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임신 중 체중증가에 따른 식습관 비교

Title
임신 중 체중증가에 따른 식습관 비교
Other Titles
Comparison of Eating Habits Based on Weight Gain During Pregnancy : Centered on Recommended Standards of IOM
Authors
오정신
Issue Date
2010
Department/Major
임상보건과학대학원 임상보건학과임상영양학전공
Publisher
이화여자대학교 임상보건과학대학원
Degree
Master
Advisors
조미숙
Abstract
Appropriate weight gain during pregnancy is essential to maintain health of pregnant women and normal development of the fetus. In 1990, the Institute of Medicine (IOM) published a guideline on appropriate levels of weight gain during pregnancy based on the Body Mass Index (BMI). There are reports that insufficient weight gain based on the recommended standards of the IOM is related to preterm birth or low birth weight and that excessive weight gain is related to childbirth of high birth weight or increase in frequency of Caesarean delivery. In this context, the purpose of this study is to investigate weight gain during pregnancy based on pre-pregnant BMI, to compare differences in general characteristics and eating habits based on the recommended standards for weight gain presented by the IOM, and to identify factors affecting weight gain of pregnant women, when the subjects of this study were 100 pregnant women of late gestation who visited a hospital located in Ilsan for regular check-up. The results of this study are as follows. The subjects of this study were firstly classified on the basis of pre-pregnant BMI. Then, based on the recommended standards presented by the IOM, the adequate gain group included the underweight group showing weight gain between 12.5 and 18.0㎏, the normal weight group showing weight gain between 11.5 and 16.0㎏, and the overweight group showing weight gain between 7.0 and 11.5㎏. Meanwhile, those who did not reach to the standards for appropriate weight gain were classified as the inadequate gain group, and those who exceeded the standards were classified as the excessive gain group. Pre-pregnant BMI of all the subjects was 20.9±2.60㎏/㎡, and that of the excessive gain group was significantly higher than that of the other two groups. As for the weight changes during pregnancy, the weight before pregnancy, the weight at the 20th week, the weight at the 36th week, and the weight delivery of the excessive gain group were significantly higher than those of the other two groups. As for the mean total pregnancy weight gain, the inadequate gain group was 10.04±1.55㎏, the adequate gain group was 13.26±2.44㎏, and the excessive gain group was 17.18±4.38㎏, indicating that there were significant differences between the groups. As for the pace of weight gain by gestational ages, the adequate gain group was within the recommended ranges presented by the IOM during all the first, the second, and the third pregnant period, showing appropriate pace. However, the inadequate gain group did not reach to the recommended ranges by the IOM in the weight gain pace during all the pregnant periods, and the excessive gain group exceeded the weight gain pace recommended by the IOM during all the pregnant periods. Based on comparison of the eating habits and nutrient intake according to the recommended standards for weight gain, the preference for greasy taste during mid pregnancy of the adequate gain group was significantly higher than the other two groups, and the excessive gain group was enhanced in size of meal and more frequent of eat-out when compared to the period of before-pregnancy. As for the mean rate of meal skipping (%), the inadequate gain group was less when compared to the other two groups. The amount of one meal was more in the excessive gain group than in the other two groups. As for the 'simpler meals' frequently eaten, the excessive gain group was "rice and one side dish," the inadequate gain group was "noodles with stock (udon and kalguksu)," and the adequate gain group was "noodles (jajangmyeon and spaghetti), indicating differences between the groups. The excessive gain group was least in the scores of eating habits, frequent of "overeating" and "gluttony," and ate "a lot of fruits." The inadequate gain group ate less "greasy foods such as fried foods or pan-fried foods)." As for the mean energy intake per day, all the three groups were insufficient when compared to the recommended intake. As for the intake rate of carbohydrate: protein: fat, the adequate gain group and the excessive gain group ingested higher rate of fat when compared to the recommended rate. As for the nutrition adequacy ratio(NAR), all the three groups were least in the NAR of folic acid, most in the NAR of phosphrus, and low in the NAR of iron (0.7 or less). The mean adequacy ratio(MAR) of all the three groups was less than 1, indicating that the mean nutrient adequacy was low. There were no significant differences between the three groups in pregnancy outcome and infant's birth weight based on the recommended standards for weight gain. Based on analysis of correlations between weight gain during pregnancy and anthropometric measurement, the adequate gain group and the excessive gain group showed significantly negative correlation between the weight gain during pregnancy and the weight and BMI before pregnancy, and showed positive correlation with the weight gain pace in early and mid pregnancy. On the contrary, the inadequate gain group showed no significant correlation between the weight gain during pregnancy and the weight and BMI before pregnancy, but showed positive correlation with the weight gain pace in early pregnancy. Based on analysis of correlations between weight gain during pregnancy and diet factors, the adequate gain group had positive correlation between weight gain and "balanced diet" and had negative correlation with "simpler meals," and the excessive gain group had positive correlation with "simpler meals" and had negative correlation with "meal skipping." All the pregnant women were more frequent of "overeating" and "gluttony" and ate more "a lot of fruit," as their weight gain was higher. In particular, the excessive gain group was frequent of "overeating" and ate less "greasy foods," while the adequate gain group ate less "salty foods." Between weight gain and nutrient intake, the adequate gain group showed significantly positive correlation with intake of vegetable fat, fiber, zinc, vitamin B₁, and vitamin C. Based on analysis of correlations among eating types, eating behaviors, and nutrient intake affecting weight gain during pregnancy, no significant correlation was shown between weight gain during pregnancy, eating types, and nutrient intake, but significant negative correlation was shown with the eating habit scores among eating behaviors. According to analysis of correlations between factors affecting infant's birth weight, the age of pregnant woman showed negative correlation with infant's birth weight, and showed positive correlations with the height, the weight before pregnancy, and the gestational age of the pregnant woman. There was no significant correlation between weight gain during pregnancy and infant's birth weight. Conclusively, the factors affecting weight gain during pregnancy were the BMI before pregnancy, eating types, and eating habits. As the BMI before pregnancy was higher, the ingestion of 'balanced diet' was less, and overeating and gluttony were more frequent, weight gain was enhanced. Therefore, for appropriate weight control of pregnant women, it may be needed to develop programs of nutritional education to induce desirable eating behaviors to apply to before-delivery education.;임신 중 적절한 체중증가는 임신부의 건강유지와 정상적인 태아발달을 위하여 필수적이다. 1990년 IOM(Institute of Medicine)에서는 임신 전 신체질량지수(Body Mass Index ; BMI)에 근거한 임신 중 체중증가의 적정수준에 대한 지침을 발표하였으며, IOM 권고 기준보다 체중증가가 부족한 경우 조산아 또는 저체중아 출산과 관련이 있고, 체중증가가 과다한 경우 과체중아 출생 혹은 제왕절개술 빈도 증가와 관련이 있는 것으로 보고되었다. 따라서 본 연구에서는 일산에 소재한 병원에 정기검진 온 임신후기 임신부 100명을 대상으로 임신 전 체질량지수에 따른 임신 중 체중증가 정도를 파악하고, IOM에서 권고한 체중증가 기준에 따른 일반특성 및 식습관의 차이를 비교하여 임신부의 체중증가에 영향을 미치는 요인을 알아내고자 수행하였으며 그 결과는 다음과 같다. 전체 연구대상자를 임신 전 BMI 기준으로 우선 분류한 뒤, IOM에서 제시한 권고안에 의거하여 저체중군은 12.5∼18.0㎏, 정상체중군은 11.5∼16.0㎏, 과체중군은 7.0∼11.5㎏의 체중증가를 보인 경우에 적정군으로 분류하였고, 적정증가기준에 미달한 경우에는 부족군, 초과한 경우에는 과도군으로 분류하였다. 전체 연구대상자의 임신 전 BMI는 20.9±2.60㎏/㎡이었으며, 과도군은 임신 전 BMI가 다른 두 군에 비해 유의적으로 크게 나타났다. 임신 기간 중 체중변화를 살펴보면, 과도군은 임신 전 체중, 20주 체중, 36주 체중, 분만 체중이 다른 두 군에 비해 유의적으로 많았고, 총 체중증가량 역시 부족군은 10.04±1.55㎏, 적정군은 13.26±2.44㎏, 과도군은 17.18±4.38㎏으로 각 군간 유의적인 차이를 보였다. 임신 주수별 체중증가 속도는 적정군의 경우 임신 1기, 2기, 3기 모두 IOM 권고 범위 안에 있어 적절한 증가 속도를 보인 반면, 부족군은 전 임신기간 동안 체중증가 속도가 IOM 권고 범위에 미달되었으며, 과도군의 경우는 전 임신기간 동안 IOM이 권고한 증가속도보다 빠른 경향을 보였다. 체중증가 권고기준에 따른 각 군간 식습관 및 영양소 섭취량을 비교한 결과, 적정군은 임신중기 기름진 맛에 대한 선호도가 다른 두 군에 비해 유의적으로 높게 나타났으며, 과도군은 임신 전과 비교하여 식사량이 늘어나고 외식을 더 자주 하는 것으로 나타났다. 평균 결식율(%)은 부족군이 다른 두 군에 비해 결식을 하지 않는 것으로 나타났고 한 끼 밥의 양은 과도군이 다른 두 군에 비해 많은 경향을 보였으며, 자주 즐겨먹은 간편식의 종류로는 과도군은 '밥과 한가지 반찬', 부족군은 '국수류(우동, 칼국수)', 적정군은 '면류(짜장면, 스파게티)'로 각 군간 다른 차이를 보였다. 과도군은 식습관 점수가 세 군 중 가장 낮았고, '과식'과 '폭식'을 자주 하며 ‘과일 섭취’가 많은 것으로 나타났으며, 부족군은 '튀김이나 전 등 기름진 음식‘을 덜 먹는 것으로 나타났다. 1일 평균 에너지 섭취량은 세 군 모두 권장량에 비해 부족하게 섭취하고 있었고, 탄수화물 : 단백질 : 지방의 섭취비율은 적정군과 과도군에서 지방의 섭취비율이 권장비율보다 높게 나타났다. 영양소 적정비(NAR)는 세 군 모두 엽산의 NAR이 가장 낮았고 인의 NAR이 가장 높았으며 칼슘, 철분의 NAR값은 0.7이하의 낮은 값을 보였다. 평균 적정비(MAR)은 세 군 모두 1 미만으로 평균 영양소 적정도가 낮게 나타났다. 체중증가 권고 기준에 따른 각 군간 임신결과와 신생아 출생체중은 유의적인 차이가 없었다. 임신 중 체중증가와 신체계측치 간의 상관관계 분석 결과, 적정군과 과도군은 임신 중 체중증가와 임신 전 체중 및 BMI간에 유의적인 음의 상관관계를 보였고 초기와 중기의 체중증가속도와는 양의 상관관계를 보인 반면, 부족군은 임신 중 체중증가와 임신 전 체중 및 BMI간에 유의적인 상관관계를 보이지 않았지만 초기 체중 증가속도와는 양의 상관관계를 나타내었다. 임신 중 체중증가와 식이요인 간의 상관관계 분석 결과, 적정군은 체중증가와 '균형식'간에 양의 상관관계가 있었으며 '간편식'과는 음의 상관관계가 있었고, 과도군은 '간편식'과는 양의 상관관계를 보였고 ‘결식'과는 음의 상관관계를 나타내었다. 전체 임신부는 체중증가가 많을수록 '과식'과 '폭식'을 자주 하고, '과일섭취'가 많은 것으로 나타났으며 특히 과도군은 '과식'을 자주하고 '기름진 음식'을 덜 먹는 것으로 나타났고 적정군은 '짠 음식'을 덜 먹는 경향을 보였다. 체중증가와 영양소 섭취량 사이에는 적정군에서 식물성 지방, 섬유소, 아연, 비타민B₁,비타민C의 섭취량과 유의적인 양의 상관관계를 나타냈다. 임신 중 체중증가에 영향을 미치는 식사형태, 식행동, 영양소 섭취량 간의 상관관계를 분석한 결과, 임신 중 체중증가와 식사형태, 영양소섭취량 간에는 유의한 상관성이 없었으나, 식행동 중 식습관 점수와는 유의적인 음의 상관관계를 보였다. 신생아 출생체중에 영향을 미치는 각 요인들 간의 상관관계를 분석한 결과, 임신부의 나이는 신생아 출생체중과 음의 상관관계를 보였고, 임신부의 신장, 임신 전 체중, 임신주수와는 양의 상관관계를 나타내었다. 임신 중 체중증가와 신생아의 출생체중 간에는 유의적인 상관관계가 나타나지 않았다. 본 연구 결과 임신 중 체중증가에 영향을 미치는 요인은 임신 전 BMI와 식사형태, 식습관 등으로 임신 전 BMI가 크고 균형식의 섭취가 적을수록, 과식과 폭식을 자주 할수록 체중증가가 많은 것으로 나타났다. 따라서, 임신부들의 적절한 체중관리를 위해서는 바람직한 식행동을 유도할 수 있는 영양교육 프로그램이 개발되어 산전교육시 적용하는 것이 중요하다고 사료된다.
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