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研究生: 李宛蓉
論文名稱: 探討懷孕、昇糖指數和相關營養素與嬰兒出生體型及婦女體重變化之關係
Examination of relationships for pregnancy, glycemic index and related nutrients with birth outcomes and maternal weight changes
指導教授: 盧立卿
學位類別: 碩士
Master
系所名稱: 人類發展與家庭學系
Department of Human Development and Family Studies
論文出版年: 2008
畢業學年度: 96
語文別: 中文
論文頁數: 288
中文關鍵詞: 昇糖指數昇糖負荷嬰兒出生體型產後體重保留24小時飲食回憶法
英文關鍵詞: glycemic index, glycemic load, birth outcomes, postpartum weight retention, 24-hours dietary recalls
論文種類: 學術論文
相關次數: 點閱:247下載:19
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  • 爲了探討懷孕、昇糖指數和相關營養素與嬰兒出生體型及婦女體重變化之相關性,本研究收集兩個長期世代追蹤資料(民91與民93世代)共289位都會區婦女之數據,從懷孕前一年最遠追蹤至產後四年;主要以電訪方式進行問卷調查,飲食部分數據由24小時飲食回憶法及回憶過去典型一天飲食而得,共收集934份飲食回憶問卷。分析發現,本研究婦女飲食中昇糖指數平均為47.81±4.15,昇糖負荷平均為129.04±50.63,昇糖負荷密度平均為64.49±12.73,而婦女的教育年數與飲食中昇糖負荷呈顯著正相關。

    在本研究中,嬰兒平均出生週數為38.95±1.05週,出生身長為49.27±2.03 cm,出生體重為3237.83±475.22 g,出生頭圍34.32±1.98 cm,出生胸圍32.93±2.03 cm。若是分性別來看嬰兒出生體型,則發現男嬰之身長、體重、頭圍、胸圍皆大於女嬰。在嬰兒出生體型方面,懷孕前一年GL與嬰兒出生身長呈顯著正相關;懷孕中期GL在控制性別及孕期體重增加量後,與嬰兒出生身長和體重呈顯著正相關性;懷孕中期GL密度在控制性別及孕期體重增加量後,會與嬰兒出生身長、體重和頭圍呈顯著正相關;然而懷孕全期的GI、GL和GL密度皆與嬰兒出生體型無關。在影響嬰兒出生體型的多元迴歸模式中,顯示母親懷孕全期攝取之熱量、三大營養素百分比以及GI、GL對於嬰兒出生體型影響力較小,主要還是決定於嬰兒性別、出生週數、母親未懷本胎次BMI、孕期體重增加量和父親身高等因素。

    婦女至產後四年體重保留情形,在產後一個月時體重保留為4.69~5.26 kg,產後六個月保留2.14~2.44 kg,產後一年為1.04~1.81 kg,產後兩年為0.75 kg,產後三年為0.36 kg,產後四年則保留1.58 kg。在雙變項分析中,產後一年及四年體重保留皆與GI、GL、GL密度無相關性;產後一年體重保留與孕期體重增加量、產後一個月和六個月體重保留以及婦女社經背景呈正相關,但與已有子女數呈負相關;產後四年體重保留與產後六個月、一年、兩年和三年體重保留量呈正相關,而與未生本胎體重、未生本胎BMI呈負相關性。此外,多元迴歸模式中顯示,飲食中GL越高或是每公斤體重攝取之熱量(活動量指標)越少者,產後四年體重保留量也會越多;由此可知產後一年體重保留之影響因素與「懷孕」的因子較相關,而產後四年體重保留則與婦女基本資料和生活型態較相關。

    The objective of the study was to examine the associations between pregnancy, glycemic index (GI), the related nutrients and birth outcomes, and postpartum weight retention based on two longitudinal cohorts. Total 289 downtown women were in the follow-ups from pregnancy to the postpartum four years. Participants were interviewed mainly by telephone, and the dietary assessment was carried out by 24-hours dietary recalls and remote typical day recalls for pre-pregnancy. Total 934 24-hours dietary recalls were analyzed, and our results showed that the average dietary glycemic index was 47.81±4.15, glycemic load (GL) was 129.04±50.63, and glycemic load density was 64.49±12.73. In addition, there was a significant positive correlation between years in schools and dietary glycemic load.

    In our study, the average gestational age for newborns was 38.95±1.05 weeks. The average birth length, weight, head circumference, and chest circumference of the newborns was 49.27±2.03 cm, 3237.83±475.22 g, 34.32±1.98 cm, and 32.93±2.03 cm, respectively. Furthermore, male babies were higher than female babies. Prepregnancy GL was positively correlated with birth length; after controlling for sex and gestational weight gain, GL during 2nd trimester was positively correlated with birth length and weight, as well as GL density during 2nd trimester was positively correlated with birth length, weight and head circumference; however, the entire gestational GI, GL and GL density had no correlation with birth outcomes. By multiple regression analysis, maternal entire gestational energy, energy-adjusted carbohydrate, protein, fat, GI, and GL had less influence on birth outcomes than other factors, such as sex, maternal gestational age, prepregnancy BMI, gestational weight gain, and paternal height.

    Regarding maternal weight retention until four years postpartum, the average weight retention was 4.69~5.26 kg at one month postpartum, 2.14~2.44 kg at six months postpartum, 1.04~1.81 kg at one year postpartum, 0.75 kg at two years postpartum, 0.36 kg at three years postpartum, and 1.58 kg at four years postpartum. By bivariate analysis, weight retention at one and four years postpartum had no correlation with GI, GL and GL density; weight retention at one year postpartum was positively correlated with socioeconomic status, gestational weight gain, weight retention at one and at six months postpartum, but was negatively correlated with number of children. Weight retention at four years postpartum was positively correlated with weight retention at six months, one, two, and three years postpartum, but was negatively correlated with pre-pregnancy weight and BMI. Moreover, by multiple regression models, we found that dietary GL was positively correlated with weight retention, but energy consumption per kg intake was negatively correlated with weight retention at four years postpartum. These data suggested weight retention at one year postpartum had stronger relationship with ”pregnancy” per se, but for weight retention at four years postpartum, subjects’ basic background and life style factors were more influential.

    第一章 緒論 第一節 研究動機..........................................1 第二節 研究目的..........................................2 第三節 名辭界定..........................................4 第二章 文獻探討 第一節 昇糖指數與昇糖負荷之研究 ㄧ、昇糖指數與昇糖負荷之定義與測定方法.........................5 二、影響食物昇糖指數的因子...................................10 第二節 昇糖指數與昇糖負荷飲食評估法 ㄧ、建立食品資料庫相關文獻...................................14 二、飲食頻率問卷法相關文獻...................................16 三、24小時飲食回憶法相關文獻.................................17 第三節 昇糖指數、昇糖負荷對於體型之影響 ㄧ、昇糖指數、昇糖負荷與體重變化..............................19 二、昇糖指數、昇糖負荷對於孕婦及新生兒體型之影響................24 第四節 懷孕對於婦女體重變化之影響 ㄧ、懷孕對於婦女體重變化之研究 ..............................28 二、懷孕對於婦女體重變化之影響因素............................30 第五節 嬰兒出生體型影響因素 ㄧ、出生體重標準............................................36 二、台灣相關文獻............................................36 三、開發中國家相關文獻 .....................................40 四、已開發國家相關文獻 .....................................42 第三章 研究方法 第一節 研究架構.........................................45 第二節 研究設計與實施流程 ㄧ、研究設計...............................................46 二、實施程序流程圖..........................................48 第三節 研究對象 ㄧ、婦幼民91世代 ..........................................49 二、婦幼民93世代 ..........................................49 第四節 資料收集步驟 一、研究工具 1.問卷內容.................................................50 2.食品營養資料庫 ..........................................53 3.追蹤過程紀錄表 ..........................................57 二、資料收集與訪員訓練 1.資料收集.................................................57 2.訪員訓練.................................................61 第五節 資料處理步驟 ㄧ、媽媽基本資料與媽媽問卷(民91產後四年與民93產後一年)..........62 二、先前已處理之問卷 .....................................62三、家庭社經背景............................................64 四、身體活動量 ............................................65 五、懷孕三期問卷的處理方式 ..............................66 六、資料庫中營養素及昇糖指數與昇糖負荷完成率 ................68 第六節 統計分析 .....................................69 第四章 研究結果 第一節 婦女基本資料、體重變化與營養素攝取 ㄧ、婦女基本資料分析........................................71 二、婦女體重變化描述........................................78 三、飲食GI、GL與營養素攝取情形...............................82 第二節 婦女飲食中昇糖指數與昇糖負荷 ㄧ、昇糖指數、昇糖負荷與昇糖負荷密度分佈性.....................89 二、昇糖指數、昇糖負荷與營養素之關係..........................91 三、昇糖指數、昇糖負荷與婦女基本資料之關係.....................92 四、影響婦女飲食中昇糖指數、昇糖負荷之多元迴歸分析..............97 第三節 嬰兒出生體型與相關因素之分析 ㄧ、嬰兒出生體型...........................................103 二、懷孕前一年和懷孕全期昇糖指數及相關營養素與嬰兒出生體型之關係.104 三、懷孕三期昇糖指數及相關營養素與嬰兒出生體型之關係 ........122 四、嬰兒不同出生體型與昇糖指數之關係 ......................137 五、婦女不同基本資料與嬰兒出生體型之關係......................141 六、婦女不同基本資料與昇糖指數之關係 ......................145 七、影響嬰兒出生體型之多元迴歸分析...........................152 第四節 產後一年體重保留與相關因素之分析 ㄧ、基本資料描述...........................................162 二、產後一年飲食攝取情形....................................164 三、婦女產後一年體重、BMI與基本資料及營養素之關係 ...........165 四、影響產後一年體重保留之因素 .............................171 五、影響婦女產後一年體重保留之多元迴歸分析....................183 第五節 產後四年體重保留與相關因素之分析 一、基本資料描述...........................................189 二、產後四年飲食攝取情形....................................191 三、婦女產後四年體重、BMI與基本資料及營養素之關係 ............192 四、影響產後四年體重保留之因素 .............................198 五、影響婦女產後四年體重保留之多元迴歸分析....................210 第五章 討論 ㄧ、婦女飲食中昇糖指數、昇糖負荷與相關營養素攝取狀況 ........215 二、影響嬰兒出生體型之相關因素 ............................219 三、婦女生產後體重變化情形..................................222 四、影響婦女產後體重保留之相關因素...........................223 第六章 結論 ...........................................227 第七章 研究限制與建議....................................231 附錄表 附錄一、民91世代研究招募流程................................247 附錄二、民91世代研究調查同意書 ...........................248 民93世代研究調查同意書 ...........................249 附錄三、民91世代孕婦基本資料................................250 民93世代孕婦基本資料................................251 民91世代健康狀況家庭生活及個人飲食頻率問卷.............252 民93世代懷孕前一年問卷 ...........................260 民91世代一週飲食及活動頻率問卷 ....................271 24小時飲食回憶 ..................................273 新生兒健康狀況問卷A.................................274 民93產後一年基本資料................................275 民93產後一年媽媽問卷................................277 民91媽媽基本資料與媽媽問卷...........................279 附錄四、民91、93世代媽媽基本資料與媽媽問卷編碼................283 附錄五、營養素完成率 ....................................288

    ㄧ、中文部份

    呂育凱(民87)低齡孕婦不良生育結果之研究-配合懷孕週數,探討低出生體重與妊娠低出生體重。國立陽明大學公共衛生研究所碩士論文,未出版,台北市。
    何啟功(民76)。懷孕婦女中西藥物使用情形及新生兒出生體重影響因素之探討。國立台灣大學公共衛生研究所碩士論文,未出版,台北市。
    邱孟肇(民86)。台灣地區新生兒出生體重-懷孕週數常模。國立台灣大學職業醫學與工業衛生研究所碩士論文,未出版,台北市。
    陳依伶(民95)。民國九十三年新竹市低體重新生兒發生原因之研究。中華大學行政管理學系研究所碩士論文,未出版,新竹市。
    陳姮霏(民93)。懷孕婦女飲食狀況對新生兒體型影響之前瞻性研究。 國立台灣師範大學人類發展與家庭學系碩士論文,未出版,台北市。
    許昭純(民74)。台北市孕婦中西藥物使用情形及嬰兒體重影響探討。國立臺灣大學公共衛生研究所碩士論文,未出版,台北市。
    黃萾芬、林依婷、張文心、陳巧明、劉珍芳(民96)。常見本土性主食類之昇糖指數。中華營誌,32(2),46-53。
    葉潔瑩(民93)。發展暨驗證以飲食與運動為介入對降低產後婦女體重留滯之成效。私立長庚大學護理研究所碩士論文,未出版,桃園縣。
    廖苑秀(民95)。孕婦第三孕期營養狀況與新生兒營養及生理之研究-以台南地區婦產科診所為例。台南科技大學生活應用科學研究所碩士論文,未出版,台南縣。
    劉桂霞、李鴻森(民88)。懷孕週數與低出生體重及極低出生體重嬰兒盛行率之研究。中山醫學雜誌,10(1),29-33。
    戴芳台(民92)。產後婦女體重變化和健康促進生活型態之相關因素探 討。私立長庚大學護理研究所碩士論文,未出版,桃園縣。
    藍守仁、嚴雅音、李建宏、邱正芬、張宜娟、謝淑芬(民80)。懷孕週數與出生體重及體重/身長比之研究。高雄醫學科學雜誌,7,168-172。
    羅巧珍(民93)。懷孕到產後飲食營養與體重變化之前瞻性研究。 國立台灣師範大學人類發展與家庭學系碩士論文,未出版,台北市。

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