Article(id=1324078152749818498, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078037817504735, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202509021, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1756742400000, receivedDateStr=2025-09-02, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614431797, onlineDateStr=2026-11-02, pubDate=1770652800000, pubDateStr=2026-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614431797, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614431797, creator=13701087609, updateTime=1793614431797, updator=13701087609, issue=Issue{id=1324078037817504735, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='3', pageStart='385', pageEnd='576', issueExtLink='null', onlineDate='null', pubDate='1770652800000', pubDateStr='2026-02-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614404396, creator='13701087609', updateTime=1793614474144, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324078330420527919, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078037817504735, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324078330420527920, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078037817504735, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=447, endPage=452, ext={EN=ArticleExt(id=1324078154419151491, articleId=1324078152749818498, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association between dietary diversity and nutritional status among community-dwelling older adults in Shanghai, columnId=1228016572783063333, journalTitle=Modern Preventive Medicine, columnName=Nutrition and Food Hygiene, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the correlation between daily dietary diversity and nutritional status among community-dwelling older adults.

Methods

Data were collected from April to October 2024 from 4 578 elderly individuals (aged≥60 years)in the four towns of Jiading District, Shanghai, employing a multistage cluster random sampling approach. A Dietary Diversity Score (DDS) was constructed based on nine food groups: cereals, vegetables, fruits, livestock meat, fish/shrimp, eggs, milk/dairy products, legumes/legume products, and oils/fats. Nutritional status was assessed using the Mini Nutritional Assessment (MNA).Ordinal logistic regression analysis was employed to examine the relationship between DDS and nutritional status, as well as the impact of specific food group intake on nutritional status.

Results

The malnourished group exhibited characteristics including older age (63.46%), primary school education or less (69.23%), non-married status (51.92%), and underweight status (25.00%).DDS was a protective factor for nutritional status in older adults (OR=1.986, 95% CI:1.649-2.392, P<0.001). The well-nourished group reported significantly higher intake frequencies than the malnourished group for fruits (χ2=50.507, P<0.001),vegetables (χ2=17.496, P<0.001), legumes (χ2=20.340, P<0.001), milk/dairy products (χ2=50.472, P<0.001), eggs (χ2=81.994,P<0.001), fish/seafood (χ2=9.825, P=0.007), and meat (χ2=52.414, P<0.001). Intake of fruits, legumes, milk/dairy products,eggs, and meat significantly increased the probability of improved nutritional status (P<0.05). The effect sizes were most pronounced for meat (OR=1.170, 95% CI: 1.470-2.718) and eggs (OR=1.123, 95% CI:1.499-2.358).

Conclusion

Promoting dietary diversity among community-dwelling older adults may help mitigate the risk of deteriorating nutritional status.

, authors=Bo-rui YANG1, Chu SHEN2, Hong-fei ZHU1, Yi-shan XU1, Li-feng ZHOU3, Ying WANG1, authorsList=Bo-rui YANG, Chu SHEN, Hong-fei ZHU, Yi-shan XU, Li-feng ZHOU, Ying WANG, authorCompany=null, correspAuthors=Li-feng ZHOU, authorNote=null, correspAuthorsNote=null, 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=1324078155329315462, articleId=1324078152749818498, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=上海市社区老年人食物多样性与营养状况的相关性研究, columnId=1228016573034721597, journalTitle=现代预防医学, columnName=营养与食品卫生, runingTitle=null, highlight=null, articleAbstract=
目的

探究社区老年人日常食物摄入多样化与营养状况的相关性。

方法

2024年4—10月于上海市嘉定区四街镇采用多阶段整群随机抽样法调查≥60岁老年人4 578例。食物多样化评分(dietary diversity score,DDS)以谷类、蔬菜类、水果类、畜肉类、鱼虾类、蛋类、奶类及奶制品、豆类及豆制品、油脂类等九个食物种类构建。使用微型营养评估量表(mini nutritional assessment,MNA)评估社区老年人的营养状况。采用有序logistic回归探讨DDS与老年人营养状况的关系以及各类食物摄入对老年人营养状况的影响。

结果

营养不良组呈高龄(63.46%)、小学及以下文化程度(69.23%)、非在婚状态(51.92%)和低体重状态(25.00%)特征。DDS是老年人营养状况的保护因素(OR=1.986,95% CI:1.649~2.392,P<0.001)。营养良好组水果(χ2=50.507,P<0.001)、蔬菜(χ2=17.496,P<0.001)、豆类(χ2=20.340,P<0.001)、牛奶或奶制品(χ2=50.472,P<0.001)、蛋类(χ2=81.994,P<0.001)、鱼或海鲜(χ2=9.825,P=0.007)和肉类(χ2=52.414,P<0.001)摄入频率均高于营养不良组。水果、豆类、牛奶或奶制品、蛋类和肉类摄入均显著提升老年人营养状况改善概率(P<0.05),效应强度以肉类(OR=1.170,95% CI:1.470~2.718)和蛋类(OR=1.123,95% CI:1.499~2.358)最为突出。

结论

提示在社区老年人中关注并改善其食物多样性,可能有助于降低营养状况恶化的风险。

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杨博瑞(2001—),女,硕士在读,研究方向:社会医学健康老龄化

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周黎峰,E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点,除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=UHYvgHRAz3LggFqHG1vV5Q==, magXml=PM4gGXJuGZ1aHGn4pb+6Ug==, pdfUrl=null, pdf=W0xaC0wL/t7Hh7m3nY3GvA==, pdfFileSize=683198, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=p90Oxxwx2qfo8Rooxo/NzA==, mapNumber=null, fund=null)}, authors=[Author(id=1324078155887157903, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1324078155983626897, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, authorId=1324078155887157903, language=EN, stringName=Bo-rui YANG, firstName=Bo-rui, middleName=null, lastName=YANG, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, address=School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1324078156054930066, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, authorId=1324078155887157903, language=CN, stringName=杨博瑞, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, address=1.复旦大学公共卫生学院/公共卫生安全教育部重点实验室/国家卫生健康委员会卫生技术评估重点实验室,上海 200032, bio={"content":"

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BMC Public Health, 2024, 24: 1465., articleTitle=Relationships between oral function,dietary intake and nutritional status in older adults aged 75 years and above:a cross-sectional study, refAbstract=null), Reference(id=1324078164959437530, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, doi=null, pmid=null, pmcid=null, year=2025, volume=39, issue=3, pageStart=290, pageEnd=293, url=null, language=null, rfNumber=[20], rfOrder=29, authorNames=王晓琴, 方镇堃, 吴晨凯, journalName=实用老年医学, refType=null, unstructuredReference=王晓琴,方镇堃,吴晨凯,等.膳食营养素养对社区老年人营养风险的影响研究[J].实用老年医学,2025,39(3):290-293., articleTitle=膳食营养素养对社区老年人营养风险的影响研究, refAbstract=null), Reference(id=1324078165039129307, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, doi=null, pmid=null, pmcid=null, year=2025, volume=39, issue=3, pageStart=290, pageEnd=293, url=null, language=null, rfNumber=[20], rfOrder=30, authorNames=Wang XQ, Fang ZK, Wu CK, journalName=Practical Geriatrics, refType=null, unstructuredReference=Wang XQ, Fang ZK, Wu CK, et al. Effect of dietary nutrition literacy on nutritional risk of elderly People in the community[J]. Practical Geriatrics, 2025, 39(3): 290-293. (In Chinese), articleTitle=Effect of dietary nutrition literacy on nutritional risk of elderly People in the community, refAbstract=null), Reference(id=1324078165123015388, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, doi=null, pmid=null, pmcid=null, year=2006, volume=291, issue=2, pageStart=E381, pageEnd=E387, url=null, language=null, rfNumber=[21], rfOrder=31, authorNames=Katsanos CS, Kobayashi H, Sheffield-Moore M, journalName=American Journal of Physiology. Endocrinology and Metabolism, refType=null, unstructuredReference=Katsanos CS, Kobayashi H, Sheffield-Moore M, et al. A high proportion of leucine is required for optimal stimulation of the rate of muscle protein synthesis by essential amino acids in the elderly[J]. American Journal of Physiology. 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"Megacity elderly care": How Shanghai is enhancing senior satisfaction through comprehensive service upgrades[EB/OL]. [2025-11-29]. https://www.shanghai.gov.cn/nw4411/20250521/9cd16db60e124efeaab01936311e8f05.html. (In Chinese), articleTitle="Megacity elderly care": How Shanghai is enhancing senior satisfaction through comprehensive service upgrades, refAbstract=null)], funds=[Fund(id=1324078160488309436, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, awardId=GWGZLXK-2023-02, language=CN, fundingSource=复旦-嘉定公共卫生高质量发展重点学科项目(GWGZLXK-2023-02), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324078155580973703, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, xref=1., ext=[AuthorCompanyExt(id=1324078155593556616, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, companyId=1324078155580973703, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China), AuthorCompanyExt(id=1324078155606139529, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, companyId=1324078155580973703, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.复旦大学公共卫生学院/公共卫生安全教育部重点实验室/国家卫生健康委员会卫生技术评估重点实验室,上海 200032)]), AuthorCompany(id=1324078155681637002, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, xref=2., ext=[AuthorCompanyExt(id=1324078155715191435, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, companyId=1324078155681637002, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.上海市嘉定区安亭镇社区卫生服务中心)]), AuthorCompany(id=1324078155803271820, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, xref=3., ext=[AuthorCompanyExt(id=1324078155811660429, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, companyId=1324078155803271820, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.上海市嘉定区外冈镇社区卫生服务中心,上海 201806)])], figs=[ArticleFig(id=1324078159842386612, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, language=EN, label=Table 1, caption=

Nutritional status and DDS of older adults by characteristic [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
项目总体不同营养状态人群分布DDS
营养不良
(n=52)
营养不良风险
(n=1008)
营养良好
(n=3 518)
χ2值P值不足
(n=22)
适中
(n=624)
充足
(n=3 932)
χ2值P值
性别47.192<0.0012.5130.285
男2 158(47.14)16(30.77)387(38.39)1 755(49.89)7(31.82)287(45.99)1 864(47.41)
女2 420(52.86)36(69.23)621(61.61)1 763(50.11)15(68.18)337(54.01)2 068(52.59)
年龄(岁)338.929<0.00134.957<0.001
60~692 153(47.03)6(11.54)344(34.13)1 803(51.25)5(22.73)259(41.51)1 889(48.04)
70~791 706(37.27)13(25.00)388(38.49)1 305(37.09)11(50.00)224(35.90)1 471(37.41)
80~89609(13.30)20(38.46)221(21.92)368(10.46)6(27.27)119(19.07)484(12.31)
≥90110(2.40)13(25.00)55(5.46)42(1.19)0(0.00)22(3.53)88(2.24)
民族10.4890.0050.0950.954
汉族4 569(99.80)52(100.00)1 002(99.40)3 515(99.91)22(100.00)623(99.84)3 924(99.80)
其他9(0.20)0(0.00)6(0.60)3(0.09)0(0.00)1(0.16)8(0.20)
文化程度102.889<0.00122.311<0.001
小学及以下1 925(42.05)36(69.23)545(54.07)1 344(38.20)11(50.00)315(50.48)1 599(40.67)
初中1 939(42.35)10(19.23)361(35.81)1 568(44.57)7(31.82)227(36.38)1 705(43.36)
高中及以上714(15.60)6(11.54)102(10.12)606(17.23)4(18.18)82(13.14)628(15.97)
婚姻状况103.634<0.00115.303<0.001
在婚3 885(84.86)25(48.08)790(78.37)3 070(87.27)19(86.36)497(79.65)3 369(85.68)
其他693(15.14)27(51.92)218(21.63)448(12.73)3(13.64)127(20.35)563(14.32)
居住情况2.1850.3355.2370.073
同住4 162(90.91)45(86.54)909(90.18)3 208(91.19)19(86.36)553(88.62)3 590(91.30)
独居416(9.09)7(13.46)99(9.82)310(8.81)3(13.64)71(11.38)342(8.70)
吸烟情况39.74<0.0014.6060.330
从不吸烟3 243(70.84)47(90.38)776(76.98)2 420(68.79)18(81.82)442(70.83)2 783(70.78)
已戒烟368(8.04)2(3.85)78(7.74)288(8.19)1(4.55)40(6.41)327(8.32)
吸烟967(21.12)3(5.77)154(15.28)810(23.02)3(13.64)142(22.76)822(20.91)
饮酒情况39.85<0.0015.6140.230
从不饮酒3 650(79.73)49(94.23)843(83.63)2 758(78.40)21(95.45)505(80.93)3 124(79.45)
已戒酒154(3.36)1(1.92)48(4.76)105(2.98)1(4.55)22(3.53)131(3.33)
饮酒774(16.91)2(3.85)117(11.61)655(18.62)0(0.00)97(15.54)677(17.22)
BMI633.553<0.0016.0220.421
偏瘦115(2.51)13(25.00)98(9.72)4(0.11)1(4.55)21(3.37)93(2.37)
正常1 846(40.32)19(36.54)579(57.44)1 248(35.47)9(40.91)231(37.02)1 606(40.84)
过重1 947(42.53)19(36.54)261(25.89)1 667(47.38)9(40.91)270(43.27)1 668(42.42)
肥胖670(14.64)1(1.92)70(6.94)599(17.03)3(13.64)102(16.35)565(14.37)
), ArticleFig(id=1324078159938855605, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, language=CN, label=表1, caption=

不同特征的老年人营养状态和DDS[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
项目总体不同营养状态人群分布DDS
营养不良
(n=52)
营养不良风险
(n=1008)
营养良好
(n=3 518)
χ2值P值不足
(n=22)
适中
(n=624)
充足
(n=3 932)
χ2值P值
性别47.192<0.0012.5130.285
男2 158(47.14)16(30.77)387(38.39)1 755(49.89)7(31.82)287(45.99)1 864(47.41)
女2 420(52.86)36(69.23)621(61.61)1 763(50.11)15(68.18)337(54.01)2 068(52.59)
年龄(岁)338.929<0.00134.957<0.001
60~692 153(47.03)6(11.54)344(34.13)1 803(51.25)5(22.73)259(41.51)1 889(48.04)
70~791 706(37.27)13(25.00)388(38.49)1 305(37.09)11(50.00)224(35.90)1 471(37.41)
80~89609(13.30)20(38.46)221(21.92)368(10.46)6(27.27)119(19.07)484(12.31)
≥90110(2.40)13(25.00)55(5.46)42(1.19)0(0.00)22(3.53)88(2.24)
民族10.4890.0050.0950.954
汉族4 569(99.80)52(100.00)1 002(99.40)3 515(99.91)22(100.00)623(99.84)3 924(99.80)
其他9(0.20)0(0.00)6(0.60)3(0.09)0(0.00)1(0.16)8(0.20)
文化程度102.889<0.00122.311<0.001
小学及以下1 925(42.05)36(69.23)545(54.07)1 344(38.20)11(50.00)315(50.48)1 599(40.67)
初中1 939(42.35)10(19.23)361(35.81)1 568(44.57)7(31.82)227(36.38)1 705(43.36)
高中及以上714(15.60)6(11.54)102(10.12)606(17.23)4(18.18)82(13.14)628(15.97)
婚姻状况103.634<0.00115.303<0.001
在婚3 885(84.86)25(48.08)790(78.37)3 070(87.27)19(86.36)497(79.65)3 369(85.68)
其他693(15.14)27(51.92)218(21.63)448(12.73)3(13.64)127(20.35)563(14.32)
居住情况2.1850.3355.2370.073
同住4 162(90.91)45(86.54)909(90.18)3 208(91.19)19(86.36)553(88.62)3 590(91.30)
独居416(9.09)7(13.46)99(9.82)310(8.81)3(13.64)71(11.38)342(8.70)
吸烟情况39.74<0.0014.6060.330
从不吸烟3 243(70.84)47(90.38)776(76.98)2 420(68.79)18(81.82)442(70.83)2 783(70.78)
已戒烟368(8.04)2(3.85)78(7.74)288(8.19)1(4.55)40(6.41)327(8.32)
吸烟967(21.12)3(5.77)154(15.28)810(23.02)3(13.64)142(22.76)822(20.91)
饮酒情况39.85<0.0015.6140.230
从不饮酒3 650(79.73)49(94.23)843(83.63)2 758(78.40)21(95.45)505(80.93)3 124(79.45)
已戒酒154(3.36)1(1.92)48(4.76)105(2.98)1(4.55)22(3.53)131(3.33)
饮酒774(16.91)2(3.85)117(11.61)655(18.62)0(0.00)97(15.54)677(17.22)
BMI633.553<0.0016.0220.421
偏瘦115(2.51)13(25.00)98(9.72)4(0.11)1(4.55)21(3.37)93(2.37)
正常1 846(40.32)19(36.54)579(57.44)1 248(35.47)9(40.91)231(37.02)1 606(40.84)
过重1 947(42.53)19(36.54)261(25.89)1 667(47.38)9(40.91)270(43.27)1 668(42.42)
肥胖670(14.64)1(1.92)70(6.94)599(17.03)3(13.64)102(16.35)565(14.37)
), ArticleFig(id=1324078160014353078, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, language=EN, label=Table 2, caption=

Comparison of food intake by nutritional status group [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数谷类水果蔬菜豆类油脂类牛奶或奶制品蛋类鱼或海鲜肉类
营养不良5249(94.23)41(78.85)50(96.15)32(61.54)51(98.08)28(53.85)42(80.77)40(76.92)44(84.62)
有营养不良风险1 008942(93.45)843(83.63)998(99.01)723(71.73)989(98.12)530(52.58)837(83.04)788(78.17)926(91.87)
营养良好3 5183 293(93.60)3 202(91.02)3 506(99.66)2 726(77.49)3 563(98.44)2 277(64.72)3 249(92.35)2 898(82.38)3 396(96.53)
χ2值0.06750.50717.49620.3400.52950.47281.9949.82552.414
P值0.967<0.001<0.001<0.0010.768<0.001<0.0010.007<0.001
), ArticleFig(id=1324078160081461943, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, language=CN, label=表2, caption=

不同营养状况组食物摄入情况比较[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数谷类水果蔬菜豆类油脂类牛奶或奶制品蛋类鱼或海鲜肉类
营养不良5249(94.23)41(78.85)50(96.15)32(61.54)51(98.08)28(53.85)42(80.77)40(76.92)44(84.62)
有营养不良风险1 008942(93.45)843(83.63)998(99.01)723(71.73)989(98.12)530(52.58)837(83.04)788(78.17)926(91.87)
营养良好3 5183 293(93.60)3 202(91.02)3 506(99.66)2 726(77.49)3 563(98.44)2 277(64.72)3 249(92.35)2 898(82.38)3 396(96.53)
χ2值0.06750.50717.49620.3400.52950.47281.9949.82552.414
P值0.967<0.001<0.001<0.0010.768<0.001<0.0010.007<0.001
), ArticleFig(id=1324078160156959416, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, language=EN, label=Table 3, caption=

Ordinal logistic regression analysis of the association between dietary diversity level and nutritional status in older adults

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β标准误WaldP值OR值(95%CI)
模型10.6700.08660.921<0.0011.954(1.652~2.312)
模型20.5880.08943.696<0.0011.800(1.511~2.143)
模型30.5750.08941.49<0.0011.777(1.492~2.115)
模型40.6860.09551.133<0.0011.986(1.649~2.392)
), ArticleFig(id=1324078160236651193, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, language=CN, label=表3, caption=

食物多样化水平与老年人营养状况的有序logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β标准误WaldP值OR值(95%CI)
模型10.6700.08660.921<0.0011.954(1.652~2.312)
模型20.5880.08943.696<0.0011.800(1.511~2.143)
模型30.5750.08941.49<0.0011.777(1.492~2.115)
模型40.6860.09551.133<0.0011.986(1.649~2.392)
), ArticleFig(id=1324078160316342970, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, language=EN, label=Table 4, caption=

Results of the ordinal logistic regression analysis on the relationship between nutritional status and food variety intake in older adults

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β标准误WaldP值OR值(95%CI)
谷类-0.1800.1471.4860.2231.158(0.626~1.115)
水果0.5060.10622.618<0.0011.112(1.347~2.044)
蔬菜0.4410.4271.0690.3011.533(0.674~3.589)
豆类0.1870.0835.1340.0231.087(1.025~1.418)
油脂类-0.0600.2760.0480.8271.318(0.548~1.618)
牛奶或奶制品0.2990.07615.302<0.0011.079(1.161~1.565)
蛋类0.6320.11629.92<0.0011.123(1.499~2.358)
鱼或海鲜-0.1570.1002.4730.1161.105(0.702~1.040)
肉类0.6920.15719.456<0.0011.170(1.470~2.718)
), ArticleFig(id=1324078160396034747, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078152749818498, language=CN, label=表4, caption=

老年人营养状况和摄入食物种类关系的有序logistic回归结果

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β标准误WaldP值OR值(95%CI)
谷类-0.1800.1471.4860.2231.158(0.626~1.115)
水果0.5060.10622.618<0.0011.112(1.347~2.044)
蔬菜0.4410.4271.0690.3011.533(0.674~3.589)
豆类0.1870.0835.1340.0231.087(1.025~1.418)
油脂类-0.0600.2760.0480.8271.318(0.548~1.618)
牛奶或奶制品0.2990.07615.302<0.0011.079(1.161~1.565)
蛋类0.6320.11629.92<0.0011.123(1.499~2.358)
鱼或海鲜-0.1570.1002.4730.1161.105(0.702~1.040)
肉类0.6920.15719.456<0.0011.170(1.470~2.718)
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上海市社区老年人食物多样性与营养状况的相关性研究
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杨博瑞 1 , 沈初 2 , 朱鸿飞 1 , 徐艺珊 1 , 周黎峰 3 , 王颖 1
现代预防医学 | 营养与食品卫生 2026,53(3): 447-452
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现代预防医学 |营养与食品卫生 2026 , 53 (3) : 447 -452
上海市社区老年人食物多样性与营养状况的相关性研究
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杨博瑞1, 沈初2, 朱鸿飞1, 徐艺珊1, 周黎峰3 , 王颖1
作者信息
  • 1.复旦大学公共卫生学院/公共卫生安全教育部重点实验室/国家卫生健康委员会卫生技术评估重点实验室,上海 200032
  • 2.上海市嘉定区安亭镇社区卫生服务中心
  • 3.上海市嘉定区外冈镇社区卫生服务中心,上海 201806
通讯作者:
周黎峰,E-mail:
作者简介:

杨博瑞(2001—),女,硕士在读,研究方向:社会医学健康老龄化

Association between dietary diversity and nutritional status among community-dwelling older adults in Shanghai
Bo-rui YANG1, Chu SHEN2, Hong-fei ZHU1, Yi-shan XU1, Li-feng ZHOU3 , Ying WANG1
Affiliations
  • School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
出版时间: 2026-02-10 doi: 10.20043/j.cnki.MPM.202509021
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目的

探究社区老年人日常食物摄入多样化与营养状况的相关性。

方法

2024年4—10月于上海市嘉定区四街镇采用多阶段整群随机抽样法调查≥60岁老年人4 578例。食物多样化评分(dietary diversity score,DDS)以谷类、蔬菜类、水果类、畜肉类、鱼虾类、蛋类、奶类及奶制品、豆类及豆制品、油脂类等九个食物种类构建。使用微型营养评估量表(mini nutritional assessment,MNA)评估社区老年人的营养状况。采用有序logistic回归探讨DDS与老年人营养状况的关系以及各类食物摄入对老年人营养状况的影响。

结果

营养不良组呈高龄(63.46%)、小学及以下文化程度(69.23%)、非在婚状态(51.92%)和低体重状态(25.00%)特征。DDS是老年人营养状况的保护因素(OR=1.986,95% CI:1.649~2.392,P<0.001)。营养良好组水果(χ2=50.507,P<0.001)、蔬菜(χ2=17.496,P<0.001)、豆类(χ2=20.340,P<0.001)、牛奶或奶制品(χ2=50.472,P<0.001)、蛋类(χ2=81.994,P<0.001)、鱼或海鲜(χ2=9.825,P=0.007)和肉类(χ2=52.414,P<0.001)摄入频率均高于营养不良组。水果、豆类、牛奶或奶制品、蛋类和肉类摄入均显著提升老年人营养状况改善概率(P<0.05),效应强度以肉类(OR=1.170,95% CI:1.470~2.718)和蛋类(OR=1.123,95% CI:1.499~2.358)最为突出。

结论

提示在社区老年人中关注并改善其食物多样性,可能有助于降低营养状况恶化的风险。

营养状况  /  老年人  /  食物多样化  /  微型营养评定量表
Objective

To investigate the correlation between daily dietary diversity and nutritional status among community-dwelling older adults.

Methods

Data were collected from April to October 2024 from 4 578 elderly individuals (aged≥60 years)in the four towns of Jiading District, Shanghai, employing a multistage cluster random sampling approach. A Dietary Diversity Score (DDS) was constructed based on nine food groups: cereals, vegetables, fruits, livestock meat, fish/shrimp, eggs, milk/dairy products, legumes/legume products, and oils/fats. Nutritional status was assessed using the Mini Nutritional Assessment (MNA).Ordinal logistic regression analysis was employed to examine the relationship between DDS and nutritional status, as well as the impact of specific food group intake on nutritional status.

Results

The malnourished group exhibited characteristics including older age (63.46%), primary school education or less (69.23%), non-married status (51.92%), and underweight status (25.00%).DDS was a protective factor for nutritional status in older adults (OR=1.986, 95% CI:1.649-2.392, P<0.001). The well-nourished group reported significantly higher intake frequencies than the malnourished group for fruits (χ2=50.507, P<0.001),vegetables (χ2=17.496, P<0.001), legumes (χ2=20.340, P<0.001), milk/dairy products (χ2=50.472, P<0.001), eggs (χ2=81.994,P<0.001), fish/seafood (χ2=9.825, P=0.007), and meat (χ2=52.414, P<0.001). Intake of fruits, legumes, milk/dairy products,eggs, and meat significantly increased the probability of improved nutritional status (P<0.05). The effect sizes were most pronounced for meat (OR=1.170, 95% CI: 1.470-2.718) and eggs (OR=1.123, 95% CI:1.499-2.358).

Conclusion

Promoting dietary diversity among community-dwelling older adults may help mitigate the risk of deteriorating nutritional status.

Nutritional status  /  Older adults  /  Dietary Diversity Sscore  /  Mini Nutritional Assessment
杨博瑞, 沈初, 朱鸿飞, 徐艺珊, 周黎峰, 王颖. 上海市社区老年人食物多样性与营养状况的相关性研究. 现代预防医学, 2026 , 53 (3) : 447 -452 . DOI: 10.20043/j.cnki.MPM.202509021
Bo-rui YANG, Chu SHEN, Hong-fei ZHU, Yi-shan XU, Li-feng ZHOU, Ying WANG. Association between dietary diversity and nutritional status among community-dwelling older adults in Shanghai[J]. Modern Preventive Medicine, 2026 , 53 (3) : 447 -452 . DOI: 10.20043/j.cnki.MPM.202509021
当代中国社会正面临人口老龄化的长期态势。作为率先进入深度老龄化的特大城市,上海市老龄化程度高于全国水平。2024年底数据显示,上海市户籍60岁及以上老年人口有577.62万,占总人口的37.6%[1]。面对如此庞大的老年群体,保障其健康和福祉对于城市发展具有重要意义。
伴随生理及社会心理因素,老年人面临较高的营养不良风险,但良好的营养状况是延缓功能衰退、提升生活质量的基础。上海社区老年人营养不良风险比例约为13.3%[2],营养不良会带来肌肉减少、免疫力下降以及伤口愈合延迟进而增加住院需求、失能率和死亡风险[3]。许多研究证实[4-6],食物多样性提升有助于全面摄入营养,为机体的生理需求提供保障,对维持老年人的营养均衡尤为重要。
目前现有相关研究多聚焦于全国层面或农村地区,且往往局限于养老院、医院等特定场景。以上海为代表的超大城市正经历深度老龄化进程,其社区结构、养老模式、居民生活水平与饮食文化均呈现出鲜明的地域特征,在这一独特社会经济文化背景下,老年人的饮食模式显著区别于其他地区,而现有研究尚未揭示该人群饮食多样性与营养状况之间的关联。因此,本研究聚焦于上海市社区老年人群,利用食物多样性评分与微型营养评定量表探索上海市社区老年人饮食情况与营养状况之间的关联,为制定符合超大城市社区特点的个性化营养干预策略提供科学依据,助力健康老龄化目标的实现。
本研究于2024年4—10月在上海市嘉定区南翔、安亭、外冈、华亭四个街镇开展,采用多阶段整群随机抽样的方法,依据各街镇60岁及以上老年人年龄和性别结构确定调查名单。在每个街道随机抽取1个居委,若样本量不足则继续随机抽取下一居委,直至满足要求。最终由村居委工作人员及楼组长负责告知被抽中的老人。
采用以下公式计算调查样本量:
其中N为计算出的样本量;α为显著性检验水平,一般取值为0.05;uα/2为正态分布中累积概率等于α/2时的μ值,α=0.05时,uα/2=1.96;δ为精确度,δ=0.015;p为检出估计值,根据现有资料显示,我国41.2%的社区老年人群存在营养不良和面临营养不良风险[7]。因而,计算所得总调查样本量不少于4 137人。
样本纳入标准:(1)抽样社区连续居住时间≥6个月的常住老年人;(2)60岁及以上;(3)思维清晰,能够与调查员正常沟通;(4)知情同意并愿意参与调查。样本排除标准:(1)存在感染、急性情况(包括急性心力衰竭、急性冠状动脉综合征及急性肺炎等)严重疾病;(2)经神经科医生诊断的严重认知障碍;(3)处于生命终末期或其他无法完成的情况。本研究已获得复旦大学伦理审查委员会的批准(IRB#2024-TYSQ-02-369),所有研究对象知情并均签署了知情同意书,最终回收有效问卷4 578份。
本研究采用问卷调查结合体格测量的方式采集数据,由培训合格的调查员对老年受试者进行面对面调查,调查内容包括社会人口学特征、身体质量指数(body mass index,BMI)、食物摄入频率调查、食物多样性评分(dietary diversity score,DDS)和营养状况等五个方面。
采用自行设计的调查问卷收集相关信息,主要涵盖性别、年龄、民族、文化程度、婚姻状况、居住情况、吸烟情况和饮酒情况。
基于体格检查收集体重和身高数据,依据公式进行BMI的计算,根据计算结果将<18.5 kg/㎡定义为偏瘦,18.5~23.9 kg/㎡属于正常体重范围,24.0~27.9 kg/㎡定义为过重体重,≥28.0 kg/㎡为肥胖[8]。
本研究通过自我报告的每周食物摄入频率问卷开展调查,问卷采用公认高效的九类食物分类法[9],该分类为问卷原始设定,未经合并。具体包括:谷类、蔬菜类、水果类、畜肉类、鱼虾类、蛋类、奶类及奶制品、豆类及豆制品、油脂类。记录每类食物每周消费情况,并按摄入频率进行二分类赋值:“每周至少摄入1次”记录为1,“每周摄入不足1次或从不摄入”记录为0。
基于上述九类食物的摄入情况,本研究构建了食物多样化评估体系[10],该评分依据每周内累积消费的食物种类数进行计算,不计入食物的摄入数量。每摄入一类食物计1分,重复摄入同一类食物不计分,最高分值为9分。DDS分值越高表明食物多样化越高。根据既有研究标准,评分结果可分为3个等级:1~3分为食物多样性不足,4~6分为食物多样性适中,7~9分为食物多样性充足[11]。
MNA量表是专门评估老年人营养状况的工具,涵盖人体测量、整体评定、饮食评价和主观评定四方面,共18个条目,总分范围为0~30分[12]。依据得分可以划分为三个级别,得分≥24分表示营养状况良好,17≤得分<24分表示存在营养不良风险,得分<17分则为营养不良[13]。
所有调查员均经过统一培训,在获取调查数据后,由专业人员对资料的准确性和完整性进行严格检查。为保证数据质量,所有回收问卷均采用EpiData软件执行双重录入流程,以确保数据录入的准确性和可靠性。
本研究数据预处理在Microsoft Excel 2021中进行,包括数据清洗、编码及基础统计描述,统计分析采用IBM SPSS Statistics 27.0进行。分类变量以频数及百分比呈现,组间差异采用χ2检验评估。为分析DDS与营养状况的独立关联,评估潜在混杂因素的影响,本研究构建了4个有序logistic回归模型:模型1未校正任何混杂因素,仅包含食物多样化水平和营养情况;模型2加入了年龄、性别和民族等人口学特征变量;模型3进一步调整了年龄、性别、文化程度、婚姻状况和居住情况等社会经济因素;模型4进一步加入吸烟情况、饮酒情况以及BMI等变量。双侧检验,以α=0.05为显著性水准。
本研究最终纳入4 578名研究对象,营养良好组有3 518例(76.86%)、营养不良风险组有1 008例(22.02%),营养不良组有52例(1.14%)。除居住状态外,不同营养状态人群的社会人口学特征均存在显著差异(P<0.05)。营养不良组呈现高龄(63.46%)、女性(69.23%)、小学及以下文化程度(69.23%)、非在婚状态(51.92%)和低体重状态(25.00%)的特征。
调查对象中食物多样性不足有22例(0.48%)、食物多样性适中624例(13.63%)、食物多样性充足3 932例(85.89%)。DDS在性别、民族、居住情况、吸烟饮酒情况和BMI等变量上的分布未呈现显著差异。年龄、文化程度及婚姻状况会显著影响老年人的DDS(P<0.05),高龄(27.27%)、小学及以下文化程度(50.00%)及非在婚状态(13.64%)构成食物多样化不足组的主要特征。见表1。
本研究发现调查对象谷类、蔬菜和油脂类摄入频率较高,而豆类、牛奶或奶制品和鱼或海鲜摄入频率较低。其中,营养良好组水果(χ2=50.507,P<0.001)、蔬菜(χ2=17.496,P<0.001)、豆类(χ2=20.340,P<0.001)、牛奶或奶制品(χ2=50.472,P<0.001)、蛋类(χ2=81.994,P<0.001)、鱼或海鲜(χ2=9.825,P=0.007)和肉类(χ2=52.414,P<0.001)的摄入频率均高于营养不良组,且差异具有统计学意义。见表2。
本研究采用有序logistic回归对食物多样性水平与老年人营养状况的关联性进行分析,结果显示,DDS等级提升与老年人营养状况改善呈正相关关系,且结果具有显著性(P<0.001),在不同调整模型下结果具有稳健性。这表明食物多样性是老年人营养状况的保护因素(β=0.686,OR=1.986,95% CI:1.649~2.392,P<0.001),食物多样性评分每提高一个等级,老年人营养状况改善的概率增加98.6%。见表3。
为深入探究九类食物摄入与老年人营养状况的关联,本研究进行了有序logistic回归分析,以营养状况作为因变量,以九类食物的摄入情况为自变量,并校正年龄、性别、文化程度、婚姻状况、居住状况和BMI等协变量。结果显示,水果、豆类、牛奶或奶制品、蛋类和肉类的摄入均显著提升老年人营养状况改善概率(P<0.05),其中肉类(OR=1.170,95% CI:1.470~2.718)和蛋类(OR=1.123,95% CI:1.499~2.358)效应最强。谷类、蔬菜和油脂类则未呈现显著关联。见表4。
健康老龄化是国家的重要战略,其核心目标不仅在于延长寿命,更注重维持老年人的功能独立性和生活质量[14]。营养不良引发的贫血和免疫功能下降会增加老年人感染、跌倒、失能等风险,威胁老年人的身体功能和生活质量。本研究分析了4 578名上海市社区老年人数据,22.02%老年人面临营养不良风险,营养不良者占比1.14%,这提示需要采取措施来改善上海市社区老年人的营养状态。
营养不良组老年人在年龄方面更趋高龄化,受教育程度普遍偏低,且非在婚比例较高,其DDS显著低于营养良好组(P<0.001),这一结果符合健康社会决定因素理论[15],低学历限制了个体营养信息获取、理解和应用能力,非在婚状态削弱了共同进餐的社会支持和备餐的便利性,导致食物结构单一化。行为模式分析结果显示,营养不良组老年人的吸烟率(5.77%)和饮酒率(3.85%)均低于营养良好组(23.02%和18.62%),且该组BMI<18.5 kg/㎡的比例达25.00%,表明营养不良的主因并非主动健康风险行为,而是长期能量与蛋白质摄入不足。
有序logistic回归结果发现DDS每提高一个等级,老年人营养状况改善的概率增加98.6%,两者呈显著正相关关系,这一发现与一项针对福建省社区老年人的研究发现一致[16]。进一步分析发现水果、豆类、奶制品、蛋类和肉类的摄入与营养改善显著相关(OR=1.079~1.170),肉类(OR=1.170)和蛋类(OR=1.123)的效应最强,该发现与多项既往研究结果相吻合[17-20]。肉类和蛋类具有提供优质蛋白且生物利用率高的优势,可弥补老年人蛋白质合成效率下降的不足,对促进肌肉修复和延缓肌肉衰减具有重要作用,同时可以供给维生素B12和铁来维持神经与脂质代谢和预防贫血[21]。因此,优化食物结构,保障优质蛋白和微量营养素摄入,对于延缓肌肉衰减和改善老年人健康状况具有重要意义。
为有效应对老年人营养不良风险问题,提升老年人的营养健康水平和生活质量,上海市可从以下几个方面采取措施:首先,加强社区营养筛查机制。结合社区卫生服务中心的常规体检,定期开展老年人营养状况评估,识别存在营养不良风险的个体,建立营养风险筛查档案,并针对不同营养状况的老年人制定科学的饮食指导和营养补充建议;其次,加强营养教育与社区支持体系,提升老年人的营养知识水平和自主管理能力。通过社区讲座、健康宣传手册等形式普及食物多样化、蛋白质摄入、维生素补充等方面的知识;此外,积极发挥家庭参与和共同进餐机制效能,以提升老年人获取多样化食物的意愿和能力。引导家庭成员参与老年人的日常饮食管理,同时依托社区食堂、老年助餐点等平台,鼓励共同用餐,增强社交支持;最后,上海的社区食堂和老年助餐点是解决老年人营养问题的核心力量。截至2024年底,全市共有405家长者食堂和2 406个各类助餐服务场所,日均供餐能力达到25万客次[22]。因此,需着力发挥社区助餐设施的作用,在社区食堂中引入营养配餐服务,根据老年人的健康状况和饮食偏好,提供低盐、低糖、高蛋白等个性化餐品。同时鼓励助餐点与营养领域专业人士合作,开展营养知识培训和饮食搭配指导,以提升整体供餐质量水平,切实降低老年人营养不良风险,提升其生活质量。
本研究的调查对象来源于上海市某区,其经济水平、饮食习惯等与其他地区存在差异,因此研究结论的外推需谨慎,未来需要在不同地域的老年人群中进行验证。其次,本研究为横断面调查,仅能揭示DDS与老年人营养状况之间的相关性,但无法明确两者之间的因果关系,且DDS是基于自我报告的食物摄入频率而非食物摄入量的定量测量,可能存在回忆偏差。未来研究可结合前瞻性队列研究,进一步探讨食物多样化对营养状况变化的动态影响。
综上所述,DDS是老年人营养状况的保护因素,水果、豆类、奶制品、蛋类和肉类的摄入与老年人的营养状况息息相关,在社区老年人中关注并改善其食物多样性,对于降低营养状况恶化的风险具有重要意义。
  • 复旦-嘉定公共卫生高质量发展重点学科项目(GWGZLXK-2023-02)
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doi: 10.20043/j.cnki.MPM.202509021
  • 接收时间:2025-09-02
  • 首发时间:2026-11-02
  • 出版时间:2026-02-10
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  • 收稿日期:2025-09-02
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复旦-嘉定公共卫生高质量发展重点学科项目(GWGZLXK-2023-02)
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    1.复旦大学公共卫生学院/公共卫生安全教育部重点实验室/国家卫生健康委员会卫生技术评估重点实验室,上海 200032
    2.上海市嘉定区安亭镇社区卫生服务中心
    3.上海市嘉定区外冈镇社区卫生服务中心,上海 201806

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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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