成都某医院超重肥胖患者食物成瘾现状及膳食模式研究.pdf

中图分类号：R153.9 单位代码：13705 UDC:612.3 密 级：公 开 硕 士 学 位 论 文 成都某医院超重/肥胖患者食物成瘾现状及膳食模式研究 学科专业：公共卫生 研究方向：营养与健康管理 学位类型：专业型硕士 指导教师：朱彦锋 副教授 学生姓名：周圆媛 学 号：2033060019 2023 年 05 月 03 日 万方数据Chengdu Medical College Master Degree Thesis Research on the current status of food addiction and dietary patterns of overweight/obese population in a hospital in Chengdu Major:Public Health Research field:Nutrition and Health Management Degree type:Professional Degree Adviser:Zhu Yanfeng Name of Postgraduate:Zhou Yuanyuan Postgraduate Number:2033060019 May 3rd,2023 万方数据万方数据目录 摘 要.I Abstract.V 前 言.1 第一章 成都某医院超重/肥胖患者 FA 现状及影响因素研究.5 1 引言.5 2 研究对象和方法.5 2.1 研究对象.5 2.2 研究方法与内容.6 2.3 相关指标定义及标准.8 2.4 质量控制.8 2.5 数据处理与统计分析.9 3 结果.9 3.1 超重/肥胖患者 FA 的发生现状.9 3.2 FA 组与 NFA 组人口学特征比较.10 3.3 FA 组与 NFA 组一般状况比较.11 3.4 FA 组与 NFA 组体格测量、实验室指标比较.12 3.5 FA 组与 NFA 组膳食调查比较.13 3.6 FA 影响因素的二元 Logistic 回归分析.17 4 讨论.19 5 小结.22 第二章 膳食模式与食物成瘾研究.24 1 引言.24 2 研究对象与方法.24 2.1 研究对象.24 2.2 研究方法与内容.25 2.3 膳食模式的建立.25 2.4 质量控制.26 2.5 数据处理与统计学方法.26 3 结果.26 3.1 超重/肥胖患者膳食模式的建立及命名.26 3.2 不同膳食模式中 FA 发生情况.29 3.3 各膳食模式与食物种类及营养素摄入情况.29 3.4 超重/肥胖患者膳食模式与 FA 关联性分析.42 万方数据 3.5 超重/肥胖患者中 FA 者膳食模式分析.43 4 讨论.56 5 小结.58 全文总结.60 正文参考文献.62 文献综述.69 附 录.90 附录 1：中英文缩略词表.90 附录 2：一般资料问卷表.91 附录 3：mYFAS 2.0 量表.92 附录 4：半定量食物频率表.94 攻读学位期间研究成果.96 致 谢.97 万方数据成都医学院硕士学位论文 I 摘 要 研究研究背景背景与目的与目的 现今肥胖已成为医学社会问题之一，严重影响着人们的身体和心理健康。近年来，“食物成瘾（FA）是导致肥胖源头之一”的话题已引起学术界的关注，FA 与肥胖在神经生物学方面有某些相似之处。国外相关研究已表明，超重/肥胖患者中大多会出现 FA 的症状。然而，FA 的问题在国内尚未得到广泛关注，对 FA 的相关研究较少，但随着人们生活水平提高，FA 的发生率逐年增加。FA 的危害不仅在于过度饮食引起超重/肥胖，还会对人精神心理上造成影响。因此本课题采用面对面问卷调查的形式，通过改良版耶鲁食物成瘾量表 2.0（mYFAS 2.0）和半定量食物频率量表（SQFFQ）对成都某医院超重/肥胖患者 FA 发生现状和膳食摄入情况进行调查，探讨其影响因素；建立膳食模式，探讨其与 FA 的关联，评价 FA 患者的膳食特点，为临床上进行 FA 筛查提供数据支撑，为国内外有关 FA 患者的膳食模式分析提供数据支撑，为后续制定 FA 的膳食指导和防治措施提供理论依据，为治疗超重/肥胖找到新的有效思路和方法。对象与对象与方法方法 采用横断面调查方法，使用一般资料问卷表、mYFAS 2.0 量表和 SQFFQ 问卷表对 2021 年 8 月至 2022 年 1 月期间于成都市某医院内分泌代谢科和代谢减重门诊就诊的超重/肥胖患者进行资料的收集，同时通过医院 HIS 系统收集研究对象的基本信息和实验室指标。比较 FA 和非 FA（NFA）患者人口学资料、实验室指标及膳食摄入水平，用二元 Logistic 回归分析其影响因素。采用因子分析法（EFA）提取膳食模式，用二元 Logistic 回归模型探索膳食模式与 FA 之间的关联，评价 FA人群的膳食模式特点。结果结果 1.成都某医院超重/肥胖患者 FA 发生率及其影响因素 本研究纳入超重/肥胖患者共 126 例。FA 发生率为 43.65%（55/126），其中轻型 31.75%，中型 11.11%，重型 0.79%。万方数据成都医学院硕士学位论文 IIII 两组比较，FA 组藏族、居住地海拔3500m、合并脂肪肝的比例、BMI、腰围、臀围、体脂率、内脏脂肪等级、HbA1c 指标均高于 NFA 组（P0.05）。且 FA组 BMI 在 2830 kg/m2和30 kg/m2的比例也均高于 NFA 组（P0.05）。FA 组薯类的摄入水平高于 NFA 组，而蔬菜类摄入水平低于 NFA 组（P0.05）。与“中国居民平衡膳食宝塔（2022）”推荐每日摄入量相比，FA 和 NFA 两组薯类、蔬菜类、水果类、奶及奶制品、大豆和坚果类摄入量均低于宝塔推荐摄入量；而谷类、动物性食物、油类摄入量均高于推荐量。与“中国居民膳食营养素参考摄入量（DRIs）”相比，FA 组和 NFA 组能量、蛋白质、脂肪、碳水化合物、烟酸、维生素 E、磷、钾、镁、铁、锌、铜、锰的摄入水平均高于 DRIs；膳食纤维、维生素 A、维生素B1、维生素 B2、维生素 C、钙、硒的摄入水平均低于 DRIs；FA 人群钠的摄入水平高于 DRIs，而 NFA 组低于 DRIs。FA 组能量、脂肪、碳水化合物、钠、锰摄入水平均高于 NFA 组人群（P0.05）。三大产能营养素的供能分配比例中，两组人群蛋白质的供能比均符合推荐比例，而两组碳水化合物的供能比均低于推荐比例，脂肪的供能比均高于推荐比例。NFA 组蛋白质供能比高于 FA 组（P0.05）。NFA 组日常饮食主要以动物性食物蛋白为主，优质蛋白来源包括动物性食物和大豆及其制品类，分别占总蛋白的 53.35%，1.63%。FA 组蛋白质摄入主要来源于动物性食物，优质蛋白来源中的动物性食物和大豆及其制品类，分别占总蛋白的 51.61%，1.37%。FA 组蛋白质来源于其他（除动植物、豆类及其制品以外的食物）的每日摄入水平高于 NFA 人群（P0.05）。二元 Logistic 回归分析结果显示，超重/肥胖患者 FA 的发生与 BMI、薯类和脂肪摄入水平呈正相关。以 BMI 在 2428 kg/m2为参照组，30kg/m2的人群更易发生 FA（OR=5.911，95%CI：1.52822.867，P=0.010）。同时薯类摄入水平（OR=1.024，95%CI：1.0021.047，P=0.034）和脂肪摄入水平（OR=1.032，95%CI：1.0031.062，P=0.033）是超重/肥胖患者发生 FA 的影响因素。2.膳食模式与 FA 的关联 通过 EFA 从膳食数据中提取 4 种膳食模式，分别为高能高脂饮食模式（主要以腌腊、加工肉制品、油炸面食和精米面类为主）、水产蔬菜模式（主要以鱼虾贝万方数据成都医学院硕士学位论文 III 类、蔬菜、奶及奶制品为主）、粗粮肉类模式（主要以粗粮、畜禽肉类为主）、甜茶油炸模式（主要以甜茶、油炸面食为主）。按膳食模式的得分从低到高划分为 Q1、Q2、Q3 三分位水平，超重/肥胖患者饮食越倾向于“粗粮肉类模式”，FA 发生率越高（P0.05）。其余膳食模式得分组人群 FA 发生率无统计学差异（P0.05）。各膳食模式与营养摄入情况的比较，“高能高脂饮食模式”中，Q3 分位人群摄入的蛋白质、碳水化合物的供能比例较低，而摄入的油类、能量、脂肪、维生素 E、钠、硒较高（P0.05）。“水产蔬菜模式”中，Q3 分位人群摄入的蔬菜、水果、动物性食物、大豆及坚果、奶及奶制品、蛋白质供能比、蛋白质、胆固醇、维生素 A、维生素 B2、维生素 C、钙、钾、硒较高，而摄入的碳水化合物供能比较低（P0.05）。“粗粮肉类模式”中，Q3 分位人群摄入的碳水化合物供能比较低，而摄入的谷类、薯类、动物性食物、大豆及坚果类、油类、能量、蛋白质、脂肪、碳水化合物、膳食纤维、灰分、维生素 B1、维生素 B2、烟酸、维生素 E、钙、磷、钾、钠、镁、铁、锌、硒、铜、锰较高（P0.05）。“甜茶油炸面食模式”中，Q3 分位人群摄入的谷类、大豆及坚果及油类、能量、蛋白质、脂肪、胆固醇、灰分、烟酸、维生素E、钾、锌、硒较高（P0.05）。多因素二元 Logistic 回归分析结果显示，“高能高脂饮食模式”在未调整模型和模型 2 调整后，与超重/肥胖患者 FA 的发生呈正相关，Q3 摄入水平的个体发生FA 风险分别是 Q1 水平的 2.934 倍和 3.495 倍（95%CI：1.072-8.034；95%CI：1.087-11.232）（P0.05）；在模型 3 调整后，这种关联消失。“粗粮肉类模式”在未调整模型和模型 2 调整后，与超重/肥胖患者 FA 的发生呈正相关，Q3 摄入水平的个体发生 FA 风险分别是 Q1 水平的 3.954 倍和 3.604 倍（95%CI：1.497-10.440；95%CI：1.075-12.084）（P0.05）。模型 3 调整后，这种关联消失。未发现“水产蔬菜模式”、“甜茶油炸模式”和超重/肥胖患者发生 FA 的相关关系（P0.05）。从超重/肥胖患者存在 FA 人群的膳食数据中共提取 4 种膳食模式，分别为酒类精米面模式（以酒类、精米面类为主）、酥油茶粗粮模式（以酥油茶、粗粮类为主）、油炸面食加工肉模式（以油炸面食和加工肉制品为主）、豆类泡菜模式（以豆类及豆制品和泡菜为主）。“酒类精米面模式”中，Q3 分位人群摄入较多的谷类、万方数据成都医学院硕士学位论文 IVIV 油类、能量、蛋白质、脂肪、碳水化合物、膳食纤维、胆固醇、灰分、维生素 A、维生素 B1、维生素 B2、烟酸、维生素 E、钙、磷、钾、镁、铁、锌、硒、铜、锰（P0.05）。“酥油茶粗粮模式”中，Q3 分位人群摄入较多的动物性食物、能量、蛋白质、脂肪、碳水化合物、膳食纤维、灰分、维生素 B1、维生素 B2、烟酸、磷、钾、钠、镁、铁、锌、铜、锰（P0.05）。“油炸面食加工肉模式”中，Q3 分位人群摄入较多的油类（P0.05）。“豆类泡菜模式”中，Q3 分位人群摄入较少的奶及奶制品、维生素 B2、钙（P0.05）。结论结论 1.成都某医院超重/肥胖人群中 FA 发生率为 43.65%。BMI、薯类和脂肪摄入水平是超重/肥胖患者发生 FA 的影响因素。建议对超重/肥胖患者应尽早进行 FA 的筛查。2.该研究共提取四种主要膳食模式：“高能高脂饮食模式”、“水产蔬菜模式”、“粗粮肉类模式”、“甜茶油炸模式”。超重/肥胖患者膳食越倾向于“粗粮肉类模式”，FA 发生率越高。调整民族、居住地海拔、脂肪肝病史、BMI、腰围、臀围等混杂因素后，超重/肥胖患者 FA 的发生与“高能高脂饮食模式”及“粗粮肉类模式”呈正相关。提倡多摄入豆类及制品、蔬菜水果、菌藻类、鱼虾贝类、奶及奶制品等低脂食物，畜禽肉类、精米面类、甜茶及酒等食物要适量摄入，保持合理均衡饮食模式。3.超重/肥胖存在 FA 的患者中提取四种主要膳食模式：“酒类精米面模式”、“酥油茶粗粮模式”、“油炸面食加工肉模式”、“豆类泡菜模式”。超重/肥胖 FA 患者膳食结构尚不尽合理，部分营养素摄入不均衡。建议对 FA 患者应及时进行健康宣教及针对性膳食干预。关键词：关键词：超重/肥胖；食物成瘾；膳食模式；因子分析 万方数据成都医学院硕士学位论文 V Abstract Research background and purpose Currently,obesity has become one of the medical and social problems,which seriously affects peoples physical and mental health.In recent years,the topic of food addiction(FA)as a source of obesity has attracted academic attention,and FA has certain similarities with obesity in terms of neurobiological effects.Studies abroad have shown that most of the overweight/obese patients show symptoms of FA.However,the problem of FA has not received widespread attention in China,and there are fewer studies related to FA.But with improvement of peoples living standards,the incidence of FA has increased year by year.The harmful effects of FA are not only overweight/obesity caused by overeating,but also the psychological impact on people.Therefore,this study used a face-to-face questionnaire to investigate the current status and dietary intake of FA among overweight/obese people in a hospital in Chengdu by using the modified Yale Food Addiction Scale 2.0(mYFAS 2.0)and the semi-quantitative food frequency questionnaire(SQFFQ)to investigate the influencing factors,establish dietary patterns,explore its association with FA,and evaluate the dietary characteristics of the FA patients,so as to provide data support for FA screening in clinical settings,provide scientific basis for providing reasonable dietary guidance suggestions for FA patients,and to find new effective ideas and methods for the treatment of overweight/obesity.Subjects and Methods A cross-sectional survey study was conducted using the general information Questionnaire,mYFAS 2.0 and SQFFQ to collect data from overweight/obese patients attending the metabolic weight loss clinic of the department of endocrinology and metabolism at a hospital in Chengdu between August 2021 and January 2022.Basic information and laboratory indices of the study subjects were collected through the hospital HIS system.The demographic data,laboratory indicators and dietary intake levels of FA and non-FA(NFA)patients were compared and the influencing factors were analyzed by binary logistic regression.Exploratory factor analysis(EFA)was used to extract dietary patterns,and binary logistic regression models were used to explore the association between dietary patterns and FA，and to evaluate the characteristics of dietary patterns in the FA population.万方数据成都医学院硕士学位论文 VIVI Result 1.Prevalence of FA in overweight/obese patients and its influencing factors in a hospital in Chengdu A total of 126 overweight/obese patients were included in this study.The incidence of FA was 43.65%(55/126),light 31.75%,medium 11.11%and severe 0.79%.Comparing between the two groups,the proportion of Tibetan ethnicity,residence altitude 3500m,combined fatty liver,BMI,waist circumference,hip circumference,body fat percentage,visceral fat grade,and HbA1c were higher in the FA group than in the NFA group(P0.05).The proportion of BMI in the FA group was higher in both 28-30 kg/m2 and 30 kg/m2 than in the NFA group(P0.05).Meanwhile,the intake level of potatoes was higher in the FA group than in the NFA group,while the intake level of vegetables was lower than in the NFA group(P0.05).Compared with the recommended daily intake of the Balanced Diet for Chinese Residents(2022),the intakes of potatoes,vegetables,fruits,milk and milk products,soybeans and nuts for both FA and NFA groups were lower than the recommended intake of the pagoda;the intakes of cereals,animal foods and oils were higher than the recommended intake respectively.Compared with the Chinese Dietary Reference Intakes(DRIs),the intake levels of energy,protein,fat,carbohydrate,niacin,vitamin E,phosphorus,potassium,magnesium,iron,zinc,copper and manganese in the FA and NFA groups were higher than the DRIs.Dietary fiber,vitamin A,vitamin B1,vitamin B2,vitamin C,calcium,and selenium intake levels were all lower than DRIs.Sodium intake levels were higher in the FA population than in the DRIs and lower in the NFA group than in the DRIs.The FA group had higher energy,fat,carbohydrate,sodium,and manganese intake levels than the NFA group(P0.05).Among the energy supply distribution ratios of the three energy-producing nutrients,the energy supply ratios of protein in both groups were in accordance with the recommended ratios,while the energy supply ratios of carbohydrates in both groups were lower than the recommended ratios,and the energy supply ratios of fats were higher than the recommended ratios.The protein energy supply ratio was higher in the NFA group than in the FA group(P0.05).The daily diet of the NFA group was mainly based on animal food protein,and the sources of high-quality protein included animal food and soybean and its products,accounting for 53.35%and 1.63%of the total protein,respectively.The protein intake of the FA group was mainly derived from animal food,and the animal food and soybean and its products 万方数据成都医学院硕士学位论文 VII categories of high-quality protein sources accounted for 51.61%and 1.37%of the total protein,respectively.The FA group had a higher daily intake level of protein derived from other(foods other than plants and animals,legumes and their products)than the NFA group(P0.05).The results of binary logistic regression analysis showed that the occurrence of FA in overweight/obese patients was positively associated with BMI,potato and fat intake levels.Using a BMI of 24-28 kg/m2 as the reference group,those 30 kg/m2 were more likely to develop FA(OR=5.911,95%CI:1.528-22.867,P=0.010).Meanwhile the level of potato intake(OR=1.024,95%CI:1.002 to 1.047,P=0.034)and fat intake(OR=1.032,95%CI:1.003 to 1.062,P=0.033)were the influencing factors for the occurrence of FA in overweight/obese patients.2.Association between dietary pattern and FA The EFA extracted four dietary patterns from the dietary data,which were high energy and high fat diet pattern(mainly cured and processed meat products,fried pasta and refined rice and noodles),aquatic and vegetable pattern(mainly fish,shrimp and shellfish,vegetables,milk and dairy products),coarse grains and meat pattern(mainly coarse grains and livestock and poultry meat),and sweet tea and fried pattern(mainly sweet tea and fried pasta).According to the score of dietary patterns from low to high,divided into Q1,Q2 and Q3,the more overweight/obese peoples dietary intake tended to coarse grains and meat pattern,the higher the incidence of FA(P0.05).Compared with each dietary pattern and nutritional intake,among the high energy and high fat diet pattern,the Q3 quartile population consumed a lower proportion of protein and carbohydrate for energy supply,and a higher intake of oil,energy,fat,vitamin E,sodium and selenium(P0.05).In the aquatic vegetable pattern,the intake of vegetables,fruits,animal foods,soybeans and nuts,milk and milk products,protein energy ratio,protein,cholesterol,vitamin A,vitamin B2,vitamin C,calcium,potassium,and selenium was higher in the Q3 quartile,while the carbohydrate energy ratio was lower(P0.05).In the coarse grain meat pattern,carbohydrate energy supply in the Q3 quartile was relatively low,while the intake of whole grains,potatoes,animal foods,soybeans and nuts,oils,energy,protein,fat,carbohydrates,dietary fiber,ash,vitamin B1,万方数据成都医学院硕士学位论文 VIIIVIII vitamin B2,niacin,vitamin E,calcium,phosphorus,potassium,sodium,magnesium,iron,zinc,selenium,copper,and manganese were higher(P0.05).In the sweet tea fried pasta pattern,the intake of whole grains,soybeans and nuts and oils,energy,protein,fat,cholesterol,ash,niacin,vitamin E,potassium,zinc,and selenium was higher in the Q3 quartile(P0.05).The results of multivariate binary logistic regression analysis showed that high energy and high fat diet pattern was positively associated with the occurrence of FA after unadjusted model and model 2 adjustment,with the risk of FA being 2.934 and 3.495 times higher in individuals with Q3 intake level than Q1 level,respectively(95%CI:1.072-8.034;95%CI:1.087-11.232)(P0.05),and this association disappeared after model 3 adjustment.Meanwhile,coarse grain meat pattern was positively associated with the occurrence of FA in overweight/obese patients after unadjusted model and model 2 adjustment,with the risk of FA in individuals with Q3 intake levels being 3.954 and 3.604 times(95%CI:1.497-10.440;95%CI:1.075-12.084)higher than Q1 levels,respectively(P0.05).There were four dietary patterns extracted from the dietary data of FA population,which were alcohol refined rice and noodle pattern(mainly alcohol and refined rice and noodles),ghee tea coarse grains pattern(mainly ghee tea and coarse grains),deep fried pasta processing meat pattern(mainly fried pasta and processed meat products),and bean kimchi pattern(mainly beans and bean products and kimchi).In the alcohol refined rice and noodle pattern,the Q3 quartile population consumed more cereals,oils,energy,protein,fat,carbohydrates,dietary fiber,cholesterol,ash,vitamin A,vitamin B1,vitamin B2,niacin,vitamin E,calcium,phosphorus,potassium,magnesium,iron,zinc,selenium,copper,and manganese(P0.05).In the ghee tea coarse grains pattern,the Q3 quartile population consumed more animal food,energy,protein,fat,carbohydrate,dietary fiber,ash,vitamin B1,vitamin B2,niacin,phosphorus,potassium,sodium,magnesium,iron,zinc,copper,and manganese,whereas(P0.05).In the deep fried pasta processing meat pattern,people in the Q3 quartile consumed more oil(P0.05).In the bean kimchi pattern,people in the Q3 quartile consumed less milk and milk products,vitamin B2,and calcium(P0.05).万方数据成都医学院硕士学位论文 IX Conclusions 1.The prevalence of FA among overweight/obese people in a hospital in Chengdu was 43.65%.BMI,potato and fat intake levels were the influencing factors for the occurrence of FA in overweight/obese patients.Recommend that overweight/obese patients should be screened for FA as early as possible.2.In this study