2型糖尿病患者的膳食状况及其与血糖控制的相关性研究

Association between dietary status and glycemic control in patients with type 2 diabetes mellitus

目的了解2型糖尿病患者的膳食状况及其与血糖控制的相关性。方法对广州某医院的2型糖尿病患者进行3 d 24 h膳食回顾调查、体格测量和血糖检测,并进行膳食状况与血糖控制情况的关联分析。结果共纳入223例2型糖尿病患者,以50~70岁(占54.7%)、男性(占57.0%)和超重(占47.5%)者为主,吸烟和饮酒率分别为23.8%(53/223)和6.7%(15/223)。轻、中、重体力活动者能量摄入量分别占推荐量的113.2%~149.1%、115.6%~122.9%和85.4%~97.4%。膳食纤维摄入量(8.3 g)和蛋白质供能比(14.0%)低于推荐量下限。维生素E和铁摄入量达到或超过推荐量(占104.4%~195.7%),维生素A、维生素B1、维生素B2、维生素C、钠和钙摄入量未达推荐量(占21.0%~87.8%)。蔬菜、水果、水产品、蛋类、奶类和大豆及坚果类摄入量未达推荐量,畜禽肉摄入量(100 g)超出推荐量上限。FPG、PPG和Hb A1c水平分别为(11.4±4.5)、(17.6±5.6)mmol/L和(9.3±2.1)%。血糖控制不良率为84.3%(188/223),与蛋白质供能比(r=0.165)、钙(r=0.223)和水产品(r=0.257)的摄入量呈正相关关系(P<0.05或P<0.01),且水产品摄入量<40 g/d和>75 g/d的患者血糖控制不良率均高于摄入40~75 g/d的患者,钙摄入≥90%RNI的患者血糖控制不良率低于摄入<90%RNI的患者(均P<0.01)。结论调查对象膳食不均衡,水产品、钙和蛋白质的摄入不合理可能与血糖控制不良有关,应加强营养教育和血糖监控,及时调整膳食方案。

Objective To evaluate the association between dietary status and glycemic control inpatients with type 2 diabetes mellitus. Methods Patients with type 2 diabetes mellitus were selected from a hospital in Guangzhou to conduct 3-day-24-hour dietary recalls. The antbropometric parameters were measured and glycemic indexes detected. Association analysis were conducted between different status of dietary intakes and glycemic control. Results A total of 223 patients with type 2 diabetes mellitus were enrolled in this study. Of the subjects,54.7% were aged 50 - 70 years, 57.0% males, and 47.5% overweight, 23.8% （53/223） smokers, and 6.7% （ 15/223 ） alcohol drinkers. Intakes of energy in subjects at light, moderate, and heavy physical activity level accounted for 113.2% - 149.1% ,115.6% - 122.9%, and 85.4% -97.4% of reference nutrient intakes （ RNIs）, respectively. The intake of dietary fiber （ 8.3 g） and proportion of energy from protein （ 14.0% ） were lower than the recommended levels. Intakes of vitamin E and iron reached or exceeded RNIs （ 104.4% - 195.7% ）, while intakes of vitamin A, thiamine, riboflavin, vitamin C, sodium, and calcium were lower than RNIs （21.0% - 87.8 % ）. Intakes of vegetables, fruits, aquatic products, eggs, dairy products, soybean, and nuts were below RNIs, but intake of livestock and poultry meat （100 g） was higher than RNIs. Levels of FPG, PPG, and HbAlc were （11.4 ±4.5）, （ 17.6 ± 5.6） mmol/L, and （9.3 ± 2.1 ） %, respectively. Of the subjects, 84.3% （ 188/223 ） were in poor glycemic control, which was positively associated with proportion of energy from protein （ r = 0. 165）, intakes of calcium （ r = 0. 223）, and aquatic products （ r = 0.257） （P 〈 0.05 or P 〈 0.01 ）. Subjects with intake of aquatic products either 〈40 g/d or 〉75 g/d had higher proportions of inadequate glycemic control than those with 40 - 75 g/d, and the rate of inadequate glycemic control in subjects with intake of calcium under 90% of RNI was lower than those exceeded 90% of RNI （ all P 〈 0.01 ）. Conclusion Most subjects failed to keep balanced diets and their inadequate glycemic control was possibly associated with imbalanced intakes of aquatic products, calcium, and protein. Therefore nutritional education and glycemic monitoring should be reinforced to make immediate adjustment for diets.