台灣懷孕婦女紅血球生成相關營養素缺乏之流行病學研究： 盛行率與飲食型態

Objective: Anemia and obesity are the most common type of nutritional disease worldwide. Pregnancy is in the phase of rapid weight gain and increased iron demand. Insufficient intake of erythropoiesis-related nutrients such as iron, protein, folate, and vitamin B12 contributes to anemia and iron deficiency anemia (IDA). Hepcidin is the essential regulator of iron homeostasis but its expression is upregulated by obesity. Currently, how the hepcidin is regulated during pregnancy and how obesity affects gestational IDA remains unclear. The broad aim of this study is to investigates the relationship among hepcidin, pre-pregnancy body mass index (pBMI), erythropoiesis-related nutrient deficiency and its associated dietary pattern among pregnant women. The specific aims of each study were to investigate: study 1) relationship between pBMI, hepcidin and erythropoiesis-related nutritional deficiencies, study 2) association between food and nutrient intake and serum hepcidin and the risk of gestational IDA, study 3) erythropoiesis-related nutritional deficiencies associated dietary pattern.
Methods: A cross-sectional survey was conducted using data from the Nationwide Nutrition and Health Survey in pregnant women, Taiwan (NAHSIT-PW 2017-2019). In total, 1520 pregnant women aged 15 to 48 years were recruited. Data were collected during the prenatal checkup, including sociodemographic characteristics, dietary intake (24-hour dietary recall, and food frequency questionnaire), and blood biochemistry. Dietary pattern was identified by the reduced rank regression (RRR) model. Adjusted multivariate linear and logistic regression were performed to estimate the beta coefficient (ß) and 95% confidence interval (CI) of serum hepcidin and the odds ratio (OR) of anemia, IDA and multiple erythropoiesis-related nutritional deficiencies (iron deficiency, folate depletion, and vitamin B12 deficiency).
Results: The mean age of pregnant women was 32.56 ± 4.69 years and the mean pBMI was 22.67 ± 4.00 kg/m2. The prevalence of anemia, IDA and multiple erythropoiesis-related nutritional deficiencies were 24.6%, 16.1%, and 16.7%, respectively. Study (1) gestational hepcidin concentrations were significantly positively correlated with pBMI among pregnant women. A U-shape association between pBMI and the prevalence of mild and severe nutritional deficiency related to erythropoiesis, including anemia and IDA. Compared to normal weight, obese pregnant women had 3.4-fold higher odds for developing multiple nutritional deficiencies related to erythropoiesis, while UW individuals had the lowest odds (0.3). Study (2) positive trends between serum hepcidin concentrations with the intake frequency of Chinese dim sum and related foods (β = 0.037) and dark leafy vegetables (β = 0.013), but hepcidin concentrations were inversely correlated with noodles and related products (β = −0.022) among IDA pregnant women. Food-hepcidin relationships seem to be dependent on the iron status of pregnant women. Total carbohydrates, carbohydrate-rich foods (rice/rice porridge), vegetables (dark leafy vegetables, and gourds/shoots/root vegetables) predicted the risk of ID or IDA. In contrast, dietary protein, total dietary fiber, and to a lesser extent, dietary iron protected against gestational IDA. The risk association between increased vegetable consumption and IDA is reduced with an increased vitamin C intake (p-trend = 0.024). Study (3) Individuals with higher intake frequencies of breakfast cereals/oats and related products, total vegetables, soybean products, nut/seeds, and fresh fruits, but lower intake of bread/its products, and processed meat products had 25.2% [OR:0.748; 95% CI: 0.623-0.900, p=0.002] and 38.6% [OR: 0.614; 95% CI: 0.473-0.797; p<0.001] decreased odds of having double and multiple erythropoiesis-related nutritional deficiencies, respectively. Moreover, dietary pattern also protects obese pregnant women against double (OR:0.495; 95%CI: 0.271-0.903, p=0.022) and multiple erythropoiesis-related nutritional deficiencies (OR: 0.499; 95%CI: 0.254-0.983, p=0.045).

Conclusion: Maintaining a healthy weight status before pregnancy incorporates with healthy dietary pattern (e.g., high intake of fruits, vegetables, and low processed food) and sufficient consumption of vitamin C may protect against gestational erythropoiesis-related nutritional deficiencies.