Journal of Nutrition and Health

The Korean Nutrition Society (한국영양학회)
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A Case-Control Study of Food Habits and Diet Intakes of Women with Gestational Diabetes Mellitus

임신성 당뇨병 환자의 식습관 및 식이섭취에 관한 환자-대조군 연구

  • Ji, Sun-Kyung (Department of Food and Nutrition, Jeonju Kijeon College) ;
  • Jang, Hak-C. (Department of Internal Medicine, College of Medicine, Seoul National University) ;
  • Choi, Hay-Mie (Department of Food and Nutrition, Seoul National University)
  • 지선경 (전주기전대학 식품영양과) ;
  • 장학철 (서울대학교 의과대학 내과학교실) ;
  • 최혜미 (서울대학교 식품영양학과)
  • Published : 2008.01.31
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Abstract

Gestational diabetes mellitus (GDM) is defined as glucose intolerance discovered or onset during pregnancy and attention is needed because of increased risk of perinatal morbidties and higher incidence of diabetes afterward. This study was performed to identify dietary factors associated with the development of gestational diabetes mellitus (GDM). Developed food frequency questionnaire containing 192 food items were used to assess nutritional status of 246 control subjects and 104 GDM subjects. Food habits of subjects were examined in the questionnaire. The more irregularity and less variety of meal were found in GDM group compared to control group and GDM group tended to eat rapidly and do not like vegetables and greasy foods. Total score of food habits in GDM was lower than control group, which suggests that GDM group have undesirable food habits. Mean daily energy and carbohydrate intakes of GDM group were higher than those of control group, and percent energy from protein was significantly higher in control. Nutrient density of protein, calcium, phosphorus and vitamin BI of GDM group was significantly lower than those of control group. Therefore dietary quality of GDM group was lower than that of control group. Odds ratio for GDM was high when energy and carbohydrate intakes were high. And when the intakes of rice, noodle, shiruduk, hamburger, boiled egg, steamed pork shank were high, the odds ratio for GDM was high. These results indicate that the amount and frequencies of several foods and dish items were related with the occurrence of GDM subjects. On the whole, GDM subjects consumed more cereals and less vegetables and less legumes. From these results, pregnant women with GDM tended to have unhealthy food habits, and carbohydrate intake was important dietary factors on the onset of GDM.

임신성 당뇨병의 발병에 영향을 미치는 식이 인자를 알아보고자 컴퓨터용 식품섭취 빈도조사지와 설문지 등을 이용하여 임신성 당뇨병의 환자군-대조군 연구를 시행한 결과는 다음과 같다. 임신성 당뇨병군이 대조군보다 연령과 BMI가 높았고, 당뇨병의 가족력이 많았다. 임신전의 식습관은 임신성 당뇨병군이 대조군보다 1일 식사횟수가 적었고, 식사시간이 불규칙하고 식사속도가 빨랐으며 채식을 적게 하고 기름진 음식을 싫어하는 경향이었으며, 식습관점수가 낮았다. 식품섭취빈도법으로 조사한 영양소 섭취량에서는 임신성당뇨병군이 대조군보다 탄수화물의 섭취량이 유의적으로 많았고 단백질의 에너지 섭취비율이 유의적으로 낮았다. 지방의 섭취량에는 두 군간에 차이가 없었으며 임신성 당뇨병군이 대조군보다 단백질과 칼슘, 인, 비타민 B,의 영양밀도가 유의적으로 낮았다. 두 그룹간에 섭취량에 유의적 차이를 보이는 식품 중 쌀, 중국국수, 돼지고기 등은 임신성 당뇨병군에서 대조군보다 많이 섭취하였고, 옥수수, 오징어채, 큰멸치, 수박, 포도, 복숭아, 밤, 땅콩, 호상 요구르트, 치즈, 검정콩, 당근 등은 대조군에서 섭취량이나 섭취빈도가 많았다. 두 군 사이에 섭취량에 유의적 차이를 보이는 음식 중 온면, 시루떡, 햄버거, 돼지고기편육, 삶은 계란 등은 임신성 당뇨병군에서 섭취량이 많았고, 전병, 두부조림, 오징어채무침, 깍두기, 야채샐러드, 김치국, 과일샐러드, 콩밥, 콩조림, 토마토쥬스 등은 대조군에서 섭취량이나 섭취빈도가 많았다. 특히 쌀의 경우에는 임신성 당뇨병군이 대조군보다 섭취량은 많았으나 섭취빈도는 적어 임신성 당뇨병군에서 1회의 섭취분량이 많았던 것으로 생각할 수 있다. 영양소 중에서는 탄수화물이나 에너지의 섭취량이 많을 때 임신성 당뇨병의 odds ratio가 증가하였고, 식품이나 음식은 쌀, 국수, 돼지고기, 온면, 시루떡, 햄버거, 삶은 계란, 돼지고기편육 등의 섭취량이 많을 때 임신성 당뇨병의 odds ratio가 증가하였다. 상관관계의 분석결과 에너지 섭취량, 탄수화물 섭취량 등이 혈액의 포도당농도와 상관관계가 있는 것으로 나타났다. 이상으로 본 연구 결과를 종합해 볼 때 임신성 당뇨병에 영향을 미치는 식이 인자는 지방보다는 탄수화물의 섭취량으로 생각되어지며 단백질을 포함한 식사의 질과 바람직하지 않은 식습관이 영향을 미칠 수 있음을 생각해 볼 수 있다.

Keywords

References

  1. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997; 20 (7): 1183-1197 https://doi.org/10.2337/diacare.20.7.1183
  2. Franz MJ, Horton ES, Beebe CA, Brunzell JD, Coulston AM, Hoogwere BJ, Stacpoole PW. Nutrition Principles for the Management of Diabetes and Related Complications. Diabetes Care 1994; 17(5): 490-518 https://doi.org/10.2337/diacare.17.5.490
  3. Yang EJ, Kim WY. The Anthropometric Characteristics of Non Insulin Dependent Diabetes Melltus in Korea. Korean J Nutr 1999b; 32(4): 401-406
  4. Kawate R, Yamakido M, Nisimoto Y. Diabetes mellitus and its vscular complications in Japanes migrants on the island of Hawaii. Diabetes Care 1979; 2: 161-170 https://doi.org/10.2337/diacare.2.2.161
  5. Sevak L, McKeigue PM, Marmot MG. Relationship of hyperinsulinemia to dietary intake in South Asian and European men. Am J Clin Nutr 1994; 59: 1069-1074 https://doi.org/10.1093/ajcn/59.5.1069
  6. Feskens E JM, Bowles CH, Kromhout D. Carbohydrate intake and body mass Index in relation to the risk of glucose intolerance in an elderly population. Am J Clin Nutr 1991; 54: 136-140 https://doi.org/10.1093/ajcn/54.1.136
  7. Major CA, Henry MJ, De Veciana M, Morgan MA. The Effect of Carbohydrate Restriction in Patients With Diet-Controlled Gestational Diabetes. Obstert Gyneol 1998a; 91 (4): 600-604
  8. Moses RG, Shand JL, Tapsell LC. The Recurrence of Gestational Diabetes: Could Dietary Differences in Fat Intake Be an Explanation? Diabetes Care 1997; 20(11): 1647-1650 https://doi.org/10.2337/diacare.20.11.1647
  9. Choi MS, Lee JH, Paik IK, Chung YS, Lee HC, Huh KB. Influence of Body Fat Distribution on Glucose Tolerance and Serum Lipids in patients with Non-Insulin Dependent Diabetes Mellitus. Diabetes 1992; 16(1): 45-53
  10. So HK. A Case-Control Study for the Dietary Habits Related to Diabetes Mellitus. Graduate School of Public Health, Kyungpook National University; 1990
  11. Choi MJ. Relation of Body Fat Distribution to Calorie Intake, Blood Glucose, and Exercies in Female Diabetics. Korean J Community Nutrition 1993; 26(2): 164-173
  12. Song MH, Lee JM. A Study on Food and Nutrients Intake and Blood Contituents of Diabetes by Obese Index. Korean J Nutr 1993; 26(8): 953-966
  13. Rho SN, Ko HS. A Clinical Properties on Nutrients Intake and Serum Concentration of Diabetic Subjects by Duration in Ansung Kyunggi-do. Korean J Nutr 1997; 30(10); 1203-1210
  14. Ahn YJ, Paik HY, Lee HK, Park YS. Comparison of Food Intakes between Newly Diagnosed Diabetics and Nondiabetics by Food Frequency Questionnaire in Adults Living in Rural Area of Korea. J Korean Soc Food Sci Nutr 1998; 27(1); 182-190
  15. Yang EJ, Kim WY. The Influence of Dietary Factors on the Incidence of Non-Insulin-Dependent Diabetes Melltus. Korean J Nutr 1999a; 32(4); 407-418
  16. Park SM, Choi SB. The Meal Management of Korean Type 2 Diabetes Patients Using Carbohydrate Counting. J Korean Diet Assoc 1999; 5(1): 64-73
  17. Kim SH. Anthropometric Characteristics, Dietary Behaviors, Nutrient Intake and pregnant Outcome in Pregnant Women with or without Gestational Diabetes Mellutes (GDM). Department of Food and Nutrtion. Graduate School, Ewha Womans University; 2000
  18. Park BK. The effects of carbohydrate-restricted diet therapy in gestational diabetes. Department of Food and Nutrtion Information Management Graduate School of Human Environment Science, Yonsei University; 2001
  19. Yang EJ. A Study on Dietary Factors Related to the Incidence of Diabetes Mellitus in korea. Department of Food and Nutrtion. Graduate School, Ewha Womans University; 1997
  20. Cousins L, Baxi L, Chez R, Coustan D, Gabbe S, Harris J, Landon M, Sacks D, Shailini. Screening Recommendations for gestational diabetes mellitus. Am J Obstet Gynecol 1991; 165(3); 493-496 https://doi.org/10.1016/0002-9378(91)90273-T
  21. National Diabetes Data Group. Classification and Diagnosis of Diabetes Mellitus and Other Categories of Glucose Intolerance. Diabetes 1979; 28(12): 1039-1057 https://doi.org/10.2337/diab.28.12.1039
  22. McDonald A, Horn LV, Slattery M, Hilner J, Bragg C, Caan B, David Jacobs Jr, Liu K, Hubert H, Gernhofer N, Betz E, Havlik D. The CARDIA dietary history: Development, implementation, and evaluation. J Am Diet Assoc 1991; 91(9): 1104-1112
  23. Ji SK. A Study of Dietary Factors and Biochemical Indices on the Onset of Gestational Diabetes Mellitus. Department of Food and Nutrtion Graduate School, Seoul National University; 2001
  24. Harris SB, Caulfield LE, Sugamori ME, Whalen EA, Henning B. The Epidemiology of Diabetes in Pregnant Native canadians. Diabetes Care 1997; 20(9): 1422-1425 https://doi.org/10.2337/diacare.20.9.1422
  25. Jang HC. Prevalence and Heterogeneity of Gestational Diabetes Mellitus in Seoul. Depatment of Internal Medicine Graduate School, Seoul National University; 1994
  26. Kim YL, Ahn MO, Kwak IP, Kim MJ, Cha KS, Chung CH, Ahn KJ, Chung YS, Lee HC, Huh KB. Clinical Features of Gestational Diabetes Mellitus in Korean. Korean J Intern Med 1992; 43(6): 776-784
  27. Feskens E JM, Bowles CH, Kromhout D. Carbohydrate intake and body mass Index in relation to the risk of glucose intolerance in an elderly population. Am J Clin Nutr 1991; 54: 136-140 https://doi.org/10.1093/ajcn/54.1.136
  28. Goldman M, Kitzmiller JL, Abrams B, Cowan RM, Laros JR KR. Obstetric Complications With GDM Effects of Maternal Weight. Diabetes 1991; 40 Suppl 2(12): 79-82 https://doi.org/10.2337/diab.40.2.S79
  29. Choi MJ. Relation of Body Fat Distribution to Calorie Intake, Blood Glucose, and Exercies in Female Diabetics. Korean J Community Nutrition 1993; 26(2): 164-173
  30. Kim SH. Changes of the Food Preferences and the Practices of Pica of Women in the Latter Half of Pregnancy. Korean J Nutr 1976; 9(4): 28-35
  31. Tepper BJ, Seldner AC. Sweet taste and intake of sweet foods in normal pregnancy and pregnancy complicated by gestational diabetes mellitus. Am J Clin Nutr 1999; 70(2): 277-284 https://doi.org/10.1093/ajcn.70.2.277
  32. Lee KU, Ryu JS, Kim YT, Shong YK, Kim GS, Lee MH. Clinical Characteristics of Korean Diabetic Patients classified by Fasting Plasma C-Peptide Level and Degree of Obesity. Korean J Intern Med 1992; 42(3): 315-321
  33. Anderson JW, Herman RH. Effect of Carbohydrate restriction on glucose tolerance of normal men and reactive hypoglycemic patients. Am J Clin Nutr 1975; 28: 748 https://doi.org/10.1093/ajcn/28.7.748