Peles Einat, Schreiber Shaul, Sason Anat, Adelson Miriam
a Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.
b Department of Psychiatry , Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.
Subst Abus. 2016 Oct-Dec;37(4):613-618. doi: 10.1080/08897077.2016.1179705. Epub 2016 Apr 19.
Weight gain was reported during methadone maintenance treatment (MMT). However, its relation to eating habits and specific risk factors, including methadone dose or serum level, was limited. The aims of this study were to characterize risk factors for weight gain and to study current eating habits, food preferences, and nutrition knowledge.
Patients with available measures of weight and height (body mass index [BMI]) at admission to MMT and at follow-up, when methadone serum levels were determined (after 1 year or when stabilized) (N = 114), were studied (using the Addiction Severity Index [ASI], drugs in urine, methadone doses, and serum levels). In addition, 109 current patients with available earlier (5.8 ± 2.6 years earlier) BMI completed eating behavior rating and nutrition knowledge questionnaires, and their current and earlier BMI were compared.
The BMI of 114 newly admitted patients increased from 22.5 ± 3.8 to 24.4 ± 4.3 (P < .0005). Once stabilized on methadone, BMI increased further (24.3 ± 4.5 to 25.6 ± 5.0; P < .0005; n = 74), with no change in methadone doses (125.6 ± 32.5 to 128.0 ± 34.1; F = 1.4, P = .2) or serum levels (495.6 ± 263.7 to 539.8 ± 306.2; F = 1.3, P = .2). Repeated-measures analyses revealed that BMI elevation was higher among 45 hepatitis C virus seronegative and 46 non-benzodiazepine-abusing on-admission patients. Those who scored lower on knowledge about healthy diet and showed a higher sweet-foods preference had a higher BMI.
BMI increased over time, but independent of methadone dosage and blood levels. As expected, worse diet habits and a desire for sweet foods are related to higher BMI. Paradoxically, healthier status (i.e., hepatitis C seronegative, no benzodiazepine abuse) at admission is predictive of greater weight gain during MMT. Education about nutrition habits is recommended.
据报道，美沙酮维持治疗（MMT）期间会出现体重增加。然而，其与饮食习惯及特定风险因素（包括美沙酮剂量或血清水平）之间的关系尚不明确。本研究旨在确定体重增加的风险因素，并研究当前的饮食习惯、食物偏好及营养知识。
对114例在接受MMT入院时及随访时（测定美沙酮血清水平后，1年或病情稳定时）有体重和身高测量值（体重指数[BMI]）的患者进行研究（使用成瘾严重程度指数[ASI]、尿液中的药物、美沙酮剂量及血清水平）。此外，109例现有早期（5.8±2.6年前）BMI数据的患者完成了饮食行为评分及营养知识问卷调查，并对其当前和早期的BMI进行了比较。
114例新入院患者的BMI从22.5±3.8增至24.4±4.3（P<.0005）。美沙酮病情稳定后，BMI进一步升高（从24.3±4.5增至25.6±5.0；P<.0005；n=74），而美沙酮剂量（从125.6±32.5增至128.0±34.1；F=1.4，P=.2）及血清水平（从495.6±263.7增至539.8±306.2；F=1.3，P=.2）均无变化。重复测量分析显示，45例丙型肝炎病毒血清学阴性及46例入院时未滥用苯二氮䓬类药物的患者BMI升高幅度更大。那些健康饮食知识得分较低且甜食偏好较高的患者BMI更高。
BMI随时间升高，但与美沙酮剂量及血药浓度无关。正如预期的那样，较差的饮食习惯及对甜食的喜好与较高的BMI相关。矛盾的是，入院时健康状况较好（即丙型肝炎血清学阴性、未滥用苯二氮䓬类药物）预示着MMT期间体重增加更多。建议开展营养习惯教育。
