摘要目的 评价在社区通过饮食控制预防糖尿病(DM)的效果.方法 随机选取福州鼓楼区两个社区作为干预(安泰社区)与对照社区(温泉社区),于2009年10月至2011年10月对干预社区进行综合饮食干预,对照社区未进行干预.2年后根据2个社区住户分布的实际情况分为每100户一群,每个社区随机抽取30群,共调查3702名干预人群和3666名对照人群.干预社区调查了一般人群980例、高危人群2070例、糖尿病人群652例,对照社区分别为898、2016和692例；两组人群采用食物频率法进行问卷调查及体检(身高、体重、血糖、血压等),比较两组一般情况.率的比较采用x2检验；均数比较应用t检验.结果 干预社区与对照社区的建档率比较差异有统计学意义(76.7％比71.2％,x2=294.69;P ＜0.01)；与对照社区比较,干预社区一般人群、高危人群和糖尿病人群的空腹血糖(FPG)、高危人群和糖尿病人群的体质指数(BMI)与收缩压(SBP)及高危人群的舒张压(DBP)均显著下降(t=4.289、11.847、8.517、4.946、7.838、8.176、12.931、8.315,均P＜0.01)；一般人群蛋白质和脂肪摄入量均显著增加而碳水化合物摄入量显著减少(t=12.72、11.40、4.11,均P＜0.01),高危人群蛋白质摄入量显著增加而碳水化合物和脂肪摄入量均显著减少(t=9.45、14.32、7.44,均P＜0.01),糖尿病人群蛋白质和脂肪摄入量均显著减少(t=5.98、15.22,均P＜0.01).与对照社区比较,干预组一般人群的豆类、水果类、乳类、蛋类的摄入有显著增加(t=6.778、9.035、4.718、14.223,均P＜0.01)；干预组高危人群的豆类、蔬菜类、水果类、乳类及蛋类的摄入有显著增加而主食、肉类和食用油的摄入量则显著下降(t=5.358、2.827、9.627、21.346、3.351、12.970、19.342、3.241,均P＜0.01),干预组糖尿病人群的乳类和蛋类的摄入有显著增加而肉类、水产品、食用油、零食及含糖饮料的摄入量则显著下降(t=8.376、2.702、4.155、3.121、8.494、6.702、10.854,均P＜0.01).结论 饮食干预可有效改善社区人群的膳食和营养结构,促进健康.其中糖尿病患者及高危人群的干预效果优于一般人群.但部分干预对象的饮食结构仍不合乎标准,因此社区饮食干预仍需长期开展,并强调控制豆类、油盐摄入量,提高果蔬及乳类摄入量.

abstractsObjective To evaluate the effects of comprehensive dietary interventions on diabetes in community populations.Methods Two communities in Drum-tower District of Fuzhou were randomly selected as the intervention community (Antai community) and control community (Wenquan community)respectively.Comprehensive dietary interventions were provided to the intervention community from October 2009 to October 2011,while no interventions to the control community.Two years after interventions,30 groups with 100 families each were randomly selected according to the actual household distributions in the two communities.A total of 3702 and 3666 people in the intervention community and the control community were investigated with questionnaires on their food frequency.Physical examination (including height,weight,blood sugar,blood pressure,etc) was also conducted.There were 980,2070 and 652 peoples in the general population,high-risk population and the diabetic population,respectively,in the intervention community; and 898,2016 and 692 people in the 3 populations in the control community.Data were analyzed with Chi-square test on the rate check and t test on the means comparison.Results There was a significant difference in archiving rate between the two communities (76.7％ and 71.2％ for intervention and control community respectively,x2 =294.69,P ＜ 0.01).Compared with the control community,fasting blood glucose of the 3 populations were significant decreased; so were the body mass index and systolic blood pressure of the high-risk or the diabetic population,and the diastolic blood pressure of the high-risk population in the intervention community (t =4.289,11.847,8.517,4.946,7.838,8.176,12.931,8.315,all P ＜0.01).In contrast to the control community,the intakes of protein and fat of the general population significantly increased (t =12.72,11.40,both P ＜ 0.01),while carbohydrate intake decreased(t =4.11,P ＜0.01) ; protein intake increased in the high-risk population(t =9.45,P ＜0.01),while the intakes of carbohydrate and fat decreased(t =14.32,7.44,P ＜0.01) ;the intakes of protein and fat of the diabetic population decreased (t =5.98,15.22,both P ＜ 0.01) in the intervention community.In comparison with the control community,the intakes of beans,fruits,dairy and eggs significantly increased in the general population (t =6.778,9.035,4.718,14.223,all P ＜ 0.01) ; the intakes of beans,vegetables,fruits,dairy and eggs increased while the intake of staple food,meat and oil decreased in the high-risk people(t =5.358,2.827,9.627,21.346,3.351,12.970,19.342,3.241,all P ＜ 0.01) ; the intake of dairy and eggs increased while that of meat,aquatic products,oil,snacks and sugary drinks decreased in the diabetic patient of the intervention community(t =8.376,2.702,4.155,3.121,8.494,6.702,10.854,all P ＜ 0.01) in the intervention community.Conclusion Dietary intervention could effectively improve components of diet and nutrition,consequently benefit health situation related to diabetes,especially to the diabetic patients and the high-risk population.However,unreasonable diet model still remained in some subjects of the intervention community.It's indicated that the dietary intervention should be continued and more measure is in need to decrease the intake of beans and oil,and increase fibrin and dairy intake.