Tonstad S, Gørbitz C, Sivertsen M, Ose L
Medical Department A, National Hospital, Oslo, Norway.
J Intern Med. 1999 Apr;245(4):337-44. doi: 10.1046/j.1365-2796.1999.00450.x.
We asked whether under-reporting of energy and cigarette smoking were associated with choice of foods and dietary composition amongst subjects with hypercholesterolaemia who had received dietary instruction to lower serum cholesterol.
DESIGN, SETTING AND SUBJECTS: Dietary intake was assessed with a 4-day weighed food record in 205 women and 141 men, aged 20-73 years, being treated at a lipid clinic (tertiary referral centre). Under-reporting was assessed by calculating the ratio of energy intake (EI) to estimated basal metabolic rate (BMR).
The median EI/BMR was 1.1 for both men and women. EI/BMR did not differ according to smoking status, but correlated negatively with body mass index (Spearman's rho = -0.32, P = 0.0001). EI/BMR was inversely associated with energy-adjusted intakes of potatoes, vegetables, fish and low-fat meats, and positively associated with intakes of nuts, potato crisps, chocolate, sour and ice cream, oils, fatty meat spreads, cakes and biscuits, and with alcohol. Thus, low EI/BMR was associated with increased energy-adjusted intakes of protein, thiamine, riboflavin, niacin, iron and cholesterol and with decreased intakes of sugar, poly- and monounsaturated fats and vitamin E (all P < 0.05). Cigarette smokers had a higher energy percentage (E%) from fat than non-smokers (29 +/- 6 vs. 26 +/- 6), a lower E% from carbohydrates (50 +/- 7 vs. 54 +/- 7) and a lower intake of vitamin C (11 +/- 7 vs. 16 +/- 9 mg MJ-1; all P = 0.0001), reflecting an increased intake of fatty meats and a decreased intake of skimmed cheese, fruit, rice and pasta, and cakes and biscuits (all P < 0.05).
Weighed dietary records reflected a 'healthier' intake of fat, protein, sugar, alcohol and some micronutrients amongst under-reporters, suggesting that self-reported dietary intakes are biased in patients with hypercholesterolaemia. Lack of responsiveness to the diet should not be assumed when dietary data are based on self-report. Smokers report a higher intake of fat and lower intake of vitamin C than non-smokers, even after dietary counsel, and may require more intensive interventions to optimize the diet.
我们探究了在接受降低血清胆固醇饮食指导的高胆固醇血症患者中，能量摄入和吸烟情况报告不足是否与食物选择及饮食构成有关。
设计、地点和研究对象：在一家脂质诊所（三级转诊中心）对205名年龄在20 - 73岁的女性和141名男性进行了研究，通过4天的称重食物记录来评估饮食摄入量。通过计算能量摄入量（EI）与估计基础代谢率（BMR）的比值来评估报告不足情况。
男性和女性的EI/BMR中位数均为1.1。EI/BMR在吸烟状况方面无差异，但与体重指数呈负相关（斯皮尔曼相关系数ρ = -0.32，P = 0.0001）。EI/BMR与能量调整后的土豆、蔬菜、鱼类和低脂肉类摄入量呈负相关，与坚果、薯片、巧克力、酸味食品和冰淇淋、油类、含脂肪肉类涂抹酱、蛋糕和饼干以及酒精的摄入量呈正相关。因此，低EI/BMR与能量调整后的蛋白质、硫胺素、核黄素、烟酸、铁和胆固醇摄入量增加以及糖、多不饱和脂肪和单不饱和脂肪及维生素E摄入量减少相关（所有P < 0.05）。吸烟者脂肪供能百分比（E%）高于非吸烟者（29±6对26±6），碳水化合物供能百分比（E%）低于非吸烟者（50±7对54±7），维生素C摄入量也低于非吸烟者（11±7对16±9毫克/兆焦耳；所有P = 0.0001），这反映出吸烟者的高脂肪肉类摄入量增加，脱脂奶酪、水果、大米、面食以及蛋糕和饼干的摄入量减少（所有P < 0.05）。
称重饮食记录反映出报告不足者在脂肪、蛋白质、糖、酒精和一些微量营养素的摄入方面更“健康”，这表明高胆固醇血症患者自我报告的饮食摄入量存在偏差。当饮食数据基于自我报告时，不应假定对饮食缺乏反应性。吸烟者即使在接受饮食咨询后，报告的脂肪摄入量仍高于非吸烟者，维生素C摄入量低于非吸烟者，可能需要更强化的干预措施来优化饮食。
