【作者】 张静；

【导师】 翟成凯；

【作者基本信息】 东南大学 ， 流行病与卫生统计， 2003， 硕士

【摘要】 目的：探讨营养教育与被动式膳食干预对社区中老年人脂类代谢及其相关慢性疾病的作用，比较单纯性营养教育与营养教育加被动式膳食干预、单向与双向媒体教育之间的效果差异。对慢病的社区防治提供理论依据与建议。方法：在南京市鼓楼区随机抽取了挹江门街道的6个社区作为研究社区，在6个社区中选取1017名45岁以上中老年人作为研究对象，经过基线调查后发现，社区中老年人群中高脂血症、高血压和糖尿病的患病率分别为53． 91%、27． 63%和6． 34%，超重和腹型肥胖的患病率高达51． 00%和86． 06%，并确定了3种慢性病与性别、年龄、文化程度以及经济收入有密切关系。根据上述结果，按社区把筛选出来的“三高”居民分为三组：膳食干预组、营养教育组和空白对照组。经检验，高脂血症、高血压和糖尿病患病率及与之关系较密切的性别、年龄、文化程度和人均月收入水平4个非行为因素在三组间分布均衡性较好。分组后对三组居民进行慢性病知识、态度和行为(KAP)的调查。然后膳食干预组给予营养教育和被动式膳食干预：营养教育组只给予单纯营养教育；对空白对照组居民不采取干预措施，只接受广播、电视等大众传播媒体的单向营养教育。教育、干预三个月后，进行第二次体检和KAP调查。本研究的被动式膳食干预，系指给予含高膳食纤维和蛋白质的低血糖生成指数食品每人每天100g。结果：1、 从两次kap调查发现，对于知识、态度和行为的改变，营养教育组与膳食干预组的知识平均知晓率差异不明显，在试验后都显著高于空白对照组；但在态度和行为的转变方面，营养教育组不如膳食干预组居民，说明被动式膳食干预对营养教育后态度、行为的转变有促进作用。空白对照组虽然试验前后知识、态度和行为的转变没有明显差异，但都是朝有利身体健康的方向在改变，说明了大众传播媒介的营养教育对慢病防治也有一定意义。2、 从试验前后体检结果发现，膳食干预组居民血脂、血压和血糖均较试验前下降，而且下降幅度超过营养教育组，空白对照组的血脂也较试验前降低。说明，对于降低血脂、血压和血糖的作用，营养教育加被动式膳食干预的效果均要比单纯性营养教育好，而且单向媒体教育(空白对照组)的效果不如双向媒体教育(营养教育组)好。建议：1、 全国普及营养教育与膳食干预；2、 国家的宏观调控：3、 居民“三自”机制的建立；4、 社区营养教育和干预应以社区卫生院为中心。更多还原

【Abstract】 · Objective1) To determine the effect of nutrition education and passive dietary intervention on metabolism of lipid and related chronic disease in middle and old aged persons of community.2) To compare single nutrition education with nutrition education plus passive dietary intervention.3) Finding out difference between education by one-way media and by two-way (face to face) media.· Methods (Education and Intervention)1) Take an investigation of basic nutritional state and acquire general information from the 1017 residents no younger than 45 years from the Yijiangmen Communities in Nanjing City.2) After medical check-up and base investigation, 260 persons who have hyperlipemia, hypertension or diabetes were selected as study population.3) Participants were randomized to 3 groups: (1)"the passive dietary intervention group", is given 100g coarse food grain everyday and nutrition education;(2)"the nutrition education group", is only given nutrition education ;(3)"the control group", accepts education by one-way media, such as TV and broadcast.· Results1) Base investigation show that the prevalence of hyperlipemia, hypertension and diabetes are 53.91%, 27.63% and 6.22% separately.2) After three month, The average value of triglyceridcs (TG), cholesterol (TC), blood sugar (GLU) and systolic blood pressure (SPB) decreased by 1.22mmol/L (P<0.0001), 0.59mmol/L (P<0.05), 1.86mmol/L (P<0.0001) and 3.30mmHg(P<0.05) respectively in the passive dietary intervention group.3) In the nutrition education group, the determination of TG, TC and GLU are cut down 0.83mmol/L (P<0.0001), 0.24 mmol/L (P<0.05) and 0.76 mmol/L(P<0.0001).4) The mean net reduction in TG is 0.37mmol/L (P<0.0001) of the control group.5) The KAP (knowledge, attitude and practice) investigation show there are significant difference in attitude and practice among three groups (p<0.0001) after intervention and education for three month.· Conclusion and Aadvice1) There are better effect on decreasing in blood lipids, blood pressure and blood sugar of nutrition education plus passive dietary intervention than of single nutrition education.2) Influence of education by two-way media on modification of healthy attitude and practice is power than by one-way (face to face) media.3) That is crux to establish the network-system, working-mechanism and pattern, feasible methods of dietary intervention and nutrition education.4) Government and experts ought to go to communities to support education and intervention of nutrition for building health community.更多还原