Article(id=1241522769490400057, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522764012647140, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202306246, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1686758400000, receivedDateStr=2023-06-15, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773931694624, onlineDateStr=2026-03-19, pubDate=1704816000000, pubDateStr=2024-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773931694624, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773931694624, creator=13701087609, updateTime=1773931694624, updator=13701087609, issue=Issue{id=1241522764012647140, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='1', pageStart='1', pageEnd='192', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773931693318, creator=13701087609, updateTime=1773931808852, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241523248643494379, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522764012647140, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241523248643494380, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522764012647140, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=50, endPage=54, ext={EN=ArticleExt(id=1241522770543170396, articleId=1241522769490400057, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Effect of food intake on nutritional status in elderly patients with diabetes mellitus, columnId=1228016572783063333, journalTitle=Modern Preventive Medicine, columnName=Nutrition and Food Hygiene, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the effect of food intake on nutritional status of elderly patients with diabetes in a physical examination center.

Methods

In total 626 subjects who underwent physical examination in a physical examination center from November 20, 2021 to September 3, 2022 were divided into diabetic group (n=130) and non-diabetic group (n=496). The general information of the subjects was collected by questionnaire, the height and weight were measured by automatic monitor, and the body mass index (BMI) was calculated. The mini nutritional assessment short-form (MNA-SF) was used to evaluate the nutrition of the subjects. The cumulative illness rating scale for geriatrics (CIRS-G) was used to evaluate the type and grade of concomitant diseases. According to the BMI level of subjects, the subjects in non-diabetic group and diabetic group were divided into obesity group, overweight group, and normal weight group. Dietary retrospective method was used to investigate the nutritional intake of different obese subjects.

Results

The CIRS-G score of the diabetic group was higher than that of the control group (t=19.827, P < 0.05). The malnutrition rate and malnutrition risk rate in the diabetic group were 13.85% and 46.15%, respectively, which were higher than those in the non-diabetic group (6.25% and 42.34%, χ2=10.676, P < 0.05). The proportion of total energy intake excess in the diabetic group was 70.00%, which was higher than that in the non-diabetic group (39.92%,χ2=41.653, P < 0.05). The proportion of obesity in the diabetic group was 23.08%, which was higher than that in the non-diabetic group (13.71%, χ2=9.982, P < 0.05). The average daily total energy intake of obese group and overweight diabetic group was 2 487.43 ± 135.23 kcal and 2 214.28 ±119.59 kcal, respectively, which was higher than that of normal weight group(2 048.56 ± 121.65, F=117.227, P<0.05). There were significant differences in carbohydrate intake, carbohydrate energy supply, protein intake, and protein energy supply among obesity group, overweight group, and normal weight group (P < 0.05).

Conclusion

The malnutrition rate of diabetic patients in this physical examination center is high, and food intake affects the nutritional status of diabetic patients.

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目的

研究某体检中心的老年糖尿病患者食物摄入对营养状况的影响。

方法

选取某体检中心于2021年11月20日—2022年9月3日进行体检的626例受试者,根据其是否患有糖尿病,将受试者分为糖尿病组和非糖尿病组,糖尿病组130例,非糖尿病组496例。采用问卷调查的方式收集受试者一般信息,采用自动监测仪测定受试者的身高和体重,计算体质量指数(body mass index,BMI)。采用微营养评估简表(mini nutritional assessment short-form,MNA-SF)对受试者的营养进行评估。采用老年病累积疾病评定量表(cumulative illness rating scale for geriatrics, CIRS-G)对受试者合并疾病的类型和级别进行评估。根据受试者BMI水平将非糖尿病组和糖尿病组受试者分为肥胖组、超重组、体重正常组。采用膳食回顾法调查不同肥胖受试者的营养摄入情况。

结果

糖尿病组患者的CIRS-G评分高于对照组(t=19.827,P<0.05)。糖尿病组患者营养不良率和营养不良风险率分别为13.85%和46.15%,高于非糖尿病组的6.25%和42.34%,(χ2=10.676,P<0.05);糖尿病组患者的总能量摄入过量的比例为70.00%,高于非糖尿病组(39.92%,χ2=41.653,P<0.05)。糖尿病组患者的肥胖比例为23.08%,高于非糖尿病组的13.71%(χ2=9.982,P<0.05)。肥胖组和超重组糖尿病患者的日均总能量摄入水平分别为(2 487.43±135.23)kcal和(2 214.28±11 9.59)kcal,均高于体重正常组[(2 048.56±121.65) kcal,F=117.227,P<0.05]。肥胖组、超重组、体重正常组糖尿病患者碳水化合物摄入量、碳水化合物供能、蛋白质摄入量、蛋白质供能组间比较差异具有统计学意义(P<0.05)。

结论

该体检中心糖尿病患者营养不良率较高,食物摄入状况会影响糖尿病患者的营养现状。

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陈哲,E-mail:
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赵恒霞(1979—),女,本科,副主任医师,研究方向:血透、慢性病管理

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General information of the subjects [n(%),()]

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资料糖尿病组(n=130)非糖尿病组(n=496)χ2/tP
性别73(56.15)213(42.94)7.2440.007
57(43.85)283(57.06)
年龄(岁)75.43±5.4975.53±6.780.1550.877
学历文盲11(8.46)27(5.44)1.7500.626
小学24(18.46)89(17.94)
中学58(44.62)229(46.17)
大专及以上37(28.46)151(30.44)
职业专业人员63(48.46)249(50.2)1.0580.589
工人66(50.77)238(47.98)
其他1(0.77)9(1.81)
婚姻状况已婚104(80.00)412(83.06)1.8380.607
未婚6(4.62)15(3.024)
离异8(6.15)20(4.03)
丧偶12(9.23)49(9.88)
居住环境独居12(9.23)51(10.28)0.1460.930
与配偶同住88(67.69)329(66.33)
与孩子或看护人同住30(23.08)116(23.39)
酗酒6(4.62)11(2.22)1.4260.137
124(95.38)485(97.78)
抽烟11(8.46)55(11.09)0.7540.385
119(91.54)441(88.91)
老年病学累积疾病评定量表(CIRS-G,分)6.34±1.244.31±0.9819.827<0.001
), ArticleFig(id=1241677612184031281, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769490400057, language=CN, label=表1, caption=

研究对象一般资料[n(%),()]

, figureFileSmall=null, figureFileBig=null, tableContent=
资料糖尿病组(n=130)非糖尿病组(n=496)χ2/tP
性别73(56.15)213(42.94)7.2440.007
57(43.85)283(57.06)
年龄(岁)75.43±5.4975.53±6.780.1550.877
学历文盲11(8.46)27(5.44)1.7500.626
小学24(18.46)89(17.94)
中学58(44.62)229(46.17)
大专及以上37(28.46)151(30.44)
职业专业人员63(48.46)249(50.2)1.0580.589
工人66(50.77)238(47.98)
其他1(0.77)9(1.81)
婚姻状况已婚104(80.00)412(83.06)1.8380.607
未婚6(4.62)15(3.024)
离异8(6.15)20(4.03)
丧偶12(9.23)49(9.88)
居住环境独居12(9.23)51(10.28)0.1460.930
与配偶同住88(67.69)329(66.33)
与孩子或看护人同住30(23.08)116(23.39)
酗酒6(4.62)11(2.22)1.4260.137
124(95.38)485(97.78)
抽烟11(8.46)55(11.09)0.7540.385
119(91.54)441(88.91)
老年病学累积疾病评定量表(CIRS-G,分)6.34±1.244.31±0.9819.827<0.001
), ArticleFig(id=1241677612376969275, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769490400057, language=EN, label=Table 2, caption=

Comparison of nutritional assessment of subjects in diabetes group and non- diabetes group [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
分组例数营养评估
正常营养不良风险营养不良
糖尿病组13052(40.00)60(46.15)18(13.85)
非糖尿病组496255(51.41)210(42.34)31(6.25)
), ArticleFig(id=1241677612527964230, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769490400057, language=CN, label=表2, caption=

糖尿病组和非糖尿病组受试者营养评估比较结果[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
分组例数营养评估
正常营养不良风险营养不良
糖尿病组13052(40.00)60(46.15)18(13.85)
非糖尿病组496255(51.41)210(42.34)31(6.25)
), ArticleFig(id=1241677612611850315, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769490400057, language=EN, label=Table 3, caption=

Obesity of subjects in diabetes group and non-diabetes group [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数肥胖超重体重正常
糖尿病组13029(22.31)52(40.00)49(37.69)
非糖尿病组49668(13.71)171(34.76)257(51.81)
), ArticleFig(id=1241677612720902224, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769490400057, language=CN, label=表3, caption=

糖尿病组和非糖尿病组受试者肥胖情况[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数肥胖超重体重正常
糖尿病组13029(22.31)52(40.00)49(37.69)
非糖尿病组49668(13.71)171(34.76)257(51.81)
), ArticleFig(id=1241677612825759831, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769490400057, language=EN, label=Table 4, caption=

Average daily total energy intake of diabetes patients in obesity group, overweight group, and normal weight group (

, figureFileSmall=null, figureFileBig=null, tableContent=
组别日均总能量摄入水平(kcal)
肥胖组(n=30)2 487.43±135.23*#
超重组(n=50)2 214.28±119.59*
体重正常组(n=50)2 048.56±121.65
F117.227
P<0.001
), ArticleFig(id=1241677612939006049, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769490400057, language=CN, label=表4, caption=

肥胖组、超重组、体重正常组糖尿病患者日均总能量摄入水平(

, figureFileSmall=null, figureFileBig=null, tableContent=
组别日均总能量摄入水平(kcal)
肥胖组(n=30)2 487.43±135.23*#
超重组(n=50)2 214.28±119.59*
体重正常组(n=50)2 048.56±121.65
F117.227
P<0.001
), ArticleFig(id=1241677613039669353, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769490400057, language=EN, label=Table 5, caption=

Dietary evaluation of obese, overweight, and normal weight diabetes patients (

, figureFileSmall=null, figureFileBig=null, tableContent=
组别碳水化合物供能比(%)蛋白质供能比(%)脂肪供能比(%)
肥胖组(n=30)51.74±4.4315.69±2.3232.71±2.11
超重组(n=50)51.29±4.8716.24±1.6831.58±2.19
体重正常组
n=50)
50.81±3.9216.35±1.9432.34±2.24
F0.4281.162.855
P0.6530.3170.061
), ArticleFig(id=1241677613169692786, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769490400057, language=CN, label=表5, caption=

肥胖组、超重组、体重正常组糖尿病患者膳食评价(

, figureFileSmall=null, figureFileBig=null, tableContent=
组别碳水化合物供能比(%)蛋白质供能比(%)脂肪供能比(%)
肥胖组(n=30)51.74±4.4315.69±2.3232.71±2.11
超重组(n=50)51.29±4.8716.24±1.6831.58±2.19
体重正常组
n=50)
50.81±3.9216.35±1.9432.34±2.24
F0.4281.162.855
P0.6530.3170.061
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老年糖尿病患者食物摄入对营养状况的影响
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赵恒霞 , 张晓婉 , 江锡梦 , 陈哲
现代预防医学 | 营养与食品卫生 2024,51(1): 50-54
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现代预防医学 | 营养与食品卫生 2024, 51(1): 50-54
老年糖尿病患者食物摄入对营养状况的影响
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赵恒霞, 张晓婉, 江锡梦, 陈哲
作者信息
  • 瑞金医院无锡分院门诊,江苏 无锡 214142
  • 赵恒霞(1979—),女,本科,副主任医师,研究方向:血透、慢性病管理

通讯作者:

陈哲,E-mail:
Effect of food intake on nutritional status in elderly patients with diabetes mellitus
Heng-xia ZHAO, Xiao-wan ZHANG, Xi-meng JIANG, Zhe CHEN
Affiliations
  • Wuxi Branch of Ruijin Hospital Outpatient Clinic, Wuxi, Jiangsu 214142, China
出版时间: 2024-01-10 doi: 10.20043/j.cnki.MPM.202306246
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目的

研究某体检中心的老年糖尿病患者食物摄入对营养状况的影响。

方法

选取某体检中心于2021年11月20日—2022年9月3日进行体检的626例受试者,根据其是否患有糖尿病,将受试者分为糖尿病组和非糖尿病组,糖尿病组130例,非糖尿病组496例。采用问卷调查的方式收集受试者一般信息,采用自动监测仪测定受试者的身高和体重,计算体质量指数(body mass index,BMI)。采用微营养评估简表(mini nutritional assessment short-form,MNA-SF)对受试者的营养进行评估。采用老年病累积疾病评定量表(cumulative illness rating scale for geriatrics, CIRS-G)对受试者合并疾病的类型和级别进行评估。根据受试者BMI水平将非糖尿病组和糖尿病组受试者分为肥胖组、超重组、体重正常组。采用膳食回顾法调查不同肥胖受试者的营养摄入情况。

结果

糖尿病组患者的CIRS-G评分高于对照组(t=19.827,P<0.05)。糖尿病组患者营养不良率和营养不良风险率分别为13.85%和46.15%,高于非糖尿病组的6.25%和42.34%,(χ2=10.676,P<0.05);糖尿病组患者的总能量摄入过量的比例为70.00%,高于非糖尿病组(39.92%,χ2=41.653,P<0.05)。糖尿病组患者的肥胖比例为23.08%,高于非糖尿病组的13.71%(χ2=9.982,P<0.05)。肥胖组和超重组糖尿病患者的日均总能量摄入水平分别为(2 487.43±135.23)kcal和(2 214.28±11 9.59)kcal,均高于体重正常组[(2 048.56±121.65) kcal,F=117.227,P<0.05]。肥胖组、超重组、体重正常组糖尿病患者碳水化合物摄入量、碳水化合物供能、蛋白质摄入量、蛋白质供能组间比较差异具有统计学意义(P<0.05)。

结论

该体检中心糖尿病患者营养不良率较高,食物摄入状况会影响糖尿病患者的营养现状。

糖尿病  /  食物摄入  /  营养摄入  /  肥胖
Objective

To investigate the effect of food intake on nutritional status of elderly patients with diabetes in a physical examination center.

Methods

In total 626 subjects who underwent physical examination in a physical examination center from November 20, 2021 to September 3, 2022 were divided into diabetic group (n=130) and non-diabetic group (n=496). The general information of the subjects was collected by questionnaire, the height and weight were measured by automatic monitor, and the body mass index (BMI) was calculated. The mini nutritional assessment short-form (MNA-SF) was used to evaluate the nutrition of the subjects. The cumulative illness rating scale for geriatrics (CIRS-G) was used to evaluate the type and grade of concomitant diseases. According to the BMI level of subjects, the subjects in non-diabetic group and diabetic group were divided into obesity group, overweight group, and normal weight group. Dietary retrospective method was used to investigate the nutritional intake of different obese subjects.

Results

The CIRS-G score of the diabetic group was higher than that of the control group (t=19.827, P < 0.05). The malnutrition rate and malnutrition risk rate in the diabetic group were 13.85% and 46.15%, respectively, which were higher than those in the non-diabetic group (6.25% and 42.34%, χ2=10.676, P < 0.05). The proportion of total energy intake excess in the diabetic group was 70.00%, which was higher than that in the non-diabetic group (39.92%,χ2=41.653, P < 0.05). The proportion of obesity in the diabetic group was 23.08%, which was higher than that in the non-diabetic group (13.71%, χ2=9.982, P < 0.05). The average daily total energy intake of obese group and overweight diabetic group was 2 487.43 ± 135.23 kcal and 2 214.28 ±119.59 kcal, respectively, which was higher than that of normal weight group(2 048.56 ± 121.65, F=117.227, P<0.05). There were significant differences in carbohydrate intake, carbohydrate energy supply, protein intake, and protein energy supply among obesity group, overweight group, and normal weight group (P < 0.05).

Conclusion

The malnutrition rate of diabetic patients in this physical examination center is high, and food intake affects the nutritional status of diabetic patients.

Diabetes  /  Food intake  /  Nutritional intake  /  Obesity
赵恒霞, 张晓婉, 江锡梦, 陈哲. 老年糖尿病患者食物摄入对营养状况的影响. 现代预防医学, 2024 , 51 (1) : 50 -54 . DOI: 10.20043/j.cnki.MPM.202306246
Heng-xia ZHAO, Xiao-wan ZHANG, Xi-meng JIANG, Zhe CHEN. Effect of food intake on nutritional status in elderly patients with diabetes mellitus[J]. Modern Preventive Medicine, 2024 , 51 (1) : 50 -54 . DOI: 10.20043/j.cnki.MPM.202306246
WHO将营养不良定义为营养摄入不足或过多、重要营养素不平衡或营养利用受损导致身体成分改变。老年患者更容易出现营养不良,包括蛋白质和能量稳态下降、激素分泌异常和食欲不振等,对老年患者的生活质量造成了威胁[1-2]。糖尿病是老年人常见的疾病之一,而糖尿病的管理过程中需要对饮食进行控制,且由于糖尿病患者肥胖或超重比例较高,因此需要进行减重管理,但是老年患者在饮食管理的执行过程中经常发生不理解饮食宣教或操作不当,进而导致营养不良或者食物摄入不合理等问题[3-4]。目前,临床上针对超重和肥胖的糖尿病患者的治疗方法为医学营养治疗,即进行饮食控制[5-6]。但是肥胖型的糖尿病患者饮食控制过程中及营养现状是否会影响营养摄入尚不明确,因此本研究将开展研究糖尿病患者营养现状及肥胖对营养摄入的影响。
以2021年11月20日—2022年9月3日在该体检中心进行体检的老年人及内分泌门诊接收的糖尿病患者为目标人群,进行问卷调查和体格检查。将既往存在糖尿病的患者纳入糖尿病组(n=130例)。另外,将同时期进行体检、确定无糖尿病的老年人纳入非糖尿病组(n=496例)。两组受试者纳入标准:受试者年龄均大于65岁;均自愿参加本研究;临床资料完整。糖尿病组患者排除标准:本次体检新发糖尿病患者;伴有严重的糖尿病并发症,如感染、糖尿病酮症酸中毒等;严重心、肾、肝功能障碍患者;认知功能障碍患者;精神系统疾病;有口服糖皮质类固醇激素病史的患者。非糖尿病组受试者排除标准:本次体检发现患有糖尿病或糖耐量异常;长期服用类固醇、β-肾上腺素能激动剂等影响糖代谢药物史者;患有肢端肥大症、库欣综合征、行胰腺切除术等可能影响糖代谢的内/外科疾病者;合并严重心、肾、肝功能障碍或其他严重疾病者;受试者及其家属不能配合或依从性较差者。所有受试者均知情且已自愿签订知情同意书。该研究已获得瑞金医院无锡分院伦理批准(伦理审批号:2022053101)。
采用问卷调查的方式收集受试者一般信息,包括姓名、性别、年龄、职业、疾病史,采用自动监测仪测定受试者的身高和体重,身高、体重测量采用经统一校正的电子计重器测量,由经过培训的、与本研究无关的专业人员采用标准方法测量[7],并计算体质量指数(body mass index,BMI)。
采用微营养评估简表(mini nutritional assessment short-form,MNA-SF)对受试者的营养进行评估,低于8分表示营养不良,8~11分表示营养不良风险,12~14分表示正常。
采用老年病累积疾病评定量表(cumulative illness rating scale for geriatrics, CIRS-G)对受试者合并的各系统疾病的类型和级别进行评估。共包括14个方面,每个系统疾病严重程度均分为5级(评分0~4分),其中0分:Ⅰ级没有损害;1分:Ⅱ级轻微损害,但不干扰正常活动,无需治疗,预后良好;2分:Ⅲ级中度损害,干扰正常活动,需要治疗,预后良好;3分:Ⅳ级重度损害,可能致残,立即需要治疗,预后较差;4分:Ⅴ级致命性损害,需要紧急治疗,预后严重。
根据受试者BMI水平将非糖尿病组和糖尿病组受试者分为肥胖组(BMI≥30.0 kg/m2)、超重组(28.0 kg/m2≤BMI≤29.9 kg/m2)、体重正常组(23.0 kg/m2≤BMI≤27.9 kg/m2[8]
采用3×24 h膳食调查回顾法调查肥胖组、超重组和体重正常组受试者膳食能量摄入:调查受试者3×24 h所有摄入的食物名称和种类、烹饪方式、饮食时间和方式等,在医务人员的指导下,让受试者采用电子厨房秤(精度0.1 g,量程3.0 kg)称重烹饪的熟食,将各类食物的摄入量进行统计。采用营养计算软件计算受试者各类营养素和食物每天的摄入量,各类食物的摄入量参照《中国居民平衡膳食宝塔》(2016年),营养摄入量参照《中国居民膳食营养素参考摄入量表》。膳食评价:计算肥胖组、超重组和体重正常组受试者蛋白质、碳水化合物、脂肪的摄入量、占理想总能量的百分比、脂肪供能比,评价膳食结构的合理性。实际总能量占理想总能量的110%以上表示摄入过量,90%~110%表示摄入理想,不足90%表示摄入不足。
为保证问卷调查的质量,本研究人员均于调查前接受标准培训。采用面对面调查的方式,保证受试者对每一项问卷内容对详细了解。并制定现场督导人员对问卷进行随机抽查,并对问卷内容进行确认。
本研究的数据分析采用SPSS 26.0进行,计数资料以[n(%)]表示,采用χ2检验比较,组间两两比较采用χ2分割法,正态分布的计量资料以()表示,两组间比较采用独立样本t检验比较,多组间比较采用单因素方差分析F检验比较。检验水准α=0.05。
本次研究共纳入626人作为研究对象,其中糖尿病组130例,非糖尿病组496例。糖尿病组和非糖尿病组受试者的性别、平均年龄、学历、职业、婚姻状况、居住环境、酗酒及吸烟情况组间比较差异均不具有统计学意义(P>0.05);糖尿病组患者的CIRS-G评分高于对照组(P<0.05)。见表1
采用微营养评估简表对糖尿病组患者和非糖尿病组受试者的营养评估结果显示,两组受试者的营养情况组间比较差异具有统计学意义(P<0.05)。见表2
糖尿病组患者的肥胖和超重比例均高于非糖尿病组,组间比较差异具有统计学意义(P<0.05)。见表3
肥胖组、超重组、体重正常组糖尿病患者日均总能量摄入水平组间比较差异具有统计学意义(P<0.05),且肥胖组和超重组糖尿病患者日均总能量摄入水平高于体重正常组(P<0.05)。见表4
肥胖组、超重组、体重正常组糖尿病患者碳水化合物供能比、蛋白质供能比、脂肪供能比、组间差异不具有统计学意义(P>0.05)。见表5
营养不良是糖尿病老年患者的常见问题,国人也逐渐关注糖尿病患者的营养问题[9-10]。西班牙的一项关于住院的糖尿病老年患者的临床研究发现,营养不良和营养不良风险的发生率分别为21.20%和39.10%,提示糖尿病老年患者存在明显的营养问题[11]。本研究采用MNA-SF对某体检中心收治的体检者进行营养评估,结果显示,糖尿病组患者营养不良率和营养不良风险率分别为13.85%和46.15%,高于非糖尿病组(6.25%和42.34%),存在营养问题的糖尿病老年患者占50%以上,提示糖尿病老年患者存在明显的营养问题。另外,糖尿病患者的总能量摄入过量的比例为70.00%,高于非糖尿病组(39.92%),提示糖尿病老年患者存在明显的总能量摄入过量问题。
肥胖和超重会增加糖尿病发病风险,且会造成胰岛素抵抗的增加,使血糖控制更加困难[12-13]。本研究结果显示,糖尿病组患者的肥胖率和超重率分别为23.08%和38.46%,高于非糖尿病组(13.71%和34.76%),体重异常患者占比61%,提示糖尿病组患者存在明显的肥胖和超重问题。另外,本研究中糖尿病组总能量摄入过量的患者比例高于非糖尿病组,推测糖尿病组患者的能量摄入问题可能与患者的肥胖有关,了解糖尿病患者肥胖与能量和营养摄入的关系有助于改善临床医学营养治疗效果。本研究结果显示,肥胖组和超重组糖尿病患者的日均总能量摄入水平分别为(2 487.43±135.23)kcal和(2 214.28±119.59)kcal,均高于体重正常组(2 048.56±121.65 kcal),而《中国居民营养与慢性疾病状况报告》2015年版[14]显示日人均摄入量为2 172 kcal,本研究中肥胖受试者日均摄入总能量高于该标准,提示过量摄入能量可能是引起糖尿病患者肥胖的原因之一。
本研究进一步分析了不同肥胖程度糖尿病患者的营养摄入情况,结果显示,肥胖组糖尿病患者的碳水化合物摄入量、蛋白质摄入量及脂肪摄入量均高于体重正常组,膳食纤维摄入量低于体重正常组,推测原因可能是糖尿病患者进食主食过多。文献报道显示[15-16],肥胖的糖尿病患者存在明显的“脑奖赏机制”和“病理性饥饿感”,患者脂肪细胞产生的瘦素、胰岛B细胞分泌的胰岛素及胰高血糖素样肽1将饥饿的信号传至下丘脑摄食调节神经通路,使患者产生饥饿感,进而增加进食量,导致摄入过多的碳水化合物和能量[17-18]。另外本研究中不同肥胖程度的糖尿病患者的脂肪供能比均高于30%,而指南推荐的脂肪供能比为20%~25%,提示脂肪供能比过量可能是糖尿病患者发病的重要原因之一。此外,本研究中不同肥胖程度的糖尿病患者的膳食纤维摄入量均低于指南推荐的标准量25~50 g,且肥胖患者膳食纤维摄入量低于体重正常组。因此,可以通过干预糖尿病患者饮食,针对肥胖的糖尿病患者,控制碳水化合物和脂肪的摄入,同时增加膳食纤维的摄入量,可能有助于改善糖尿病患者糖脂代谢水平,降低糖尿病的发病率及肥胖率。
综上,该体检中心糖尿病患者存在营养不良率较高,总能量摄入过量、肥胖患者比例较高的问题,且肥胖患者总能量摄入过量,主要来源于碳水化合物,建议降低肥胖的糖尿病患者的碳水化合物及脂肪摄入,增加膳食纤维,对临床上糖尿病患者的饮食控制具有一定的指导意义。但是本研究也存在一定的缺陷,本研究中受试者均为某体检中心进行体检的受试者,纳入受试者的代表性可能有一定的偏差。
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doi: 10.20043/j.cnki.MPM.202306246
  • 接收时间:2023-06-15
  • 首发时间:2026-03-19
  • 出版时间:2024-01-10
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    瑞金医院无锡分院门诊,江苏 无锡 214142

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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
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Percentage of total
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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
栓菌属 Trametes 5 2.39
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