| BackgroundObesity pandemic has become a public health problem for human being.The prevalence of overweight and obesity appears to increase with age,and the steepest increases are observed in women aged 19-50 years.Among women of reproductive age,pregnancy-related weight changes may contribute to this obesity epidemic.Recently,studies found that systemic inflammation which was generally considered to be a consequence of obesity,may act as a cause of subsequent weight change.Diet-induced inflammation,as determined by dietary inflammatory index(DⅡ)can predict serum level of several inflammatory bio-markers.Association between DII score and a range of health outcomes including obesity have been reported and reviewed.But the associations between dietary inflammatory potential and postpartum weight change and retention(PPWR)were poorly researched.ObjectiveThe purpose of this article is to(1)investigate the status of PPWR among women in Guangzhou China;(2)explore the relationships between dietary inflammatory potential,serum inflammatory bio-marker and postpartum weight outcomes,so as to provide scientific basis for reasonable diet and physique to guide postpartum weight loss.MethodsThis cohort study included 485 pregnant women who meet the inclusion criteria in maternal and child hospital in Yuexiu and Baiyun District in Guangzhou China.468 of them completed the follow-up survey at 42 days postpartum,and 435 completed the follow-up survey at 1 year after delivery.The assessments included the maternal height,weight and dietary intake.The latter variable was based on three consecutive 24-hour food records collected at 2 weeks and 1 year postpartum and used to calculate the energy-adjusted dietary inflammatory index(EDII),for each participant A total of 274 serum samples were collected at 42 days postpartum to detect the levels of serum Interleukin 6(IL6)and Interferon y(IFN-y).A analysis of covariance(ANCOVA),repeated measure ANOVA and general linear regression were performed to examine the relationships between the EDII scores and postpartum weight outcomes.The dose-response association of IL6 and PPWR were examined by restricted cubic spline.Results1.Information of postpartum weight outcomes:The average PPWR at 42 days postpartum was 4.53±5.65 kg.At 1 year postpartum,the mean PPWR was 3.96±8.62 kg and 42.6%of participants had weights>5 kg heavier than their pre-pregnancy weights.The average postpartum weight changes from 3 to 42 days and from 42 days to 1 year postpartum were-4.09±6.25 kg and-0.64±8.84 kg,respectively.Women had less postpartum weight loss after childbirth.2.EDII calculation and evaluation:The mean EDII score during puerperium(n=468)and at 1 year postpartum(n=435)were 1.33±1.84 and 1.48±1.71 respectively.Women with higher EDII score tend to consumed more pro-inflammatory nutrients such as cholesterol and saturated fatty acids,and less anti-inflammatory nutrients such as dietary fiber,vitamin A,B1,C,niacin,monounsaturated fatty acids and food such as beans,vegetables and fruits,livestock meat fish shrimp and crab.3.Anthropometric characteristics of the participants according to the EDII scores:Results of repeated measure ANOVA indicating a varied trend of postpartum BMI.ANCOVA showed that women with high EDII score during puerperium tend to have higher PPWR(P-diff=0.022,P-trend=0.050)at 42 days postpartum and less weight loss from 3 to 42 days postpartum(P-diff=0.002,P-trend=0.009).Higher EDII score at 1 year postpartum was positively correlated with PPWR(P-diff=0.005,P-trend=0.002)at 1 year postpartum and negatively correlated with weight loss from 42 days to 1 year postpartum(P-diff=0.006,P-trend=0.001)and weight loss 3 days to 1 year postpartum(P-diff=0.002,P-trend<0.001).The general linear regression models showed that EDII during puerperium was associated with a 0.40 kg increase in weight change(95%CI:0.11,0.70;P=0.008)from 3 to 42 days postpartum.In addition,a 1-unit increase in the EDII at 1 year postpartum was associated with a 0.52 kg increase in weight change(95%CI:0.02,1.02;P=0.042)from 42 days to 1 year postpartum and a 0.63 kg increase in weight change(95%CI:0.13,1.14;P=0.015)from 3 days to 1 year postpartum and 0.75 kg increase in the PPWR(95%CI:0.29,1.22;P=0.002)at 1 year postpartum.4.The relationship between EDII and serum inflammatory bio-markers:EDII during puerperium puerperium was positively correlated with serum level of IL6 at 42 days postpartum(r--0.173,P<0.01),but not with IFN-y level(r=-0.076,P>0.05).There was no significant correlation between EDII at 1 year postpartum and IL6,IFN-y.5.The relationship between serum inflammatory bio-markers and postpartum weight outcomes:ANCOVA showed that there were no statistic difference in PPWR among tertiles of serum level of IFN-γ.There are statistic difference in PPWR at 42 days(P-diff=0.001,P-trend=0.012)and 1 year postpartum(P-diff=0.039,P-trend=0.048),and PPWR was lowest in second tertiles group.Restrictive cubic spline model showed that the correlation between IL6 and PPWR at 1 year postpartum were significant(F=3.32,P=0.038)and nonlinear(Pnonlinear=0.012).Conclusions1.Most women in Guangzhou have a high PPWR within 1 year after childbirth,42.6%of women were>5 kg heavier than their pre-pregnancy weight The rate of weight loss is faster during puerperium,but it’s lower after puerperium.2.Adherence to a diet with a high EDII score might minimize postpartum weight loss and promote higher PPWR.A 1-unit increase in the EDII during puerperium was associated with a 0.40 kg increase in weight change from 3 to 42 days postpartum.For a 1-unit increase in the EDII at 1 year postpartum was associated with the weight change from 1 days to 1 year,weight change from 3 days to 1 year and PPWR at 1 year postpartum increase 0.52 kg,0.63 kg,0.75 kg respectively.3.EDII during puerperium was positively correlated with serum level of IL6.Postpartum anti-inflammatory diet can reduce the level of systemic inflammation.The second tertiles array of serum level of IL6 was associated with lowest postpartum PPWR,and the correlation of IL6 with PPWR was nonlinear. |
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