門診老年糖尿病人營養及血糖 控制狀況之探討

Explore the nutritional status and glycemic control elderly patients with diabetes

張釋文(Shin-Wen Chang)

指導教授 ： 張菡馨

中山醫學大學/健康管理學院/營養學研究所/碩士(2015年)

https://doi.org/10.6834/CSMU.2015.00078

摘要

營養不良在社區或是在機構中是老人常見的問題，且老人糖尿病盛行率不斷上升，引發死亡率增加。本研究目的為運用短式簡易營養評估量表(MNA-SF)，作為門診老年糖尿病人之營養不良篩選工具，希望能提供適時的營養介入及良好的血糖管理，以減少門診老年人營養不良的傷害及減緩糖尿病慢性併發症的發生。研究期間為2014年6月至2014年12月，採立意取樣對象為順天醫院內科門診參加「糖尿病醫療給付改善方案」年度評估管理照護的病人，最終符合收案條件共有70人。內容包括個案基本資料、體位測量、MNA-SF、血液生化、尿液檢測、24小時飲食回憶記錄、飲食衛教。結果顯示：在營養方面，MNA-SF總分≧12正常有52位（74.29%）， MNA-SF總分≦11可能有營養不良的有18位（25.71%）；且MNA-SF的總數和受試者腰圍、小腿圍及血色素、血清白蛋白有極為顯著的相關性(p<0.001)。在三大營養素及六大類食物份數攝取方面，受試者每日實際攝取熱量及蛋白質攝取量都比營養師建議較高；分別為1683.4±234.6 kcal/day及59.9±13.5 g/day；依照行政院衛生署老人每日飲食指南，男性在奶類、蔬菜類攝取不足，在蛋豆魚肉類及油脂類攝取過多。女性在奶類、蔬菜類及水果類攝取不足，但僅在油脂類有攝取過多的現象。在老年糖尿病控制指標方面，HbA1c＜7.5控制良好有49位(70%)、BP＜140/80 mmHg控制良好有38位(54.29%)、LDL-C<100 mg/dl控制良好有31(44.29%)；但在腎臟病篩檢方面異常有41位(58.57%)。參加「糖尿病醫療給付改善方案」的老年人，因定期接受醫療團隊照護及營養衛教指導，在血糖、血壓及血脂控制成果多數良好；但在合併腎病變的照護及衛教須再加強。經MNA-SF篩選後，仍有25.71%可能為營養狀況不良，需營養師進一步評估介入；所以在老人門診及成人預防保健「健康加值」方案檢查時，快速增加簡易的MNA-SF篩檢是可行的。

關鍵字

營養不良 ； 短式簡易營養評估量表 ； 三大營養素 ； 老年糖尿病控制指標

並列摘要

Malnutrition or in institutions for the elderly is a common problem in the community, and the rising prevalence of diabetes for the elderly, causing increased mortality. The purpose of this study is the use of short-form Mini Nutritional Assessment (MNA-SF), as an outpatient elderly diabetic human malnutrition screening tool, hoping to provide timely intervention and good glycemic nutrition management to reduce malnutrition in the elderly outpatient mitigation of injury and chronic complications of diabetes. During the study period was from June 2014 to December 2014, adopted a purposive sample object Sun Tian Hospital outpatients participated in the annual assessment of patients managed care "program to improve diabetes health care payments," eventual-
ly meet the conditions for a total of 70 cases recorded. Including cases basic informati
-on, position measurement, MNA-SF, blood biochemistry, urine test, 24 hours dietary recall records, dietary health education. The results show that: In nutrition, MNA-SF scores than or equal to 12 normal have 52 (74.29%), MNA-SF score 11 or less likely to have malnourished 18 (25.71%); and the MNA-SF total number of subjects waist circumference, calf circumference and hemoglobin, serum albumin, there is a very significant correlation (p <0.001). In the three major nutrients and parts of six major categories of food intake aspect, the subject daily calorie intake and protein intake actually amount higher than nutritionists recommend; was 1683.4 ± 234.6kcal / day and 59.9 ± 13.5g / day; in accordance with the Department of Health for the elderly daily dietary guidelines for men in inadequate intake of milk and vegetables, in ex-
cessive intake beans,meat,fish,egg and lipids.Women intake in inadequate intake of milk , vegetable and fruits, but only in excessive intake of lipids. In elderly diabetic control indicators, HbA1c less than 7.5 have good control of 49 (70%), blood pressure less than 140/80mmHg have good control of 38 (54.29%), low density lipoprotein cholesterol less than 100mg /dl have good control of 31 (44.29%); however, in terms of kidney disease screening abnormal have 41 (58.57%). Participate in the "pay to improve diabetes health care program," the elderly, because of regular medical care and nutrition health education team guidance, blood glucose, blood pressure and lipid control most favorable outcome; however, the merger Nephropathy care and health education should be further strengthened. After screening MNA-SF, still 25.71% of poor nutritional status may need to further assess the involvement of a nutritionist; so the elderly outpatient and adult preventive care "health bonus" scheme checks, increase the quick and easy screening MNA-SF it is feasible.

並列關鍵字

malnutrition ； Mini Nutritional Assessment Short Form ； the three major nutrients ； senile diabetes control targets

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