孕期微量营养素摄入与妊娠期糖尿病患者血糖控制效果的相关性研究

张长英; 陈学理; 冯云仁; 石靓; 贺媛

doi:10.16766/j.cnki.issn.1674-4152.003078

孕期微量营养素摄入与妊娠期糖尿病患者血糖控制效果的相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.003078

1.
新昌县人民医院产科，浙江绍兴 312500
2.
新昌县人民医院化验室
3.
国家卫生健康委科学技术委员会，北京 100081

基金项目:

国家卫生健康委科学技术研究所课题 20191IX007

详细信息

通讯作者:
张长英，E-mail：18767184564@163.com

中图分类号: R714.256
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- 被引次数: 0
出版历程
- 收稿日期: 2023-03-13
- 网络出版日期: 2023-08-28

Study on the correlation between micronutrient intake during pregnancy and glycemic control outcomes in patients with gestational diabetes

1.
Obstetrical Department of Xinchang People ' s Hospital, Shaoxing, Zhejiang 312500, China

摘要

摘要: 目的分析孕期微量营养素摄入与妊娠期糖尿病(GDM)患者血糖控制效果的相关性，为临床微量营养素的补充提供依据。方法于2020年5月—2023年1月选择新昌县人民医院定期进行产前检查的100名GDM患者及同期产检血糖正常的100名孕妇为对照组进行研究(妊娠均为27~35周)，通过问卷调查、24 h膳食回顾法获得研究对象的基本信息和膳食摄入状况。采用二元logistic回归分析研究微量营养素摄入对GDM孕妇血糖控制效果的影响。结果与对照组比较，GDM组的膳食总能量、蛋白质及脂肪摄入量分别为(2 217.65±156.09)kcal、(97.24±11.42)g、(66.23±7.83)g，均高于对照组[(2 163.44±113.24)kcal、(86.43±9.82)g、(61.77±6.33)g，均P < 0.05]；二元logistic回归分析显示，高蛋白质、高脂肪、低碳水化合物供能比是GDM孕妇血糖控制的危险因素(OR=2.462、2.533、2.126，P < 0.05)；维生素A、维生素B₁、维生素B₂、维生素B₆、维生素D、维生素E、锌、铁、铜、硒是GDM孕妇血糖控制的保护因素(OR=0.451、0.237、0.184、0.760、0.228、0.081、0.871、0.311、0.073、0.105，P < 0.05)。结论 GDM孕妇蛋白质及脂肪摄入过多、碳水化合物摄入过少。微量营养素摄入增加与GDM孕妇血糖控制较好有关，临床应重视微量营养素的补充，降低妊娠期糖尿病的发生。
- 妊娠期糖尿病 /
- 血糖控制 /
- 微量营养素
Abstract: Objective To analyze the correlation between micronutrients intake during pregnancy and the effect of blood glucose control in patients with gestational diabetes (GDM), and to provide a basis for clinical supplementation of micronutrients. Methods From May 2020 to January 2023, 100 GDM patients who underwent regular prenatal examinations at Xinchang People ' s Hospital and 100 pregnant women with normal blood glucose levels during the same period of prenatal examination were selected as the GDM group and the control group for the study (all were 27 to 35 weeks of gestation). Basic information and dietary intake status of the study subjects were obtained through questionnaire surveys and 24-hour dietary review methods. Binary logistic regression analysis was used to investigate the effect of micronutrient intake on blood glucose control in GDM pregnant women. Results Compared with the control group, the total dietary energy, protein, and fat intake of the GDM group were (2 217.65±156.09) kcal, (97.24±11.42) g, and (66.23±7.83) g, respectively, which were higher than those in the control group [(2 163.44±113.24) kcal, (86.43±9.82) g, (61.77±6.33) g, all P < 0.05]; Binary logistic regression showed that high protein, high fat and low carbohydrate energy supply ratio were risk factors for blood glucose control in GDM pregnant women (OR=2.462, 2.533, 2.126, P < 0.05); Vitamin A, vitamin B₁, vitamin B₂, vitamin B₆, vitamin D, vitamin E, zinc, iron, copper, and selenium were protective factors for glycemic control in pregnant women with GDM (OR=0.451, 0.237, 0.184, 0.760, 0.228, 0.081, 0.871, 0.311, 0.073, 0.105, P < 0.05). Conclusion The diet structure of GDM pregnant women is unreasonable, the intake of protein and fat is too high, and the intake of carbohydrate is too low. Increased micronutrient intake is associated with better control of blood glucose in GDM pregnant women. clinical emphasis should be placed on micronutrient supplementation to reduce the incidence of gestational diabetes.
- Pregnancy diabetes /
- Blood glucose control /
- Micronutrients

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表 1 2组孕妇一般资料及膳食调查结果比较

Table 1. Comparison of general information and dietary survey results between the two groups of pregnant women

组别	例数	年龄 (x±s，岁)	孕周 (x±s，周)	BMI (x±s)	初产妇(例)		MAP (x±s，mmHg)	HR (x±s，次/min)	饮食情况(例)		膳食总能量 (x±s，kcal)
组别	例数	年龄 (x±s，岁)	孕周 (x±s，周)	BMI (x±s)	是	否	MAP (x±s，mmHg)	HR (x±s，次/min)	规律	不规律	膳食总能量 (x±s，kcal)
对照组	100	28.82±3.41	31.21±2.56	21.58±3.41	75	25	86.10±8.71	84.22±5.85	79	21	2 163.44±113.24
GDM组	100	29.03±4.16	31.29±3.11	21.62±3.70	70	30	86.17±9.24	84.15±6.21	77	23	2 217.65±156.09
统计量		0.390^a	0.199^a	0.079^a	0.627^b		0.055^a	0.082^a	0.117^b		2.811^a
P值		0.697	0.843	0.937	0.428		0.956	0.935	0.733		0.005

组别	例数	蛋白质摄入量 (x±s，g)	蛋白质供能比 (x±s，%)		脂肪摄入量 (x±s，g)		脂肪供能比 (x±s，%)	碳水化合物摄入量(x±s，g)			碳水化合物供能比(x±s，%)
对照组	100	86.43±9.82	26.67±2.74		61.77±6.33		24.11±2.86	312.42±18.79			52.45±4.28
GDM组	100	97.24±11.42	31.81±3.11		66.23±7.83		33.26±2.92	316.79±22.33			37.31±4.16
统计量		7.177^a	12.401^a		4.430^a		22.386^a	1.497^a			25.366^a
P值		< 0.001	< 0.001		< 0.001		< 0.001	0.136			< 0.001
注：^a为t值，^b为χ²值；1 mmHg=0.133 kPa。

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表 2 2组孕妇维生素摄入量比较(x±s)

Table 2. Comparison of vitamin intake between the two groups of pregnant women (x±s)

组别	例数	维生素A(μgRE)	维生素B₁(mg)	维生素B₂(mg)	维生素B₃(mg)	维生素B₆(mg)	维生素D(μg)	维生素E(mg)	维生素K(μg)
对照组	100	700.28±92.13	2.34±0.35	2.98±0.66	17.11±1.51	1.88±0.17	5.07±0.83	32.45±3.09	712.22±35.26
GDM组	100	670.15±89.77	2.21±0.18	2.31±0.43	16.89±1.34	1.51±0.12	4.76±1.01	30.83±2.56	715.33±40.21
t值		2.342	3.303	7.363	1.090	17.781	2.371	4.037	0.582
P值		0.020	0.001	< 0.001	0.277	< 0.001	0.019	< 0.001	0.562

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表 3 2组孕妇微量元素摄入量比较(x±s)

Table 3. Comparison of trace element intake between the two groups of pregnant women (x±s)

组别	例数	钙(mg)	镁(mg)	锌(mg)	铁(mg)	铜(mg)	铬(μg)
对照组	100	680.22±48.72	378.91±32.83	16.58±2.80	17.89±2.25	2.12±0.19	25.22±2.77
GDM组	100	759.48±56.33	365.42±33.65	13.24±1.23	16.53±1.88	1.87±0.10	24.71±2.64
t值		10.642	2.869	10.921	4.638	13.158	1.333
P值		< 0.001	0.005	< 0.001	< 0.001	< 0.001	0.184

组别	例数	锰(mg)	硒(μg)	钼(μg)	钾(mg)		铅(mg)
对照组	100	4.51±0.82	55.81±3.82	113.51±20.16	2 418.91±110.42		122.55±5.81
GDM组	100	4.55±0.93	51.26±4.33	112.92±18.75	2 533.62±128.79		131.31±7.22
t值		0.323	7.880	0.214	6.762		9.453
P值		0.747	< 0.001	0.831	< 0.001		< 0.001

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表 4 营养素摄入与GDM孕妇血糖控制效果的二元logistic回归分析

Table 4. Binary logistic regression analysis of nutrient intake and glycemic control effect in pregnant women with GDM

变量	β	SE	Wald χ²	P值	OR值	95% CI
高蛋白质摄入	0.901	0.406	4.936	0.026	2.462	1.112~5.451
高脂肪摄入	0.929	0.306	9.237	0.002	2.533	1.391~4.613
低碳水化合物供能比	0.754	0.354	4.549	0.033	2.126	1.063~4.252
维生素A	-0.796	-0.370	4.637	0.031	0.451	0.218~0.931
维生素B₁	-1.440	-0.727	3.918	0.048	0.237	0.057~0.986
维生素B₂	-1.693	-0.642	6.963	0.008	0.184	0.052~0.647
维生素B₆	-0.274	0.137	4.011	0.045	0.760	0.581~0.994
维生素D	-1.478	-0.677	4.772	0.029	0.228	0.061~0.859
维生素E	-2.513	-0.965	6.782	0.009	0.081	0.012~0.537
锌	-0.138	0.058	5.747	0.017	0.871	0.778~0.975
铁	-1.168	-0.376	9.643	0.002	0.311	0.149~0.650
铜	-2.617	-1.070	5.988	0.014	0.073	0.009~0.594
硒	-2.254	-0.710	10.085	0.001	0.105	0.026~0.422

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