饮食质量与Ⅱ型糖尿病患者肥胖情况的相关性

Diet quality is inversely correlated with obesity in patients with type Ⅱ diabetes

目的探讨Ⅱ型糖尿病(T2DM)患者肥胖症的发生与膳食习惯、摄入以及质量的相关性。方法选取2017年3月至2018年6月在广西桂东人民医院诊断为T2DM患者243例,根据体重指数分为肥胖组和非肥胖组。膳食情况和食物摄入量采用食物频率调查问卷进行收集,同时采用健康饮食-2010指数(Alternate Healthy Eating Index-2010,AHEI-2010)、国际膳食质量指数(Diet quality index-international, DQI-I)和DASH饮食评分(Dietary Approaches to Stop Hypertension diet score)评估膳食质量情况。结果与非肥胖T2DM患者组相比,肥胖T2DM患者的AHEI-2010指数(P<0.001)、DQI-I指数(P<0.001)和DASH总分(P=0.044)均显著较低。肥胖T2DM患者组的食物摄入总能量、蛋白质摄入量、肉、家禽等肉类食物的摄入量显著的高于非肥胖T2DM组(P<0.05),但蔬菜(P=0.014)摄入量较低。多元Logistic回归分析显示,AHEI-2010与T2DM患者的肥胖症差异具有显著的统计学负相关性(OR(95%CI)值=0.95(0.91～0.99),P=0.020)。与此同时,AHEI-2010和DASH体系中的肉类元素(OR(95%CI)值=0.71(0.51～0.99);OR(95%CI)值=0.57(0.38～0.84)以及DQI-I指数中的多样性均与肥胖症具有显著的负相关(OR(95%CI)值=0.63(0.46～0.86)。结论 T2DM患者膳食模式与质量与肥胖症密切相关,增加食物种类的摄入和降低肉类、高脂肪和加工食品摄入可以有效的改善膳食质量,指导T2DM患者肥胖人群的健康管理。

Objective To examine the correlation between diet quality and obesity in patients with T2DM. Methods 243 patients with T2DM from Guidong People’s Hospital of Guangxi from March, 2017 to June, 2018 were selected and divided into two groups based on their body mass index (BMI): obese group and non-obese group.Dietary status and food intake information were collected using a food frequency questionnaire. Diet quality was assessed using such indices as Alternate Healthy Eating Index-2010 (AHEI-2010), Diet Quality Index-International (DQI-I), and Dietary Approach to Stop Hypertension (DASH) score. Results Compared with non-obese T2DM patients, the obese counterparts had significantly lower AHEI-2010 (P<0.001), DQI-I (P<0.001), and DAH total scores (P=0.044). The obese patients also had a higher intake of total energy (P<0.001), protein (P=0.023), and meat, poultry and other meat foods (P<0.001), but a lower intake of vegetables (P=0.014). The multivariate logistic regression analyses demonstrated that the AHEI-2010 total score had an inverse correlation with obesity (OR=0.95 [0.91~0.99], P=0.020). This association remained significant after further adjustment for glycemic control. Inverse associations were also found between obesity and multivariate adjusted component scores, including red/processed meat of AHEI-2010 and DASH score (OR=0.71 [0.51~0.99], P=0.044;OR=0.57 [0.38~0.84], P=0.005) and DQI-I variety (OR=0.63 [0.46~0.86], P=0.004). Conclusion The dietary pattern and quality of patients with T2DM are closely related to obesity.Increasing the diversity of the food sources and reducing the intake of meat, and high fat and processed meats can effectively improve the quality of the diet and the health management of obesity of patients with T2DM.