饮食和体育锻炼干预对糖尿病发病及危险因素的影响

发布时间：2018-03-26 15:37

本文选题：糖尿病　切入点：干预　出处：《青岛大学》2017年硕士论文

【摘要】：目的:通过社区对“青岛市糖尿病预防项目”的大规模调查人群进行3年随访研究,比较项目区和非项目区通过饮食和体育锻炼干预对糖尿病预防的长期影响,验证饮食和体育锻炼干预在社区人群中实施的现实可行性,为对无症状人群进行早期干预推迟糖尿病发病提供依据。方法:采用“青岛市糖尿病预防项目”自2009年进行大规模基线调查的6100名研究对象,实际调查5110名,应答率为83.77%,剔除糖尿病患者831人,对剩余的4279名研究对象进行为期3年的随访研究。其中市北区、市南区、胶南市、黄岛区为项目区,原四方区、即墨市为非项目区,对项目区进行3年饮食和体育锻炼干预,非项目区不给予任何干预措施。对基线人群和随访人群均进行问卷调查、体格检查和实验室检测。比较干预前后项目区和非项目区糖尿病发病及体重、空腹血糖、餐后两小时血糖、总胆固醇、甘油三酯和高密度脂蛋白等血糖和血脂指标的变化。结果:2009年基线调查糖尿病患病率为16.3%,对4279名研究对象进行3年随访共回收有效问卷2312例,其中项目区为1456例,非项目区为856例。3年随访新发糖尿病患者200人,糖尿病累计发病率为8.7%。饮食和体育锻炼干预与糖尿病发病成负相关,饮食和体育锻炼干预、血压、糖尿病家族史能预测糖尿病发病,但是吸烟、饮酒、BMI、肥胖和血脂的差异无统计学意义(P0.05)。饮食和体育锻炼的RR值及其(95%CI)为0.58(0.41~0.81),是糖尿病发病的保护因素。血压的RR值及其(95%CI)为2.02(1.45~2.81),糖尿病家族史的RR值及其(95%CI)为2.03(1.39~2.95),两者均是是糖尿病发病的危险因素。体重、收缩压在项目区中降低,在非项目区中增加,两组差异有统计学意义(P0.05);空腹血糖、高密度脂蛋白在非项目区和项目区中均降低,但在项目区中降低明显,两组差异有统计学意义(P0.05);腰围、腰臀比都有增加,项目区增加低于非项目区,两组差异有统计学意义(P0.05);舒张压略有增加,但项目区增加高于非项目区,两组差异有统计学意义(P0.05);餐后2小时血糖均有增加,项目区中变化高于非项目区,两组差异有统计学意义(P0.05);甘油三酯、总胆固醇、Hb A1c在非项目区中降低,在项目区中增加,两组差异有统计学意义(P0.05);研究对象体质指数在两组之中差异无统计学意义(P0.05)。结论:饮食和体育锻炼干预能够改善患者体重、有效控制血糖和调节血脂的代谢,降低高危人群糖尿病的发病风险,对无症状人群进行早期的饮食和体育锻炼干预推迟糖尿病发病提供了科学依据。
[Abstract]:Objective: to compare the long-term effects of diet and physical exercise intervention on diabetes prevention between the project area and the non-project area through a 3-year follow-up study on the large scale survey population of "Qingdao Diabetes Prevention Project" in the community. To verify the practical feasibility of diet and physical exercise intervention in community population, Methods: 6100 subjects of large-scale baseline survey conducted by Qingdao Diabetes Prevention Project since 2009, 5110 actual subjects, were selected to provide evidence for the early intervention of asymptomatic population to delay the onset of diabetes. The response rate was 83.77, 831 patients were excluded from diabetes mellitus, and the remaining 4279 subjects were followed up for three years. Among them, Shibei District, Southern District, Jiaonan City, Huangdao District were project area, original Sifang District, Jimo City was non-project area, Three years diet and physical exercise intervention were carried out in the project area, and no intervention measures were given in the non-project area. The baseline population and the follow-up population were investigated with questionnaires. Physical examination and laboratory tests. Diabetes incidence and body weight, fasting blood glucose, two hours postprandial blood glucose, total cholesterol were compared before and after intervention. Results: the baseline survey of diabetes mellitus prevalence rate in 2009 was 16.3. A total of 2312 effective questionnaires were collected from 4279 subjects for 3 years, including 1456 cases in the project area. There were 856 cases in non-project area, 200 newly diagnosed diabetes patients were followed up for 3 years, the cumulative incidence of diabetes was 8.7. Diet and physical exercise intervention was negatively correlated with diabetes, diet and physical exercise intervention, blood pressure, diet and physical exercise intervention, A family history of diabetes can predict the onset of diabetes, but smoking, The RR value of diet and physical exercise and its 95 CI) were 0.58 ~ 0.41 ~ 0.81, which were the protective factors of diabetes. The RR value of blood pressure and its 95 ~ (95) CI were 2.02 ~ 1.45 ~ 2.81, the RR value of diabetic family history and its 95 ~ (95) CI were 2.03 ~ 1.39 ~ 2.95 ~ (-1), respectively. They are all risk factors for diabetes. Systolic blood pressure decreased in the project area and increased in the non-project area, the difference between the two groups was statistically significant (P 0.05), fasting blood glucose and high density lipoprotein decreased in both the non-project area and the project area, but significantly decreased in the project area. The differences between the two groups were statistically significant (P 0.05), waist circumference and waist-to-hip ratio were all increased, the increase in the project area was lower than that in the non-project area, and the difference between the two groups was statistically significant (P 0.05). The diastolic blood pressure increased slightly, but the increase in the project area was higher than that in the non-project area. The difference between the two groups was statistically significant (P 0.05), the blood glucose increased in 2 hours after meal, the change in the project area was higher than that in the non-project area, the difference between the two groups was statistically significant (P 0.05), the triglyceride, total cholesterol HbA1c decreased in the non-project area, and increased in the project area. There was no significant difference in body mass index between the two groups. Conclusion: diet and physical exercise intervention can improve the body weight, control blood sugar and regulate the metabolism of blood lipids. Reducing the risk of diabetes in high risk groups and providing scientific basis for the early intervention of diet and physical exercise to delay the onset of diabetes in the asymptomatic population.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1

【参考文献】