代谢相关脂肪性肝病基于中国居民膳食指南的个体化干预研究

Individualized intervention for patients with metabolic fatty liver disease based on Dietary Guidelines for Chinese Residents

背景代谢相关脂肪性肝病(metabolic associated fatty liver disease,MAFLD)在全球范围内广泛流行,不良的饮食生活习惯与其发生发展密切相关,通过饮食运动及生活方式干预是防治MAFLD的重要措施之一,但目前关于MAFLD的饮食运动及生活方式的干预策略尚无定论,其方式方法仍需要进一步研究.目的基于中国居民膳食指南为MAFLD患者制定个体化膳食及运动处方,探索个体化限制能量平衡膳食联合运动指导的干预方式对改善MAFLD的作用.方法根据是否接受个体化饮食运动干预分为干预组和对照组,分别在入组时(T0)收集患者的人体测量指标、实验室检测指标,通过问卷调查了解患者的一般信息、家族史、膳食及生活习惯、食物频率等,根据患者实际情况给予干预组患者个体化膳食处方和运动处方,对照组给予常规健康宣教,6 mo后(T1)再次收集患者的资料,比较干预前后人体测量指标和实验室检测指标的变化.结果127例MAFLD患者(对照组32例,干预组95例)中,汽车出行者占62.99%,久坐者(>8 h/d)占48.82%,饮食口味重者占比>50%,爱加餐者占37.01%;食物因子分析提取五个主因子,分别解释为“菌蔬”因子、“粮乳”因子、“肉蛋”因子、“水产”因子和“零食”因子,其中“肉蛋”因子的上五分位(Q5)可使高甘油三酯和高胆固醇的危险性分别增加为其下五分位(Q1)的5.60倍(95%CI:1.41-22.24)和6.45倍(95%CI:1.51-27.63);水产因子的中五分位(Q3)可使高胆固醇的危险性增加为其Q1的4.54倍(95%CI:1.10-18.78);干预组和对照组的人体测量指标和实验室检测指标(除对照组的糖化血红蛋白)在干预前后的差异均有统计学意义(P<0.05),且两组指标的变化差值间的差异有统计学意义(P<0.05).结论基于中国居民膳食指南个体化制定膳食及运动干预方案有助于降低MAFLD患者的体重、体质指数、腰围、内脏脂肪面积、体脂比等人体测量指标,可有效改善患者糖脂代谢状况.

BACKGROUND Metabolic associated fatty liver disease(MAFLD)is widely prevalent.Poor dietary and living habits are closely related to the development of MAFLD.Diet and exercise intervention is one of the important measures for the prevention and treatment of MAFLD,but the intervention strategies are still inconclusive,and further research is still required.AIM To explore the effect of individualized intervention through limited energy balanced diet and exercise on MAFLD.METHODS MAFLD patients were divided into either an intervention group or a control group according to whether they received individualized diet and exercise intervention or not.At the time of enrollment(T0),the anthropometric information and laboratory indicators of the patients were collected,and the general information,family history,dietary and living habits,and food frequency of the patients were collected by questionnaire survey.Individualized diet and exercise intervention was executed in the interven-tion group,while routine health education without indivi-dualized intervention was executed in the control group.We collected the above parameters after 6 mo(T1)for the second time,and then compared their differences between RESULTS Among 127 MAFLD patients included,those with daily travelling by car accounted for 62.99%,and those preferring sedentary lifestyle(>8 h/d),heavy flavor food,and extra meal accounted for 48.82%,>50%,and 37.01%,respectively.Five main factors were extracted after factor analysis,including“fungus and vegetable”,“grain and milk”,“meat and egg”,“aquatic”,and“snack”.The upper quintile(Q5)of the“meat and egg”factor could increase the risk of high triglyceride(odds ratio[OR]=5.60,95%confidence interval[CI]:1.41-22.24)and high cholesterol(OR=6.45,95%CI:1.51-27.63)compared with the lower quintile(Q1);the middle quintile(Q3)of the“aquatic”factor could also increase the risk of high cholesterol(OR=4.54,95%CI:1.10-18.78).The differences in anthropometric information and laboratory test indicators(except glycosylated hemoglobin in the control group)between T0 and T1 were statistically significant(P<0.05)both in the intervention group and in the control group.CONCLUSION Individualized dietary and exercise intervention based on the Dietary Guidelines for Chinese Residents can help MAFLD patients reduce body weight,body mass index,waist circumference,visceral fat area,body fat ratio,etc.and improve their glucose and lipid metabolism effectively.