Journal of the Korean Society of Food Science and Nutrition (한국식품영양과학회지)

The Korean Society of Food Science and Nutrition (한국식품영양과학회)
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Effects of Nutrition Education in Type 2 Diabetes Mellitus on Diabetes Control and Blood Antioxidant Status

제2형 당뇨환자에 대한 영양교육이 당뇨병 관리와 혈액 항산화 상태에 미치는 영향

  • Shin, Kyung-Nam (Dept. of Food Science and Nutrition, Andong National University) ;
  • Lee, Hye-Sang (Dept. of Food Science and Nutrition, Andong National University) ;
  • Kwon, Chong-Suk (Dept. of Food Science and Nutrition, Andong National University)
  • 신경남 (안동대학교 생활과학대학 식품영양학과) ;
  • 이혜상 (안동대학교 생활과학대학 식품영양학과) ;
  • 권정숙 (안동대학교 생활과학대학 식품영양학과)
  • Received : 2011.03.04
  • Accepted : 2011.04.22
  • Published : 2011.05.31
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Abstract

Diabetic patients need nutritional education more than those suffering from other diseases because of the necessity of controlling blood glucose levels with dietary treatment. The purpose of this study was to find out the effectiveness of nutrition education on diabetes control and antioxidant status, both of which are related to diabetic complications. Thirty (15 males and 15 females) type 2 diabetes mellitus patients aged $66.7{\pm}8.8$ years participated in a 4-week nutrition education program. Nutrient intakes, blood glucose level, antioxidant status, and DNA damage were evaluated before, immediately after, and three months after the education program. Changes in those parameters over time were analyzed using repeated-measures analysis of covariance. Over time, HbA1c (p=0.000), plasma total cholesterol (p=0.002), plasma thiobarbituric acid related substances (TBARS; p=0.000), and leukocyte DNA damage (p=0.000) significantly decreased; plasma retinol (p=0.001), plasma tocopherol (p=0.000), erythrocyte catalase (CAT; p=0.000), and erythrocyte glutathione peroxidase (GPx; p=0.000) significantly increased. In an evaluation of nutrient intakes by Dietary Reference Intakes for Koreans (KDRI), energy (p=0.009), phosphorus (p=0.033), sodium (p=0.001), potassium (p=0.019), zinc (p=0.043), riboflavin (p=0.050), folic acid (p=0.048) and vitamin C (p=0.008) intakes had significant positive changes. In a correlation analysis of the biochemical and nutritional changes resulting from the education program, plasma TBARS were negatively correlated with potassium (r=-0.418, p<0.05), iron (r=-0.443, p<0.05), riboflavin (r=-0.432, p<0.05), and folic acid (r=-0.446, p<0.05) intakes, while plasma retinol was positively correlated with energy (r=0.543, p<0.01), protein (r=0.543, p<0.01), phosphorus (r=0.425, p<0.05), iron (r=0.485, p<0.05), zinc (r=0.570, p<0.01) and niacin (r=0.510, p<0.05) intakes. Erythrocyte CAT was positively correlated with folic acid intake (r=0.605, p<0.01). From these results, we suggest that an improvement in nutrition resulting from a diabetic education program for type 2 diabetes patients led to improvement in their antioxidant status, also possibly reducing complications resulting from diabetes.

본 연구는 효과적인 당뇨 교육 및 평가 방안을 모색하는데 기초 자료를 제시하고자 안동시 보건소를 내원하는 제2형 당뇨병 환자를 대상으로 4주간의 당뇨교육을 하고, 교육 전, 교육 후 및 교육 후 3개월에 각각 영양소 섭취, 혈당 관리와 항산화 영양상태 및 DNA 손상 정도를 조사하여 영양교육의 효과를 평가하였다. 시기에 따른 교육 효과를 반복 측정 분산 분석으로 검정한 결과, HbA1c와 총 콜레스테롤은 유의적으로 감소하였고, 혈장 레티놀(p=0.001)과 토코페롤(p=0.000), 그리고 CAT(p=0.000)와 GPx(p=0.000)의 활성은 유의적으로 상승하였으며, 혈장 과산화지질(TBARS) 농도(p=0.000)와 DNA 손상 정도(p=0.000)는 유의적으로 감소한 것으로 나타났다. 영양소 섭취 상태에 대한 영양교육의 효과는 에너지의 경우, 교육 전에 EER의 76.4% 수준으로 섭취하였으나 교육 직후와 교육 후 3개월에 각각 83.6%와 90.6%로 유의하게 증가한 것으로 나타났다(p=0.009). 에너지 섭취의 증가와 함께 인(p=0.033), 나트륨(p=0.001), 칼륨(p=0.019), 아연(p=0.043), 리보플라빈(p=0.050), 엽산(p=0.048) 및 비타민 C(p=0.008)의 섭취도 유의적으로 증가하였다. 한편, 영양소 섭취 상태의 변화와 생화학적 특성 변화 간의 관련성을 분석한 결과, 대부분의 영양소 섭취 변화는 공복혈당 및 HbA1c의 변화와 유의성은 없었으나 음의 상관성을 보였고, 칼륨(r=-0.418, p<0.05), 철분(r=-0.443, p<0.05), 리보플라빈(r=-0.432, p<0.05) 및 엽산(r=-0.446, p<0.05)의 섭취 상태 개선이 혈액의 과산화지질 감소와 관련성이 있는 것으로 나타났다. 에너지(r=0.543, p<0.01), 단백질(r=0.545, p<0.01), 인(r=0.425, p<0.05), 철분(r=0.485, p<0.05), 아연(r=0.570, p<0.01) 및 나이아신(r=0.510, p<0.05)의 섭취는 혈장 레티놀과, 엽산섭취(r=0.605, p<0.01)의 변화는 CAT와 각각 유의적인 양의 상관성을 보였다. 이처럼 당뇨병에서 식이를 통한 영양소의 섭취 증가는 항산화 상태 개선 및 산화 스트레스 감소와 일부 연관이 있는 것으로 사료된다.

Keywords

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