Analysis Of Influencing Factors Of Mastitis In Lactating Mothers In Changchun

Objective:The purpose of this study is to investigate the individual influencing factors of lactation mastitis by collecting and analyzing the basic information,diet and medical history of mastitis lactating mothers and healthy lactating mothers in Changchun,in order to provide the basis for the lactating mastitis prevention.Methods:According to the inclusion and exclusion criteria,94 lactating mastitis patients and 105 control lactating mothers were recruited from a 3-A-grade hospital in Changchun,and all of them signed informed consent.The demographic information,medical history,blood and postpartum diet of the subjects were collected.Microsoft Excel 2010 was used to organize data and build databases.Dietary inflammatory index（DII）was calculated based on dietary intake.Energy residual method was performed to adjust nutrients,food groups and DII.Demographic characteristics,dietary intake and disease situation were described and analyzed through BONC DSS Statistic 25.0.The quantitative data were expressed by x±s or Median(P₂₅,P₇₅),and were compared by t-test,variance analysis or rank sum test.The qualitative data were expressed by frequency and percentage,and were compared by chi-square test.Correlation analysis was conducted by Pearson or Spearman,and Cramer’s V coefficient or Gamma coefficient.Binary Logistic regression model was constructed and evaluated by the receiver operating characteristic curve（ROC）.All statistical tests were bilateral,where P-values were considered statistically significant at P<0.05.Results:1.A total of 199 cases were recruited in this study,including 94 of lactating mothers with mastitis and 105 healthy ones.There was no difference in age between the two groups（mastitis group 30.83±3.61 years vs.control group 30.57±3.23years）.There was no difference in gestational age（mastitis group 38.84±1.49weeks vs.control group 38.68±2.21 weeks）.There was no difference in the rate of vaginal delivery（mastitis group 47.9%vs.control group 35.2%）.In the mastitis group,80.9%of subjects breast-fed was within 6 months,compared with 84.4%in the control group,and there was no difference between the two groups.There was no difference in weight gain during pregnancy（mastitis group 14.89±6.23kg vs.control group 15.74±6.07kg）.There were differences in occupation（P=0.013）,education（P=0.004）and birth times（P=0.001）.There were no difference in infant sex,birth length and birth weight between the two groups.2.There was no statistical difference in prepregnancy smoking rate between the two groups（mastitis group 4.3%vs.control group 1.0%）.The alcohol consumption rates before pregnancy were 9.6%and 1.0%in the two groups,respectively.The mastitis group was significantly higher than the control group（P=0.014）.3.There were statistical differences in the energy（P<0.001）,protein（P=0.003）and carbohydrate（P<0.001）intake,and the mastitis group was lower than control group.There was no difference in lipid intake between the two groups.The intakes of Vitamin A（P<0.001）,Vitamin B₁（P<0.001）,Vitamin B₂（P=0.040）and Vitamin C（P=0.001）in mastitis group were significantly lower than that in control group.The intakes of minerals Calcium（P<0.001）,Potassium（P=0.002）,Selenium（P<0.001）and Manganese（P=0.008）were significantly lower than that of the control group.The intakes of saturated fatty acids（SFA）and monounsaturated fatty acids（MUFA）in mastitis group were lower than that in control group（P<0.001）.There was no statistical difference in polyunsaturated fatty acids（PUFA）intake between the two groups.The intakes of protein and carbohydrate in mastitis group were still lower after energy adjustment,and the differences were significant（P<0.001）.Vitamin A（P<0.001）,Vitamin B₁（P<0.001）,Vitamin B₂（P=0.001）and Vitamin C（P<0.001）in mastitis group were also lower than those in control group after energy adjustment.The intakes of Calcium（P<0.001）,Potassium（P<0.001）,Selenium（P<0.001）and Manganese（P=0.001）in minerals were lower than those in the control group,and the differences were significant after energy adjustment.Iron intake also showed a difference,with mastitis group significantly lower than control group（P=0.005）.There were still lower than control group in SFA and MUFA intake in mastitis group（P<0.001）.There was still no statistical difference in PUFA intake.The intake of cereals in mastitis group was higher than that in control group（P<0.001）,and both of them exceeded the recommended intake.The intakes of tubers（P<0.001）,vegetables（P=0.001）,milk（P=0.030）,soybean（P=0.009）and nuts（P<0.001）were significantly lower than that of the control group,and not meeting the recommended intake.The intake of seafood in animal food in mastitis group was significantly lower than that in control group（P=0.012）.There was no significant difference in the intake of fruits and other of animal foods between the two groups.The intake of oil in mastitis group was higher than that in control group（P<0.001）.After energy adjustment,there was no statistical difference in the intake of eggs and animal meat in animal food,but significant differences in the intake of other food groups（P<0.05）.The intake of cereals was higher than that in control group（P<0.001）.Tubers（P<0.001）,vegetables（P<0.001）,fruits（P=0.014）,milk（P=0.023）,soybean（P<0.001）and nuts（P<0.001）intakes were lower than the control group,and not meeting the recommended intake.The intake of seafood in animal food in mastitis group was significantly lower than that in control group（P=0.002）.The intakes of poultry meat（P=0.036）and oil（P<0.001）were significantly higher than control group.4.DII was calculated using 21 of the 45 food components in the score.The DII was-0.77±0.11 in the mastitis group and-0.91±0.11 in the control group,but there was no statistical difference between the two groups.The mean DII after energy adjustment in mastitis group was-0.53±0.10,and that in control group was-0.97±0.10.The DII in mastitis group was significantly higher than that in control group（P=0.003）.5.84 patients had white blood cell（WBC）index,and more than half of them had abnormal WBC level,with a mean value of 10.45×10⁹/L.83 patients had hypersensitive c-reactive protein（hs-CRP）markers,and most of them exceeded the normal range,with a median level of 24.69mg/L.Most patients had fever of more than 37.3℃.64.9%of patients had red and swollen in breasts and half of them had breast lumps.The main types of inflammation were acute inflammation and milk deposition,accounting for 42.6%and 36.2%,respectively.Some patients developed breast abscess,accounting for 17.0%.A few patients had chronic inflammation.More than half of the inflammation happened in the right breast,accounting for54.3%,and there were small number of the inflammation occurring in both breasts,accounting for 11.7%.6.There was no linear correlation between DII and WBC.DII was positively correlated with hs-CRP and fever level,and the correlation coefficients were 0.234（P=0.033）and 0.248（P=0.016）,respectively.7.There was a correlation between postpartum massage history and disease severity in mastitis patients,and the correlation coefficient was 0.300（P=0.014）.Postpartum trauma history,ediburgh postnatal and depression scale（EPDS）score,and feeding mode did not correlate with disease severity.8.A Logistic regression model was established with occupation,education,first pregnancy,first birth,pre-pregnancy smoking,pre-pregnancy drinking and DII after energy adjustment as independent variables,and the occurrence of lactation mastitis or not as dependent variables.High school degree or below（P=0.031）,first birth（P=0.004）,drinking before pregnancy（P=0.026）and higher DII after energy adjustment were independent risk factors for lactation mastitis.The remaining factors were determined to be meaningless after Logistic regression analysis.9.ROC curve was used to evaluate the prediction effect of the model.The area under ROC curve was 0.768,and the standard error was 0.033（P<0.001）,95%confidence interval（CI）was 0.703～0.833,sensitivity was 67.02%,specificity was75.24%.Conclusion:1.The diet of lactation mastitis group was characterized by high carbohydrate,and insufficient intakes of multiple vitamins and minerals.The dietary structure was unbalanced.2.Mastitis lactating patients have higher dietary inflammation levels.3.High school degree or below,first birth,pre-pregnancy drinking history and high DII postpartum diet are associated with the occurrence of mastitis during lactation.