减重代谢手术后病人放牧饮食潜在类别的影响因素分析

Latent class analysis of influencing factors of grazing behavior among patients undergoing metabolic and bariatric surgery

目的探究减重代谢手术(metabolic and bariatric surgery,MBS)后病人放牧饮食的潜在类别特征,分析不同类别的影响因素。方法采用便利抽样法,选取2024年1月至2024年6月南京医科大学第一附属医院减重代谢外科随访门诊接诊的MBS术后病人作为研究对象。采用基线资料调查表、中文版放牧饮食量表[Rep(eat)-Q]、三因素饮食量表-R21(TFEQ-R21)、中文版抑郁-焦虑-压力量表-21(DASS-21)进行调查。对MBS术后病人的放牧饮食进行潜在类别分析,通过单因素分析和多元logistic回归分析探讨其影响因素。结果共发放236份问卷,回收有效问卷230份,有效回收率为97.5%。其中178例(77.4%)病人存在放牧饮食。MBS术后病人的放牧饮食可分为3个潜在类别,分别为“放牧饮食低风险——均衡型”(48.3%)、“放牧饮食中风险——强迫型”(37.4%)、“放牧饮食高风险——非强迫型”(14.3%)。相比于“放牧饮食中风险——强迫型”,术后时间<12个月、术后时间12~<24个月、失控性进食得分越低的病人归属于“放牧饮食低风险——均衡型”的概率更大(OR=0.256,P=0.003;OR=0.311,P=0.020;OR=1.195,P<0.001);相比于“放牧饮食高风险——非强迫型”,无抑郁、限制性进食得分越高、失控性进食得分越低者归属于“放牧饮食低风险——均衡型”类别的概率更大(OR=0.184,P<0.001;OR=0.670,P<0.001;OR=1.261,P=0.001)。结论MBS术后病人的放牧饮食发生率处于较高水平,并且具有明显的分类特征,医护人员可根据其分类特征及影响因素设计个性化的干预策略。

Objective To explore the potential categories and influencing factors of grazing behavior among patients undergoing metabolic and bariatric surgery(MBS).Methods From January to June 2024,MBS outpatients were selected by convenience sampling.Baseline Demographic Information Questionnaire,Chinese version of Repetitive Eating Questionnaire[Rep(eat)-Q],21-item Three-Factor Eating Questionnaire(TFEQ-R21)and Chinese Version of Depression Anxiety and Stress Scale-21(DASS-21)were administered.One-way ANOVA and Logistic regression analyses were performed for identifying the factors associated with potential categories of grazing behavior.Results Among a total of 236 questionnaires,230 valid ones were returned with an effective recovery rate of 97.5%.Grazing behavior occured in 178 patients(77.4%).Grazing behaviors among MBS patients were divided into 3 latent classes of"low risk of grazing behavior-regular"(48.3%),"medium risk of grazing behavior-compulsive"(37.4%)and"high risk of grazing behavior-repetitive"(14.3%).As compared with"medium risk of grazing behavior-compulsive",patients with postoperative time<12 month,postoperative time 12–<24 month and lower scores of uncontrolled eating were more likely to be classified as"low risk of grazing behavior-regular"(OR=0.256,P=0.003;OR=0.311,P=0.020;OR=1.195,P<0.001);As compared with"high risk of grazing behavior-repetitive",patients with nodepression,restricted eating and uncontrolled eating were more likely to be classified as"low risk of grazing behavior-regular"(OR=0.184,P<0.001;OR=0.670,P<0.001;OR=1.261,P=0.001).Conclusion The incidence of grazing behavior in MBS patients is at a high level with distinct characteristics of classification.Healthcare professionals may design personalized intervention strategies according to the influencing factors of different latent classes of grazing behavior.