糖尿病前期人群的医学营养干预研究

发布时间：2018-09-12 09:05

【摘要】：目的:通过对糖尿病前期人群进行医学营养干预,改善其糖脂代谢,调整肠道菌群结构,减少或延缓糖尿病等慢性代谢性疾病的发生与发展。探索可推广的防治糖尿病前期的医学营养干预模式,推动对糖尿病前期人群进行主动干预。方法:从社区人群中筛选出符合糖尿病前期诊断标准的研究对象100例,随机分成干预组(50例)和对照组(50例)。对干预组人群进行为期9个月(共3个阶段)的医学营养干预:(1)干预第1阶段(第1~3月),干预组人群通过多种方式接受营养宣教、饮食、运动和心理等医学营养干预。(2)干预第2阶段(第4~6月),继续第1阶段干预的基础上,对干预组人群提供膳食纤维粉(10克/日)和低血糖生成指数(GI)的粗杂粮(50克/日)营养配方干预食品。(3)干预第3阶段(第7~9月),进行与第1阶段相同的干预。对照组人群不采取任何的干预措施。干预组人群在每阶段干预前后检测观察指标,对照组人群在整个试验前后检测。观察指标包括体重、腰围(WC)、血压等生理指标;血糖、血脂、空腹胰岛素(FINS)等血液生化指标;大肠杆菌、双歧杆菌、乳酸杆菌的肠道菌群指标。分析比较检测结果。结果:1.整个干预试验后(9个月末),干预组人群的观察指标(收缩压除外)与试验前(基线)比均明显改善(P0.05),对照组人群的体重与其基线比明显升高(P0.05),其余指标变化无统计学意义(P0.05)。干预组人群与对照组人群相比,其体重、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、餐后2h血糖(2h PG)、糖化血红蛋白(Hb A1c)、甘油三酯(TG)、FINS、HOMA-IR明显下降(P0.05),肠道有益菌双歧杆菌数明显升高(P0.05)。2.干预第1阶段末,干预组人群的少数指标(体重、WC、2h PG)与基线比明显改善(P0.05),其余指标多数有改善趋势,但差异无统计学意义(P0.05)。3.干预第2阶段末,干预组人群的绝大多数观察指标与第1阶段末比明显改善,其中体重、WC、DBP、FPG、2h PG、Hb A1c、TC、TG、LDL-C、FINS、HOMA-IR、大肠杆菌数明显下降(P0.05),而肠道有益菌乳酸杆菌数、双歧杆菌数明显升高(P0.05),HDL-C、SBP有改善趋势,但差异无统计学意义(P0.05)。4.干预第3阶段末,干预组人群的肠道有益菌双歧杆菌数与第2阶段末比明显下降(P0.05),但其余指标变化均不明显(P0.05)。与第1阶段末相比,干预组人群的绝大多数观察指标仍明显改善,其中体重、WC、DBP、FPG、2h PG、Hb A1c、TC、TG、LDL-C、FINS、HOMA-IR、大肠杆菌数明显下降(P0.05),乳酸杆菌数和双歧杆菌数明显升高(P0.05)。5.试验后,干预组中29人(63.0%)血糖转归正常,1人(2.2%)进展为糖尿病;对照组中5人(10.6%)血糖恢复正常,6人(12.8%)进展为糖尿病,两组转归率差异有统计学意义(P0.05)。结论:1.医学营养干预能改善糖尿病前期人群的糖脂代谢,减轻胰岛素抵抗,降低其体重、腰围和血压,延缓和避免糖尿病前期进展为糖尿病。2.医学营养干预能调整糖尿病前期人群的肠道菌群结构,扶持有益肠道菌,压制条件致病菌,恢复肠道微生态,阻止或延缓糖尿病等慢性代谢性疾病的发生发展。3.膳食纤维和低GI粗杂粮营养配方干预食品对糖尿病前期人群的糖脂代谢、肠道菌群结构等起改善作用。
[Abstract]:OBJECTIVE: To explore a popularizable medical nutrition intervention model for the prevention and treatment of diabetes mellitus and to promote active intervention in the pre-diabetic population by improving glucose and lipid metabolism, adjusting intestinal flora structure, reducing or delaying the occurrence and development of chronic metabolic diseases such as diabetes mellitus. 100 subjects were randomly divided into intervention group (50 cases) and control group (50 cases). Medical nutrition intervention was carried out in intervention group for 9 months (a total of 3 stages): (1) intervention stage 1 (1-3 months), intervention group received nutrition education, diet, transportation through a variety of ways. Medical nutritional intervention such as exercise and psychology. (2) Intervention stage 2 (4-6 months), on the basis of continuing intervention stage 1, dietary fiber meal (10 g/day) and hypoglycemic index (GI) of coarse grains (50 g/day) nutritional formula intervention food were provided to the intervention group. (3) Intervention stage 3 (7-9 months), the same intervention as stage 1. Intervention group was tested before and after each intervention stage, and control group was tested before and after the whole experiment. Observation indexes included body weight, waist circumference (WC), blood pressure, blood glucose, blood lipids, fasting insulin (FINS) and other blood biochemical indicators; Escherichia coli, bifidobacterium, lactobacillus. Intestinal flora indicators. Analysis and comparison of the results. Results: 1. After the whole intervention test (9 months end), the intervention group of population observation indicators (except systolic blood pressure) and pre-test (baseline) were significantly improved (P 0.05), the control group of population weight and its baseline ratio increased significantly (P 0.05), the other indicators were not statistically significant (P 0.05). Compared with the control group, the body weight, SBP, DBP, FPG, 2H PG, Hb A1c, TG, FINS, HOMA-IR were significantly decreased (P 0.05), and the number of intestinal beneficial bacteria bifidobacteria was significantly increased (P 0.05). 2. At the end of the first intervention stage, a few indicators (body weight, WC, 2H PG) were found in the intervention group. At the end of the second stage, the majority of the observed indexes in the intervention group were significantly improved compared with the end of the first stage, including body weight, WC, DBP, FPG, 2H PG, Hb A1c, TC, TG, LDL-C, FINS, HOMA-IR, and E. coli count decreased significantly (P 0.05). The number of intestinal beneficial bacteria, lactobacillus, Bifidobacterium significantly increased (P 0.05), HDL-C, SBP had an improvement trend, but there was no significant difference (P 0.05). 4. At the end of the third intervention stage, the number of intestinal beneficial bacteria in the intervention group was significantly lower than that at the end of the second stage (P 0.05), but the other indicators did not change significantly (P 0.05). The overwhelming majority of the observed indicators in the intervention group were still significantly improved, including body weight, WC, DBP, FPG, 2H PG, Hb A1c, TC, TG, LDL-C, FINS, HOMA-IR, E. coli count decreased significantly (P 0.05), Lactobacillus count and bifidobacteria count increased significantly (P 0.05). After the experiment, 29 (63.0%) of the intervention group returned to normal blood glucose, and 1 (2.2%) of the control group developed diabetes. 5 (10.6%) of the patients recovered to normal blood glucose and 6 (12.8%) developed diabetes mellitus. There was a significant difference in the prognosis between the two groups (P 0.05). Conclusion: 1. Medical nutrition intervention can improve glucose and lipid metabolism, reduce insulin resistance, reduce body weight, waist circumference and blood pressure, delay and avoid the development of diabetes mellitus. Nutritional intervention can adjust the intestinal flora structure of pre-diabetic population, support beneficial intestinal bacteria, suppress conditional pathogenic bacteria, restore intestinal microecology, prevent or delay the occurrence and development of chronic metabolic diseases such as diabetes. 3. Dietary fiber and low GI coarse grain nutritional formula intervention food on glycolipid metabolism of pre-diabetic population, intestinal bacteria. Group structure plays an important role in improving.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1

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