目的研究社区老年糖尿病患者的膳食供能现状及基于合理营养自评系统的干预效果,为糖尿病患者的营养干预提供依据。方法于2013年6-12月,在上海市徐汇区随机抽取4个街道,其中2个街道为干预组,2个街道为对照组;随机抽取在册管理且年龄为60~75岁的糖尿病患者为研究对象,每组157例。干预前后,两组均在调查员的指导下,结合膳食营养评价系统,开展72 h膳食回顾调查。干预组开展6个月的周期性膳食干预,包括强化糖尿病教育和基于合理营养自评系统的个性化膳食指导和管理。对照组进行社区居民常规糖尿病管理。应用Stata 11.0软件进行t检验、χ~2检验和logistic回归分析。结果干预前,干预组能量摄入不足者(64.9%)与过量者(25.5%)并存,能量摄入合理者仅占9.6%;三大营养素供能构成中,脂肪摄入量超标者所占比例(40.2%)多于不足者(17.8%),蛋白质、碳水化合物摄入量不足者所占比例(分别为36.9%和29.9%)多于超标者(分别为14.0%和24.9%)。干预后,干预组能量摄入正常者所占比例升至21.0%,能量摄入不足者所占比例下降为58.0%;蛋白质、脂肪摄入量正常者所占比例分别上升至61.2%和52.1%,但碳水化合物摄入正常者所占比例上升不明显。与干预前比较,干预后干预组能量摄入、蛋白质、脂肪供能构成差异均有统计学意义(P<0.05),碳水化合物供能构成差异无统计学意义(P>0.05)。与干预前比较,干预后对照组能量摄入和三大营养素供能构成差异均无统计学意义(P>0.05)。干预后,对照组糖化血红蛋白(Hb A1C)达标率(35.7%)低于干预组(59.9%),差异有统计学意义(P<0.01)。logistic回归分析结果显示,脂肪摄入供能占比是影响HBA1C达标的危险因素(OR=1.042,95%CI:1.017~1.068)。结论老年糖尿病患者膳食结构不合理的情况普遍存在,科学的膳食干预手段能够改善饮食结构,改善糖尿病的控制效果。 Objective To study the status of dietary energy supply in community-aged diabetic patients and the intervention effect based on the reasonable nutrition self-assessment system to provide basis for nutritional intervention in patients with diabetes mellitus. Methods From June to December in 2013, four streets were randomly selected from Xuhui District, Shanghai. Two of them were in the intervention group and two in the control group. The patients with diabetes under 60 years old and aged 60 to 75 Study object, each group 157 cases. Before and after the intervention, both groups under the guidance of investigators, combined with dietary nutrition evaluation system, to carry out 72 h diet review survey. The intervention group conducted a six-month periodic dietary intervention that included intensive diabetes education and personalized dietary guidance and management based on a rational nutritional self-assessment system. Control group for routine management of diabetes residents. Stata 11.0 software was used for t test, χ ~ 2 test and logistic regression analysis. Results Before the intervention, the energy intake of the intervention group (64.9%) and the excess (25.5%) coexisted, accounting for only 9.6% of the energy intake. Among the three nutrient supply components, those with excessive intake of fat (40.2%) were more than those who were deficient (17.8%). The proportion of those who had inadequate intake of protein and carbohydrates (36.9% and 29.9% respectively) was higher than those who exceeded the standards (14.0% and 24.9% respectively). After intervention, the proportion of patients with normal energy intake in the intervention group rose to 21.0% and the percentage of those with insufficient energy intake dropped to 58.0%; the proportion of those with normal protein and fat intake increased to 61.2% and 52.1% respectively , But the proportion of normal carbohydrate intake increased not obvious. Compared with those before intervention, there were significant differences in energy intake, protein and fat supply between intervention group and intervention group (P <0.05). There was no significant difference in carbohydrate energy supply between the two groups (P> 0.05). Compared with those before intervention, there were no significant differences in energy intake and energy composition of the three nutrients after intervention (P> 0.05). After the intervention, the Hb A1C compliance rate (35.7%) in the control group was lower than that in the intervention group (59.9%), the difference was statistically significant (P <0.01). Logistic regression analysis showed that the proportion of fat intake and energy supply was the risk factor for HBA1C compliance (OR = 1.042, 95% CI: 1.017-1.068). Conclusion The unreasonable dietary structure of elderly diabetic patients is widespread. Scientific dietary interventions can improve the diet and improve the control effect of diabetes.