慢阻肺缓解期患者营养不良及其相关因素分析

观察７６例慢阻肺缓解期患者的肺功能，饮食摄入情况与营养状况的关系，并探讨了ＣＯＰＤ患者营养不良发生的机理。结果显示５４．０％的ＣＯＰＤ患者体重低于理想体重的９０％。８４．２％的患者膳食中热能摄入量低于正常人标准供给量。ＦＥＶ１占预计值百分比，ＦＥＶ１／ＦＶＣ％与饱含中总热能摄入量占正常人标准供给量的百分比呈正相关，ＦＶＣ占预计值百分比与Ｅ％ＲＤＡ相关无显著性。     

我国北方COPD,肺心病患者膳食营养调查

对我国北方慢性阻塞性肺病及肺心病患者１２３例进行了膳食营养调查，结果表明，热能和１６种营养素摄入量中，热能，蛋白质，脂肪，碳水化合物，钙，锌，硒，镁，铜，锰，ＶｉｔＢ１，ＶｉｔＢ２，ＶｉｔＰＰ，ＶｉｔＥ与每人每天营养标准供给量（ＲＤＡ）比较，均有显著性差异（Ｐ〈０．００１），ＶｉｔＡ，ＶｉｔＣ与ＲＤＡ相比，差异不显著（Ｐ〉０．０５）。提示临床医师，营养师应重视这些患者的合理营养。     

营养状况对慢性阻塞性肺病患者肺通气功能的影响

为了解营养状况对慢性阻塞性肺病（ＣＯＰＤ）患者通气功能的影响，对１５０例ＣＯＰＤ患者进行肺通气功能测定，其中９３例体重正常，５７例体重明显减轻（营养不良）。结果显示营养不良组与体重正常组比较，其中ＭＶＶ，ＦＶＣ，Ｖ７５，ＰＥＦ等反映呼吸肌力以及大气道功能的指标相差非常显著（Ｐ〈０．００１），而ＭＭＥＦ，Ｖ５０Ｖ２５等反映小气道功能的指标两组无显著性差异（Ｐ〉０．２）。并且两组在ＣＯＰＤ病程同一阶段     

支气管哮喘与慢性阻塞性肺疾病患者气道阻力测定的临床意义

为探讨支气管哮喘与慢性阻塞性肺疾病（ＣＯＰＤ）缓解期患者气道阻力测定的临床意义，对６１例哮喘患者与７３例ＣＯＰＤ患者进行了气道阻力（Ｒａｗ）、气道传导率（Ｇａｗ）与肺通气功能测定。结果显示：哮喘缓解期患者Ｒａｗ明显增高（ｐ＜０００１），Ｇａｗ明显降低（ｐ＜０００１），用力呼气流量（Ｖ）、ＦＥＶ１％与ＭＭＥＦ正常或轻度降低，出现了Ｒａｗ－Ｖ分离现象；ＣＯＰＤ缓解期患者Ｒａｗ明显增高，Ｇａｗ明显降低，ＦＥＶ１％与ＭＭＥＦ亦相应呈现明显降低。据此作者认为，Ｒａｗ－Ｖ分离现象是哮喘患者肺功能变化的特点，可作为早期哮喘与不典型哮喘诊断的重要依据     

NIDDM患者维生素C,E营养状况及红细胞SOD活性相关性研究

目的;了解非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者ＶｉｔＣ,ＶｉｔＥ营养状况,。探讨ＶｉｔＣ,ＶｉｔＥ与超氧化物歧化酶（ＳＯＤ０的关系及临床意义。方法：调查３７例ＮＩＤＤＭ住院患者的膳食,测定血浆ＶｉｔＣ,ＶｉｔＥ和红细胞ＳＯＤ活性,对其相关性进行分析。     

慢阻肺患者营养状况和饮食指导软件系统的设计

慢阻肺患者营养状况和饮食指导软件系统的设计顾宇彤１蔡映云１雷光浦２柳启沛３营养不良是慢性阻塞性肺疾病（慢阻肺，ｃｈｒｏｎｉｃｏｂｓｔｒｕｃｔｉｖｅｐｕｌｍｏｎａｒｙｄｉｓｅａｓｅ，ＣＯＰＤ）患者常见的并发症。对ＣＯＰＤ患者的营养状况进行评价有助于全...     

无创正压通气在慢性阻塞性肺疾病合并肺性脑病时的应用研究

目的 研究慢性阻塞性肺疾病（ＣＯＰＤ）患者合并肺性脑病时进行无创双水平正压通气（ＢｉＰＡＰ）的效果。方法 ６４例ＣＯＰＤ合并肺性脑病患者分为ＢｉＰＡＰ组和气管插管机械通气（ＥＴＩ－ＭＶ）组,观察两组的治疗效果。结果 两组患者在存活率方面无显著差异;与ＢｉＰＡＰ组比较,ＥＴＩ－ＭＶ组在治疗４小时后,呼吸衰竭得以纠正,但住院期间的严重并发症却明显增多,住院时间也明显延长。结论 对于ＣＯＰＤ合并肺性脑病     

呼吸训练改善慢性阻塞性肺疾病患者肺功能的效果

为研究呼吸训练配合深吸气练习器改善慢性阻塞性肺疾病患者肺功能的效果。将４８例缓解期ＣＯＰＤ患者随机分为训练组２６例,进行呼吸训练配合抗阻深吸气锻炼,每天３０ｍｉｎ;对照组２２例进行临床常规治疗,各３个月。测定并对比训练前后肺指标ＰＶＣ（ｍｌ）、ＦＥＶ１．０（ｍｌ）、ＭＭＦ（Ｓ／Ｌ）、ＭＶＶ（Ｌ）。     

长期氧气治疗

慢性阻塞性肺疾病（ＣＯＰＤ）和哮喘急性发作期治疗的主要措施之一是充足的供氧,长期氧气治疗（ＬＴＯＴ）能影响ＣＯＰＤ的预后。因此,在家中进行吸氧治疗的病人不断增多,长期或短期使用均可。 ＣＯＰＤ是慢性阻塞性肺炎、肺气肿和某些慢性哮喘的总称,具有气流阻塞数月不能改善的特征,阻塞可通过测定一秒钟用力呼气容积（ＦＥＶ１）和用力肺活量（ＦＶＣ）判断。ＣＯＰＤ可分为轻度、中度和重度三级。重度ＣＯＰＤ病人可能逐渐进展成慢性呼吸衰竭（慢呼衰）。而未经治疗的慢呼衰则可导致重要脏器供氧不足的病理改变,例如红细胞增多…     

饮食补充对慢性阻塞性肺疾病的影响

饮食补充对慢性阻塞性肺疾病的影响周满祥王柯黄顺根慢性阻塞性肺疾病（ＣＯＰＤ）患者常伴营养不良，并由此给患者带来不利影响。国内、外研究证明：营养支持可降低感染和呼吸衰竭的发生率，降低死亡率［１］。为减少此类患者发病，我们对１１例ＣＯＰＤ患者给予饮食补...     

一日三餐高脂低碳水化合物摄入对健康成人糖耐量的影响

目的观察葡萄糖耐量（OGTT）前1天高脂低碳水化合物撮入（热量相同但碳水化合物撮入减少,脂肪撮入增加）对健康成人糖耐量的影响,从而进一步确定是否OGTT前1天高脂低碳水化合物（HF）撮入导致糖耐量减低（IGT）的误诊。方法30例男性健康成人随机分为两组（HF组和对照组）进行交叉试验;分别于OGTT前1天早、中、晚餐时撮入热量相同的HF或对照配餐;次日清晨行75g OGTT;分别测定血糖、胰岛素、游离脂肪酸、甘油三酯厦胆固醇浓度;2次OGTT间隔1周。结果OGTT前1天HF使糖负荷后30、60、120分钟血糖分别升高33％、51％厦42％,胰岛素分泌指数（△I／△G）降低50％,空腹血浆游离脂肪酸（FFA）浓度上升100％,使30％健康成人被误诊为IGT。结论即使总热量撮入相同,OGTT前1天HF引起健康成人空腹血浆游离脂肪酸水平升高,抑制早期胰岛素分泌,引起糖负荷后血糖的升高,导致IGT的误诊。     

Urinary citrate excretion in patients with renal stone: roles of leucocyte ATP citrate lyase activity and potassium salts therapy

BACKGROUND: Hypocitraturia is a major metabolic abnormality in rural Northeast Thais with renal stones. These people also have low serum and urinary potassium and consume a high carbohydrate and low fat diet, which together might influence the intracellular metabolism and urinary excretion of citrate. METHODS: In Study A, we measured plasma and urinary chemistries and assayed leucocyte ATP citrate lyase (ACL) activity in 30 normal urban control subjects (Group A1) and 30 rural renal stone patients (Group A2) in Northeast Thailand. Some of the subjects from both groups were also used to evaluate the intake of carbohydrate, protein and fat. In Study B, we examined the effects of potassium salts therapy with another group of 30 rural renal stone patients: Group B1 (n = 15) treated with potassium chloride and Group B2 (n = 15) with potassium-sodium citrate (with an aim to achieve 42 mEq potassium, 21 mEq sodium and 62 mEq citrate per day for 1 month). RESULTS: In Study A, the leucocyte ACL activity of Group A1 was much lower than that of Group A2 (3.2 +/- 0.7 vs. 9.3 +/- 3.8 micromol acetylhydroxamate/mg protein/30 min, p < 0.0001). The plasma potassium, urinary excretions of potassium and citrate in Group A1 were higher than in Group A2. When data of the two groups were combined, urinary citrate excretion was inversely correlated with leucocyte ACL activity (r = 0.6783, p < 0.001). While the dietary protein intake did not differ between Groups A1 and A2, the carbohydrate intake by Group A1 was significantly lower (65.2 +/- 7.9% vs. 83.1 +/- 2.9%, p < 0.01) and fat higher (21.0 +/- 6.4% vs. 6.2 +/- 4.1%, p < 0.002) than Group A2. After treatment with potassium chloride (Group B1), only the potassium was increased (p < 0.001), while those treated with potassium-sodium citrate (Group B2) experienced a significant increase in urinary pH (p < 0.002), potassium (p < 0.001) and citrate (p < 0.001), and a decrease in leucocyte ACL activity (p < 0.001). CONCLUSIONS: Compared to normal subjects, renal stone patients have low urinary citrate excretion with high leucocyte ACL activity. In Northeast Thailand, low potassium status and a high carbohydrate and low fat diet may cause the increased ACL activity. However, hypokaliuria, hypocitraturia and high leucocyte ACL activity can be corrected by potassium-sodium citrate salt therapy.     

长春市社区老年高血压患者膳食结构现状调查

目的了解社区老年高血压患者膳食结构,为实施护理干预提供依据。方法通过方便取样对长春市某社区104名老年高血压患者膳食结构进行自制问卷调查。结果被调查的老年高血压患者平均每人每日食物摄入中三大营养素供能比例不平衡,脂肪供能偏高,占34％,碳水化合物供能偏低,占54％,蛋白质供能较合理,占12％;相关营养素摄入量：钠偏高,而钾、钙、镁偏低。结论与中国居民膳食指南比较,目前老年高血压患者膳食结构不合理,应通过合理的、有针对性的护理干预使老年高血压患者建立正确的膳食观念、膳食习惯。     

Effect of protein on sympathetic nervous system activity in the rat. Evidence for nutrient-specific responses.

Increased energy intake activates the sympathetic nervous system (SNS) in animals and man. While dietary carbohydrate and fat stimulate, the impact of dietary protein on the SNS is not well defined. The present studies examine the effect of protein ingestion on sympathetic function based upon the measurement of [3H]norepinephrine (NE) turnover in heart and interscapular brown adipose tissue (IBAT) as the index of SNS activity. In these experiments, animals were pair-fed mixtures of laboratory chow and refined preparations of casein, sucrose, and lard to permit comparisons among nutrients with total energy intake held constant or with additional energy provided in the form of a single nutrient. After 5 d of eating a 2:1 mixture of chow and either casein or sucrose cardiac, [3H]NE turnover was less (P less than 0.005) in casein-fed rats (6.4%/h and 28.9 ng NE/h) than in animals given sucrose (11.2%/h and 46.5 ng NE/h). Similar results were obtained in IBAT and in experiments using 1:1 mixtures of chow and casein/sucrose. Casein-fed animals also displayed slower rates of NE turnover than lard-fed rats in both heart (7.8%/h vs. 13.2, P less than 0.001) and IBAT (7.0%/h vs. 12.8, P less than 0.01). Addition of casein (50% increase in energy intake) to a fixed chow ration raised NE turnover slightly, but not significantly, in heart (an average increase of 15% in six experiments). Thus, in distinction to SNS activation seen with dietary carbohydrate or fat, the SNS response to dietary protein is minimal in both heart and IBAT, indicating that the effect of increased energy intake on the SNS is dependent upon diet composition.     

Effect of digestible carbohydrates on glucose control in insulin-dependent diabetic patients

Recent studies have demonstrated that high-carbohydrate-high-fiber diets may improve the metabolic control in diabetes. To evaluate the influence of dietary carbohydrates separate from dietary fiber on blood glucose control, six insulin-dependent diabetic patients (IDD) were assigned in random order to two weight-maintaining diets for consecutive periods of 10 days. The diets differed in carbohydrate (41% in diet A and 60% in diet B) and fat content (41% and 20%, respectively) but were identical in calories, proteins, simple sugars, and fiber. After each dietary period blood glucose was continuously monitored for 24 h (Biostator GCIIS, Life Science Instruments, Miles Laboratories, Elkhart, Indiana). The M value was 48 +/- 20 after diet A and 96 +/- 27 after diet B (t = 3.83, P less than 0.025); the mean daily blood glucose was 152 +/- 5 mg/dl after diet A and 206 +/- 11 mg/dl after diet B (t = 7.50, P less than 0.001). Similarly, the blood glucose level for the 3-h period after each of the three main meals was lower after diet A than after diet B (analysis of variance: F = 5.2, P less than 0.05). No significant difference in fasting serum cholesterol, triglycerides, or serum lipoprotein composition was observed between the two diets. In order to separate the influence of dietary carbohydrate and fat on postprandial blood glucose concentration, an additional test meal experiment was performed in eight insulin-dependent diabetic patients. In random order on consecutive days they were given two standard meals that were identical in carbohydrate and protein content and differed only in the amount of olive oil added to the meals (12 g versus 36 g).(ABSTRACT TRUNCATED AT 250 WORDS)     

Traditional and alternative nutrition--levels of homocysteine and lipid parameters in adults

Values of homocysteine and lipid parameters were measured in groups of adults consuming alternative nutrition (vegetarians/lactoovo/, vegans) and compared with a group consuming traditional diet (omnivores, general population). Frequency of hyperhomocysteinemia was 53% in the vegans group, 28% in vegetarians vs. 5% in omnivores. In conditions of lower methionine intake (reduced content in plant proteins), the remethylation pathway of homocysteine metabolism prevails and it is vitamin B12 and folate-dependent. The intake of vitamin B12 is equal to zero in vegans; vegetarians consume 124% of the RDA vs. 383% in omnivores. Serum vitamin levels are significantly lower in subjects consuming alternative nutrition with deficiency observed in 24% of vegetarians, 78% of vegans vs. 0% in omnivores. Serum folate levels are within the reference range in all groups. Mild hyperhomocysteinemia in the groups consuming alternative diet is a consequence of vitamin B12 deficiency. Vegetarians and vegans meet the RDA for energy and fat, and have a favourable proportion of saturated, mono- and polyunsaturated fatty acids on total energy intake; the ratio of linoleic/alpha-linolenic acid in their diet corresponds with the recommendations. They have low cholesterol consumption and higher vitamin E and C intake. Optimal fat intake of correct composition is reflected in lower values of atherosclerosis risk factors (cholesterol, LDL-cholesterol, atherogenic index, saturated fatty acids, triacylglycerols), and significantly higher levels of protective substances (linoleic acid, alpha-linolenic acid, HDL-cholesterol, vitamin E, vitamin E/cholesterol, vitamin C). Low lipid risk factors but higher findings of mild hyperhomocysteinemia in vegetarians mean a diminished protective effect of alternative nutrition in cardiovascular disease prevention.     

No influence of high- and low-carbohydrate diet on the oral glucose tolerance test in pregnancy

OBJECTIVE: Our objective was to determine the influence of the carbohydrate content of the diet preceding the oral glucose tolerance test (OGTT) in pregnancy on the test results and to evaluate the necessity of the recommended preparatory high-carbohydrate diet. STUDY DESIGN: Thirty-four women from our outpatient clinic were enrolled in this prospective study. After giving informed consent, each women underwent a 90-min lesson (supervised by a dietary assistant) covering the carbohydrate, protein and fat content of different foods. Women were then randomized and in a crossover design started a diet with either a low or a high carbohydrate content. We were aiming at a carbohydrate intake of 40% in the low-carbohydrate week (LCH) and 50% in the high-carbohydrate week (HCH). Compliance was monitored by a detailed food diary which the women kept and which included the weight of the foods they consumed. RESULTS: The actual dietary intakes as calculated from the food diaries showed that the mean caloric intake was 1801 +/- 314 kcal in the LCH and 2118 +/- 312 kcal in the HCH week (<0.001). During the LCH diet, CH intake was 39 +/- 6.1% and 49 +/- 6.6% in the HCH week (P < 0.001). The carbohydrate intake per kilogram bodyweight was 30 +/- 5.3 kcal vs. 35 +/- 5.2 kcal (P < 0.001). The number of patients diagnosed with gestational diabetes was two in the LCH and three in the HCH week (not significant). The sum of the OGTT values (fasting, 1 h and 2 h) after the LCH was 18.9 +/- 2.1 mmol/l vs. 18.8 +/- 2.1 mmol/l after the HCH (P = 0.51). No differences could be found in both groups regarding the fasting, 1-h, or 2-h glucose values. Including patients with a CH difference of at least 5%, 10%, and 15% carbohydrate between the weeks, we still did not observe any differences in the OGTT sum. We also looked at a possible influence of the CH content of the diet on the day before the test and of the last meal before the OGTT results and observed there was none. CONCLUSION: This is the first study which has observed the influence of the previous day's meal on the test results. We conclude from our results that the carbohydrate percentage of the preparatory diet did not influence the results of an OGTT, even when we increased the difference in carbohydrate intake stepwise up to 15%. This might indicate that a preparatory diet before the OGTT is not necessary for women with normal nutritional behavior.     

Assessment of a food frequency questionnaire as a screening tool for low fat intakes

This study tested the ability of a self-administered food frequency questionnaire (FFQ) to identify women with low fat intakes. FFQs were completed by 95 control participants of a dietary trial at a mean of 2.9 ± 0.8 years post-randomization. Subjects were selected in approximately equal numbers from women who were low-fat eaters (⩽30% of energy from fat) and high-fat eaters (>30% of energy from fat). Percentage energy from fat derived from food records and FFQ were similar in both the low- and high-fat eaters. Percentage of energy from carbohydrate and total grams of carbohydrate (low-fat eaters only) were slightly higher measured by FFQ than by food records, and percentage of energy from protein was slightly lower. The correlation between nutrient intake measured by FFQ and food records for the whole group was 0.74 for percentage of energy from fat, 0.50 for total fat, 0.59 for percentage of energy from carbohydrate, 0.43 for total carbohydrate, 0.53 for percentage of energy from protein, 0.27 for total protein, and 0.32 for energy intake. Correlations were slightly lower when the low-and high-fat eaters were examined separately. The area under the receiver operating characteristic (ROC) curve, 0.83, was significantly above 0.5 (p < < 0.001), indicating that the FFQ discriminated between low- and high-fat eaters significantly better than chance. The FFQ cutoff point of 30% of energy from fat had a true positive rate of 0.63 and false positive rate of 0.24. The use of this cutoff point for screening would result in the loss of 36% of potential subjects and an estimated increase in baseline percentage of energy from fat intake of 2.3 percentage points.     

Institutional dietary provision for diabetic patients

We compared the diet of residents with diabetes with current British Diabetic Association (BDA) recommendations, and the nutritional adequacy and content of the diet using 3-day food diaries. We studied 52 residents with diabetes and 48 age- and sex-matched controls from 37 nursing, residential and elderly mentally infirm homes in one city. The daily intake of fat, protein, carbohydrate and fibre of the group with diabetes did not comply with current BDA guidelines, and 52% of diabetic residents and 46% of controls had a lower daily energy intake than currently recommended. The diet of diabetic residents did not comply with current recommendations. Undernutrition is common in both groups.