared to the 24 hour recall, the relatively validity of FFQ by correlation coefficients and kappa statistics, we found the nutrients kappa statistics were -0.073 (saturated fatty acids) to 0.189 (sodium), and nutrients density kappa statistics were -0.073(vitamin E) to 0.189 (Glycemic index, GI). Average intraclass correlation coefficients in nutrients and nutrients density were 0.11 and 0.12 respectively. Correlation between FFQ and 24-hour dietary recall were 40% (16/40) of nutrients and 48.57% (17/35) of the nutrient density were generally statistically significant, and nutrient and nutrient density show that dietary fiber had the high relative validity between the two methods. By bivariate analysis, we found that GWG was not only positively related to intake of calories, GI and glycemic load(GL), but also pasta and other starchy vegetables, caffeine beverages. Postpartum weight retention and rice intake was negatively correlated. By the multiple regression analyses, the results showed that GWG was positively correlated with gestational age, dietary GL, intake of rice. Postpartum weight retention was significantly positively correlated with GWG, and negatively correlated with rice intake. Height, prepregnancy weight, BMI, and gestational age and birth size were significantly correlated. Regarding the impact of maternal dietary intakes on birth outcomes, we found that birth weight and the nutrients density of animal protein, cholesterol, vitamin B12. Women intake of eggs, poultry in pregnancy was positively correlated with birth weight. By the multiple regression analyses, the results showed that birth weight was significantly positively correlated with gestational age, maternal pre-pregnant weight, and the nutrient density of animal protein. Birth length was positively correlated with gestational age and the nutrient density of protein intake during pregnancy. Birth length was negatively correlated with the nutrient density of zinc, pantothenic acid. Chest circumference at birth was significantly positively correlated with soy intake. This study found that the relative validity between FFQ and 24-hour dietary recall is acceptable. Dietary consumption Form prepregnancy, pregnancy to postpartum showed significant changes. Diet is associated with pregnancy- related weight changes and birth outcomes.