53名社区2型糖尿病患者膳食称重调查及营养评价

通过社区的健康促进来控制糖尿病正成为各国糖尿病防治研究的热点。在糖尿病社区干预措施中，营养教育和饮食治疗是其最重要的内容之一，评价饮食治疗合理与否需要进行人群膳食调查。本调查采用称重法和食物计量图片法及膳食模拟法对社区糖尿病病人摄人食物的种类和数量进行较准确的记录，以客观地评价糖尿病病人的膳食状况，为社区糖尿病病人营养干预和营养教育工作提供科学依据。     

51例肺癌患者术后化疗期的营养状况调查

目的探讨化疗2次以上的肺癌术后患者的营养状况变化。方法选取51例肺癌术后化疗住院患者进行SGA营养评估、膳食营养情况、人体测量及血生化检查结果的调查，比较SGA评估不同组患者的营养状况。结果通过营养评价结果发现SGA评估不同组患者的体重、体质指数、肱三头肌皮褶厚度、上臂肌围、总蛋白、白蛋白、血红蛋白均存在差异（P〈0．01，P〈0．05）。结论肺癌术后化疗患者营养不良的发生率较高，通过简洁、有效、快速的SGA评估法可早期发现并预防营养不良风险。     

营养与心血管病防治

随着国民经济的好转，膳食结构发生了显著变化，全国营养调查显示谷类、块茎类、豆类食物摄人量减少，动物性食物，植物油、食盐摄人量上升。这些变化导致我国慢性非传染性疾病的发病率和死亡率都比以往有显著增加。心血管病成为死亡原因的第一位。心血管病的主要危险因素高血脂、高血压、肥胖、糖尿病都与营养有关。控制某些膳食因素后可使     

不同氟水平地区人群膳食营养调查

为了解膳食蛋白质和钙不足与地方性氟中毒流行和程度的关系，选择全国三组低、适宜和高饮水氟浓度地区，每组包括营养正常和不足两调查点，进行膳食营养和总摄氟量调查。调查结果表明营养正常地区膳食营养摄入量为蛋白质７２．４－１０９．７ｇ，优质蛋白占蛋白２８－２９％，热量２６４９－３９１７Ｋａｌ，钙７３４．１－１００９．９ｍｇ，其他成份也基本达到从给量标准，部摄氟量１．７－１４．８ｍｇ，营养不足地区蛋白质５７．     

糖尿病膳食配餐8原则

我患糖尿病30余年来一直坚持糖尿病营养治疗膳食的配餐原则，我感觉糖尿病饮食不但没给我带来多少痛苦，反而受益颇多。我觉得糖尿病营养治疗膳食的配餐原则不仅是糖尿病病友必须坚持的，其他一些存在健康隐患的人群（如血脂紊乱、高血压、高血糖、肥胖和脂肪肝等人群），也是应该参照或借鉴的。     

营养平衡是生命的“保护神”——饮食疗法的体会

生命诚可贵，全靠营养配。合理的膳食方式．是糖尿病患者控制病情的基石，也是偏瘦患者增重保健康的重要措施。我是一名年过75岁、走完16年抗糖路的偏瘦糖尿病患者，在膳食安排和营养供给上，严格按照糖尿病治疗饮食原则．人大于出，体重才逐渐上升，体重达标后，改吃“进出平衡”的热量食谱．使我的体重始终保持正常状态．不胖不瘦．健康结实，病情趋于稳定。患病这16年，饮食帮了我大忙．有三点体会与大家一同分享。     

保住营养素 才算懂营养

营养治疗是糖尿病治疗的基石。然而，国内多项调查显示，我国相当一部分2型糖尿病患者的营养素摄入配比不合理，维生素、矿物质等的摄入量普遍低于“中国居民每日膳食营养素参考”的标准。     

1型糖尿病的医学营养治疗

医学营养治疗（medical nutrition therapy，MNT）是1型糖尿病综合治疗的重要组成部分，其强调在保证正常生长发育、体力活动的同时，达到血糖、血压、脂代谢的理想控制。成功的糖尿病管理，需要每日关注营养处方，尤其是膳食质量以及比较准确的食物中含有的碳水化合物摄入量。儿童、青少年期发生的糖尿病90％为1型糖尿病，因其生长发育的需求，对胰岛素需要量经常变化，并且由于发育阶段的特殊营养需求，其膳食及生活也应随之进行调整。本文旨在对于1型糖尿病MNT的原则，使用方法以及营养师的工作进行阐述。     

围绝经期女性病人膳食调查与营养评价

目的调查围绝经期女性膳食特点与营养状况。方法对150例围绝经期女性,采用24 h膳食回顾法、身体测量和各项生化指标进行营养状况的综合评价。结果围绝经期女性膳食调查结果显示谷类、奶及奶制品、肉类、豆及豆制品及坚果摄入不足,脂肪供热比偏高。维生素中只有维生素C和维生素E摄入量达到推荐量,矿物质及膳食纤维均未达到推荐量。体格检查显示超重、肥胖比例近1/3;血脂异常比例也较高,低密度脂蛋白胆固醇升高比例最高,达41.3%。体质量指数与谷类摄入量、血三酰甘油水平与肉类摄入量、血高密度脂蛋白胆固醇水平与豆制品摄入量呈正相关(P0.05)。结论围绝经期女性存在膳食不均衡、超重肥胖、血脂异常及骨量代谢异常等营养问题,应加强营养宣教,促进合理膳食。     

2型糖尿病医学营养治疗进展

医学营养治疗是糖尿病患者应该长期坚持的、基础性的治疗措施。目前我国T2DM患者的膳食结构尚需改进。本文综述了近年来糖尿病医学营养治疗的作用、饮食结构和食物选择、依从性保障3方面的进展,提出糖尿病营养治疗应基于我国各地传统食材,结合人们生活工作实际,设计糖尿病健康饮食模式。合理运用网络平台可以提高营养教育的效率和依从性。     

团队管理下一对一营养干预模式在早期糖尿病肾病治疗中的效果评价

目的 评价团队管理下一对一营养干预模式在早期糖尿病肾病治疗中的效果.方法 以2015年1月至2016年2月首次来天津医科大学第二医院血液内分泌科住院的120例早期糖尿病肾病患者(尿白蛋白/肌酐比值30～ 299 μg/mg)为研究对象,在传统的药物治疗、医学营养治疗、运动疗法、糖尿病教育的基础上,按照随机数字表将患者分为两组,一组为传统模式组(n=60),一组为团队管理下一对一营养干预模式组(团队干预组,n =60).团队干预组根据患者的实际需求和理解能力采取一对一的模式,定期随访观察患者,收集两组治疗前、治疗3个月后膳食状况、营养指标、HbA1c、24 h尿微量白蛋白(UMA)、血清白蛋白、血糖和血脂指标.采用中文版糖尿病管理自我效能表(C-DMSES)评估患者糖尿病自我管理能力.结果 治疗3个月后,与传统模式组相比,团队干预组蛋白质摄入量明显降低,优质蛋白比例提高,植物油、食盐摄入量明显降低(t=2.54～ 5.18,P均＜0.05),因加入≥20 g的麦淀粉,主食摄入量没有明显差异(P＞0.05).团队干预组与传统模式组相比,空腹血糖、餐后2h血糖(2 hPG)、HbA1c、24 hUMA、甘油三酯水平均下降(t=1.94 ～3.74,P均＜0.05).体重指数、腰围、总胆固醇、血清白蛋白水平在两组间比较,差异均无统计学意义(P均＞0.05).团队干预组C-DMSES明显高于传统模式组(t=14.2,P＜0.05).结论 团队管理下一对一营养干预模式可显著改善早期糖尿病肾病患者膳食摄入情况,患者各项临床指标明显好转,自我管理效能得到提高.     

Dietary alterations due to perceptions in acute viral hepatitis lead to sub‐optimal calorie intake and increased length of hospitalization

Summary. Although there are no dietary restrictions recommended in acute viral hepatitis (AVH), there is an altered food intake, probably because of perceptions and traditional nutritional practices, leading to sub‐optimal intake and poorer clinical outcome. Therefore, we aimed to determine nutritional intake of AVH patients before and after disease onset and to investigate if optimal intake following nutrition education shortened the length of hospitalization (LOH). Seventy‐five patients with AVH were interviewed for foods consumed and avoided because of perceptions during illness. Nutrition education was given to all patients with meal plan. In‐patients were monitored for their nutritional intake until discharge. All patients were followed up after 2 weeks to assess compliance to the plan. There was a statistically significant decrease in mean calorie and protein intake in AVH patients during illness [1314 kcal (standard deviation, SD 291) and 27.5 g (SD 8.84)] when compared with that before onset of the disease [1873 kcal (SD 246) and 51.5 g (SD 8.03); P < 0.0001]. Mean LOH in patients consuming a high calorie diet [6.28 days (SD 2.91)] was significantly lower than those consuming low calories [8.36 days (SD 2.59), P = 0.024]. Two‐week follow up revealed that 70% of patients modified their diet to a balanced normal diet as per the given plan. Our study showed that AVH patients consumed sub‐optimal calories because of perceptions and traditional nutritional practices. Nutrition education played a major role in achieving overall nutritional goals and in decreasing the LOH.     

限蛋白质摄入对2型糖尿病早期肾病的影响

目的 评估限蛋白质摄入对２型糖尿病肾病在肾功能和营养状况方面的影响。方法 门诊６７例早期肾病病人,按就诊顺序分为限蛋白治疗组和正常蛋白组,试验期为１年。结果 两组病人体重指数、血常规及血液生化、血糖指标、血液肾功能治疗后无显著性差异。治疗组两组间血清白蛋白有显著性差异。实验组尿白蛋白排泄率明显下降。结论 限蛋白膳食可以显著减少２型糖尿病早期肾病病人尿白蛋白排泄率,从而改善营养状况,保护肾功能。     

Ernährung bei Diabetes

According to the current nutritional recommendations issued by professional diabetes and nutrition associations, diabetic patients should keep to a diet consisting of 45–60% carbohydrates, 10–20% protein, and not more than 35% fat. However, not all of these nutritional recommendations are evidence based. For example, current studies show that the intake of insoluble roughage may be underrepresented. It is also possible that diabetic patients could benefit from keeping to the lower end of the recommended range for carbohydrates (45%) and the upper end of the range advised for protein (20%).     

Comparison of the diet of self-declared diabetics with non-diabetic patients in the SU.VI.MAX study: did the diabetics modify their nutritional behavior?

OBJECTIVE: Dietary recommendations, a pillar in the treatment of diabetes, form part of official guidelines. However, it is not known how well these recommendations are followed in the diabetic population in France. The purpose of this study was to compare the habitual diet of self-declared diabetics with non-diabetics and to evaluate whether recommendations are being followed. METHODS: The intakes of several nutrients and foods of 67 self-declared diabetic patients were compared to those of 4658 non-diabetics in the SU.VI.MAX study (a primary prevention trial evaluating the impact of antioxidant supplementation on chronic disease). All patients (aged 45 to 60 years) who had completed at least five 24-hr dietary records over the first 18 months of the SU.VI.MAX study were included. We excluded patients who had not declared a diagnosis of diabetes and those with plasma fasting glucose levels over 7 mmol/l. RESULTS: The diabetic patients who declared being diabetic reported lower carbohydrate intakes (185 +/- 10.4 vs 219 +/- 1.4 g/d for men [p=0.001], 137 +/- 9.6 vs 165 +/- 1.0 g/d for women [0.005]), with a 50% reduction in consumption of oligosaccharides. Lipid intakes were unchanged for men, but reduced for women (61 +/- 4.1 g/d vs 72 +/- 0.4 g/d [p=0.01] with a 20% reduction in saturated fatty acids. Protein consumption was higher in the diabetic than in the non-diabetic men, but comparable for the women. Energy intakes were only lower in the diabetic women (1458 +/- 81 vs 1665 +/- 9 Kcal/d for women [p=0.01]). Micronutrient intakes were similar to those of non-diabetics, but appeared to be inadequate, particularly for anti-oxidants. Diabetic men consumed more margarine and less alcohol than did the non-diabetics. CONCLUSION: Diabetic patients who declared being diabetic did modify their nutritional behaviour, as they reduced their carbohydrate intake (both men and women), increased their protein intake (men only), and decreased their lipid and energy intakes (women only). However, carbohydrate intakes were unbalanced and there was excess protein intake. So patients who declared being diabetic are not as non-compliant in nutrition as commonly thought; they try to modify their diet, but often inappropriately. This may be explained by the fact that dietary advice stems from different sources and may be contradictory. A diabetic education program requires standardised training of health professionals and the provision of unequivocal information to the mass media and the general public.     

Malnutrition in patients suffering from chronic heart failure; the nurse's care

Chronic heart failure is associated with a bad prognosis with considerably shortened survival and repeated hospitalisations. Patients suffering from heart failure also have symptoms that can affect their food intake, for example, tiredness when strained, breathing difficulties and gastrointestinal symptoms like nausea, loss of appetite and ascites. Pharmacological therapy can lead to a loss of appetite, which will make the intake of food inadequate to fill the required energy and nutritional needs. The nurse's interest in and knowledge of diet issues can improve these patients' nutritional status. The aim of this literature review was to describe the nurse's interventions regarding malnutrition in patients suffering from chronic heart failure. The literature search gave 13 articles, which were analysed, and sentences whose content was related to the aim were identified. Three areas of content appeared; drug treatment and consequences, gastrointestinal effects, and information and education. The results show that the nutritional status of these patients can be significantly improved by means of simple nursing interventions. Future research should focus on controlled experimental studies to evaluate differences in body weight, body mass index and quality of life between patients suffering from chronic heart failure, who are taking part in a fully enriched nutrition intervention, and patients suffering from chronic heart failure, who are eating their normal diet.     

Appropriate physical activity and dietary intake achieve optimal metabolic control in older type 2 diabetes patients

Aims/Introduction

The aim of the present study was to investigate an appropriate level of physical activity and optimal dietary intake in older type 2 diabetes patients.

Materials and Methods

The cross‐sectional study enrolled 210 older type 2 diabetes patients. Participants were interviewed to obtain information on physical activity, 24‐h dietary recall and typical weekly dietary patterns. Anthropometric measurements, and biochemical analysis of blood and urine were determined.

Results

Moderate physical activity (either moderate leisure‐time physical activity or moderate physical activity level) and diet with protein intake of ≥0.8 g/kg/day were associated with lower glycated hemoglobin and triglyceride, higher high‐density lipoprotein, lower waist circumference, body mass index and body fat, as well as better serum magnesium and albumin levels in older diabetic patients. In contrast, inadequate protein intake was correlated with higher glycated hemoglobin, triglyceride, body fat percentage, waist circumference and body mass index. In addition, high physical activity with inadequate protein and magnesium intake might exacerbate magnesium deficiency, resulting in poor glycemic control in older diabetic patients. Furthermore, low physical activity and inadequate protein intake were linked with poor glycemic control, and lower high‐density lipoprotein, and higher triglyceride, body fat percentage, waist circumference and body mass index.

Conclusions

Moderate physical activity and adequate dietary protein intake (≥0.8 g/kg/day) might be the optimal recommendation for better metabolic control in older adults with type 2 diabetes.     

223例糖尿病病人膳食现状调查

目的：评价当前糖尿病病人膳食质量,方法：采用膳食史法和24h回顾法,调查了223例糖尿病病人膳食热能,主要营养素摄入量和生能营养素来源及所占热能比例。结果：与标准供给量比较,部分糖尿病病人热能摄取过剩,脂肪热比偏大,动物性蛋白质及胆固醇摄入过多,以肥胖体型者明显,结论：当前糖尿病人群的膳食质量存在问题,需要综合性的营养干预,其中肥胖体型者重点干预对象。     

Effects of Ascaris infection on human nutrition

The role of Ascaris lumbricoides infection in human nutrition was investigated in 12 children 5-10 years of age. Daily levels of dietary protein intake varied from 1-2.8 g/kg body weight but were kept constant for each child as was caloric intake. Nitrogen, fat balance, and d-xylose absorption determinations were done before and after deworming. A mean reduction in fecal nitrogen excretion of 230 mg/day was noted after worm removal. In 7 children harboring 48 or more parasites, the reduction in fecal nitrogen amounted to 7.2% of the dietary nitrogen. In 3 children receiving 1 g of protein/kg body weight, the improved nitrogen absorption after deworming led to an increased nitrogen retention. In 8 children the infection was associated with moderate steatorrhea (13.4% of dietary fat) and impairment of d-xylose absorption; the former was markedly reduced, and the latter was partially improved following treatment. It is concluded that Ascaris infection in children can lead to marked nutritional impairment when a high parasite load is associated with a low protein intake.