膳食模式对社区管理2型糖尿病患者血糖控制影响的研究  

Study of the effects of dietary patterns on glycemic control in community type 2 diabetic mellitus patients

作　　者：雷丽云 秦莉 王占国 王君[1,4] 赵群 姬超琴 陈波[7] 张庆军[8] 周芳[8] 武鸣[9] 周金意[9] 王文绢[1] Lei Liyun;Qin Li;Wang Zhanguo;Wang Jun;Zhao Qun;Ji Chaoqin;Chen Bo;Zhang Qingjun;Zhou Fang;Wu Ming;Zhou Jinyi;Wang Wenjuan(Obesity and Metabolic Disease Prevention and Control Room,National Center for Chronic and Non-communicable Disease Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 100050,China;Department for Surveillance and Early Earning,Beijing Center for Public Health Emergency Management,Beijing 100053,China;Health Supervision Institute,Langfang Economic and Technological Development Zone,Langfang 065001,China;Key Laboratory of Environment and Population Health,National Institute of Environmental Health,Chinese Center for Disease Conrtol and Prevention,Beijing 100021,China;Department of Infectious Disease and Endemic Disease Control,Beijing Tongzhou District Center for Disease Control and Prevention,Beijing 101100,China;Chronic Disease Prevention and Treatment Department,Beijing Tongzhou District Center for Disease Control and Prevention,Beijing 101100,China;Cancer and Key Chronic Disease Control and Prevention Laboratory,National Center for Chronic and Non-communicable Disease Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 100050,China;Institute of Chronic and Non-communicable Diseases,Hubei Provincial Center for Disease Control and Prevention,Wuhan 430079,China;Department of Chronic and Non-communicable Disease Control and Prevention,Jiangsu Provincial Center for Disease Control and Prevention,Nanjing 210009,China)

机构地区：[1]中国疾病预防控制中心慢性非传染性疾病预防控制中心肥胖与代谢性疾病防控室,北京100050 [2]北京市公共卫生应急管理中心监测预警科,北京100053 [3]廊坊经济技术开发区卫生监督所,廊坊065001 [4]中国疾病预防控制中心环境与健康相关产品安全所环境与人群健康重点实验室,北京100021 [5]北京市通州区疾病预防控制中心传染病与地方病控制科,北京101100 [6]北京市通州区疾病预防控制中心慢性病防治科,北京101100 [7]中国疾病预防控制中心慢性非传染性疾病预防控制中心重点慢病防控实验室,北京100050 [8]湖北省疾病预防控制中心慢性非传染性疾病防治所,武汉430079 [9]江苏省疾病预防控制中心慢性非传染病防制所,南京210009

出　　处：《中华流行病学杂志》2024年第2期242-249,共8页Chinese Journal of Epidemiology

基　　金：世界糖尿病基金会(WDF13-805)。

摘　　要：目的了解膳食对社区管理2型糖尿病(T2DM)患者血糖控制的影响,为实施针对糖尿病患者的防治策略和措施提供依据。方法于2015年在常熟市和武汉市随机抽取8个社区,对进行社区管理的T2DM患者进行问卷调查、身体测量和血糖检测。研究采用因子分析获得膳食模式。并分别以FPG、餐后2 h血糖控制是否达标为因变量,进行非条件多因素logistic回归分析影响因素。结果最终共纳入1818名T2DM患者,患者FPG控制率为57.59%(95%CI:55.30%~59.86%),餐后2 h血糖控制率为24.90%(95%CI:22.93%~26.91%);因子分析得到5种膳食模式:动物性食物模式、水果-水产-薯类模式、蔬菜-谷物模式、蛋-奶-豆模式和油盐模式。非条件多因素logistic回归分析显示,调整其他因素后,FPG达标概率降低与动物性食物模式(OR=0.71,95%CI:0.52~0.98)、水果-水产-薯类模式(OR=0.71,95%CI:0.51~0.97)相关,餐后2 h血糖达标概率降低与水果-水产-薯类模式(OR=0.60,95%CI:0.40~0.90)相关,FPG和餐后2 h血糖达标概率增加均与蔬菜-谷物模式(OR=1.41,95%CI:1.03~1.94;OR=1.68,95%CI:1.13~2.51)、蛋-奶-豆模式(OR=1.75,95%CI:1.25~2.46;OR=1.56,95%CI:1.00~2.42)有关。与蛋-奶-豆模式Q4组相比,膳食模式组合(水果-水产-薯类模式Q4组、蔬菜-谷物模式Q2组、蛋-奶-豆模式Q3组)FPG控制达标可能性更高(OR=6.79,95%CI:1.15~40.23,P=0.035);与蔬菜-谷物模式Q4组相比,膳食模式组合(水果-水产-薯类模式Q4组、蔬菜-谷物模式Q3组、蛋-奶-豆模式Q2组、油盐模式Q2组)餐后2 h血糖控制达标可能性更高(OR=12.78,95%CI:1.26~130.05,P=0.031)。结论搭配得当的膳食模式及膳食模式组合更有利于武汉市和常熟市社区管理T2DM患者的FPG和餐后2 h血糖控制,应加强患者营养教育,提高患者食物搭配能力。Objective To understand the impact of diet on glycemic control in community-managed patients with type 2 diabetes mellitus(T2DM)and provide evidence for implementing prevention strategies and measures for diabetes patients.Methods Eight communities were randomly selected from Changshu and Wuhan in 2015,and T2DM patients managed in the community were selected to conduct questionnaire surveys,physical measurements,and blood glucose testing.Factor analysis was used to obtain dietary patterns.A binary logistic regression model was used to analyze the factors affecting glycemic control.Results Finally,1818 T2DM patients were included,and the control rate of FPG was 57.59%(95%CI:55.30%-59.86%),and the control rate of 2 h postprandial blood glucose(2 h PBG)was 24.90%(95%CI:22.93%-26.91%).Five dietary patterns were obtained by factor analysis:animal food pattern,fruit-aquatic products-potato patterns,vegetable-grain pattern,egg-milk-bean pattern,and oil-salt patterns.No-conditional multivariate logistic regression analysis showed that after adjusting for confounding factors,the reduced probability of FPG control was related to animal food pattern(OR=0.71,95%CI:0.52-0.98)and fruit-aquatic products-potato patterns(OR=0.71,95%CI:0.51-0.97).The decrease in the 2 h PBG control probability was related to fruit-aquatic products-potato patterns(OR=0.60,95%CI:0.40-0.90).The increased probability of FPG and 2 h postprandial glucose control were both related to vegetable-grain pattern(OR=1.41,95%CI:1.03-1.94;OR=1.68,95%CI:1.13-2.51)and egg-milk-bean pattern(OR=1.75,95%CI:1.25-2.46;OR=1.56,95%CI:1.00-2.42).Compared with the Q4 group of egg-milk-bean pattern,the FPG control rate of the combination of"fruit-aquatic products-potato pattern(Q4 group),vegetable-grain pattern(Q2 group),egg-milk-bean pattern(Q3 group)"was higher(OR=6.79,95%CI:1.15-40.23,P=0.035).Compared with the Q4 group of vegetable-grain pattern,the combination of"fruit-aquatic products-potato pattern(Q4 group),vegetable-grain pattern(Q3 group),egg-milk-bean pattern(Q2

关 键 词：糖尿病 2型 膳食模式 血糖控制 

分 类 号：R587.1[医药卫生—内分泌]