个体化营养指导对单纯性肥胖患者减重 及体重维持效果的初步研究. (Chinese)

Objective To explore the effects of individualized nutrition training on weight loss and weight maintenance in patients with simple obesity. Methods Of 100 simple obese patients from the obesity clinic of Endocrinology and Metabolism Department between Jan. 2015 and Dec. 2016, 12 patients dropped out halfway and 88 patients were recruited and randomly divided into 2 groups: the individualized nutrition training (INT) group (n=48) and the conventional nutrition intervention (CNI) group (n=40). The therapeutic process included intervention, transition and maintenance period. Under the guidance of a specialist physician, a registered nutritionist and a nurse, each patient received treatment including 3 month intervention period (a low‑calorie, low‑carbohydrate diet: daily calories<1 200 kcal, carbohydrate 20% to 30%, protein 30% to 35%, fat 35% to 40%), followed by 1 month transition period and 12 month maintenance period (a balanced diet: daily calories ≤25 kcal/kg, carbohydrates 55% to 60%, protein 15% to 20%, fat≤30%). In CNI group nutrition prescriptions were provided by the nutritionist, nutrition education and monthly follow‑up were completed by the nurse, and the safety was monitored by the physician. In INT group during intervention period, the nutritionist gave individualized nutrition training covering 3 meals daily by Wechat. Additionally, the advices for exercise intensity, dietary requirements and follow‑up frequency were consistent in these two groups. The scores of dietary behavior and the weight rates of reaching the standard at different time points were compared between these two groups. Fisher exact probability method, t test and Spearman method were used for statistical analysis. Results No differences was found in the initial dietary behavior scores between these two groups (3.92±1.13 and 3.88±0.97, P>0.05). After intervention, the dietary behavior scores in INT group increased significantly than those in CNI group at the beginning of the maintenance period (7.81±0.67 and 7.13±1.22, P<0.01) and at the end of the maintenance period (7.00±1.11 and 4.68±1.10, P<0.01); The weight loss percentage of the patients in INT group increased significantly than those in the CNI group at the end of the intervention period (15.0% and 9.2%, P<0.01), at the beginning of the maintenance period (14.2% and 8.4%, P<0.01) and at the end of the maintenance period (11.3% and 2.6%, P<0.01).The weight loss percentage over 5% in INT group was more than those in CNI group at the end of the maintenance period (91.7% vs 20.0%, P<0.01). Conclusion Individualized nutrition training may help patients with simple obesity lose more weight and prevent weight rebound. [ABSTRACT FROM AUTHOR]

目的观察个体化饮食指导对单纯性肥胖患者减重及体重维持的效果。方法选取 2015年1月至2016年12月于南方医科大学第三附属医院的100例单纯性肥胖患者，按随机数字表分为 个体化营养指导（INT）组与常规营养干预（CNI）组，中途12例退出，最终纳入INT 组48例，CNI 组 40例。治疗过程分为干预期、过渡期、维持期。两组干预期均采用低热量低碳水化合物饮食（碳水化 合物供能占比20%~30%，脂肪供能占比35%~40%，蛋白质供能占比30%~35%）干预3个月，随后经过 1个月过渡期（介于干预期与维持期之间），逐渐过渡至维持期采取平衡膳食模式（碳水化合物供能占 比55%~60%，蛋白质供能占比15%~20%，脂肪供能占比≤30%），观察12个月。两组患者运动强度、饮 食要求及随访频率一致。比较两组不同时间点的饮食行为评分、体重达标率，采用t 检验、Fisher确切 概率法、Spearman法进行统计学分析。结果INT组和CNI组患者间干预开始前（0个月）饮食行为评 分分别为（3.92±1.13）、（3.88±0.97）分，差异无统计学意义（P>0.05），INT组维持期开始时（4个月）和维 持期结束时（16个月）的评分分别为（7.81±0.67）、（7.00±1.11）分，高于CNI 组的（7.13±1.22）、（4.68± 1.10）分，差异均有统计学意义（均P<0.01）。与CNI组相比，INT组患者干预期结束时（分别为15.0% 和9.2%）、维持期开始时（分别为14.2%和8.4%）及维持期结束时（分别为11.3%和2.6%）体重变化程 度均高于CNI组，差异有统计学意义（P<0.01）。与CNI组相比，维持期结束时INT组体重下降5%达标 率（分别为20.0%和91.7%）差异有统计学意义（P<0.01）。结论个体化营养指导可能有助于患者进 一步减轻体重，并预防患者体重反弹. [ABSTRACT FROM AUTHOR]

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