社区老年人2型糖尿病膳食危险因素分析

Analysis of the dietary risk factors in elderly type 2 diabetes mellitus patients of communities

目的分析社区老年人2型糖尿病（T2DM）的膳食危险因素，为T2DM的膳食防治提供科学依据。方法在体检人群中随机选取T2DM患者与健康对照者各426例进行病例一对照研究，体检者进行体格检查和实验室检查，并进行膳食问卷调查。比较两组间各变量差异，应用非条件logistic回归法分析T2DM膳食危险因素。结果病例组体质指数、收缩压、舒张压、空腹血糖、血清甘油三酯均高于对照组，差异均有统计学意义（P〈0．01）；每日摄入能量[（1941．96±843．14）keal]、蛋白质【（84．36±51．37）g]、维生素A[（1155．91±332．52）IxgRE]、铁【（40．43±28．91）mg】、锌[（12．77±10．86）mgl、硒[（64．12±35．87）斗朗均高于对照组[每日摄入能量（1806．86±581．48）keal、蛋白质（76．67±26．02）g、维生素A（745．53±121．52）lugRE、铁（34．23±11．63）mg、锌（11．11±7．97）mg、硒（55．73±21．54）¨剖，差异均有统计学意义（P〈O．05，P〈0．01）；膳食纤维【（21．76±7．38）g】、硫胺素【（1．66±0．14）mg】、钙[（870．84±226．21）mg]均低于对照组【膳食纤维（24．07±10．16）g、硫胺素（2．23±0．51）mg、钙（961．67±297131）mgl，差异均有统计学意义（P〈0．05，P〈0．01）；碳水化合物供能比（63．67％±6．66％）低于对照组（63．92％±6．65％），蛋白质供能比（15．32％±2．59％）高于对照组（15．17％±2．49％），差异均有统计学意义（P〈0．01，P〈0．05）；多因素非条件logistic回归分析显示，蛋白质（OR=1．015，95％CI：1．003～1．025）、铁（OR=1．003，95％CI：1．001-1．010）和维生素A（OR=1．004，95％CI：1．001～1．012）是T2DM的膳食危险因素，膳食纤维（OR=0．896，95％C1：0．884～0．918）、钙（OR=O．988，95％CI：0．972-0．998）和硫胺素（OR=O．406，95％CI：0．395-0．429）是T2DM的膳食保护因素。结论适当控制能量、蛋白质的摄人，适量增加蔬菜、水果等含食膳食纤维多的食物以及富含硫胺素的食物可以预防和减少T2DM的发牛。

Objective To analyze the dietary risk factors in elderly type 2 diabetes mellitus （T2DM） patients in communities, and to provide the scientific basis for prevention and treatment of T2DM. Methods T2DM cases （n=426） and healthy controls （n=426） were randomly selected for a case-control study, which was performed with the physical examination, laboratory test and the food frequency questionnaire. The differences between the two groups were compared, and the dietary risk factors of T2DM were analyzed by unconditional logistic regression. Results The levels of BMI, SBP, DBP, FPG and serum TG in case group were significantly higher than those in control group （P〈0.01）. The daily intakes of energy, protein, vitamin A, iron, zinc and selenium in case group were （1 941.96±843.14） keal, （84.36±51.37） g, （1 155.91±332.52） μg RE, （40,43±28.91） μg, （12.77±10.86） mg and （64.12±35.87） μg, respectively, which were significantly higher than those [（1 806.86±581.48） kcal, （76.67±26.02） g, （745.53±121.52） ixg RE, （34.23±11.63） μg, （11.11±7.97） mg and （55.73±21.54） μg] in control group （P〈O.05 or P〈O.O1 ）. But the daily intakes of dietary fiber, thiamine, calcium in case group were （21.76±7.38） g, （1.66±0.14） mg and （870.84± 226.21 ） mg, respectively, which were significantly lower than those [（24.07±10.16） g, （2.23±0.51） mg and （961.67±297.31） μg, respectively] in control group （P〈0.05 or P〈0.01 ）. The energy ratio （63.67%±6.66%） of carbohydrate in case group was lower than that （63.92%±6.65%） in control group, and the energy ratio （15.32%±2.59%） of protein in case group was higher than that （ 15.17%±2.49%） in control group （P〈0.05 or P〈0.01 ）. The unconditional logistic regression indicated that the protein （OR=l.015, 95%CI： 1.003-1.025）, iron （OR=l.003, 95%CI： 1.001-1.010）, vitamin A （OR=l.004, 95%C1： 1.001-1.012） were risk factors; the dietary fiber （OR=0.896, 95%CI： 0.884-0.918）, calcium （OR=0.988, 95%CI： 0.972-0.998） and thiamine （OR=0.406, 95%CI： 0.395-0.429） were protection factors for T2DM. Conelusion To control the intake of energy and eat more invegetable and fruit could prevent and reduce T2DM.