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目的了解2型糖尿病(T2DM)合并肺结核患者膳食营养状况,为制订合理营养治疗方案提供依据。方法连续选取深圳市福田区慢性病防治院2013年1月至2016年12月已确诊的T2DM合并肺结核患者(A组)、单纯肺结核患者(B组)和健康体检者(C组),每组各146例为研究对象,用体质指数(BMI)和血清白蛋白(ALB)作为营养指标,采用连续3日24 h膳食回顾法调查膳食结构和营养素摄入量。用SPSS 18.0软件进行方差分析、χ~2检验,采用多因素logistic回归分析探讨T2DM合并肺结核患者营养不良的影响因素。结果以BMI评价的营养不良发生率,A组为43.8%,B组为36.9%,C组为1.4%,3组间差异有统计学意义(P<0.05);以ALB评价的营养不良发生率,A组为62.3%,B组为47.3%,C组为0,3组间差异有统计学意义(P<0.05)。与推荐摄入量相比,A组的谷类、蔬菜类、水果类、水产类、坚果类、奶和奶制品、豆类和豆制品平均每标准人日摄入量过低,饮水、畜禽肉、食用油及食盐摄入过多,而碳水化合物、蛋白质、膳食纤维、钙、锌、钾、铁、镁、维生素B1(VitB1)、维生素B_2(VitB_2)、维生素A(VitA)、维生素C(VitC)平均每标准人日摄入量不足,钠、锰和维生素E(VitE)摄入量相对过多,A组总热量、碳水化合物、蛋白质和钙摄入量低于B组和C组,差异有统计学意义(P<0.05)。各组平均碳水化合物供能比分别为A组48.8%、B组50.0%,C组50.0%,脂肪供能比分别为A组36.6%、B组35.2%,C组34.7%,蛋白质供能比分别为A组14.5%、B组14.8%,C组15.3%。多因素logistic逐步回归分析显示,体育锻炼、睡眠时间<7 h、奶和奶制品摄入≥3次/周与T2DM合并肺结核患者低蛋白血症有关。结论深圳福田区T2DM合并肺结核患者营养不良发生率高,膳食质量比健康人群及单纯肺结核患者差,碳水化合物供能比过低,脂肪供能比过高,应加强膳食营养教育,并充分考虑生活方式干预。
Objective To understand the nutritional status of patients with type 2 diabetes mellitus (T2DM) complicated with pulmonary tuberculosis and provide the basis for the formulation of rational nutrition therapy. Methods The patients with T2DM complicated with pulmonary tuberculosis (A group), patients with simple pulmonary tuberculosis (Group B) and healthy subjects (C group) were selected continuously from January to December 2016 in Futian District, Shenzhen. One hundred and sixty-six healthy volunteers were enrolled in this study. Body mass index (BMI) and serum albumin (ALB) were used as nutritional indicators to investigate dietary patterns and nutrient intakes for 24 consecutive days on the 3rd. ANOVA and χ ~ 2 test were performed with SPSS 18.0 software, and multivariate logistic regression analysis was used to explore the influencing factors of malnutrition in T2DM patients with pulmonary tuberculosis. Results The incidence of malnutrition was assessed by BMI. The incidence of malnutrition was 43.8% in group A, 36.9% in group B, and 1.4% in group C, with significant differences between the three groups (P <0.05) , 62.3% in group A, 47.3% in group B, 0 and 3 in group C (P <0.05). Compared with the recommended intake, the average standard daily intake of cereals, vegetables, fruits, aquatic products, nuts, milk and dairy products, beans and soy products in Group A was too low. Drinking water, livestock and poultry Meat, edible oil and salt intake too much, while carbohydrates, protein, dietary fiber, calcium, zinc, potassium, iron, magnesium, vitamin B1 (VitB1), vitamin B_2, vitamin A, vitamin C (VitC), the intake of sodium, manganese and vitamin E was relatively excessive. The total calorie, carbohydrate, protein and calcium intake of group A were lower than those of group B and C , The difference was statistically significant (P <0.05). The average carbohydrate-to-energy ratio in each group was 48.8% in group A, 50.0% in group B and 50.0% in group C, respectively, with 36.6% for fat in group A, 35.2% in group B and 34.7% in group C, respectively 14.5% in group A, 14.8% in group B and 15.3% in group C, respectively. Multivariate logistic stepwise regression analysis showed that physical exercise, sleep time <7 h, milk and milk products intake ≥ 3 times / week with T2DM in patients with pulmonary hypoproteinemia associated. Conclusion The incidence of malnutrition in patients with T2DM complicated with tuberculosis in Futian District of Shenzhen is high. The quality of diet is worse than that of healthy people and patients with simple pulmonary tuberculosis. The ratio of carbohydrate to energy supply is too low and the ratio of fat to energy supply is too high. Dietary nutrition education should be strengthened and lifestyle Ways to intervene.