美国人口生活方式改变的医疗保健提供者建议：NHANES 2011-2016 结果。
Health Care Providers' Advice on Lifestyle Modification in the US Population: Results from the NHANES 2011-2016.
机构信息
Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Austria.
Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Compass House, Cambridge, UK.
出版信息
Am J Med. 2019 Apr;132(4):489-497.e1. doi: 10.1016/j.amjmed.2018.11.021. Epub 2018 Dec 3.
OBJECTIVE
Health care providers are encouraged to prescribe lifestyle modifications for preventing and managing obesity and associated chronic conditions. However, the pattern of lifestyle advice provision is unknown. We investigate the prevalence of advised lifestyle modification according to weight status and chronic conditions in a US nationally representative sample.
METHODS
Adults ages 20-64years (n = 11,467) from the National Health and Nutrition Examination Survey between 2011 and 2016 were analyzed, with weight status and chronic conditions (high blood pressure, high blood cholesterol, osteoarthritis, coronary heart disease, and type 2 diabetes mellitus). Lifestyle modification advice by health care providers included: increase physical activity/exercise, reduce dietary fat/calories, control/lose weight, and all of the above.
RESULTS
High blood pressure (32.7%) and cholesterol (29.3%) were highly prevalent compared with osteoarthritis (7.4%), type 2 diabetes (5.7%), and coronary heart disease (3.7%). Those with type 2 diabetes received considerably more frequent advice (56.5%; 95% confidence interval [CI], 52.4%-60.6%) than those with high blood pressure (31.4%; 95% CI, 29.3%-33.6%) and cholesterol (27.0%; 95% CI, 24.9%-29.3%). Prevalence of lifestyle advice exhibited substantial increases with graded body mass index and comorbidity (all P < .001). After adjusting for comorbid conditions, advice was more commonly reported among women, those overweight/obese, nonwhite, or insured. A remarkably low proportion of overweight (21.4; 95% CI, 18.7%-24.3%) and obese (44.2%; 95% CI, 41.0%-47.4%) adults free of chronic conditions reported receiving any lifestyle advice.
CONCLUSIONS
Prevalence of lifestyle modification advised by health care providers is generally low among US adults with chronic conditions, and worryingly low among those without chronic conditions, however overweight or obese. Prescribed lifestyle modification is a missing opportunity in implementing sustainable strategies to reduce chronic condition burden.
目的
鼓励医疗保健提供者针对预防和管理肥胖症及相关慢性疾病提出生活方式调整建议。然而，目前尚不清楚生活方式建议的提供模式。我们在一个具有全国代表性的美国样本中，根据体重状况和慢性疾病调查了建议的生活方式调整的流行情况。
方法
2011 年至 2016 年期间，对国家健康与营养调查（National Health and Nutrition Examination Survey）中年龄在 20-64 岁的 11467 名成年人进行了分析，这些成年人的体重状况和慢性疾病包括高血压、高胆固醇、骨关节炎、冠心病和 2 型糖尿病。医疗保健提供者提供的生活方式调整建议包括：增加体育锻炼/运动、减少饮食中的脂肪/卡路里、控制/减轻体重和上述所有内容。
结果
高血压（32.7%）和高胆固醇（29.3%）的发病率远高于骨关节炎（7.4%）、2 型糖尿病（5.7%）和冠心病（3.7%）。2 型糖尿病患者得到的建议频率明显更高（56.5%；95%置信区间 [CI]，52.4%-60.6%），而高血压患者（31.4%；95% CI，29.3%-33.6%）和高胆固醇患者（27.0%；95% CI，24.9%-29.3%）的建议频率较低。随着身体质量指数和合并症的分级增加，生活方式建议的流行程度显著增加（均 P<.001）。在调整了合并症的情况下，女性、超重/肥胖者、非白人或有保险的人群报告的建议更为常见。令人惊讶的是，没有慢性疾病的超重（21.4%；95% CI，18.7%-24.3%）和肥胖（44.2%；95% CI，41.0%-47.4%）成年人接受任何生活方式建议的比例都很低。
结论
美国患有慢性疾病的成年人中，医疗保健提供者建议进行生活方式调整的比例普遍较低，而在没有慢性疾病的情况下，特别是超重或肥胖的成年人中，这一比例更是低得令人担忧。开处生活方式调整处方是实施可持续策略以减轻慢性疾病负担的一个缺失机会。
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