The Influence of a Physician and Patient Intervention Program on Dietary Intake

BackgroundEfficient dietary interventions for patients with hypertension in clinical settings are needed.ObjectiveTo assess the separate and combined influence of a physician intervention (MD-I) and a patient intervention (PT-I) on dietary intakes of patients with hypertension.DesignA nested 2×2 design, randomized controlled trial conducted over 18 months.ParticipantsA total of 32 physicians and 574 outpatients with hypertension.InterventionMD-I included training modules addressing the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure hypertension management guidelines and lifestyle modification. PT-I included lifestyle coaching to adopt the Dietary Approaches to Stop Hypertension (DASH) eating pattern, reduce sodium intake, manage weight, increase exercise, and moderate alcohol intake.Main outcome measuresDietary intakes were measured by the Block Food Frequency Questionnaire. Concordance with the DASH dietary pattern was estimated by a DASH score.Statistical analysesThe main effects of MD-I and PT-I, and their interaction, were evaluated using analysis of covariance.ResultsAfter 6 months of intervention, MD-I participants significantly increased intakes of potassium, fruits, juices, and carbohydrate; decreased intake of fat; and improved overall dietary quality as measured by the Healthy Eating Index. PT-I intervention resulted in increased intakes of carbohydrate, protein, fiber, calcium, potassium, fruits and fruit juices, vegetables, dairy and Healthy Eating Index score, and decreased intakes in fat, saturated fat, cholesterol, sodium, sweets, and added fats/oils/sweets. In addition, PT-I improved overall DASH concordance score. The change in DASH score was significantly associated with the changes in blood pressure and weight at 6 months. At 18 months, most changes reversed back toward baseline levels, including the DASH score.ConclusionsBoth MD-I and PT-I improved eating patterns at 6 months with some sustained effects at 18 months. Even though all dietary changes observed were consistent with the DASH nutrient targets or food group guidelines, only the PT-I intervention was effective in improving the overall DASH concordance score. This finding affirms the role of medical nutrition therapy in long-term intensive interventions for hypertension risk reduction and weight management and underlines the need for development of maintenance strategies. Furthermore, this study emphasizes the importance of collaborations among physicians, registered dietitians and other dietetics practitioners, and lay health advisors while assisting patients to make healthy behavior changes.     

Effectiveness of a Lifestyle Intervention Program Among Persons at High Risk for Cardiovascular Disease and Diabetes in a Rural Community

Purpose: To evaluate the feasibility of translating the Diabetes Prevention Program (DPP) lifestyle intervention into practice in a rural community. Methods: In 2008, the Montana Diabetes Control Program worked collaboratively with Holy Rosary Healthcare to implement an adapted group-based DPP lifestyle intervention. Adults at high risk for diabetes and cardiovascular disease were recruited and enrolled (N = 101). Participants set targets to reduce fat intake and increase physical activity (≥150 mins/week) in order to achieve a 7% weight loss goal. Findings: Eighty-three percent (n = 84) of participants completed the 16-session core program and 65 (64%) participated in 1 or more after-core sessions. Of those completing the core program, the mean participation was 14.4 ± 1.6 and 3.9 ± 1.6 sessions during the core and after core, respectively. Sixty-five percent of participants met the 150-min-per-week physical activity goal during the core program. Sixty-two percent achieved the 7% weight loss goal and 78% achieved at least a 5% weight loss during the core program. The average weight loss per participant was 7.5 kg (range, 0 to 19.7 kg), which was 7.5% of initial body weight. At the last recorded weight in the after core, 52% of participants had met the 7% weight loss goal and 66% had achieved at least a 5% weight loss. Conclusion: Our findings suggest that it is feasible to implement a group-based DPP in a rural community and achieve weight loss and physical goals that are comparable to those achieved in the DPP.     

我国2型糖尿病人生活方式干预效果综述

目的：了解目前我国糖尿病的流行情况及生活方式干预研究现状,分析干预研究的效果及存在的问题,为更好地开展糖尿病的控制工作提供科学依据.方法在中国学术文献总库(CNKI)、中文科技期刊数据库(VIP) PubMed、Web of Science 等主要中英文数据库中,检索对我国2型糖尿病患者进行1年或1年以上生活方式干预的随机对照试验进行文献综述.结果12个随机对照试验共包括2806例2型糖尿病患者纳入综述,干预组1475例,对照组1331例.干预组空腹血糖(FDG)[WMD ＝-1．54,95％CI (-1．96,-1．12)]、饮食控制[OR ＝5．52,95％CI (2．42,13．05)]、合理运动[OR ＝2．23,95％CI (1．56,3．19)]、自我监测[OR ＝3．87,95％CI (2．23,6．69)]4项评价指标均优于对照组,差异有统计学意义(P ＜0．01).但也存在干预主要集中于城市、对患者心理健康重视不够和健康教育方案不完善等问题.结论对2型糖尿病患者进行生活方式干预可有效控制糖尿病的病情发展,提高患者的生活质量,但需要注重干预方案的完善和实施方式的改进.     

饮食干预对老年糖尿病患者血糖和血脂的影响

目的探讨饮食干预对老年糖尿病患者血糖和血脂的影响。方法将医院2011年4-10月收治的100例二型糖尿病患者分为观察组和对照组,两组均采用降糖药和胰岛素治疗,对照组采用常规管理,观察组在对照组的基础上加强饮食护理干预,比较两组的血糖及血脂控制效果。结果观察组显效27例,有效15例,总有效率为84.0%,显著高于对照组的总有效率68.0%（P〈0.05）。两组干预后空腹血糖（FBG）、餐后2 h血糖（2hFBG）、睡前血糖、糖化血红蛋白（HbA1c）、总胆固醇（TC）及甘油三酯（TG）的含量均较治疗前显著改善,但观察组的改善效果显著优于对照组（P〈0.05）。且观察组的胰岛素抵抗指数显著低于对照组（P〈0.05）。结论饮食干预能更有效的控制血糖,减少并发症,提高糖尿病患者的生活质量,取得很好的社会效益和经济效益。     

住院糖尿病患者心理干预联合胰岛素泵强化治疗的效果及费用的研究

目的：探讨心理干预联合胰岛素泵强化治疗住院糖尿病患者的效果及费用情况,为临床选择合适的治疗方案提供依据。方法：将100例住院糖尿病患者随机分为A组、B组、对照组。A组、B组患者入院后均进行抑郁自评量表（SDS）、焦虑自评量表（SAS）测定,根据评分确定患者情感障碍的分级,A组采取相应措施进行心理干预,必要时给予药物治疗,同时应用胰岛素泵泵入胰岛素类似物控制血糖。B组应用胰岛素泵泵入胰岛素类似物控制血糖。对照组进行每天多次注射胰岛素类似物治疗。所有患者均接受综合治疗措施。结果：A组在达到良好控制血糖的治疗中所需要的时间、总住院时间、费用（总医疗费用、总药费）均低于B组（P〈0．05）;B组在达到良好控制血糖的治疗中所需要的时间、总住院时间、费用（总医疗费用、总药费）均低于对照组（P〈0．05）。结论：心理干预联合胰岛素泵注射胰岛素能更快更有效地控制血糖,减少了患者住院天数及治疗费用,是一种安全、有效、经济的治疗方法。     

Theoretical Reductions in Discretionary Choices Intake via Moderation,Substitution, and Reformulation Dietary Strategies Show Improvements in Nutritional Profile: A Simulation Study in Australian 2- to 18-Year-Olds

Background

Excessive consumption of discretionary choices (nutrient-poor foods and beverages) negatively impacts on children’s diet quality and increases the risk of obesity and related chronic conditions. Dietary guidelines are complex, and simple messages based on effective dietary strategies are needed to improve population compliance with dietary guidelines.

The Development and Feasibility Outcomes of a Youth Suicide Prevention Intensive Outpatient Program

Objective

Suicide is a leading cause of death in adolescents worldwide. There is an absence of effective and low cost treatment strategies for this growing public health problem. Current practice consists of brief hospitalization of acutely suicidal youth, but many get inadequate follow-up treatment. There are few alternatives to individual outpatient services offered at too low an intensity for an acutely distressed population. This paper describes the development, feasibility, acceptability, and preliminary clinical outcomes of an intensive outpatient program (IOP) for suicidal adolescents over a two-year period.

2010年莒南县农村居民糖尿病患病率及膳食营养摄入与糖尿病的关联性调查

[目的]了解莒南县农村居民2型糖尿病患病率,探讨糖尿病、糖耐量减低与膳食营养摄入的关联,以便指导糖尿病防治工作。[方法]2010年,在莒南县农村地区随机抽取435名18岁以上居民进行膳食营养调查和血糖检测,对检出的41例糖尿病(DM)病人、糖耐量减低(IGT)者及随机抽取的41名血糖正常者,调查其各种食物摄取情况,采用条件Logistic回归分析营养素摄入情况。[结果]调查435人,检出糖尿病(DM)病人12例,检出率为2.76%;检出糖耐量减低(IGT)者29例,检出率为6.67%。DM、IGT检出率,DM、IGT合计检出率为9.43%,男性为8.88%,女性为9.96%(P>0.05);18～29岁为4.11%,30～39岁为6.59%,40～49岁为5.75%,50～59岁为13.86%,≥60岁为15.66%(P<0.05);道口乡为11.48%,相沟乡为8.15%,大店镇为8.99%(P>0.05)。调查血糖正常者41人,血糖异常者41例(DM者12例、IGT者29例),膳食情况,异常组摄入总热能、碳水化合物、视黄醇、核黄素高于对照组(P<0.05)。条件Logistic回归结果,年龄大与总热能、碳水化合物摄入量多为血糖异常的危险因素(OR值分别为1.105、1.165、1.120);膳食纤维摄入量多为血糖异常的保护因素,OR值为0.866。[结论]年龄大、总热能摄入量多、碳水化合物摄入量多、膳食纤维摄入量少的农村居民DM、IGT者较多。     

Monthly Variations in Dietary Intake of Women Participating in the Supplemental Nutrition Assistance Program

Background

Households participating in the Supplemental Nutrition Assistance Program (SNAP) have been shown to spend the majority of their program benefits within the first 3 days of receipt. Hence, it is important to investigate dietary intakes of SNAP participants based on time since receipt of benefits.

Day-to-Day Variation in Food Intake and Energy Expenditure in Healthy Women: The Dietitian II Study

Because day-to-day food intake varies, we tested the hypothesis that ad libitum food intake and energy expenditure show corrective responses over periods of 1 to 10 days in healthy young women. Food intake and accelerometry measurements were collected daily for 17 days in 15 young women. Total daily energy expenditure (TDEE) using doubly labeled water was also measured. The daily deviations in macronutrient and energy intake and energy expenditure from the average values were compared with the deviations observed over succeeding intervals to estimate the corrective responses. The intraindividual coefficients of variation for energy intake averaged ±25%, ranging from 16% to 34%. TDEE had a coefficient of variation of 8.3%, and accelerometry had a coefficient of variation of 8.4% (range=4.6% to 16.4%). Energy expenditure by accelerometry (2,087±191 kcal/day) was not significantly different from TDEE (2,128±177 kcal/day), but reported daily energy intake was 20.4% lower (1,693±276 kcal/day). There were significant corrective responses in energy from fat and total energy intake. This occurred from Days 3 to 6, with a peak at Day 5 that disappeared when data were randomized within each subject. Human beings show corrective responses to deviations from average energy and macronutrient intakes with a lag time of 3 to 6 days, but not 1 to 2 days. These corrective responses are likely to play a role in bringing about weight stability.     

护理干预对糖尿病患者依从性及治疗效果的影响研究

目的探讨护理干预对糖尿病（DM）患者依从性及治疗效果的影响。方法将2009年1月～2009年6月问我院糖尿病患者58例随机分为观察组和对照组,两组均给予常规治疗及护理,观察组同时给予系统的护理干预措施。结果干预后观察纽患者空腹血糖及餐后2h血糖均明显优于对照纽（P〈0．05）。观察纽并发症总发生率为3．45％,对照纽为27．59％,两组比较差异具有统计学意义（P〈0．05）。观察组治疗依从性为100％,对照组为72．41％,两组比较差异具有统计学意义（P〈0．05）。结论护理干预能提高糖尿病的治疗依从性,并能改善患者的治疗效果。     

Comparing Methods from the National Cancer Institute vs Multiple Source Method for Estimating Usual Intake of Nutrients in the Hispanic Community Health Study/Study of Latino Youth

BackgroundThe Multiple Source Method (MSM) and the National Cancer Institute (NCI) method estimate usual dietary intake from short-term dietary assessment instruments, such as 24-hour recalls. Their performance varies according to sample size and nutrients distribution. A comparison of these methods among a multiethnic youth population, for which nutrient composition and dietary variability may differ from adults, is a gap in the literature.ObjectiveTo compare the performance of the NCI method relative to MSM in estimating usual dietary intakes in Hispanic/Latino adolescents.DesignData derived from the cross-sectional population-based Hispanic Community Health Study/Study of Latino Youth, an ancillary study of offspring of participants in the adult Hispanic Community Health Study/Study of Latino Youth cohort. Dietary data were obtained by two 24-hour recalls.Participants/settingOne thousand four hundred fifty-three Hispanic/Latino youth (aged 8 to 16 years) living in four urban US communities (Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA) during 2012 through 2014.Main outcome measuresThe NCI method and the MSM were applied to estimate usual intake of total energy, macronutrients, minerals and vitamins, added sugar, and caffeine.Statistical analysesMean, standard deviation, minimum and maximum values, coefficient of variation, variance ratio, and differences between NCI and MSM methods and the 2-day mean were estimated in several percentiles of the distribution, as well as concordance correlation coefficients and Bland-Altman plot analysis.ResultsThe distributions of all nutrients studied were very similar between NCI and MSM. The correlation between NCI and MSM was >0.80 for all nutrients (P<0.001), except dietary cholesterol, vitamin C, and n-3 fatty acids. In individual estimations, NCI method predicted higher estimates and lower variance than the MSM. The lowest level of agreement was observed in the values at the tails of the distribution, and for nutrients with high variance ratio.ConclusionsOverall, both MSM and NCI method provided acceptable estimates of the usual intake distribution using 24-hour recall, and they better represented the usual intake compared with 2-day mean, correcting for intraindividual variability.     

Native Youth Participating in the Together on Diabetes 12-Month Home-Visiting Program Reported Improvements in Alternative Healthy Eating Index-2010 Diet Quality Domains Likely to Be Associated With Blood Pressure and Glycemic Control

BackgroundThe Together on Diabetes (TOD) intervention was a home-visiting diabetes prevention and management program for Native youth.Objectives(1) Examine the impact of the TOD program on diet quality using the Alternative Healthy Eating Index (AHEI-2010); (2) determine association between diet quality and cardiometabolic health.DesignThe TOD program was conducted from October 2012 to June 2014 and was evaluated using a pretest-posttest study design from baseline to 12 months. Dietary intake was assessed using a food frequency questionnaire.Participants/settingThere were 240 participants between 10 and 19 years of age from 4 reservation-based, rural tribal communities in the southwestern United States that had been diagnosed with T2DM or prediabetes or were identified as at risk based on body mass index and a qualifying laboratory test.InterventionYouth were taught a 12-lesson curriculum on goal setting, nutrition, and life skills education.Main outcome measuresBehavioral and physiologic outcomes related to diabetes.Statistical analysisChanges in AHEI-2010 score and associations with cardiometabolic measures were tested, over time, using adjusted longitudinal linear mixed-effects models.ResultsThe study sample reported an average energy intake of 2016 kcal/d (±1260) and AHEI-2010 score of 47.4 (±7.4) (range: 0-110, higher = better diet quality), indicating low diet quality at baseline. At 12 months’ follow-up, there was a reduction in kilocalories (mean = −346 kcal/d; P < .001), sugar-sweetened beverages (mean = −2 fluid oz/d; P = .032), red/processed meat (mean = −1.5 oz/d; P = .008), and sodium (mean = −650 mg/d; P < .001) but no change in AHEI-2010 score (P = .600). The change in systolic blood pressure from baseline to 12 months for participants within the highest AHEI-2010 quartile group was significantly larger than the change in participants within the lowest quartile group (mean = −5.90 mm Hg; P = .036).ConclusionsDespite stable AHEI-2010 scores during follow-up, there were improvements in diet quality domains likely to be associated with cardiometabolic health. Home-visiting programs like TOD are promising interventions for decreasing dietary intake of poor-quality foods.     

肝癌预防和干预策略探讨

目的 了解国内外肝癌预防和干预的有效措施,为我国制定肝癌防治策略提供参考.方法 检索“CHKD中国医院知识仓库”和“Pubmed”电子数据库中有关肝癌预防与控制的文献,对文献筛选后进行回顾性分析.结果 本研究共纳入中文文献7篇,英文文献18篇,描述了不同国家采取的肝癌预防干预措施及效果评估.结论 我国肝癌防治项目建议采取以下策略：对初级卫生保健服务人员和一般居民开展肝癌防治知识健康教育活动,进行乙肝病毒血清学检测和乙肝疫苗接种,对肝癌高危人群定期筛查和随访管理.     

Effects of a Lifestyle Intervention in Young Women with GDM and Subsequent Diabetes

The purpose of this study was to examine whether a 9-month intensive lifestyle intervention could lead to weight loss and improve cardiovascular risk factors among young women with both gestational diabetes mellitus (GDM) and newly diagnosed diabetes. A total of 83 young women, who had GDM and were subsequently diagnosed as type 2 diabetes at an average of 2.6 years after delivery, participated in a 9-month intensive lifestyle intervention and a follow-up survey at 6–9 years postintervention. After the 9-month intervention, these women had a weight loss of 2.90 kg (−4.02% of initial weight), decreased waist circumference (−3.12 cm), body fat (−1.75%), diastolic blood pressure (−3.49 mmHg), fasting glucose (−0.98 mmol/L) and HbA1c (−0.72%). During the 6–9 years postintervention period, they still had lower weight (−3.71 kg; −4.62% of initial weight), decreased waist circumference (−4.56 cm) and body fat (−2.10%), but showed a slight increase in HbA1c (0.22%). The prevalence of using glucose-lowering agents increased from 2.4% at baseline to 34.6% after the 9-month lifestyle intervention, and to 48.4% at 6–9 years postintervention. A 9-month intensive lifestyle intervention can produce beneficial effects on body weight, HbA1c and other cardiovascular risk factors among young women with previous GDM who subsequently developed new diabetes.     

The Association between Changes in Coronary Artery Calcium Scores,Dietary Intake,Physical Activity,and Depression Symptoms among the Population of Gaza Strip,Palestine

BackgroundThis study aimed to identify the association between macronutrient intake, physical activity, and depressive symptoms and changes in coronary artery calcium score among the population of Gaza Strip.MethodThe study sample consisted of 269 individuals who underwent non-enhanced coronary computed tomography using 64-slice MDCT (Siemens, Germany) at Al-Shifa medical complex between September 2017 and January 2018. The study participants were divided into two groups; group one, consisting of coronary calcium calcification scoring (CAC) of greater than zero (CAC score > 0), and group two, CAC less than or equal to zero (CAC score ≤ 0). Data about macronutrient intake, physical activity, and depressive symptoms were collected using a validated self-administered questionnaire. Additionally, the participants'' anthropometric characteristics and blood biochemical markers were measured.ResultsOut of 269 participants, 45-recorded CAC score > 0; 72% of them were males with a mean age of 52.6 ± 5.4 years. Significant differences between the two groups in terms of total energy, lipid intake, and carbohydrate were found (P-value of 0.020, 0.012, and 0.034, respectively). No significant differences were recorded in protein intake, physical activity, and depression. Multivariate logistic regression analysis under adjustment for possible confounding factors revealed that macronutrient intake, physical activity, and depressive symptoms were not associated with the development of CAC in two models.ConclusionBased on our findings, macronutrient intake, physical activity, and depressive symptoms are not associated with the development of CAC among the population of Gaza.     

糖尿病合并心血管病的治疗与护理配合疗效分析

目的：探讨护理干预对糖尿病并发心血管病的影响。方法：选取2009年5月-2011年10月笔者所在科治疗的糖尿病合并心血管病的患者120例,随机分为两组,即对照组60例,采用内科常规降糖治疗,治疗组60例在内科常规降糖治疗的基础上,给予适当的护理干预,比较两组疗效。结果：经过出院后1年随访：治疗组血压异常率20％（12例）,心电图异常率10％（6例）;血糖异常率30％（18例）。对照组血压异常率40％（24例）,心电图异常率50％（30例）;血糖异常率60％（36例）,两组心血管、糖尿病指标比较差异均有统计学意义俨〈0．05）。结论：糖尿病患者在内科常规降糖治疗的基础上,给予适当的护理干预,能够提高糖尿病患者生活质量,促进患者健康。