營養介入對居家照護之糖尿病病人營養及血脂改善成效

Effects of Nutritional Intervention to Improve Nutritional Status and Blood Lipids for Home-care Diabetes Patients

莊淑如(Shu-Ru Zhuang) ； 嚴永裕(Yeong-Yu Yan) ； 王進崑(Chin-Kun Wang)

《臺灣營養學會雜誌》 37卷2期 (2012/06) Pp. 85-92

https://doi.org/10.6691/NSJ.201206_37(2).0004

摘要

糖尿病為國人十大死因的第四位，目前台灣約有100萬的糖尿病病人，醫療費用佔健保經費的1/8。糖尿病的飲食治療首重合宜的總熱量攝取、適當的營養素比例及足夠的纖維質攝取，穩定的血糖控制，將可降低併發症的發生率。居家照護的病人因無營養師定期介入營養照護且照護者對營養知識的缺乏，不合適的營養支持所引發的血糖不穩將影響身體對營養素的利用率。本研究主要藉由營養師飲食調整合併高纖維糖尿病營養品作為糖尿病患部份營養來源，探討是否能改善營養狀況較差之糖尿病患者的營養狀況，故評估指標以維持血糖與改善營養為主。由居家安養病人中篩選出糖尿病患者（空腹血糖值＞126mg/dL但＜180mg/dL；或已被檢查確認是糖尿病之患者；或6.5％＜HbA1c＜7.2%之患者）且經由營養師評估符合1.體重過輕（BMI＜18）、2.血清白蛋白低於正常值（小於3.5g/dL）、3.經營養評估後確定為營養狀況不良、4.飲食攝取量不夠、5.無法進食（本試驗納入管灌受試者）等任一條件之受試者共計39位個案，補充量平均為500 ± 56大卡，平均補充40 ± 12天。結果顯示：受試者之體重由60.9 ± 10.7kg顯著增加至61.3 ± 10.6kg（p=0.010），身體質量指數由24.07 ± 3.76kg/m^2顯著增加至24.25 ± 3.78kg/m^2（p=0.015），腰圍由84.9 ± 7.6cm 顯著增加至85.2 ± 7.7cm（p=0.036），三頭肌皮下脂肪厚度由1.97 ± 0.78cm 顯著增加至2.00 ± 0.76cm（p=0.005），中臂圍由27.4 ± 4.3cm顯著增加至27.6 ± 4.0cm（p=0.031），血清白蛋白由4.02 ± 0.46g/dL顯著地提升至4.18 ± 0.49g/dL（p=0.001），血清總蛋白質由7.26 ± 0.49g/dL顯著地提升至7.46 ± 0.41g/dL（p=0.005），三酸甘油酯濃度由158.6 ± 89.4mg/dL地顯著降低至126.4 ± 59.25mg/dL（p=0.008）。本研究顯示，經由營養師的飲食調整及以高纖維糖尿病營養品作為部份營養來源，可以提升糖尿病病患體位及營養狀況及改善血脂異常。

關鍵字

糖尿病 ； 高營養不良風險 ； 三頭肌皮下脂肪 ； 血清白蛋白 ； 三酸甘油酯

並列摘要

Diabetes is the fourth leading cause of death of people in Taiwan. There are about one 1 million diabetic patients in Taiwan, and medical costs account for 1/8 of health insurance funds. Goals for diabetic dietary therapeutics are to control total caloric intake, provide an appropriate ratio of nutrient and fiber intake, and maintain stable blood sugar control; these will help reduce the occurrence of complications. Because home care patients receive no nutritional interventions, and caregivers have low or inadequate nutritional knowledge, the instability of blood sugar control caused by inappropriate nutritional support will affect the utilization of nutrients. In this study, a high-fiber diabetes nutritional formula provided a portion of the source of nutrition for diabetic patients. We assessed the effects of improving the nutritional status of poor-nutrition patients using indicators such as maintaining blood sugar levels and a better nutritional status. Thirty-nine cases were recruited in this study. The enrollment criteria were home care patients either with diabetes (fasting blood sugar of 126～180 mg/dL, having been diagnosed as having diabetes, having 6.5% ＜ HbA1c ＜ 7.2% and considered to be underweight (with a body mass index of ＜ 18kg/m^2), having lower serum albumin than normal ( ＜ 3.5g/dL), or having been assessed as being malnourished, with a poor dietary intake or dysphagia (including tube feeding). The dose of the formula was 500 ± 56 kcal/day, and the duration of the intervention was 40 ± 12 days. Results showed that the subjects' triceps skin fold thickness significantly increased from 1.97 ± 0.78 to 2.00 ± 0.76cm (p = 0.005), serum albumin significantly increased from 4.02 ± 0.46 to 4.18 ± 0.49g/dL (p = 0.001), serum total protein significantly increased from 7.26 ± 0.49 to 7.46 ± 0.41g/dL (p = 0.005), and triglyceride levels significantly dropped from 158.6 ± 89.4 to 126.4 ± 59.5mg/dL (p = 0.008). This study showed that the high-fiber diabetes nutritional formula could improve diabetes patients' anthropometrics, nutritional status, and blood lipids when provided as a part of the source of nutrition for diabetic patients.

並列關鍵字

diabetes ； malnutrition ； triceps skin fold thickness ； albumin ； triglyceride