CAJ | 학술논문

目的：探讨妊娠糖尿病（GDM）营养干预对脂代谢的作用。方法选取北京协和医院营养科门诊孕中晚期GDM患者127例为研究对象，按照孕期限能量糖尿病饮食方法进行营养干预，限制碳水化合物供能比≤50%，燕麦等粗杂粮占主食的50%，以提高膳食纤维摄入量，限制饱和脂肪来源食物，推荐橄榄油等。监测干预期内患者体重变化，通过膳食记录计算膳食脂代谢相关指标（能量、脂肪供能比、各种脂肪酸占比、不溶性膳食纤维含量等），比较干预前后患者血清总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）水平的变化，并检验膳食因素与脂代谢指标的相关性。结果127例接受膳食干预的患者中37例提交有效膳食记录，计341天（97个周代表值），据此计算干预期膳食结果能量为（7980±1785）kJ/d，脂肪供能比为（29.9±5.3）%，饱和脂肪酸占总脂肪酸的（29.13±3.95）%，单不饱和脂肪酸占总脂肪酸的（41.44±2.78）%，不溶性膳食纤维为（24.34±11.65）g/d。TC、HDL、LDL干预前后无显著差异，TG水平干预前为（2.92±1.39） mmol/L，干预后为（3.27±1.33）mmol/L（P＜0.05）。干预膳食的不溶性纤维含量与干预后血清LDL-C水平相关（R＝0.28，P＜0.05）。结论 GDM患者孕中晚期营养干预符合脂代谢管理的需要，有助于预防患者孕晚期脂代谢异常，该膳食模式对脂代谢的影响可能是多种因素共同作用的结果。
목적：탐토임신당뇨병（GDM）영양간예대지대사적작용。방법선취북경협화의원영양과문진잉중만기GDM환자127례위연구대상，안조잉기한능량당뇨병음식방법진행영양간예，한제탄수화합물공능비≤50%，연맥등조잡량점주식적50%，이제고선식섬유섭입량，한제포화지방래원식물，추천감람유등。감측간예기내환자체중변화，통과선식기록계산선식지대사상관지표（능량、지방공능비、각충지방산점비、불용성선식섬유함량등），비교간예전후환자혈청총담고순（TC）、감유삼지（TG）、고밀도지단백담고순（HDL-C）、저밀도지단백담고순（LDL-C）수평적변화，병검험선식인소여지대사지표적상관성。결과127례접수선식간예적환자중37례제교유효선식기록，계341천（97개주대표치），거차계산간예기선식결과능량위（7980±1785）kJ/d，지방공능비위（29.9±5.3）%，포화지방산점총지방산적（29.13±3.95）%，단불포화지방산점총지방산적（41.44±2.78）%，불용성선식섬유위（24.34±11.65）g/d。TC、HDL、LDL간예전후무현저차이，TG수평간예전위（2.92±1.39） mmol/L，간예후위（3.27±1.33）mmol/L（P＜0.05）。간예선식적불용성섬유함량여간예후혈청LDL-C수평상관（R＝0.28，P＜0.05）。결론 GDM환자잉중만기영양간예부합지대사관리적수요，유조우예방환자잉만기지대사이상，해선식모식대지대사적영향가능시다충인소공동작용적결과。
Objective To investigate the effect of nutritional intervention for gestational diabetes mellitus (GDM) on lipid metabolism. Method A total of 127 cases of GDM in the second or third trimester that were admitted by Nutrition Clinic of Peking Union Medical College Hospital were selected as subjects. Calorie-restricted diabetic diet was adopted for nutritional intervention. Calories provided by carbohydrates were limited to no more than 50%; oats and other coarse grains accounted for 50% of the staple food to improve intake of dietary ifbre;saturated fats were restricted and olive oil was recommended. Body weight of the patients were monitored during the intervention, and lipid metabolism indicators (energy, percentage of energy from fat, percentage of various fatty acids, insoluble dietary ifber, etc.) were calculated according to the dietary records. Changes in serum total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) were recorded, and their correlation with diet lipid metabolism indicators were analyzed. Result 37 cases of the 127 pregnant women submitted effective dietary records. According to these records, total calorie during intervention was (7980±1785) kJ/d, calorie from fat accounted for (29.9±5.3)%, saturated fatty acids accounted for (29.13±3.95)%and monounsaturated fatty acids accounted for (41.44±2.78)% of total fatty acids, intake of insoluble dietary ifber was (24.34±11.65) g/d. TC, HDL, LDL showed no signiifcant difference before and after intervention. TG was (2.92±1.39) mmol/L before intervention and (3.27±1.33) mmol/L (P < 0.05) after intervention (P<0.05). Content of insoluble dietary ifber was signiifcantly correlated with serum LDL-Cafter intervention (R = 0.28, P < 0.05). Conclusion The nutritional intervention for GDM patients in the second or third trimester satisifed the requirements for lipid metabolism management, beneifted prevention of abnormal lipid metabolism in the third trimester, such effect may be the combined results of multiple factors.