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研究生:張珮蓉
研究生(外文):CHANG, PEI-JUNG
論文名稱:地中海飲食分數和全面飲食品質修正版分數對臺灣女性周產期憂鬱症狀的影響
論文名稱(外文):Effects of Mediterranean Diet Score and Overall Dietary Index-Revised on perinatal symptomatic depression in Taiwanese women
指導教授:李美璇李美璇引用關係
指導教授(外文):LEE, MEEI-SHYUAN
口試委員:李美璇林富宮鐘羅元婷李孟璋黃怡真
口試委員(外文):LEE, MEEI-SHYUANLIN, FU-GONGC.LO,YUAN-TINGLEE, MENG-CHANGHUANG, YI-CHEN
口試日期:2022-05-06
學位類別:碩士
校院名稱:國防醫學院
系所名稱:公共衛生學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2022
畢業學年度:110
語文別:中文
論文頁數:199
中文關鍵詞:地中海飲食全面飲食品質修正版周產期憂鬱症愛丁堡產後憂鬱量表
外文關鍵詞:Mediterranean dietOverall Dietary Index-Revised, ODI-RPerinatal depressionEdinburgh Postnatal Depression Scale, EPDS
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背景與重要性:
女性憂鬱症的終身盛行率約為10-25%,在懷孕及生產後達到高峰。多數研究僅探討產後憂鬱症狀,忽略了產前憂鬱的可能性。飲食是影響憂鬱的危險因子之一,有研究針對單一營養素或食物進行探討,但飲食屬於複合體,也可以評估整體飲食的影響。地中海飲食被認為可降低憂鬱風險,在臺灣以整體飲食品質評估周產期婦女之憂鬱症狀的文獻尚少。

研究目的:
探討第三孕期及產後早期之地中海飲食分數及全面飲食品質與產前及產後憂鬱症狀之相關。

研究方法:
本論文為一橫斷及追蹤型研究,召募對象為2020年6月至2022年2月於三軍總醫院產科門診進行產檢之健康懷孕婦女300名,後續追蹤至產後早期完成訪視者為258名。在第三孕期及產後6週內(早期)回診時,分別完成基本人口學資料、半定量飲食頻率問卷(semi-quantitative food frequency questionnaire, FFQ)評估受訪前一個月期間飲食及愛丁堡產後憂鬱量表(Edinburgh Postnatal Depression Scale, EPDS)。以FFQ資料換算成地中海飲食分數(Mediterranean diet score, MDS)及全面飲食品質修訂版之分數(Overall Dietary Index Revised, ODI-R)。EPDS≧10分為有憂鬱症狀,再以羅吉斯迴歸分別探討兩種飲食品質分數與憂鬱症狀的關係。

結果:
第三孕期及產後早期憂鬱症狀之盛行率分別為31.3%及35.7%。約有六成之產後憂鬱症狀者在產前即有憂鬱症狀,產前有憂鬱症狀者至產後有憂鬱症狀之風險是產前無憂鬱症狀者之5.37倍(p<0.001)。第三孕期及產後早期之MDS皆與憂鬱症狀無關。第三孕期ODI-R分數與體能活動對第三孕期憂鬱症狀具交互作用(p=0.026)。控制危險因子後,有運動習慣之婦女隨著ODI-R分數增加,憂鬱風險顯著下降,且呈線性趨勢(p for trend=0.009),Q4組之憂鬱風險為Q1組的0.19倍(95% CI: 0.05-0.80)。第三孕期之ODI-R也可預測產後早期之憂鬱症狀風險,隨著分數增加,產後憂鬱症狀風險呈顯著下降趨勢,雖經調整後不顯著。而第三孕期憂鬱症狀與飲食品質分數對產後早期憂鬱症狀具交互作用(p<0.001),經分層後,第三孕期無論有無憂鬱症狀,產後憂鬱風險皆會隨著ODI-R分數增加而下降,且第三孕期有憂鬱症狀者之產後憂鬱風險下降更多,雖不顯著。產後早期,婦女的ODI-R分數與產後憂鬱症狀無顯著相關。

結論:
就臺灣周產期憂鬱症狀而言,以國民飲食指南與指標訂定的ODI-R有較佳的預測力,而非MDS。第三孕期良好的飲食品質與體能活動可使第三孕期憂鬱症狀風險降低,且效果可延續至產後早期。產後早期之飲食品質與產後憂鬱症狀無關。

關鍵字:地中海飲食、全面飲食品質修正版、周產期憂鬱症、愛丁堡產後憂鬱量表

Background: The lifetime prevalence of depression in women is approximately 10-25%, peaking after pregnancy and childbirth. Most studies focus on postpartum depression and ignore prenatal depression. Diet is a risk factors for depression. Some studied a single nutrient or food on depression. But diets is complex and the impact of the overall diet can also be assessed. The Mediterranean diet is thought to reduce the risk of depression, and few studies in Taiwan have evaluated the effect of overall diet quality on depression symptoms in perinatal women.

Purpose: To investigate the association of Mediterranean Diet Score (MDS) and Overall Dietary Index-Revised (ODI-R) with prenatal and postpartum symptomatic depression in the third trimester and early postpartum.

Method: This thesis was a cross-sectional and follow-up study. Participants were 300 healthy pregnant women who underwent obstetric examinations at the Obstetrics and Gynecology Clinic of the Tri-Service General Hospital from June 2020 to February 2022, of whom 258 were followed up to the early postpartum (6-week). Demographics and basic characteristics questionnaire, a semi-quantitative food frequency questionnaire (FFQ) to assess diet in the preceding month and the Edinburgh Postpartum Depression Scale (EPDS) were completed at the third trimester and postpartum follow-up, respectively. The FFQ data were converted into MDS and ODI-R scores. Symptomatic depression was defined as EPDS  10 and logistic regression was used to explore the relationship between the two dietary quality scores and symptomatic depression.

Results: The prevalence of symptomatic depression in the third trimester and early postpartum was 31.3% and 35.7%, respectively. About 60% participants with postpartum symptomatic depressive had prenatal symptomatic depression. Participants with prenatal depression had 5.37 folds the risk of postpartum depression compared to those without prenatal depression (p<0.001). MDS was not associated with perinatal symptomatic depression. In the third trimester, ODI-R scores and physical activity interacted with symptomatic depression (p=0.026). After adjusting for other risk factors, the risk of symptomatic depressive in women with exercise habits decreased significantly with increasing ODI-R quartiles, with a linear trend (p for trend = 0.009). Compared to Q1, the OR (95% CI) for Q4 was 0.19 (0.05-0.80). ODI-R in the third trimester also predicted the risk of early postpartum symptomatic depression. The risk of postpartum symptomatic depression decreased significantly with increasing ODI-R quartiles although not significantly after adjustment. Symptomatic depression in the third trimester and diet quality scores had an interaction on early postpartum symptomatic depression (p<0.001). After stratification, regardless of with or without depression in the third trimester, the risk of symptomatic depression decreased with the increase of the ODI-R quartiles. The effect of diet was greater among those with symptomatic depression in the third trimester than among those without symptoms, but not significantly. Postpartum ODI-R was not associated with postpartum symptomatic depression.

Conclusions: ODI-R based on national dietary guidelines and recommendations had better predictive power than MDS in perinatal symptomatic depression in Taiwan. Better diet and physical activity in the third trimester may reduce the risk of developing symptomatic depression, and this effect may persist into the early postpartum period. Postpartum dietary quality was not associated with postpartum symptomatic depression.

Keywords: Mediterranean diet, Overall Dietary Index-Revised(ODI-R), Perinatal depression, Edinburgh Postnatal Depression Scale(EPDS)

目錄
中文摘要 vi
英文摘要(Abstract) ix
第一章 緒論 1
第一節 研究背景與重要性 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 周產期憂鬱 4
壹、 現況 4
貳、 全球周產期憂鬱之盛行率及危險因子 5
參、 周產期憂鬱之評估 18
第二節 地中海飲食 20
壹、 地中海飲食之發展 20
貳、 地中海飲食及相關營養素對健康之影響 21
第三節 全面飲食品質 25
第四節 地中海飲食及飲食品質與憂鬱之相關 28
壹、 一般族群 28
貳、 周產期婦女 31
第三章 研究問題與假設 35
第一節 研究問題 35
第二節 研究假設 36
第四章 研究材料與方法 37
第一節 研究架構與設計 37
第二節 研究對象 38
第三節 研究流程 39
第四節 研究工具 41
第五節 資料處理與統計方法 47
第五章 結果 51
第一節 第三孕期樣本基本特性分佈 51
第二節 第三孕期樣本的飲食情況 55
第三節 影響第三孕期婦女憂鬱症狀風險之變項 59
第四節 產後早期樣本基本特性分佈 61
第五節 產後早期樣本的飲食情況 66
第六節 影響產後早期婦女憂鬱症狀風險之變項 69
第七節 第三孕期婦女飲食品質與第三孕期婦女憂鬱症狀風險之相關 71
第八節 第三孕期婦女飲食品質與產後早期憂鬱症狀風險之相關 74
第九節 產後早期婦女飲食品質與產後早期憂鬱症狀風險之相關 80
第十節 第三孕期婦女憂鬱症狀與產後早期婦女憂鬱症狀之相關 83
第六章 討論 84
第一節 第三孕期及產後早期婦女之基本特性與飲食品質 84
第二節 影響第三孕期及產後早期婦女憂鬱症狀之變項 88
第三節 第三孕期及產後早期婦女飲食品質與憂鬱症狀 90
第四節 臺灣孕產婦預測憂鬱症狀適用之飲食品質評估方式 96
第五節 體能活動的角色 100
第六節 研究優點與限制 102
第七章 結論及未來研究建議 105
參考文獻 107
附錄 173
人體試驗/研究計畫同意函 173
婦女基本資料問卷 174
產婦基本資料問卷 175
飲食頻率問卷 177
愛丁堡產後憂鬱症評估量表 183


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