营养综合干预对社区代谢综合征患者症状体征的影响
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摘要
目的通过社区代谢综合征患者症状体征的前后比较,分析本社区营养综合干预的效果,并探索适合上海社区的营养综合干预的管理模式。
方法选择本社区25～85岁的代谢综合征(metabolic syndrome, MS)患者199名,分为营养干预组84名和对照组115名。营养综合干预分为前三个月的强化干预和后9个月的一般干预。干预内容包括营养宣教、膳食指导以及定期的体重、血糖、血压等监测；对照组仅进行健康宣教。根据干预前后问卷及体检结果,分析评价本干预措施对代谢综合征患者症状体征的影响以及营养综合干预模式在社区慢性病治疗中的可行性。
结果营养干预组经过12个月的综合干预后,根据配对资料的t检验及方差分析得出干预组的各项体检结果与基线情况相比,收缩压、舒张压、体重、腰围、臀围、BMI及腰臀比的改变有统计学意义(P<0.05)；负荷2h后血糖、糖化血红蛋白以及载脂蛋白A、B的改变与对照组相比也有统计学意义。干预组经过12个月的营养干预,对代谢综合征的知识、态度和行为调查与对照组相比也有明显差异。
结论倡导健康的生活方式,而不是一味的寻求如何治疗,是目前社区慢性病管理工作的共识。在社区开展适宜各自情况的不同形式的营养综合干预,以更科学的提倡健康的生活方式是提高人群健康水平、提升生活质量、解决医疗费用不断上涨的必由之路。本课题所采取的营养综合干预措施,对改善代谢综合征患者的症状体征具有明显的效果,这一模式简便易行、成本低廉,值得进一步推广
Objectives The object is to compare the effect of the comprehensive nutrition intervention on metabolic syndrome (MS) patients'signs and symptoms in community. We also want to explore an appropriate method for intervention, prenvention and control of MS in community of Shanghai, and improve its effect in controlling MS.
Methods According to the criteria of MS given by International Diabetes Federal (IDF),199 people of 25 to 85-year-old were divided into nutrition intervention group and control group. There were 84 people in intervention group and 115 people in control group. Nutrition integrated intervention include the first 3 months' intensive intervention and next 9 months' general intervention. The main interventions includes nutritional dietary guidance, regular body weight, blood glucose, blood pressure monitoring. The control group only had a health missionaries. According to the results of intervention questionnaires and physical examination before and after we want to analyze and evaluate the intervention's effect on metabolic syndrome with symptoms, the impact of nutrition intervention model integrated in the community, and the feasibility of the treatment of chronic diseases.
Results After 12 months of comprehensive intervention, based on paired t test and variance analysis, there were significant difference of the medical obtained results in the intervention group compared to baseline. SBP, DBP, weight, waist circumference, hip circumference, BMI, and waist-hip ratio were statistically significant changed (P<0.05); OGTT, HbAlC, and apolipoprotein A, B also have statistical significance. And after twelve months intervention, there were significant difference in KAP investigation between the two groups.
Conclusion Promote a healthy lifestyle rather than to find a way of treatment, is currently the consensus in chronic disease management. With the accelerated pace of work life, urban people are faced with over-nutrition and nutritional imbalance problems. Therefore, to promote different forms of comprehensive nutrition intervention in communities by the government is the only way to improve the level of people's health, enhance the life quality and solve the rising medical costs. This topic has taken an integrated nutrition intervention for improving the signs and symptoms of MS patients; it's also a significant effect, for it is easy, low cost and should be further broadcast.
方法选择本社区25～85岁的代谢综合征(metabolic syndrome, MS)患者199名,分为营养干预组84名和对照组115名。营养综合干预分为前三个月的强化干预和后9个月的一般干预。干预内容包括营养宣教、膳食指导以及定期的体重、血糖、血压等监测；对照组仅进行健康宣教。根据干预前后问卷及体检结果,分析评价本干预措施对代谢综合征患者症状体征的影响以及营养综合干预模式在社区慢性病治疗中的可行性。
结果营养干预组经过12个月的综合干预后,根据配对资料的t检验及方差分析得出干预组的各项体检结果与基线情况相比,收缩压、舒张压、体重、腰围、臀围、BMI及腰臀比的改变有统计学意义(P<0.05)；负荷2h后血糖、糖化血红蛋白以及载脂蛋白A、B的改变与对照组相比也有统计学意义。干预组经过12个月的营养干预,对代谢综合征的知识、态度和行为调查与对照组相比也有明显差异。
结论倡导健康的生活方式,而不是一味的寻求如何治疗,是目前社区慢性病管理工作的共识。在社区开展适宜各自情况的不同形式的营养综合干预,以更科学的提倡健康的生活方式是提高人群健康水平、提升生活质量、解决医疗费用不断上涨的必由之路。本课题所采取的营养综合干预措施,对改善代谢综合征患者的症状体征具有明显的效果,这一模式简便易行、成本低廉,值得进一步推广
Objectives The object is to compare the effect of the comprehensive nutrition intervention on metabolic syndrome (MS) patients'signs and symptoms in community. We also want to explore an appropriate method for intervention, prenvention and control of MS in community of Shanghai, and improve its effect in controlling MS.
Methods According to the criteria of MS given by International Diabetes Federal (IDF),199 people of 25 to 85-year-old were divided into nutrition intervention group and control group. There were 84 people in intervention group and 115 people in control group. Nutrition integrated intervention include the first 3 months' intensive intervention and next 9 months' general intervention. The main interventions includes nutritional dietary guidance, regular body weight, blood glucose, blood pressure monitoring. The control group only had a health missionaries. According to the results of intervention questionnaires and physical examination before and after we want to analyze and evaluate the intervention's effect on metabolic syndrome with symptoms, the impact of nutrition intervention model integrated in the community, and the feasibility of the treatment of chronic diseases.
Results After 12 months of comprehensive intervention, based on paired t test and variance analysis, there were significant difference of the medical obtained results in the intervention group compared to baseline. SBP, DBP, weight, waist circumference, hip circumference, BMI, and waist-hip ratio were statistically significant changed (P<0.05); OGTT, HbAlC, and apolipoprotein A, B also have statistical significance. And after twelve months intervention, there were significant difference in KAP investigation between the two groups.
Conclusion Promote a healthy lifestyle rather than to find a way of treatment, is currently the consensus in chronic disease management. With the accelerated pace of work life, urban people are faced with over-nutrition and nutritional imbalance problems. Therefore, to promote different forms of comprehensive nutrition intervention in communities by the government is the only way to improve the level of people's health, enhance the life quality and solve the rising medical costs. This topic has taken an integrated nutrition intervention for improving the signs and symptoms of MS patients; it's also a significant effect, for it is easy, low cost and should be further broadcast.
引文
1. Grundy SM, Hansen B, Smith SC, et al. Clinical management of metabolic syndrome:report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association Conference on scientific issues related to management.Circulation,2004, 109(4):551-556.
2. Alberti KG, Zimmet PZ, Shaw JE, etal. The metabolic syndrome a new world-wide Definition.Lancet,2005,366(9491:1059-1062.
3. Festa AD, Agostino RJr, Howard G, et al. Chronic subclinical Inflammation as part of the insulin resistance syndrome:the insulin resistance atherosclerosis study(IRAS). Circulation,2000, 102(1):42-47.
4. Hakka HM, Laaksonen DE, JamesB, et a.l Themetabolic syndrome and total and cardiovas cularmortality in middle aged men [J]. JAMA,2002,288: 2709-2716
5. Sharada Shankar, Ann C Klassen, Elizabeth Garrett, Evaluation of a nutrition education intervention for women residents of Washington DC, public housing communities.2007,22(3):425-437.
6. Kimathi AN, Gregoire MB, Dowling RA, Stone MK. A healthful options food station can improve satisfaction and generate gross profit in a worksite cafeteria. J Am Diet Assoc.2009 May;109(5):914-7.
7.孙丽荣,王家驰.代谢综合征(MS)的临床处理及其再认识[J].辽宁实用糖尿病杂志,2003,11(4)：13-15
8.陈蕾；贾伟平；陆俊茜等.上海市成人代谢综合征流行调查.中华心血管病杂志,2003,12：167-169.
9.中华医学会糖尿病学会分会代谢综合征研究协作组.中华医学会糖尿病学分会关于代谢综合征的建议.中华糖尿病杂志,2004,12-3.
10.蒋一鸣；俎德玲；郑家胜等.社区老年代谢综合征的特点及综合干预探讨.中国农村卫生事业管理,2007,06：424-426
11.张健.生活干预对代谢综合征患者生物学指标的影响观察.中国医药导报,2007,18：52-53.
12.伍佩英,宋晓敏,金其林.生活方式与代谢综合征的关系.中国临床营养杂志.2007,15-4.
13.江继强,周志强,鲁铭新.代谢综合征患者的社区干预效果.上海医 药.2008,29-12
14.顾惠琳,陈支援,丁随新.代谢综合征社区干预效果观察.上海预防医学杂志,2010,22(1)：5-8.
15.王文绢,施侣元,王克安.SF-36量表在糖尿病和糖耐量减低患者生命质量研究中的信度、敏感性和可行性评价.现代康复.2000,4-4.
16. World Health Organization definition, diagnosis and classification of diabetes mellitus and its complications; report of a W HO consultation, part 1. Diagnoses and classification of diabetes mellitus Gene-Vfl[R]. World Health. Organization.1999
17.李建民、王抒、曾平.北京市职业人群代谢综合征患病基线调查[J].基础医学与临床,2004,24(2)；217—220.
18.中国肥胖同题工作组资料汇总分析协作组.我国成人体重指数或腰围对相关疾病危险因子异常的预测价值适宜体重指数和腰围切点的研究[J].中华流行病学杂志,2002；23：5-10.
19.吴元民,邵宝荣.上海市华阳社区糖尿病、高血压、血脂紊乱及代谢综合征基线调查[J].上海医学,2001.24(4)：195—198.
1.中华医学会糖尿病分会代谢综合征研究协作组.中华医学会糖尿病分会关于代谢综合征的建议[J].中华糖尿病杂志,2004,12：156-161.
2.顾东风,Reynolds K,杨文杰,等.中国成年人代谢综合征的患病率[J].中 华糖尿病杂,2005,13(3)：181-185.
3.卢伟,刘美霞,李锐.上海15-74岁居民代谢综合征的流行特征[J].中华预防医学杂志,2006,40(4)：262-267.
4. Gibbons RJ, Smith SC, Antman E.American College of Cardiology;American Heart Association. American College of Cardiology/American Heart Association clinical practice guidelines:PartⅡ:evolutionary changes in a continuous quality improvement project[J].Ciroulation 2003,107(24):3101-3107.
5.魏华伟,任梅芳.代谢综合征的干预进展[J].中华护理杂志,2005,40(10)：760-761.
6. Third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults(Adult Treatment Panel Ⅲ). Final report. Circulation,2002,106:3143-3421.
7.戴军.多因素干预对老年代谢综合征患者的影响[J].上海医学,2007,30(7)：540-541.
8.王绪山,徐祥英,倪子琴,等.代谢综合征患者生活方式干预的临床研究[J].中国康复医学杂志,2007,22(9)：805-806.
9.米杰,张力.控制代谢综合征关键在预防[J].中华预防医学杂志,2004,38(4)：219-220.
10.张广文,赵平,综述,杨思进,审校.代谢综合征的研究新进展[J].心血管病学进展,2007,28(4)：587-589.
11.齐玉琴,魏国,综述.代谢综合征的临床研究现状[J].医学研究生学报,2006,19(11)：1044-1046.
2. Alberti KG, Zimmet PZ, Shaw JE, etal. The metabolic syndrome a new world-wide Definition.Lancet,2005,366(9491:1059-1062.
3. Festa AD, Agostino RJr, Howard G, et al. Chronic subclinical Inflammation as part of the insulin resistance syndrome:the insulin resistance atherosclerosis study(IRAS). Circulation,2000, 102(1):42-47.
4. Hakka HM, Laaksonen DE, JamesB, et a.l Themetabolic syndrome and total and cardiovas cularmortality in middle aged men [J]. JAMA,2002,288: 2709-2716
5. Sharada Shankar, Ann C Klassen, Elizabeth Garrett, Evaluation of a nutrition education intervention for women residents of Washington DC, public housing communities.2007,22(3):425-437.
6. Kimathi AN, Gregoire MB, Dowling RA, Stone MK. A healthful options food station can improve satisfaction and generate gross profit in a worksite cafeteria. J Am Diet Assoc.2009 May;109(5):914-7.
7.孙丽荣,王家驰.代谢综合征(MS)的临床处理及其再认识[J].辽宁实用糖尿病杂志,2003,11(4)：13-15
8.陈蕾；贾伟平；陆俊茜等.上海市成人代谢综合征流行调查.中华心血管病杂志,2003,12：167-169.
9.中华医学会糖尿病学会分会代谢综合征研究协作组.中华医学会糖尿病学分会关于代谢综合征的建议.中华糖尿病杂志,2004,12-3.
10.蒋一鸣；俎德玲；郑家胜等.社区老年代谢综合征的特点及综合干预探讨.中国农村卫生事业管理,2007,06：424-426
11.张健.生活干预对代谢综合征患者生物学指标的影响观察.中国医药导报,2007,18：52-53.
12.伍佩英,宋晓敏,金其林.生活方式与代谢综合征的关系.中国临床营养杂志.2007,15-4.
13.江继强,周志强,鲁铭新.代谢综合征患者的社区干预效果.上海医 药.2008,29-12
14.顾惠琳,陈支援,丁随新.代谢综合征社区干预效果观察.上海预防医学杂志,2010,22(1)：5-8.
15.王文绢,施侣元,王克安.SF-36量表在糖尿病和糖耐量减低患者生命质量研究中的信度、敏感性和可行性评价.现代康复.2000,4-4.
16. World Health Organization definition, diagnosis and classification of diabetes mellitus and its complications; report of a W HO consultation, part 1. Diagnoses and classification of diabetes mellitus Gene-Vfl[R]. World Health. Organization.1999
17.李建民、王抒、曾平.北京市职业人群代谢综合征患病基线调查[J].基础医学与临床,2004,24(2)；217—220.
18.中国肥胖同题工作组资料汇总分析协作组.我国成人体重指数或腰围对相关疾病危险因子异常的预测价值适宜体重指数和腰围切点的研究[J].中华流行病学杂志,2002；23：5-10.
19.吴元民,邵宝荣.上海市华阳社区糖尿病、高血压、血脂紊乱及代谢综合征基线调查[J].上海医学,2001.24(4)：195—198.
1.中华医学会糖尿病分会代谢综合征研究协作组.中华医学会糖尿病分会关于代谢综合征的建议[J].中华糖尿病杂志,2004,12：156-161.
2.顾东风,Reynolds K,杨文杰,等.中国成年人代谢综合征的患病率[J].中 华糖尿病杂,2005,13(3)：181-185.
3.卢伟,刘美霞,李锐.上海15-74岁居民代谢综合征的流行特征[J].中华预防医学杂志,2006,40(4)：262-267.
4. Gibbons RJ, Smith SC, Antman E.American College of Cardiology;American Heart Association. American College of Cardiology/American Heart Association clinical practice guidelines:PartⅡ:evolutionary changes in a continuous quality improvement project[J].Ciroulation 2003,107(24):3101-3107.
5.魏华伟,任梅芳.代谢综合征的干预进展[J].中华护理杂志,2005,40(10)：760-761.
6. Third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults(Adult Treatment Panel Ⅲ). Final report. Circulation,2002,106:3143-3421.
7.戴军.多因素干预对老年代谢综合征患者的影响[J].上海医学,2007,30(7)：540-541.
8.王绪山,徐祥英,倪子琴,等.代谢综合征患者生活方式干预的临床研究[J].中国康复医学杂志,2007,22(9)：805-806.
9.米杰,张力.控制代谢综合征关键在预防[J].中华预防医学杂志,2004,38(4)：219-220.
10.张广文,赵平,综述,杨思进,审校.代谢综合征的研究新进展[J].心血管病学进展,2007,28(4)：587-589.
11.齐玉琴,魏国,综述.代谢综合征的临床研究现状[J].医学研究生学报,2006,19(11)：1044-1046.