【作者】 付泽建；

【导师】 郭俊生； 马文领；

【作者基本信息】 第二军医大学 ， 营养与食品卫生学， 2009， 硕士

【摘要】 长途货运汽车司机(以下简称长途司机)工作时间和工作环境的特殊性决定了其生活方式和饮食规律的特殊性。长途司机平时的饮食非常不规律,食物选择不合理,同时对高速公路服务站的食物质量也不满意。国内关于长途司机健康状况的报道不多,且主要局限于对某些特定传染病如乙型肝炎和HIV的调查报告。关于长途司机食物消费量和营养素摄入水平特别是与长途司机夜视力密切相关的维生素A(Vitamin A,VA)营养状况的系统性研究,国内外均未见报道。因此,本研究通过调查长途司机日常饮食中食物消费情况和营养素摄入量、食物选择习惯,检测血清视黄醇含量和暗适应能力等,分析其膳食结构特征以及VA的摄入量和营养状况。一、目的了解长途司机膳食结构特点、日常食物消费习惯和营养素摄入量,着重探讨与夜视力相关的VA摄入量及营养状况,发现该人群日常饮食中存在的问题及存在的健康隐患。二、对象与方法(一)研究对象本次调查选取24h之内不能往返且近期无患感染性或急慢性胃肠道疾病的长途司机纳入为调查对象。共调查长途司机145名,年龄在18到55岁之间,分别来自上海和南通3个大型物流配货场,调查前与所有调查对象均签订知情同意书并给予补偿。(二)膳食调查方法1.24h膳食回顾法采用3d,24h回顾法结合三维食物模型的辅助,调查两个工作日和一个休息日的食物消费情况。2.食物频率调查问卷参考其他成熟的食物频率问卷调查表格,自行设计以富含VA的食物为主的食物频率问卷调查表,并在正式调查前进行多次预试验反复修改完善。该调查表主要用于调查长途司机富含VA食物的摄入频率、就餐规律和饮食习惯等内容。(三)生化指标检测1.血清视黄醇血清视黄醇水平检测采用高效液相色谱分析法(HPLC)。准确量取100μl血清置于1.5ml离心管中,加入200μl无水乙醇,用漩涡器漩涡5min沉淀蛋白。加入正己烷800μl,漩涡15min,4000r/min离心5min。提取萃取液400μl缓氮气吹干,100μl流动相定容,10000r/min离心2min,10μl进样。所有处理过程均严格避光操作。评价标准:血清视黄醇<0.7μmol/L为缺乏,<1.05μmol/L为边缘性缺乏,<1.4μmol/L为临界不足。2.血脂指标血清总胆固醇(TC)的测定方法为CHOD-PAP法,甘油三酯(TG)的测定方法为GPO-PAP法,高密度脂蛋白胆固醇(HDL-C)的测定方法为消除法。评价标准:高胆固醇血症指TC≥5.72mmol/L;总胆固醇水平边缘性升高是指TC5.20-5.71 mmol/L;高甘油三酯血症为TG≥1.70mmol/L;低高密度脂蛋白胆固醇血症指HDL-C≤0.91mmol/L。有高胆固醇血症、高甘油三酯血症、低高密度脂蛋白胆固醇血症三种中的任意一种即判断为血脂异常。(四)超重和肥胖参照《中国营养科学全书》要求和仪器说明书使用方法测量身高和体质量。计算体质指数[BMI=体质量(kg)/身长(m)~2],由于本次调查对象皆为≥18岁成年人故以BMI 24.0-28为超重,BMI>28为肥胖。(五)眼睛暗适应能力检查采用YA-2型暗适应仪检测暗适应时间。仪器在使用前进行调试,在VA营养状况良好的对照人群中试用,确定正常值范围。检测过程在暗室中进行,检测步骤:暗室适应5min→强光漂白2min→在黑暗环境中辨别出标志物开口方向→操作员读取暗适应时间。(六)数据统计分析所有数据录入均由两位录入员分别录入,最后经第三人逐一检查核对。统计分析包括:连续性变量描述性分析,包括均数、标准差、中位数等;相关性分析,采用Pearson相关(正态分布资料)或Spearman秩相关(非正态分布资料)分析。所有统计分析均采用SPSS11.0软件分析。三、结果(一)样本特征在纳入调查的145名长途司机中男性143名,女性2名。其中超重44人(30.8%),肥胖25人(17.5%)。血脂共检测128例,高甘油三酯血症、高胆固醇血症和低高密度脂蛋白胆固醇血症和总胆固醇边缘升高患病率依次为60.2%、1.6%、40.6%和7.8%,血脂异常患病率达到68.0%。(二)食物消费量和营养素来源膳食调查共调查富含纳入标准的长途司机145人,完成膳食调查共408个人日,其中工作日268个人日,休息日140个人日。工作日,平均每人每日能量摄入量仅达到971kcal(36.0%RNI),蛋白质、脂肪和碳水化合物的摄入量分别是40.7g、39.4g和134.5g,各种维生素(除维生素E以外)和矿物质(除钠以外)的摄入量都远远低于RNI;休息日的膳食结构则是高能量、高动物性食物和低植物性食物消费,导致能量、蛋白质和脂肪摄入量过高。平均每人每日能量摄入量为2917kcal(121.6%),蛋白质、脂肪和碳水化合物的摄入量分别是118.5g(16.2%)、92.4g(28.5%)和307.2g(42.1%)。另一方面,蔬菜、水果、薯类和奶类制品摄入量低,导致VA等维生素和矿物质的摄入量偏低。(三)VA营养状况长途司机VA摄入量中位数为329.7μgRE/人/日,达到或超过RNI的比例不足15%,另有50%以上的司机平均每人每日VA摄入量不足50%RNI。其中工作日平均每人每日VA摄入量为252.6μgRE,而休息日是602.3μgRE,分别仅达到RNI的31.5%和75.2%。VA的食物来源中,工作日VA的摄入量37.3%来源于蛋类食物,34.9%源于蔬菜类食物提供的总类胡萝卜素,仅有12.0%来源于畜禽肉和鱼虾贝类等食物。休息日VA的来源中,39.1%来自于植物性食物,蔬菜、水果和饮料类分别占23.1%、9.7%和3.2%;60.9%来自于动物性食物,畜肉类、蛋类和鱼类分别占37.2%、19.0%和4.3%。食物频率调查结果显示,长途司机膳食VA来源单一,富含VA的动物肝脏消费量很低,只有26.2%的司机能达到一月吃一次以上猪肝的频率,吃猪肝的频率少于一月一次的占22.8%,另有33.0%的人从来不吃猪肝,鸡、鸭、肝脏的消费情况也类似,能够达到一月吃一次以上的仅占16.8%,40.9%的人从来不吃。植物性食物中,富含β-胡萝卜素的薯类、坚果类食物消费量极低。检测血清视黄醇115例,血清视黄醇均值2.04±0.58mmol/L。低于1.4μmol/L、1.05μmol/L和0.7μmol/L的分别占8.7%(11人)、3.5%(4人)和0.9%(1人)。该群体中有13.2%的个体血清视黄醇水平在临界不足以下。长途司机暗适应能力检测共41例,暗适应时间平均值为31±14s。其中,暗适应时间超过30s为14例,超过60s为3例,分别占总检测人数的34%和7%。四、讨论长途司机工作日和休息日的膳食结构存在明显差别,食物来源和营养素摄入量均存在较大差距。工作日极低的食物消费量导致能量和营养素普遍摄入不足;休息日的膳食中动物性食物消费量过高而蔬菜、水果、奶制品、薯类以及菌藻类食物消费频率低,从而导致能量、动物来源蛋白质和脂肪摄入量过高,而VA和钙等营养素摄入量不足。根据本调查研究发现的问题,我们认为:首先,应提高高速公路上长途司机服务站的服务水平,包括提高膳食质量、降低供应价格,满足长途司机的需要,使长途司机乐于在服务站就餐,并从中获得良好的食物和营养素供给;其次,应对长途司机进行大量的营养宣传,提供对维护身体健康重要性的认识,指导他们如何正确选择和搭配食物。比如,在工作日里,上车前可以多买一些矿泉水、水果、牛奶和全麦面包等食物放在车上,及时补充身体的需要,少食用方便面、甜饮料等食物。休息日注意食物的合理搭配,提倡以谷类为主,多吃蔬菜水果和薯类,提高大豆等富含植物性蛋白质的食物的摄入量。适量食用瘦肉、猪肝等营养素密度高的动物性食物,少食用肥肉和荤油。食物应尽量多样化,增加坚果类、奶类、菌藻类等营养素含量丰富食物的摄入量。五、结论本课题研究主要结论如下:(1)长途司机超重、肥胖和血脂异常患病率远高于我国普通成年人水平。(2)长途司机膳食结构不合理,工作日和休息日饮食差异大。(3)长途司机VA摄入不足现象普遍,VA营养状况不良。更多还原

【Abstract】 BackgroudTruck drivers are exposed to a variety of stressful situations,such as working long hours,sleep deprivation,inadequate rest and relaxation,being away from home and support systems,and driving in hazardous conditions.Also because of long night working maybe need more vitamin A.However,up to date there has few papers regarding the health status of truck drivers in domestic,and most of these papers were limited in investigating several definite infection diseases,such as HBV HIV infectious rate.Meanwhile there were plenty of research papers in abroad concerning the high incidence rate of chronic disease and several cancers,such as obesity,coronary artery disease,diabetes mellitus, lung cancer,colorectal cancer,and these papers which uniformly considered that long-haul truck drivers were at risk for poor health outcomes.The prevalence rates of working factors affecting health problems of truck drivers were significantly higher than the general population in the items on irregular shift work,working environment,working posture, handling heavy materials,job stress due to overloading and long working time and limited time off.One paper suggested that Drivers who placed greater importance on healthful food choices had more positive attitudes about restaurants’provision of such options,they wanted more healthful options.Researches also indicated that long-haul truck drivers were very concerned with taste.Diet and nutrition are important factors in the promotion and maintenance of good health throughout the entire life course.Their role as determinants of chronic NCDs is well established.However,up to date,there were none published papers concerning the food consumption and nutrients intake of long-haul truck drivers,none with the vitamin A status which makes key point in the dark adaptation of long-haul truck drivers.This study is conducting a dietary survey to investigate the food consumption and nutrients intake,food choice habit,nutritional and health knowledge in long-haul truck drivers.ObjectiveThe objective of the study was to investigate the dietary patterns,food consumption and nutrient intake of the long-haul truck drivers:evaluated vitamin A status of the long-haul truck drivers;explore the exist problems in the long-haul truck drivers" daily diet.Subjects and methods1.Research objectsSubjects(n=145) were long-haul truck drivers,aged 18-55years,came from three big freight yards in Shanghai and Nan tong(a big harbor city of Jiangsu province).2.Dietary survey methods2.1 24h recall dietary surveyThree days 24-hour food recalls were conducted in two working days and a resting day,which assist by plenty of food models(as a present from Shanghai GongRong food model Manufacture Company).Food intakes were adjusted for age,sex and physical activity to yield standardized estimates per ’reference man’,defined as an adult male,19-59 years of age,65 kg body weight,undertaking very light physical work.Average daily nutrient intakes were calculated on the basis of Chinese food composition Tables(Institute of Health,2002) and expressed per reference man.2.2 Food frequency questionnaireA food frequency questionnaire with vitamin A(includingβ-carotene)-containing foods was conducted.Several preliminary experiments were undertaken before the formal experiment.3.Biochemistry index detection3.1 Serum retinolFasting blood samples were obtained from 128 healthy long-haul truck drivers. Fasting intravenous blood(5 ml) was drawn from each subject between 08.00 hours and 12.00 hours,using negative pressure vacuum pipe(10ml).Samples were immediately placed on ice in light-free jars and then transported to the laboratory(within 4 h of the last blood sample).On arrival at the laboratory the blood samples were immediately divided into fractions and stored at -80o.Serum level of retinol was determined by the HPLC method.3.2 Serum lipoidsSerum total cholesterol(TC) level was determined by CHOD-PAP method;Serum triglyceride(TG) was determined by GPO-PAP method;high density lipoprotein cholesterol(HDL-C) level was determined by elimination method. Hypercholesteremia(TC≥5.72mmol/L):total cholesterol borderline heighten (TC5.20-5.71mmol/L);hypertriglyceridemia(TG≥1.70mmol/L);Low HDL-C (HDL-C≤0.91mmol/L).Dyslipidemia resulted in one of hypercholesteremia, hypertriglyceridemia,Low HDL-C.3.3 Overweight and obesityAll subjects were asked to worn only light clothes and with barefoot before stand in the health meter.Body mass index(BMI) criterion standard:<18.5(underweight); 18.5-23.9(normal);24-27.9(overweight);≥28(obese).4.Dark adaptometryYA-2 dark adaptometry was used in Dark adaptation detection.The range of normal values of the equipment was pre-performed by healthy control subjects.Steps of the detection:five minutes of pre-adaptation→two minutes of highlight exposure→identify the direction of the marker→record the time by the equipment runner.5.Data statistical analysisAll data entered by two staffs,and check out by another staff in the end.Descriptive statistics including means,medians,standard deviations and ranges of average values were computed for all relevant biochemical indicators of dietary intakes of nutrients,foods and frequencies of intake of selected foods,and vitamin A status.All the data were analyzed using the SPSS 11.0 statistical software package.Results1.Sample featureThere were 145 long-haul truck drivers completed the dietary survey.143 were male and 2 were female.Mean age and occupational age of these long-haul truck drivers was 35y and 5.5y,respectively.408 days of dietary records were conducted.Based on BMI measurements for 145 subjects,one was underweight;75 were normal;69 were overweight;of these,25 were obese.Serum lipoids level was detected in 128 blood sample. The prevalence rates of hypertriglyceridemia.hypercholesteremia,low serum high density lipoprotein cholesterol,total cholesterol marginal increase or hyperlipemia were 60.2%, 1.6%,40.6%,7.8%,68.0%,respectively.2.Food consumption and nutrients resourceDietary patterns between working days and resting days were quite different.Both food consumption and nutrients intake showed great gap between working days and resting days.In working days,neither macro-nutrients nor micro-nutrients intake were sufficient, according to the Recommended Nutrient Intake(RNI).Extremely low food consumption contribute to the results discussed above.In working days,protein,fat and carbohydrate intake per person per day was 40.7,39.4 and 134.5g,respectively.Energy intake was 1161kcal per person per day.Intake of all kinds of vitamins(except vitamin E) and mineral (except sodium) were low in compare to the RNI.However,in resting days,most nutrients intake were sufficient,though,because of the high consumption of meat and meat products, Poultry and poultry products and edible oil,protein(118.5g,15.0%energy intake) and fat (132.6g,37.7%energy intake) intake were too high,energy intake was 3177kcal per person per day(132.4%RNI),meanwhile,carbohydrate intake(307.2g,38.9%energy intake) was low in compare to the Chinese dietary guideline,which recommended that diet carbohydrate should contribute to 55-65%total energy intake.On the other hand,low consumption level of vegeTables and fruits,milk and dairy products,Tubers,starches and products,were associated with low intake level of vitamin A and calcium.3.Vitamin A intake and serum retinol levelThe average retinol equivalent intake in per day was 329.7μg for per reference man. The drivers with the retinol equivalent intake equal or higher than RNI accounted for 15% and those with the intake lower than 50%of the RNI accounted for 50%.Vitamin A intake was quite different between working days and resting days.The average retinol equivalent intake in per day was 252.6μg for per reference man in working days compared to 602.3μg in resting days,accounted for 31.5%and 75.2%of the RNI.Serum retinol was detected in 115 blood sample.The average serum retinol concentration was 2.04μmol/l.The prevalence rates of serum retinol <0.70μmol/L,<1.05μmol/L and 1.40μmol/L were 0.9%(N=1),3.5 %(N=4),8.7%(N=11),respectively.4.Dark adaptation time41 subjects were conducted dark adaptation detection.The mean dark adaptation time was 31±14s,which 14(34%) drivers over 30s,3(7%) drivers over 60s.Discussion and suggestionThere were wide gaps in the dietary patterns between working days and resting days. Both food consumption and nutrients intake showed great different between working days and resting days.In working days,neither macro-nutrients nor micro-nutrients intake were sufficient.In resting days,because of the high consumption of Meat and meat products. Poultry and poultry products and edible oil,energy,protein and fat intake were too high; meanwhile,carbohydrate intake was lower in compare to the Chinese dietary guideline.On the other hand,low consumption level of vegeTables/fruits,milk and dairy products. Tubers,starches and products,were associated with low intake of several vitamins and minerals such as vitamin A and calcium.A new battle has begun to ensure the health and nutrition of Long-haul truck drivers. It is vital that government develop new effective policies and educational strategies together with many nutritional promotions by those public organizations to deal with these challenges.On one hand,raise the meals quality in the truck-stop restaurant.Drivers want to improve health,but not if it means a reduction in palatability.On the other hand,the long-haul truck drivers could be taught to make a better choice in choosing foods,such as, eat more natural vegetality foods not these deep processing products.Conclusions1.While obesity and dyslipidemia continues to increase among the general population in China,for long-haul drivers these problem are much more severe.Nearly one third of drivers in this study are overweight,over two thirds of drivers are dyslipidemia.2.There were severe problems resided in the long-haul truck drivers’ daily diet.In working days,the extremely low food consumption leads to wide-bound nutrients intake inadequacy, while in resting days,the Long-haul truck drivers group has developed dietary patterns that include excessive energy intake and a high intake of saturated fatty acids and cholesterol together with insufficient levels of vitamins,minerals,and dietary fiber.3.The consumption frequency of foods containing plentiful retinol or vitamin A precursors was extremely low.Insufficient intake of Vitamin A was widespread in long-haul truck drivers,which may affect the darkness visual acuity of the long-haul drivers when working in the dark environment.更多还原