摘要
目的 研究社区老年糖尿病患者的膳食供能现状及基于合理营养自评系统的干预效果,为糖尿病患者的营养干预提供依据。方法 于2013年6-12月,在上海市徐汇区随机抽取4个街道,其中2个街道为干预组,2个街道为对照组;随机抽取在册管理且年龄为60～75岁的糖尿病患者为研究对象,每组157例。干预前后,两组均在调查员的指导下,结合膳食营养评价系统,开展72 h膳食回顾调查。干预组开展6个月的周期性膳食干预,包括强化糖尿病教育和基于合理营养自评系统的个性化膳食指导和管理。对照组进行社区居民常规糖尿病管理。应用Stata 11.0软件进行t检验、χ2检验和logistic回归分析。结果 干预前,干预组能量摄入不足者（64.9%）与过量者（25.5%）并存,能量摄入合理者仅占9.6%;三大营养素供能构成中,脂肪摄入量超标者所占比例（40.2%）多于不足者（17.8%）,蛋白质、碳水化合物摄入量不足者所占比例（分别为36.9%和29.9%）多于超标者（分别为14.0%和24.9%）。干预后,干预组能量摄入正常者所占比例升至21.0%,能量摄入不足者所占比例下降为58.0%;蛋白质、脂肪摄入量正常者所占比例分别上升至61.2%和52.1%,但碳水化合物摄入正常者所占比例上升不明显。与干预前比较,干预后干预组能量摄入、蛋白质、脂肪供能构成差异均有统计学意义（P〈0.05）,碳水化合物供能构成差异无统计学意义（P〉0.05）。与干预前比较,干预后对照组能量摄入和三大营养素供能构成差异均无统计学意义（P〉0.05）。干预后,对照组糖化血红蛋白（Hb A1C）达标率（35.7%）低于干预组（59.9%）,差异有统计学意义（P〈0.01）。logistic回归分析结果显示,脂肪摄入供能占比是影响HBA1C达标的危险因素（OR=1.042,95%CI：1.017～1.068）。结论 老年糖尿病患者膳食结构不合理的情况普遍存在,科学的膳食干预手段能够改善饮食结构,改善糖尿病的控制效果。
Objective To study the dietary energy supply of elderly diabetes patients in communities and the intervention effects based on a reasonable nutritional assessment system, and to provide the basis for nutrition intervention of diabetes patients. Methods From June to December of 2013, four communities（two as intervention group, other two as control group） were selected randomly from Xuhui District of Shanghai. The elderly diabetes patients （60-75 years old ） were selected randomly as the subjects （157 cases for each group）. After intervention, the retrospective investigation for 72 h was performed based on a reasonable nutritional assessment system. Periodic dietary intervention for 6 months was conducted in intervention group, which included the health education of diabetes and personal dietary guide based on a reasonable nutritional assessment system. The convention diabetes management was conducted in control group. The t test, X2 test and logistic regression were used to analyze the data with Stata 11.0 software. Results Before intervention, the proportions of deficient energy intake, excess energy intake and reasonable energy intake in intervention group were 64.9%, 25.5% and 9.6%, respectively; the proportion （40.2%） of excess fat intake was higher than that（ 17.8% ） of deficient fat intake in intervention group; the proportions （36.9% and 29.9% ） of deficient protein and carbohydrate intake were higher than those （ 14.0% and 24.9% ） of excess protein and carbohydrate intake in intervention group. After intervention, the proportion（21.0% ） of reasonable energy intake increased, the proportion（58.0%） of deficient energy intake reduced, the proportions （61.2% and 52.1% ） of reasonable protein and fat intake increased, but the proportion of reasonable carbohydrate intake did not enhance significantly in intervention group. There were significant differences of energy, protein and fat intake（P〈O.05 ）, but no significant difference of carbohydrate intake （P〉0.05） between pre-intervention and post-intervention in intervention group. However, there were no significant differences of protein, fat and carbohydrate intake between preintervention and post-intervention in control group （P〉0.05）. After intervention, the reach standard rate （35.7%） of HbA1c in control group was significantly lower than that（59.9% ） in intervention group （P〈0.01）. Stepwise logistic regression model showed that the risk factor of HbA1c reach standard was the proportion of fat intake （OR =1.042, 95% CI：1.017-1.068）. Conclusion There was the prevalence of unreasonable dietary structure in elderly diabetes patients, the scientific dietary intervention measures can improve the dietary structure and diabetes control.
作者
顾海雁
钱孝琳
朱惠仙
沈慧
张小红
GU Hai-yan QIAN Xiao-lin ZHU Hui-xian SHEN Hui ZHANG Xiao-hong(Xuhui District Center for Disease Prevention and Control, Shanghai 200237, Chin)
出处
《中国慢性病预防与控制》
CAS
2016年第9期655-659,共5页
Chinese Journal of Prevention and Control of Chronic Diseases
基金
上海市徐汇区医学重点学科(慢性非传染性疾病预防控制)配套课题(XHZDXK1112)
上海市徐汇区科委课题(SHXH201019)
关键词
糖尿病
膳食调查
干预措施
Diabetes mellitus
Dietary investigation
Intervention measures
