目的:分析非肥胖型妊娠期糖尿病(GDM)孕妇膳食脂肪摄入情况,了解其对血脂和糖尿病发病的影响。方法:以2010年1月~2013年1月在该院产科门诊确诊的GDM患者133例为病例组;以年龄、孕周作为频数匹配因素,选取同一时期产检的正常孕妇110例作为对照组,采用24 h回顾性膳食调查(3天),分析两组孕妇膳食结构,比较两组的孕期增重和血脂水平。结果:病例组在孕24~28周较孕前平均增重(9.38±4.02)kg,高于对照组〔(6.48±3.84)kg〕,两组比较,差异有统计学意义(t=-4.26,P<0.001);病例组平均每日总能量、蛋白质、脂肪和碳水化合物的摄入量明显升高;病例组孕妇平均每日饱和脂肪酸摄入量为(15.73±7.75)g,明显高于对照组〔(12.53±4.44)g〕,两组比较,差异有统计学意义(t=-4.02,P<0.001);病例组单不饱和脂肪酸供能比为(12.65±3.23)%、多不饱和脂肪酸供能比为(10.47±2.90)%,均低于对照组〔(13.47±3.23)%,(11.95±3.21)%〕,两组比较,差异有统计学意义(t=1.98,3.77,P均<0.05);病例组血清胆固醇〔(6.89±1.42)mmol/L〕、甘油三酯〔(3.21±1.14)mmol/L〕、低密度脂蛋白胆固醇〔(3.08±0.83)mmol/L〕、游离脂肪酸〔(1.02±0.46)mmol/L〕均高于对照组孕妇〔(6.00±0.92)mmol/L、(2.30±0.68)mmol/L、(2.67±0.61)mmol/L、(0.88±0.35)mmol/L〕,两组比较,差异有统计学意义(P<0.001);病例组平均每天饱和脂肪酸摄入量对血清游离脂肪酸、胆固醇、低密度脂蛋白胆固醇水平影响最大,呈正相关;随着饱和脂肪酸摄入量增加,患GDM的可能性增加(β=1.14,OR=3.14,95%CI=1.80~5.47,P<0.001),而随着单不饱和脂肪酸供能比和多不饱和脂肪酸供能比的增加,患GDM的可能性减小(β=-0.67,OR=0.51,95%CI=0.29~0.85,P=0.016;β=-0.55,OR=0.58,95%CI=0.35~0.95,P=0.031)。结论:非肥胖型GDM孕妇孕期膳食中脂肪摄入的不合理性表现为脂肪的摄入量、脂肪供能比、饱和脂肪酸摄入量增多,单不饱和脂肪酸供能比和多不饱和脂肪酸供能比减少,直接导致了孕期体重增加过多和血脂水平升高,从而导致了GDM的发生。饱和脂肪酸摄入量是GDM的危险因素,而单不饱和脂肪酸供能比和多不饱和脂肪酸供能比则是GDM的保护因素。 Objective: To analyze the dietary fat intake of pregnant women with non-obese gestational diabetes mellitus (GDM) and to understand their effects on the incidence of blood lipids and diabetes. Methods: From January 2010 to January 2013, 133 GDM patients diagnosed in obstetrics and gynecology department of our hospital were selected as case group. One hundred and fourteen pregnant women of the same period were selected as the frequency matching factors by age and gestational age. The 24 h retrospective dietary survey (3 days) was used to analyze the dietary structure of pregnant women in the two groups. The pregnancy weight gain and blood lipid levels were compared between the two groups. Results: The mean weight gain of the cases before pregnancy was (9.38 ± 4.02) kg in the 24th to 28th weeks of gestation, which was higher than that of the control group [(6.48 ± 3.84) kg〕, the difference was statistically significant (t = -4.26, P <0.001). The average total daily energy, protein, fat and carbohydrate intake of patients in the case group were significantly increased. The mean daily saturated fatty acid intake of pregnant women was (15.73 ± 7.75) g, significantly higher than that of the control (12.53 ± 4.44) g, the differences between the two groups were statistically significant (t = -4.02, P <0.001). The ratio of monounsaturated fatty acids in the patients was (12.65 ± 3.23)%, (10.47 ± 2.90)%, which were lower than those in the control group (13.47 ± 3.23% vs 11.95 ± 3.21%, respectively). The differences between the two groups were statistically significant (t = 1.98, 3.77, P (3.21 ± 1.14) mmol / L], LDL cholesterol [(3.08 ± 0.83) mmol / L〕, and serum cholesterol (1.02 ± 0.46) mmol / L〕 were significantly higher than those in the control group [(6.00 ± 0.92) mmol / L, (2.30 ± 0.68) mmol / L, ) mmol / L〕, the difference between the two groups was statistically significant (P <0.001); the average of each case group There was a positive correlation between the intake of saturated fatty acids and serum free fatty acids, cholesterol and LDL cholesterol. With the increase of saturated fatty acid intake, the risk of GDM increased (β = 1.14, OR = 3.14, 95% CI = 1.80-5.47, P <0.001). However, with the increase of monounsaturated fatty acid supply ratio and polyunsaturated fatty acid supply ratio, the risk of GDM was decreased (β = -0.67, OR = 0.51, 95 % CI = 0.29-0.85, P = 0.016; β = -0.55, OR = 0.58, 95% CI = 0.35-0.95, P = 0.031). CONCLUSION: The unreasonable fat intake of non-obese GDM pregnant women during pregnancy is the intake of fat, the ratio of fat to energy, the increase of saturated fatty acid intake, the ratio of monounsaturated fatty acid supply and the supply of polyunsaturated fatty acids Than the decrease, a direct result of weight gain during pregnancy and elevated blood lipids, resulting in the occurrence of GDM. Saturated fatty acid intake is a risk factor for GDM, and monounsaturated fatty acid supply ratio and polyunsaturated fatty acid supply ratio is the protective factor of GDM.