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Article(id=1322168572412014612, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322168387082502716, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.06.009, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1742227200000, receivedDateStr=2025-03-18, revisedDate=1766851200000, revisedDateStr=2025-12-28, acceptedDate=null, acceptedDateStr=null, onlineDate=1793159152367, onlineDateStr=2026-10-28, pubDate=1774368000000, pubDateStr=2026-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793159152367, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793159152367, creator=13701087609, updateTime=1793159152367, updator=13701087609, issue=Issue{id=1322168387082502716, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='6', pageStart='881', pageEnd='1056', issueExtLink='null', onlineDate='null', pubDate='1774368000000', pubDateStr='2026-03-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793159108180, creator='13701087609', updateTime=1793159108180, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=950, endPage=956, ext={EN=ArticleExt(id=1322168572625924117, articleId=1322168572412014612, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Latent profile of nutritional literacy and dietary health belief differences in maintenance hemodialysis patients, columnId=1220689484526572183, journalTitle=Chinese Nursing Research, columnName=Original Articles, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the latent categories of nutritional literacy and the differences in dietary health beliefs across different categories in maintenance hemodialysis(MHD) patients.

Methods

A total of 238 MHD patients from the hemodialysis center of Taihe Hospital in Shiyan city were selected as the study subjects from October to December 2024 by convenience sampling.Data were collected using a general demographic information questionnaire,the Nutritional Literacy Assessment Questionnaire for MHD Patients,and the Dietary Health Belief Questionnaire for Hemodialysis Patients.Latent profile analysis(LPA) was used to classify patients' nutritional literacy into different categories,and differences in dietary health beliefs across categories were compared.

Results

The nutritional literacy of MHD patients could be classified into three latent categories,namely passive acceptance type(34.5%),guidance-dependent type(52.1%),and self-management type(13.4%).There were statistically significant differences in the total scores of dietary health beliefs among MHD patients with different nutritional literacy categories(P<0.05).Logistic regression analysis showed that age,gender,and place of residence were influencing factors of the latent categories of nutritional literacy in MHD patients(P<0.05).

Conclusions

There is heterogeneity in the nutritional literacy of MHD patients.The levels of dietary health beliefs vary across different nutritional literacy categories.Healthcare professionals should develop personalized intervention strategies based on patients' nutritional literacy categories to improve their nutritional literacy and dietary health beliefs.

, authors=Zefeng BAO, Lingli LI, Chunhui ZHANG, Li XIA, Lyuman XIAO, Bing LIU, authorsList=Zefeng BAO, Lingli LI, Chunhui ZHANG, Li XIA, Lyuman XIAO, Bing LIU, authorCompany=null, correspAuthors=Bing LIU, authorNote=null, correspAuthorsNote=
LIU Bing, E-mail: sy-
, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322168573326372888, articleId=1322168572412014612, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=维持性血液透析病人营养素养潜在剖面及饮食健康信念差异, columnId=1220689484681761433, journalTitle=护理研究, columnName=科研论著, runingTitle=null, highlight=null, articleAbstract=
目的

探索维持性血液透析（MHD）病人营养素养潜在类别及不同类别的饮食健康信念差异。

方法

采用便利抽样法，选取2024年10月—12月十堰市太和医院血液净化中心的238例MHD病人为研究对象，采用一般人口学资料调查表、MHD病人营养素养测评问卷、血液透析病人饮食健康信念问卷进行调查。通过潜在剖面分析（LPA）将病人营养素养分为不同类别，比较各类别饮食健康信念差异。

结果

MHD病人营养素养可分为3个潜在类别，即被动接受型（34.5%）、指导依赖型（52.1%）和自主管理型（13.4%）。不同营养素养类别的MHD病人饮食健康信念总分比较，差异有统计学意义（P<0.05）。Logistic回归分析结果显示，年龄、性别、居住地是MHD病人营养素养潜在类别的影响因素（P<0.05）。

结论

MHD病人营养素养存在异质性，不同营养素养类别病人的饮食健康信念水平不同。医务人员应根据病人营养素养类别制定个性化干预策略，提升其营养素养和饮食健康信念。

, authors=鲍泽锋, 李伶俐, 张春晖, 夏丽, 肖侣嫚, 刘冰*, *, authorsList=鲍泽锋, 李伶俐, 张春晖, 夏丽, 肖侣嫚, 刘冰, authorCompany=null, correspAuthors=刘冰, authorNote=

鲍泽锋，护士，硕士研究生在读

, correspAuthorsNote=
刘冰，E-mail:sy-
LIU Bing, E-mail: sy-
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language=null, rfNumber=26, rfOrder=25, authorNames=曾茂, 李婷婷, 鲜金利, journalName=现代预防医学, refType=null, unstructuredReference=曾茂,李婷婷,鲜金利,等.国内外营养素养研究进展[J].现代预防医学,2020,47(18):3309-3312., articleTitle=国内外营养素养研究进展, refAbstract=null), Reference(id=1322530627874832960, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168572412014612, doi=null, pmid=null, pmcid=null, year=2022, volume=16, issue=null, pageStart=439, pageEnd=447, url=null, language=null, rfNumber=27, rfOrder=26, authorNames=DUAN D F, LIU M, CHEN Y, journalName=Patient Preference and Adherence, refType=null, unstructuredReference=DUAN D F,LIU M,CHEN Y,et al.Food literacy and its associated factors in non-dialysis patients with chronic kidney disease in China:a cross-sectional study[J].Patient Preference and Adherence,2022,16:439-447., articleTitle=Food literacy and its associated factors in non-dialysis patients with chronic kidney disease in China:a cross-sectional study, refAbstract=null), 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AuthorCompanyExt(id=1322530616889950705, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168572412014612, companyId=1322530616864784879, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1湖北医药学院，湖北 442000)])], figs=[ArticleFig(id=1322530621965058586, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168572412014612, language=EN, label=Figure 1, caption=Characteristic distribution of the three latent categories of nutritional literacy in MHD patients, figureFileSmall=iaiL8AdMc46XnQVPv+wpCQ==, figureFileBig=5d4zYwmqpbGyAR7WbnO90w==, tableContent=null), ArticleFig(id=1322530622036361755, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168572412014612, language=CN, label=图1, caption=MHD病人营养素养3个潜在类别的特征分布, figureFileSmall=iaiL8AdMc46XnQVPv+wpCQ==, figureFileBig=5d4zYwmqpbGyAR7WbnO90w==, tableContent=null), ArticleFig(id=1322530622132830748, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168572412014612, language=EN, label=Table 1, caption=

Model fit indices for profile of nutritional literacy in MHD patients

, figureFileSmall=null, figureFileBig=null, tableContent=
模型AICBICaBICEntropyP类别概率
LMRTBLRT
11 780.1681 814.8911 783.1941.000
21 519.7561 575.3121 524.5970.793<0.001<0.0010.437/0.563
31 432.0281 508.4181 438.6850.830<0.001<0.0010.345/0.521/0.134
41 424.9271 522.1511 433.4000.8300.1250.0200.042/0.311/0.508/0.139
), ArticleFig(id=1322530622229299741, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168572412014612, language=CN, label=表1, caption=

MHD病人营养素养潜在剖面拟合指标

, figureFileSmall=null, figureFileBig=null, tableContent=
模型AICBICaBICEntropyP类别概率
LMRTBLRT
11 780.1681 814.8911 783.1941.000
21 519.7561 575.3121 524.5970.793<0.001<0.0010.437/0.563
31 432.0281 508.4181 438.6850.830<0.001<0.0010.345/0.521/0.134
41 424.9271 522.1511 433.4000.8300.1250.0200.042/0.311/0.508/0.139
), ArticleFig(id=1322530622296408606, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168572412014612, language=EN, label=Table 2, caption=

Comparison of dietary health belief scores among different latent categories of nutritional literacy in MHD patients（x±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
类别例数感知易感性感知严重性感知益处感知障碍自我效能总分
被动接受型829.94±3.2613.52±3.509.72±3.0916.22±3.809.27±3.3558.67±8.61
指导依赖型12411.36±3.23①13.45±3.4210.73±3.33①15.23±3.5310.51±2.81①61.29±7.33①
自主管理型3213.47±4.07①②12.78±3.4212.47±3.63①②15.78±3.2112.31±3.65①②66.81±9.33①②
F值13.170.588.191.8911.3911.77
P<0.0010.560<0.0010.153<0.001<0.001
), ArticleFig(id=1322530622459986463, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168572412014612, language=CN, label=表2, caption=

不同营养素养潜在类别MHD病人的饮食健康信念得分比较（x±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
类别例数感知易感性感知严重性感知益处感知障碍自我效能总分
被动接受型829.94±3.2613.52±3.509.72±3.0916.22±3.809.27±3.3558.67±8.61
指导依赖型12411.36±3.23①13.45±3.4210.73±3.33①15.23±3.5310.51±2.81①61.29±7.33①
自主管理型3213.47±4.07①②12.78±3.4212.47±3.63①②15.78±3.2112.31±3.65①②66.81±9.33①②
F值13.170.588.191.8911.3911.77
P<0.0010.560<0.0010.153<0.001<0.001
), ArticleFig(id=1322530622564844064, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168572412014612, language=EN, label=Table 3, caption=

Univariate analysis of influencing factors of latent categories of nutritional literacy in MHD patients

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类被动接受型（n=82）指导依赖型（n=124）自主管理型（n=32）统计值P
性别[例（%）]男57（69.5）66（53.2）10（31.3）χ2=14.4090.001
女25（30.5）58（46.8）22（68.8）
婚姻状况[例（%）]未婚2（2.4）15（12.1）2（6.3）0.080①
已婚67（81.7）94（75.8）27（84.4）
离异4（4.9）5（4.0）3（9.4）
丧偶9（11.0）10（8.1）0（0.0）
家庭人均月收入[例（%）]<2 000元23（28.0）39（31.5）6（18.8）
2 000~6 000元53（64.6）78（62.9）23（71.9）χ2=2.3570.670
>6 000元6（7.3）7（5.6）3（9.4）
文化程度[例（%）]小学及以下33（40.2）23（18.5）5（15.6）0.012①
初中37（45.1）65（52.4）16（50.0）
高中/中专5（6.1）14（11.3）3（9.4）
专科4（4.9）18（14.5）6（18.8）
本科及以上3（3.7）4（3.2）2（6.3）
医保类型[例（%）]城市医疗保险31（37.8）58（46.8）16（50.0）
新型农村合作医疗51（62.2）64（51.6）15（46.9）0.259①
其他0（0.0）2（1.6）1（3.1）
居住情况[例（%）]独居6（7.3）14（11.3）4（12.5）
与家人同居75（91.5）109（87.9）28（87.5）0.781①
其他1（1.2）1（0.8）0（0.0）
居住地[例（%）]城市69（84.1）119（96.0）28（87.5）χ2=8.6890.013
农村13（15.9）5（4.0）4（12.5）
是否在职[例（%）]否76（92.7）100（80.6）25（78.1）χ2=6.5760.037
是6（7.3）24（19.4）7（21.9）
透析龄[例（%）]<24个月2（2.4）15（12.1）6（18.8）
24~<37个月14（17.1）30（24.2）11（34.4）χ2=15.380.004
≥37个月66（80.5）79（63.7）15（46.9）
透析频率[例（%）]每周2次1（1.2）3（2.4）1（3.1）0.602①
每周3次3（3.7）7（5.6）3（9.4）
2周3次1（1.2）0（0.0）0（0.0）
2周5次77（93.9）114（91.9）28（87.5）
并发症[例（%）]无19（23.2）49（39.5）19（59.4）χ2=13.9880.001
有63（76.8）75（60.5）13（40.6）
年龄（x±s,岁）59.62±9.3454.16±11.1753.09±9.60F=8.200<0.001
), ArticleFig(id=1322530622850056737, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168572412014612, language=CN, label=表3, caption=

MHD病人营养素养潜在类别影响因素的单因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类被动接受型（n=82）指导依赖型（n=124）自主管理型（n=32）统计值P
性别[例（%）]男57（69.5）66（53.2）10（31.3）χ2=14.4090.001
女25（30.5）58（46.8）22（68.8）
婚姻状况[例（%）]未婚2（2.4）15（12.1）2（6.3）0.080①
已婚67（81.7）94（75.8）27（84.4）
离异4（4.9）5（4.0）3（9.4）
丧偶9（11.0）10（8.1）0（0.0）
家庭人均月收入[例（%）]<2 000元23（28.0）39（31.5）6（18.8）
2 000~6 000元53（64.6）78（62.9）23（71.9）χ2=2.3570.670
>6 000元6（7.3）7（5.6）3（9.4）
文化程度[例（%）]小学及以下33（40.2）23（18.5）5（15.6）0.012①
初中37（45.1）65（52.4）16（50.0）
高中/中专5（6.1）14（11.3）3（9.4）
专科4（4.9）18（14.5）6（18.8）
本科及以上3（3.7）4（3.2）2（6.3）
医保类型[例（%）]城市医疗保险31（37.8）58（46.8）16（50.0）
新型农村合作医疗51（62.2）64（51.6）15（46.9）0.259①
其他0（0.0）2（1.6）1（3.1）
居住情况[例（%）]独居6（7.3）14（11.3）4（12.5）
与家人同居75（91.5）109（87.9）28（87.5）0.781①
其他1（1.2）1（0.8）0（0.0）
居住地[例（%）]城市69（84.1）119（96.0）28（87.5）χ2=8.6890.013
农村13（15.9）5（4.0）4（12.5）
是否在职[例（%）]否76（92.7）100（80.6）25（78.1）χ2=6.5760.037
是6（7.3）24（19.4）7（21.9）
透析龄[例（%）]<24个月2（2.4）15（12.1）6（18.8）
24~<37个月14（17.1）30（24.2）11（34.4）χ2=15.380.004
≥37个月66（80.5）79（63.7）15（46.9）
透析频率[例（%）]每周2次1（1.2）3（2.4）1（3.1）0.602①
每周3次3（3.7）7（5.6）3（9.4）
2周3次1（1.2）0（0.0）0（0.0）
2周5次77（93.9）114（91.9）28（87.5）
并发症[例（%）]无19（23.2）49（39.5）19（59.4）χ2=13.9880.001
有63（76.8）75（60.5）13（40.6）
年龄（x±s,岁）59.62±9.3454.16±11.1753.09±9.60F=8.200<0.001
), ArticleFig(id=1322530622938137122, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168572412014612, language=EN, label=Table 4, caption=

Assignment of independent variables

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值方式
性别女=0，男=1
文化程度本科及以上=（0，0，0，0），小学及以下=（1，0，0，0）,初中=（0，1，0，0）,高中/中专=（0，0，1，0）,专科=（0，0，0，1）
居住地农村=0，城市=1
是否在职是=0，否=1
透析龄≥37个月=（0，0），<24个月=（1，0）,24~<37个月=（0，1）
并发症有=0，无=1
年龄原值代入
), ArticleFig(id=1322530623009440291, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168572412014612, language=CN, label=表4, caption=

自变量赋值方式

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值方式
性别女=0，男=1
文化程度本科及以上=（0，0，0，0），小学及以下=（1，0，0，0）,初中=（0，1，0，0）,高中/中专=（0，0，1，0）,专科=（0，0，0，1）
居住地农村=0，城市=1
是否在职是=0，否=1
透析龄≥37个月=（0，0），<24个月=（1，0）,24~<37个月=（0，1）
并发症有=0，无=1
年龄原值代入
), ArticleFig(id=1322530623089132068, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168572412014612, language=EN, label=Table 5, caption=

Logistic regression analysis of influencing factors of latent categories of nutritional literacy in MHD patients

, figureFileSmall=null, figureFileBig=null, tableContent=
因变量自变量回归系数标准误Wald χ2值POR值95%CI
指导依赖型①年龄-0.0580.0199.0480.0030.943[0.908,0.980]
性别-0.7770.3913.9500.0470.460[0.214,0.989]
文化程度 小学及以下-0.1261.0270.0150.9020.881[0.118,6.591]
初中0.3950.9840.1610.6881.485[0.216,10.218]
高中/中专0.3891.1170.1210.7281.476[0.165,13.166]
专科0.4431.1490.1480.7001.557[0.164,14.812]
居住地1.4740.6465.2030.0234.366[1.230,15.491]
是否在职-0.3970.6180.4130.5200.672[0.200,2.258]
透析龄 <24个月1.5520.8673.2030.0734.723[0.863,25.850]
24~<37个月0.1690.4330.1530.6951.185[0.507,2.766]
并发症0.4620.4001.3350.2481.587[0.725,3.474]
自主管理型①年龄-0.0660.0334.1710.0410.936[0.878,0.997]
性别-1.5920.6356.2840.0120.203[0.059,0.707]
文化程度 小学及以下-1.8541.8371.0180.3130.157[0.004,5.736]
初中-0.2451.6140.0230.8790.783[0.033,18.503]
高中/中专0.1161.8040.0040.9491.123[0.033,38.573]
专科-0.1191.7180.0050.9450.888[0.031,25.757]
居住地0.1931.1180.0300.8631.213[0.136,10.855]
是否在职0.1140.9630.0140.9061.121[0.170,7.395]
透析龄 <24个月2.0101.1632.9870.0847.464[0.764,72.935]
24~<37个月1.0030.7171.9560.1622.727[0.669,11.121]
并发症1.2460.6643.5180.0613.475[0.946,12.770]
), ArticleFig(id=1322530623156240933, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168572412014612, language=CN, label=表5, caption=

MHD病人营养素养潜在类别影响因素的Logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
因变量自变量回归系数标准误Wald χ2值POR值95%CI
指导依赖型①年龄-0.0580.0199.0480.0030.943[0.908,0.980]
性别-0.7770.3913.9500.0470.460[0.214,0.989]
文化程度 小学及以下-0.1261.0270.0150.9020.881[0.118,6.591]
初中0.3950.9840.1610.6881.485[0.216,10.218]
高中/中专0.3891.1170.1210.7281.476[0.165,13.166]
专科0.4431.1490.1480.7001.557[0.164,14.812]
居住地1.4740.6465.2030.0234.366[1.230,15.491]
是否在职-0.3970.6180.4130.5200.672[0.200,2.258]
透析龄 <24个月1.5520.8673.2030.0734.723[0.863,25.850]
24~<37个月0.1690.4330.1530.6951.185[0.507,2.766]
并发症0.4620.4001.3350.2481.587[0.725,3.474]
自主管理型①年龄-0.0660.0334.1710.0410.936[0.878,0.997]
性别-1.5920.6356.2840.0120.203[0.059,0.707]
文化程度 小学及以下-1.8541.8371.0180.3130.157[0.004,5.736]
初中-0.2451.6140.0230.8790.783[0.033,18.503]
高中/中专0.1161.8040.0040.9491.123[0.033,38.573]
专科-0.1191.7180.0050.9450.888[0.031,25.757]
居住地0.1931.1180.0300.8631.213[0.136,10.855]
是否在职0.1140.9630.0140.9061.121[0.170,7.395]
透析龄 <24个月2.0101.1632.9870.0847.464[0.764,72.935]
24~<37个月1.0030.7171.9560.1622.727[0.669,11.121]
并发症1.2460.6643.5180.0613.475[0.946,12.770]
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维持性血液透析病人营养素养潜在剖面及饮食健康信念差异
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鲍泽锋 , 李伶俐 , 张春晖 , 夏丽 , 肖侣嫚 , 刘冰 *, *
护理研究 | 科研论著 2026,40(6): 950-956
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护理研究 |科研论著 2026 , 40 (6) : 950 -956
维持性血液透析病人营养素养潜在剖面及饮食健康信念差异
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鲍泽锋, 李伶俐, 张春晖, 夏丽, 肖侣嫚, 刘冰*, *
作者信息
  • 1湖北医药学院，湖北 442000
通讯作者:
刘冰，E-mail:sy-
LIU Bing, E-mail: sy-
作者简介:

鲍泽锋，护士，硕士研究生在读

Latent profile of nutritional literacy and dietary health belief differences in maintenance hemodialysis patients
Zefeng BAO, Lingli LI, Chunhui ZHANG, Li XIA, Lyuman XIAO, Bing LIU
Affiliations
  • 1Hubei University of Medicine, Hubei 442000 China
    • Corresponding Author:
    LIU Bing, E-mail: sy-
出版时间: 2026-03-25 doi: 10.12102/j.issn.1009-6493.2026.06.009
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摘要
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目的

探索维持性血液透析（MHD）病人营养素养潜在类别及不同类别的饮食健康信念差异。

方法

采用便利抽样法，选取2024年10月—12月十堰市太和医院血液净化中心的238例MHD病人为研究对象，采用一般人口学资料调查表、MHD病人营养素养测评问卷、血液透析病人饮食健康信念问卷进行调查。通过潜在剖面分析（LPA）将病人营养素养分为不同类别，比较各类别饮食健康信念差异。

结果

MHD病人营养素养可分为3个潜在类别，即被动接受型（34.5%）、指导依赖型（52.1%）和自主管理型（13.4%）。不同营养素养类别的MHD病人饮食健康信念总分比较，差异有统计学意义（P<0.05）。Logistic回归分析结果显示，年龄、性别、居住地是MHD病人营养素养潜在类别的影响因素（P<0.05）。

结论

MHD病人营养素养存在异质性，不同营养素养类别病人的饮食健康信念水平不同。医务人员应根据病人营养素养类别制定个性化干预策略，提升其营养素养和饮食健康信念。

维持性血液透析  /  营养素养  /  饮食健康信念  /  潜在剖面分析  /  影响因素
Objective

To explore the latent categories of nutritional literacy and the differences in dietary health beliefs across different categories in maintenance hemodialysis(MHD) patients.

Methods

A total of 238 MHD patients from the hemodialysis center of Taihe Hospital in Shiyan city were selected as the study subjects from October to December 2024 by convenience sampling.Data were collected using a general demographic information questionnaire,the Nutritional Literacy Assessment Questionnaire for MHD Patients,and the Dietary Health Belief Questionnaire for Hemodialysis Patients.Latent profile analysis(LPA) was used to classify patients' nutritional literacy into different categories,and differences in dietary health beliefs across categories were compared.

Results

The nutritional literacy of MHD patients could be classified into three latent categories,namely passive acceptance type(34.5%),guidance-dependent type(52.1%),and self-management type(13.4%).There were statistically significant differences in the total scores of dietary health beliefs among MHD patients with different nutritional literacy categories(P<0.05).Logistic regression analysis showed that age,gender,and place of residence were influencing factors of the latent categories of nutritional literacy in MHD patients(P<0.05).

Conclusions

There is heterogeneity in the nutritional literacy of MHD patients.The levels of dietary health beliefs vary across different nutritional literacy categories.Healthcare professionals should develop personalized intervention strategies based on patients' nutritional literacy categories to improve their nutritional literacy and dietary health beliefs.

maintenance hemodialysis  /  nutritional literacy  /  dietary health beliefs  /  latent profile analysis  /  influencing factors
鲍泽锋, 李伶俐, 张春晖, 夏丽, 肖侣嫚, 刘冰. 维持性血液透析病人营养素养潜在剖面及饮食健康信念差异. 护理研究, 2026 , 40 (6) : 950 -956 . DOI: 10.12102/j.issn.1009-6493.2026.06.009
Zefeng BAO, Lingli LI, Chunhui ZHANG, Li XIA, Lyuman XIAO, Bing LIU. Latent profile of nutritional literacy and dietary health belief differences in maintenance hemodialysis patients[J]. Chinese Nursing Research, 2026 , 40 (6) : 950 -956 . DOI: 10.12102/j.issn.1009-6493.2026.06.009
正文
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终末期肾病（end-stage renal disease，ESRD）病人普遍面临蛋白质-能量消耗（protein-energy wasting，PEW）的严峻挑战，其中维持性血液透析（maintenance hemodialysis，MHD）病人的PEW发生率高达60%，直接导致其死亡风险增加2~3倍[1]。尽管国际肾脏营养指南强调个体化饮食管理的重要性[2]，但在临床实践中病人饮食依从率不足40%[3]，这一现象凸显了在MHD病人管理中加强营养教育与支持的紧迫性和必要性。营养素养（nutrition literacy）是指个体获取、理解并运用营养信息以维护自身营养状况的能力，其不仅可以直接影响MHD病人的营养状况，还可以间接影响MHD病人慢性肾病进展[4]。饮食健康信念（dietary health beliefs）反映了个体对饮食与健康、不合理饮食与疾病之间关系的整体认知，对指导科学饮食行为具有重要作用[5]。病人的营养素养水平、饮食健康信念会影响其对饮食管理的认知和执行效果，进而影响其健康状态和生存质量，掌握相应的营养知识、培养良好的饮食健康信念是帮助MHD病人预防不良并发症并改善预后的关键。现有研究通常以量表得分的不同临界值界定病人的疾病接受度水平[6-8]，这种方法未能充分考虑个体异质性。潜在剖面分析（latent profile analysis，LPA）作为一种新兴的统计方法，能够根据外显变量的差异将研究对象划分为不同人群，并分析不同类别间相关指标的差异及群体特征[9]。本研究基于LPA探讨MHD病人营养素养不同分型及其与饮食健康信念的差异，旨在为构建更精准的个性化干预措施提供科学依据，进而改善病人的营养状况和长期预后。
1　对象与方法
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1.1　研究对象
采用便利抽样法，选取2024年10月—12月十堰市太和医院血液净化中心的MHD病人为研究对象。纳入标准：1）规律透析≥3个月且病情稳定；2）具备基本的读写能力；3）对本研究知情同意。排除标准：1）患有精神疾病；2）合并严重心力衰竭、活动性感染或恶性肿瘤。根据样本量计算公式确定样本量：N=Ζα/2  σδ2，其中，N代表估计样本量，Ζα/2为所选置信水平相关的Ζ值，σ为总体标准差，δ为允许的误差。本研究中，Ζα/2   =1.96，δ=0.5，根据以往研究结果[7]我国MHD病人营养素养的标准差为3.72，计算得出样本量为 214例，考虑到问卷调查过程中会产生无效问卷和失访人群问题，最终纳入样本量为238例。本研究已通过湖北医药学院伦理委员会批准（编号：2024-RE-064）。
1.2　研究工具
1.2.1　一般人口学资料调查表
由研究者参考过往研究自行设计，涵盖人口学特征（年龄、文化程度、家庭人均月收入等）及疾病特征（透析龄、并发症等）。
1.2.2　MHD病人营养素养测评问卷
该问卷由苏铭钰等[10]基于健康素养分层理论和知信行理论研制，用于测评MHD病人营养素养水平，包含营养态度、营养知识、营养技能、信息互动、信息评判5个维度，共25个条目，采用Likert 5级评分法，“很不同意”“不同意”“不能确定”“同意”“很同意”依次计1、2、3、4、5分，总分为25~125分，病人得分越高表示营养素养水平越高；问卷整体的Cronbach′s α系数为0.950，各维度的Cronbach′s α系数为0.824~0.893。
1.2.3　血液透析病人饮食健康信念问卷
该问卷由张园等[11]编制，包括感知易感性、感知严重性、感知益处、感知障碍、自我效能5个维度，共23个条目，采用Likert 5级评分法，从“非常不同意”到“非常同意”依次计1~5分，总分为23~115分，得分越高表示病人饮食健康信念越强；该问卷的总体Cronbach′s α系数为0.879。
1.3　资料收集与方法
由研究者进行问卷发放，调查前向病人解释研究目的，取得病人信任。问卷由研究对象本人填写，独自填写困难者由研究者协助填写。问卷回收后现场核查问卷完整性，剔除缺失值>10%的问卷。共发放问卷250份，回收有效问卷238份，问卷有效回收率为95.2%。
1.4　统计学方法
采用Mplus 8.3软件进行潜在剖面分析，模型适配检验指标主要包括赤池信息准则（AIC）、贝叶斯信息准则（BIC）、样本校正的BIC（aBIC）、熵（Entropy）、罗-梦戴尔-鲁本校正似然比检验（LMRT）和基于Bootstrap的似然比检验（BLRT），其中，AIC、BIC、aBIC数值越小表示模型拟合越好；Entrop值越接近1表示分类准确率越高；LMRT、BLRT检验有统计学意义（P<0.05）表示k个模型拟合优于k-1个模型[12]。采用SPSS 26.0进行统计分析，符合正态分布的定量资料以均数±标准差（x±s）表示，定性资料以频数、百分比（%）表示，组间比较采用t检验、方差分析、χ2检验或Fisher精确概率法。采用Logistic回归分析探究MHD病人营养素养潜在类别的影响因素。以P<0.05表示差异有统计学意义。
2　结果
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2.1　MHD病人营养素养评分
238例病人的MHD病人营养素养测评问卷总分为64~116（92.35±9.69）分，营养态度维度条目均分为（4.19±0.67）分，营养知识维度条目均分为（3.80±0.41）分，营养技能维度条目均分为（3.88±0.46）分，信息互动维度条目均分为（3.13±0.52）分，信息评判维度条目均分为（3.47±0.52）分。
2.2　MHD病人营养素养的潜在剖面分析
基于MHD病人营养素养测评问卷5个维度得分，构建1~4个潜在类别模型并进行拟合优度检验，结果显示，随着潜在类别数增加，AIC、BIC、aBIC整体呈下降趋势，其中模型4的AIC、aBIC最低，但其LMRT未达到显著性阈值（P>0.05），表明增加第4个潜在类别未能显著提升模型解释力。模型3的Entropy值高于模型2，同时，模型3的LMRT与BLRT检验均有统计学意义（均P<0.001），综合考虑后选择MHD病人营养素养的3个潜在类别进行分析。详见表1。
2.3　MHD病人营养素养潜在类别的特点及命名
MHD病人营养素养3个潜在类别的营养态度、营养知识、营养技能、信息互动及信息评判维度得分见图1。根据各维度外显特征，对3个潜在类别进行命名。类别1包括82例（34.5%）病人，各维度得分均低于其他类别，且营养态度维度得分与其他2个类别差异较大，反映其营养管理主动性薄弱，故命名为“被动接受型”；类别2包括124例（52.1%）病人，各维度呈中等水平，但进一步分析发现，其营养态度维度得分（4.49分）与营养技能维度得分（3.93分）之间存在较大差距，反映了知信行理论中的态度、行为断层现象，需加以指导实现知识转化，故命名为“指导依赖型”。类别3包括32例（13.4%）病人，各维度得分均优于其他组，且营养态度维度得分（4.80分）、营养知识维度得分（4.36分）与营养技能维度得分（4.45分）形成协同效应，故命名为“自主管理型”。
2.4　不同营养素养潜在类别MHD病人的饮食健康信念得分比较（见表2）
2.5　MHD病人营养素养潜在类别影响因素的单因素分析（见表3）
2.6　MHD病人营养素养潜在类别影响因素的Logistic回归分析
以MHD病人营养素养潜在类别为因变量（以被动接受型作为参照），以MHD病人营养素养潜在类别影响因素单因素分析中有统计学意义的变量（P<0.05）为自变量，进行Logistic回归分析，结果显示，与指导依赖型、自主管理型相比，年龄较大、男性病人更易归为被动接受型；与被动接受型相比，居住地为城市的病人更易归为指导依赖型（均P<0.05）。自变量赋值方式见表4。Logistic回归分析结果见表5。
3　讨论
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3.1　MHD病人营养素养有待提高
本研究结果显示，238例MHD病人营养素养总分为64~116（92.35±9.69）分，与刘炎灵等[13-14]研究结果相似。MHD病人的营养素养水平有进一步提升空间，反映出我国在血液透析病人对营养素养的关注度应进一步加强，需加强饮食健康指导与干预。潜在剖面分析结果显示，MHD病人营养素养存在个体差异，被动接受型病人82例（34.5%），其各维度得分均低于其他组别，尤其在营养态度维度与其他组别差距明显，表明该类病人对营养管理的认知和态度消极，缺乏主动管理的意识，导致其在营养知识、技能及信息处理能力方面表现不佳，难以有效落实健康饮食行为[15]。指导依赖型病人124例（52.1%），其各维度得分处于3组中的中等水平，但营养态度维度得分（4.49分）与营养技能维度得分（3.93分）之间存在较大差距，提示尽管病人在营养态度上表现出一定的积极认知，但在实际的营养技能应用方面未能有效转化[16]。需加强指导，促进营养知识转化和应用，提升营养素养[17]。自主管理型病人32例（13.4%），其各维度得分在3组中均最高，营养态度维度得分（4.80分）、营养知识维度得分（4.36分）与营养技能维度得分（4.45分）形成协同效应，表明该类病人具备积极的营养态度和较高的知识技能水平，能自主管理营养摄入，有效处理和评判营养信息，更好地保持营养状态、提高生活质量[18]。综合提升病人营养态度、知识和技能可促使病人向自主管理型转变，提高整体营养素养。
3.2　不同营养素养潜在类别病人的饮食健康信念存在差异
良好的饮食健康信念是提高MHD病人健康饮食行为和健康结局的关键[19]。本研究结果显示，不同营养素养潜在类别的MHD病人饮食健康信念总分比较，差异有统计学意义（P<0.05），其中，被动接受型病人的饮食健康信念得分最低，指导依赖型病人居中，自我管理型病人得分最高。被动接受型病人年龄为（59.62±9.34）岁，高于其他两组病人。肾脏病病人饮食管理要求严格，需注重营养搭配，但年龄较大的MHD病人往往生活习惯已固定，受自身饮食偏好及家庭成员影响，导致其采取健康饮食行为的行动力不足[20]。此外，老年病人可能存在专业知识获取渠道有限、对系统掌握透析相关饮食知识信心不足、对营养管理的认知和态度相对消极等问题，进一步降低其对健康饮食重要性的认识。说明营养素养对饮食健康信念具有直接或间接作用。针对被动接受型病人特点，可协助其制定个性化的饮食和液体管理方案，提升病人自我效能和行动力[21]；同时通过制定饮食教育手册、配备专科营养师以及利用“互联网+”移动应用程序等方式[22]，拓宽病人获取知识的途径，让其全面了解健康饮食对疾病控制和康复的重要性，增强病人饮食健康意识，实现从医院到家庭的持续性饮食和营养管理。已有研究表明，透析时间较长的病人通常容易获取和理解关于透析和饮食健康的信息[23]，但本研究透析龄≥37个月的病人中，被动接受型病人占比较大，病人饮食健康信念得分却较低，可能是由于个性化的指导缺乏使他们难以将获得的信息应用到自己的具体情况中。自主管理型病人在饮食健康信念方面的得分最高，与已有研究结果[24]相似。自我效能高的病人会更主动地寻求健康信息和技能，制定合理的饮食计划并积极执行，通过参与自身的健康管理，获取知识、技能和信心，从而提升饮食健康信念。建议临床针对不同营养素养潜在类别的MHD病人设计干预策略，对被动接受型病人，提高其对健康饮食的认知和理解；针对指导依赖型病人，可通过开发模拟决策训练系统，强化其健康饮食相关技能；对自主管理型病人，构建同伴支持网络，以促进健康信念的阶梯式转化。
3.3　年龄、性别、居住地是MHD病人营养素养潜在类别的影响因素
本研究结果显示，与指导依赖型、自主管理型相比，年龄较大、男性病人更易归为被动接受型；与被动接受型相比，居住地为城市的病人更易归为指导依赖型（均P<0.05）。1）老年人通常对健康生活的需求降低，对营养管理的意识较弱，导致其对饮食控制产生抵触情绪[25]。同时，老年人身体机能减退，日常生活能力受限，难以有效开展营养改善行动；此外，社交支持不足也可能影响他们的饮食选择和营养摄入，导致行为实践能力下降，进而造成营养素养评分较低[7]。2）男性营养素养需进一步提升，女性在营养素养方面通常表现更佳，这可能与女性病人对健康生活的关注度更高有关。女性在家庭中往往承担了更多家务，在食物选择和膳食准备过程中有更多机会接触营养知识，且更愿意积极获取健康信息并改善饮食习惯[26]。3）已有研究结果显示，居住在城市的病人营养素养较高[27]。血液透析病人的营养素养水平是反映医疗服务质量、病人自我管理能力和健康教育效果的一项综合性评价指标。受城市医疗设施完善、经济水平较高、健康教育与健康促进宣传较多等因素影响，城市血液透析病人的营养素养往往较高。同时，由于城市病人能够更便捷地获取营养知识和专业指导，生活方式和饮食习惯也相对更健康，有利于进一步促进营养素养提升；城市病人通常有稳定的收入来源，能够更好地承担营养食品和补充剂费用，从而更容易实现营养均衡的饮食；此外，城市病人可能具有更广泛的社交网络，这些社交关系可以提供健康信息和支持，促进营养素养提升[28]。
4　小结
收起
本研究通过潜在类别分析将血液透析病人营养素养分为3个潜在类别，即被动接受型、指导依赖型、自我管理型，且多因素分析结果显示，年龄、性别、居住地是其影响因素。但本研究的样本来源相对单一，仅选取十堰市1所三级甲等医院的病人进行横断面研究，一定程度上限制了研究结果的普适性和代表性。未来研究应更加注重多中心、大样本的调查与分析，从而更加全面、深入地挖掘影响血液透析病人营养素养的各种因素，为后期实施精准护理提供更科学、可靠的依据。

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doi: 10.12102/j.issn.1009-6493.2026.06.009
  • 接收时间：2025-03-18
  • 首发时间：2026-10-28
  • 出版时间：2026-03-25
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  • 收稿日期：2025-03-18
  • 修回日期：2025-12-28
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    1湖北医药学院，湖北 442000

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刘冰，E-mail:sy-
LIU Bing, E-mail: sy-
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Number of
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total species (%)		 属
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
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