孕婦不同蛋白質飲食攝取來源對於孕期體重增加量及出生體型之影響

蛋白質為孕期唯一建議需增加攝取之巨量營養素，但鮮少有研究針對動、植物性飲食來源與孕期體重增加量(Gestational weight gain，GWG)及新生兒體型發展進行探討，因此本研究將區分不同蛋白質來源，以營養素及食物類別角度，分析不同孕期攝取狀況及各餐次中動、植物性蛋白質影響。研究對象為民國91及98年於台北市立聯合醫院所招募的295對孕期產婦及其子女，收集懷孕17~20週(孕期前期)與36週~生產(孕期後期)的24小時飲食回憶及新生兒體位資料進行分析(n=193)，並分析全孕期FFQ資料(n=188)來與24小時飲食回憶評估結果對照。研究結果顯示在非營養素因子中，GWG與孕婦年齡(r=-0.187)呈顯著負相關；出生體重則與孕前BMI(r=0.254)、GWG(r=0.236)呈顯著正相關，且男嬰平均出生體重顯著高於女嬰(3303g vs 3041g)。營養攝取分析中發現，比較前、後孕期熱量(1912kcal vs 2094kcal)、脂質(67g vs 77g)及醣類(253g vs 272g)攝取，孕期後期顯著高於孕期前期，而前、後孕期的蛋白質(75g vs 77g)攝取並未有顯著差異。以24小時飲食回憶分析全孕期動、植物性食物類別攝取分佈，植物性蛋白質來源主要為麥類(47%)、黃豆類(16%)及米類(14%)，動物性來源則為豬肉類(24%)、禽肉類(17%)及奶類(16%)。比較前、後孕期食物類別蛋白質攝取差異，發現孕期後期堅果種子類、加工肉品類及奶類蛋白質攝取顯著高於前期(p<0.05)。餐次分析中全孕期三餐蛋白質分配百分比為22%、38%及39%，而三餐動、植物性蛋白質比值為1.5、1.3及1.4，且發現前、後孕期攝取動物性蛋白質佔一日所攝取總動物性蛋白質百分比，晚餐為最高，其次為午餐及早餐。不同孕期動、植物性蛋白質相關性分析中發現，動、植物性蛋白質對於GWG及新生兒體型相關性多為不顯著。食物類別相關性分析中發現，GWG與全孕期魚類(r=0.188)、牛肉類(r=0.144)、蛋類(r=0.210)、奶類(r=0.175)攝取量具有顯著正相關，但GWG與各食物類所提供之蛋白質則無相關性存在；新生兒體型方面發現，孕期後期水果類攝取量(r=0.236)及其蛋白質(r=0.187)對於出生體重呈顯著正相關。餐次相關性分析結果顯示，三餐動物性蛋白質攝取量對於GWG皆有正相關之趨勢(p>0.05)，而午、晚餐植物性蛋白質則與GWG有負相關之趨勢(p>0.05)；新生兒體型方面，三餐次之動、植物性蛋白質攝取對於新生兒體型之相關性則無一致性。本研究為台灣第一個針對孕期婦女之動、植物性飲食來源蛋白質攝取進行分析與探討。研究發現全孕期熱量平均攝取約為2000kcal，每公斤體重蛋白質攝取界於1.16~1.31之間，以24小時飲食回憶及FFQ評估動、植物性蛋白質攝取比值分別為1.24及1.25，兩者結果相近，雖然孕期動、植物性蛋白質攝取對於GWG及新生兒體型之相關性不強，但仍需注意孕期食物選擇與份量。

關鍵字

孕期飲食；動植物性蛋白質；食物類別；餐次；孕期體重增加量；新生兒體型

並列摘要

Protein is the only macronutrient that DRIs suggests to increase the intake during pregnancy. But few studies focus on the influence between the maternal dietary protein sources and gestational weight gain (GWG) or birth sizes. Therefore, this study examine protein intakes with related nutrients, food items and mealtime to identify the impact of different dietary sources. We recruited subjects who were healthy pregnant women from Taipei Municipal Women’s and Children’s Hospital in two cohorts (n=295). We collected anthropometric information of mothers and their newborns and dietary data include 17 to 20 weeks pregnant (early pregnancy) and 36 weeks pregnant until delivery (late pregnancy) by one-day 24hr dietary recall (n=193). Additionally, we used another dietary method, food frequency questionnaire (FFQ), to compare the results with 24hr dietary recalls (n=188). In background information analysis, a significantly negative correlation was found between GWG and maternal age (r=-0.187). Birth weight was positively associated with pre-pregnancy BMI (r=0.254) and GWG (r=0.236), and boys were heavier at birth than girls (3303g vs 3041g). Differences in dietary intake between early and late pregnancy, we found that energy (1912kcal vs 2094kcal), fat (67g vs 77g) and carbohydrate intakes (253g vs 272g) in late pregnancy were higher than in early pregnancy, but protein intake (77g vs 75g) is similar. Wheat (47%),soybean protein (16%)and rice (14%) contributed to the main proportion of plant protein consumption, and pork (24%), poultry (17%) and milk (16%) were the main sources of animal protein during full-term pregnancy. Protein intake from peanuts, processed meat and milk in late pregnancy were significantly higher than in early pregnancy. The distribution of protein (of total protein percentage) in three meals were 22%, 38% and 39%, and animal-to-plant protein ratio were 1.5, 1.3 and 1.4. Furthermore, animal protein consumption from dinner accounted for the highest proportion than from breakfast and lunch both in early and late pregnancy. Different sources of dietary protein intake had a not significant correlation with GWG and birth size. Consumption of fish(r=0.188), beef(r=0.144), egg(r=0.210) and milk(r=0.175) had a significantly positive correlation with GWG during full-term pregnancy, but no correlation was found between protein intakes of food items and GWG. Not only intake of fruit(r=0.236) but its protein (r=0.187) significantly and positively associated with birth weight in late pregnancy. In the mealtime analysis, we also found a positive but not significant correlation between all three meals intake of animal protein and GWG (p>0.05). On the other hand, plant protein for lunch and dinner had a negative but not significant correlation with GWG (p>0.05). Different sources of dietary protein intake on birth sizes for three meal, the correlation was inconsistency. This is the first study to examine different sources protein intake during pregnancy in Taiwan. We found average energy intake was 2000kcal in full-term pregnancy, and protein intake was between 1.26 to 1.31g per kilogram body weight. There were similar ratios of animal and plant protein by 24hr dietary recalls and FFQ, and the value were 1.24 and 1.25 respectively. But we suggested that in a food abundant environment, dietary protein including plant and animal sources may not have strong impact on GWG and birth weight. However, food choices and dietary intake during pregnancy are still important.