Grylls W K, McKenzie J E, Horwath C C, Mann J I
Paraparaumu Hospital, Capital and Coast Health, Private Bag, Wellington, New Zealand.
Eur J Clin Nutr. 2003 Nov;57(11):1386-93. doi: 10.1038/sj.ejcn.1601700.
To investigate the relations between lifestyle factors (diet and exercise), glycated haemoglobin (HbA(1c)) and body mass index (BMI) in older adults with diabetes.
A community hospital-based cross-sectional study of 150 noninstitutionalized, ambulatory adults (>/=65 y) with diabetes, residing within New Zealand's Kapiti region.
Patients were recruited from all general practices; two diabetes clinics; local diabetes society and through advertisements in community newspapers. A total of 211 eligible people were identified, but 60 refused to participate and one withdrew. In all, 150 people completed the study (71% participation rate).
Nutrient intakes were calculated by a food-frequency questionnaire. Physical activity was assessed by interview using a validated questionnaire. Medical history and demographic data were obtained by interview or self-completed questionnaires; height, weight and HbA(1c) were measured. Multivariate models using bootstrapping and stepwise linear regression were used to select factors associated with HbA(1c) and BMI.
Each five-unit increase in energy from dietary saturated fat and five-unit increase in BMI were associated with 6% (95% confidence interval=2-10%; P=0.004) and 4% (0.3-7%; P=0.031) increases in HbA(1c), respectively. For females with moderate, compared with low overall activity, there was a 14% (7-20%; P=0.000) reduction in BMI while for males the reduction was only 5% (-1-11%; P=0.116). BMI decreased 5% (2-9%; P=0.004) with each 10-y increase in age, while a five-unit increment in energy from dietary sucrose was associated with a 6% (1-11%; P=0.025) increase in BMI.
Reducing dietary saturated fat and excess body weight may be useful means of improving glycaemic control in older adults with diabetes. Increasing physical activity and reducing energy from dietary sucrose may assist weight control, the former particularly in women.
探讨老年糖尿病患者的生活方式因素（饮食与运动）、糖化血红蛋白（HbA1c）和体重指数（BMI）之间的关系。
一项基于社区医院的横断面研究，研究对象为居住在新西兰卡皮蒂地区的150名非机构化、能自主活动的成年人（年龄≥65岁）且患有糖尿病。
患者从所有普通诊所、两家糖尿病诊所、当地糖尿病协会招募，并通过社区报纸上的广告招募。总共确定了211名符合条件的人，但60人拒绝参与，1人退出。共有150人完成了研究（参与率71%）。
通过食物频率问卷计算营养素摄入量。使用经过验证的问卷通过访谈评估身体活动。通过访谈或自行填写问卷获取病史和人口统计学数据；测量身高、体重和HbA1c。使用自抽样和逐步线性回归的多变量模型来选择与HbA1c和BMI相关的因素。
饮食中饱和脂肪能量每增加五个单位以及BMI每增加五个单位，分别与HbA1c升高6%（95%置信区间=2-10%；P=0.004）和4%（0.3-7%；P=0.031）相关。对于总体活动为中度的女性，与低度总体活动相比，BMI降低了14%（7-20%；P=0.000），而对于男性，降低仅为5%（-1-11%；P=0.116）。年龄每增加10岁，BMI降低5%（2-9%；P=0.004），而饮食中蔗糖能量每增加五个单位与BMI升高6%（1-11%；P=0.025）相关。
减少饮食中的饱和脂肪和超重可能是改善老年糖尿病患者血糖控制的有效方法。增加身体活动和减少饮食中蔗糖的能量可能有助于控制体重，前者对女性尤其有效。
