基于手机应用程序的膳食干预对超重或肥胖人群减重及食物成瘾的影响

Effects of mobile application-based dietary intervention on weight loss and food addiction in overweight or obese people

目的探讨基于手机应用程序(application,APP)的膳食干预对成年超重或肥胖人群减重及食物成瘾的影响。方法收集2015年8月至2018年1月宁波市第一医院肥胖多学科联合门诊的18岁以上超重或肥胖者101例作为研究对象。受试者接受健康宣教和个体化饮食指导,并通过智能手机体重管理APP上交饮食日志,营养师对饮食不达标的受试者进行指导和纠正12周。在干预前和干预后(12周)分别进行询问调查、体格检查、实验室检查及耶鲁食物成瘾量表问卷调查,比较干预前后受试者的体重、食物成瘾症状计数得分及食物成瘾者比例的变化情况。分别采用配对资料的t检验、卡方检验或Fisher精确检验对体成分测量值、血生化指标以及症状计数得分进行统计学检验。结果共纳入101例超重或肥胖受试者,男性31例,女性70例,年龄为(30.4±7.3)岁,体质指数(BMI)为(32.76±4.46)kg/m2,体重为(89.95±17.12)kg,食物成瘾者占比为26.73%。通过手机APP膳食干预12周后,患有食物成瘾的人数从27例减至14例,比例下降了12.9%,症状计数≥3的比例从41.6%下降到19.8%(χ2=5.17、11.26,均P<0.01),症状计数由2.25±1.61下降到1.50±1.31(t=3.64,P<0.001);同时,体重、BMI和腰围较干预前分别下降了(6.54±1.03)kg、(2.35±0.36)kg/m2、(6.50±0.86)cm(t=6.36、5.62、3.78,均P<0.001);代谢指标如空腹血糖、胰岛素抵抗指数和低密度脂蛋白胆固醇显著改善,分别下降了(0.38±0.10)mmol/L、1.83±0.46、(0.22±0.75)mmol/L(t=3.67、3.59、2.97,均P<0.01)。结论基于智能手机APP的膳食干预能有效改善超重和肥胖人群的血糖、血脂水平,减少内脏脂肪堆积,减轻胰岛素抵抗程度,改善食物成瘾状态。

Objective“Food addiction”may be one of the drivers of the obesity epidemic.Bariatric surgery-induced weight loss can significantly alleviate food addiction in overweight or obese people.Appetite regulation is part of the feedback control system for energy balance.The purpose of this study was to investigate the effects of mobile application-based dietary intervention on weight-loss and food addiction in overweight and obese adults.Methods A total of 101 overweight or obese people aged over 18 years,who were admitted to the obese multidisciplinary clinic of Ningbo First Hospital from August 2015 to January 2018 were enrolled.All subjects received health education and dietary guidance,and submitted their diet log through the weight management application of their smartphone.Over 12 weeks,a dietitian guided and corrected the subjects who did not meet the diet standards.Interviews,physical examinations,laboratory tests,and the Yale Food Addiction Scale Questionnaire survey were administered before and after the intervention(12 weeks)comparing subjects’weight,food addiction symptom count,and the proportion of food addiction before and after intervention.Statistical analysis of body composition measurements,blood biochemical parameters,and symptom count scores was performed using paired data t-test,McNemar chi-square test,and Fisher’s exact test.Results A total of 101 overweight and obese subjects were enrolled,including 31 males and 70 females,with an average age of(30.4±7.3)years,mean body mass index of(32.76±4.46)kg/m2,and average body weight of(89.95±17.12)kg.The proportion of food addiction was 26.73%.After 12 weeks of dietary intervention with the mobile application,the number of people with food addiction decreased from 27 to 14,the proportion of food addiction decreased by 12.87%,the proportion of symptom counts≥3 decreased from 41.58%to 19.80%.(χ2=5.17,11.26,all P<0.01),and the symptom count decreased from 2.25±1.61 to 1.50±1.31(t=3.64,P<0.001).Simultaneously,body weight,BMI,and waist circumference decreased by(6.54±1.03)kg,(2.35±0.36)kg/m2,and(6.50±0.86)cm(t=6.36,5.62 and 3.78,all P<0.001),respectively,compared with those before the intervention.Metabolic indicators such as fasting glucose,insulin resistance index,and LDL-C cholesterol also significantly improved,with a decrease of(0.38±0.10)mmol/L,1.83±0.46,(0.22±0.75)mmol/L(t=3.67,3.59,2.97,all P<0.01).Conclusion The smartphone application-based dietary intervention can effectively improve blood glucose and lipid levels in overweight and obese people,reduce visceral fat accumulation and reduce insulin resistance,and improve the food addiction status of overweight and obese people.