【作者】 王劲；

【导师】 郭红卫；

【作者基本信息】 复旦大学 ， 卫生毒理学， 2008， 博士

【摘要】 目的:发现养老机构老人膳食营养摄入问题,并建立相应的综合膳食评价工具,提出改善该人群的措施对策。揭示养老机构高龄老人的能量摄入、能量消耗与体质指数三者间关系,为高龄老年人获得理想体重提供合理建议。进行养老机构高龄老年人硫胺素和核黄素需要量的研究,为高龄老人硫胺素和核黄素参考摄入量制定提供参考依据。方法:经分层抽样,采用3天膳食称重法对上海市4所养老院177名60岁以上自理老人进行膳食调查,并根据老年人的营养需要特点,调整2005年中国DBI的部分单项指标定义和计分取值建立和验证针对老年人的DBI（膳食平衡指数）评分系统。采用5天膳食称重法、体格测量和要因加算法对35名65岁以上养老机构老人进行营养调查和总能量消耗估算。采用《中文版简易智力状况检查量表》、血浆MDA（丙二醛）、血浆T-SOD（总超氧化物歧化酶）、血浆CuZn-SOD和血浆Mn-SOD检测35名老人的认知功能状况和抗氧化能力。以4小时负荷尿中硫胺素和核黄素排出量及全血谷胱甘肽还原酶活性系数为指标,采用线性和非线性回归分析、回归预测和残差分析方法,对35名较高龄老人进行为期14天的硫胺素和核黄素需要量研究。结果:177名养老机构老人的膳食缺乏粗粮、薯类、乳类、坚果和种子类等食品;大多数营养素摄入量以不足为主,尤其是维生素B₁、维生素B₂、维生素C、叶酸、碘、锌和硒等;能量和大部分营养素摄入量与膳食支出呈负相关;各营养素摄入量基本没有超过ULs,但脂肪和钠摄入量超过AI值的个体比例较高。蛋白质和脂肪食物来源尚可,但钙和铁的食物来源较差;饱和脂肪摄入过多,而单不饱和脂肪摄入不足;碳水化合物和蛋白质供能比稍不足,而脂肪供能比过多:早餐能量分配比偏低。老年人DBI评价系统总体上可反映上述177名样本人群的绝大多数食物种类和营养成分摄入的实际状况,并可综合反映膳食中各营养素摄入不足、过量和不平衡状况的方向和程度。样本人群膳食总体摄入不足,性别、年龄和伙食费对膳食质量均有影响,影响该人群膳食质量的食物种类主要是奶类豆类、蔬菜水果、食用油和动物性食物。35名较高龄老人基线期的能量、碳水化合物、蛋白质、脂肪、硫胺素和核黄素摄入量分别是（5.63±1.32）MJ、（193.8±51.3）g、（45.2±9.9）g、（43.3±11.6）g、（0.82±0.25）mg、（0.46±0.15）mg,能量、蛋白质、硫胺素和核黄素的摄入不足比例分别是88.6%、77.1%、88.6%和100%,能量消耗为（4.90±1.26）MJ、体力活动水平为1.12、BMI超重和肥胖比例为48.6%。35名较高龄老年人群补充核黄素后,出现了抗氧化能力提高,脂质过氧化产物下降和认知测量评分提高等现象35名抽样养老机构较高龄老年人硫胺素的估算EAR值为1.26mg,RNI值为1.48mg;核黄素的估算EAR值为1.35mg,RNI值为1.63mg。结论:177名研究对象膳食营养以不足为主,应减少高钠食品、饱和脂肪和胆固醇含量偏高食品的摄入量,并增加早餐摄食量。所建立的针对老年人群的DBI评价系统基本能反映研究对象的膳食质量和主要问题。35名较高龄住养老机构老人总体体力活动水平和营养摄入低下,能量入超。补充核黄素后出现抗氧化能力提高,脂质过氧化产物下降和认知评分提高等现象。硫胺素的估算EAR值和RNI值分别是1.26mg和1.48mg,核黄素的估算EAR值和RNI值分别是1.35mg和1.63mg。更多还原

【Abstract】 Objective:To discover the weakness of nutrient intake of the elderly living in facilities for the elderly, and develop the corresponding composite assessment instructment of diet,the solutions were presented to promote adequate nutrition for them.To elaborate the implications underlying among energy intake,energy and body mass index,the reasonable advice was given for the elderly to acquire an ideal body weight.Thiamin requirement and riboflavin requirement of the elderly adults at an advanced age were studied as the basis of development of dietary reference intakes for thiamin and riboflavin.Methods:A detailed 3-day dietary survey using a weighed-food recording on each subject was conducted for 177 elderly persons over the age of 60,independent of activities of daily living, in 4 resthomes in a Shanghai municipal district for the elderly by stratified sampling.Aimed at characteristics of nutrition requirement for the older adults,the approached DBI for the Chinese elderly persons,of which the validity was identified,was adapted from selection food components and scoring schemes of 2005 Chinese DBI.35 older individuals over the age of 65,whose cognitive performance and antioxidant capabilities were assessed by using the mini-mental status examination of Chinese version and determining plasma levels of malondialdehyde（MDA）,total superoxide dismutase （T-SOD）,copper-zinc superoxide dismutase（CuZn-SOD） and manganese superoxide dismutase（Mn-SOD）,were applied to conduct a nutritional survey and estimate energy expenditure in a resthome for the elderly by a weighed-food recording and anthropometry on each subject and factorial calculation.The studies of thiamin and riboflavin requirement for 14 days were conducted for 35 subjects in older age above mentioned by using linear and nonlinear regression analyses, regression prediction and residual analyses of indices about thiamin and riboflavin excretion in 4 hours urine after loading and blood glutathione reductase activity coefficient（BGRAC）, and so on.Results:The diet pattern in 177 elderly people investigated was lack in coarse grain, tubers,milk,nuts and seeds,and so on.Intakes of most of nutrients were indicated inadequate, especially such as vitamin B₁,vitamin B₂,vitamin C,folic acid,iodine,zinc and selenium. Intakes of energy and the majority of nutrients were significantly correlated negatively with the expenditure of money on the subjects’diet.The intakes of all nutrients of subjects barely exceeded the ULs,nevertheless there were many of individuals with intakes of fat and sodium above the upper limit of the AI values.The constituent ratios of food sources of protein and fat were better,but those of calcium and iron were poor.The fraction of energy from saturated fat was excessive,and that of monounsaturated was inadequate,and the energy-yielding proportions from carbohydrate and protein were insufficient whereas that from fat was too much,but the proportion of energy from breakfast was fractionally low.The DBI scoring and evaluating system could summarily embody the actual intake of most food groups and nutrient components,and synthetically reflect the direction and degrees of deficient intake,excessive intake and inbalanced status of nutrient intake.On the whole, intakes of diets of sample subjects were inadequate.Gender,age and fare expenses could affect the diet quality,and the leading impact factors of food groups on diet quality of subjects occurred for dairy products,legumes,vegetables,fruits,edible oil and animal foods.Intakes of energy,carbohydrate,protein,fat,thiamine and riboflavin of 35 older adults at an advanced age at baseline were（5.63±1.32）MJ,（193.8±51.3）g,（45.2±9.9）g,（43.3±11.6） g,（0.82±0.25） mg and（0.46±0.15） mg,respectively.The sample fraction of inadequate intakes of energy,protein,thiamine and riboflavin was 88.6%,77.1%,88.6% and 100%,respectively.Total energy expenditure was（4.90±1.26）MJ.The physical activity level（PAL） was 1.12.The proportion of overweight and obesity for BMI was 48.6%.Changes such as improvement in capabilities of antioxidation and decline in levels of lipid peroxide and a rise in the MMSE score,occurred after 35 subjects at an advanced age receiving riboflavin supplements.The computing EAR value and the computing RNI value for thiamin were 1.26mg and 1.48mg,respectively.Meanwhile,the computing EAR value and the computing RNI value for riboflavin were 1.35mg and 1.63mg,respectively.Conclusions:These findings indicate that the major nutrition problems of 177 subjects in question are inadequacy of dietary nutrition.It is suggested that consumption of food rich in sodium,saturated fat and cholesterol should be reduced,meanwhile intakes of foods from breakfast is to the contrary.The DBI assessment system developed for the Chinese elderly adults could summarily reflect the diet quality of the subjects,and find the major problems of the dietary pattern presented herein.The level of average physical activity level and nutritional status for 35 older adults is low, and the average energy intake exceeds the average energy expenditure among the sampling subjects,whose capabilities of antioxidation and the cognitive score improve,but levels of lipid peroxidate decline after supplement of riboflavin.These preliminary results from the current studies show that for the elderly over 65 years of age the EAR and the RNI for thiamin are 1.26mg and 1.48mg,respectively,and the EAR and the RNI for riboflavin are 1.35mg and 1.63mg,respectively.更多还原