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住院医师的饮食模式、代谢标志物和主观睡眠测量。

Dietary patterns, metabolic markers and subjective sleep measures in resident physicians.

机构信息

Post Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Uberlândia, Minas Gerais, Brazil.

出版信息

Chronobiol Int. 2013 Oct;30(8):1032-41. doi: 10.3109/07420528.2013.796966. Epub 2013 Aug 21.

Abstract

Shiftwork is common in medical training and is necessary for 24-h hospital coverage. Shiftwork poses difficulties not only because of the loss of actual sleep hours but also because it can affect other factors related to lifestyle, such as food intake, physical activity level, and, therefore, metabolic patterns. However, few studies have investigated the nutritional and metabolic profiles of medical personnel receiving training who are participating in shiftwork. The aim of the present study was to identify the possible negative effects of food intake, anthropometric variables, and metabolic and sleep patterns of resident physicians and establish the differences between genders. The study included 72 resident physicians (52 women and 20 men) who underwent the following assessments: nutritional assessment (3-day dietary recall evaluated by the Adapted Healthy Eating Index), anthropometric variables (height, weight, body mass index, and waist circumference), fasting metabolism (lipids, cortisol, high-sensitivity C-reactive protein [hs-CRP], glucose, and insulin), physical activity level (Baecke questionnaire), sleep quality (Pittsburgh Sleep Quality Index; PSQI), and sleepiness (Epworth Sleepiness Scale; ESS). We observed a high frequency of residents who were overweight or obese (65% for men and 21% for women; p = 0.004). Men displayed significantly greater body mass index (BMI) values (p = 0.002) and self-reported weight gain after the beginning of residency (p = 0.008) than women. Poor diet was observed for both genders, including the low intake of vegetables and fruits and the high intake of sweets, saturated fat, cholesterol, and caffeine. The PSQI global scores indicated significant differences between genders (5.9 vs. 7.5 for women and men, respectively; p = 0.01). Women had significantly higher mean high-density lipoprotein cholesterol (HDL-C; p < 0.005), hs-CRP (p = 0.04), and cortisol (p = 0.009) values than men. The elevated prevalence of hypertriglyceridemia and abnormal values of low-density lipoprotein cholesterol (LDL-C; >100 mg/dL) were observed in most individuals. Higher than recommended hs-CRP levels were observed in 66% of the examined resident physicians. Based on current recommendations, a high prevalence of low sleep quality and excessive daytime sleepiness was identified. These observations indicate the need to monitor health status and develop actions to reassess the workload of medical residency and the need for permission to perform extra night shifts for medical residents to avoid worsening health problems in these individuals.

摘要

轮班工作在医学培训中很常见,并且是 24 小时医院覆盖的必要条件。轮班工作不仅带来了实际睡眠时间的减少,还影响了与生活方式相关的其他因素,如饮食摄入、身体活动水平,因此也影响了代谢模式。然而,很少有研究调查参与轮班工作的接受培训的医务人员的营养和代谢概况。本研究的目的是确定饮食摄入、人体测量变量以及居民医生的代谢和睡眠模式的可能负面影响,并确定性别差异。该研究纳入了 72 名住院医师(52 名女性和 20 名男性),他们接受了以下评估:营养评估(通过适应性健康饮食指数评估的 3 天饮食回忆)、人体测量变量(身高、体重、体重指数和腰围)、空腹代谢(脂质、皮质醇、高敏 C 反应蛋白 [hs-CRP]、葡萄糖和胰岛素)、身体活动水平(Baecke 问卷)、睡眠质量(匹兹堡睡眠质量指数;PSQI)和嗜睡(Epworth 嗜睡量表;ESS)。我们观察到超重或肥胖的居民频率很高(男性 65%,女性 21%;p = 0.004)。男性的体重指数(BMI)值明显更高(p = 0.002),并且自开始住院以来自我报告的体重增加(p = 0.008)明显高于女性。两种性别都存在不良的饮食,包括蔬菜和水果摄入量低,甜食、饱和脂肪、胆固醇和咖啡因摄入量高。PSQI 全球评分显示性别之间存在显著差异(女性为 5.9,男性为 7.5;p = 0.01)。女性的高密度脂蛋白胆固醇(HDL-C;p < 0.005)、hs-CRP(p = 0.04)和皮质醇(p = 0.009)值明显高于男性。大多数个体的甘油三酯升高和低密度脂蛋白胆固醇(LDL-C;> 100mg/dL)异常值升高。根据当前建议,发现 66%的受检住院医师的 hs-CRP 水平升高。根据目前的建议,发现睡眠质量低和白天过度嗜睡的患病率很高。这些观察结果表明,有必要监测健康状况并采取行动重新评估住院医师的工作量,并允许住院医师额外上夜班,以避免这些个体的健康问题恶化。

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