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

  • 제40권5호
  • /
  • Pages.689-695
  • /
  • 2011
  • /
  • 1226-3311(pISSN)
  • /
  • 2288-5978(eISSN)
한국식품영양과학회 (The Korean Society of Food Science and Nutrition)
권호 표지
DOI QR코드

DOI QR Code

제2형 당뇨환자에 대한 영양교육이 당뇨병 관리와 혈액 항산화 상태에 미치는 영향

Effects of Nutrition Education in Type 2 Diabetes Mellitus on Diabetes Control and Blood Antioxidant Status

  • 신경남 (안동대학교 생활과학대학 식품영양학과) ;
  • 이혜상 (안동대학교 생활과학대학 식품영양학과) ;
  • 권정숙 (안동대학교 생활과학대학 식품영양학과)
  • 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)
  • 투고 : 2011.03.04
  • 심사 : 2011.04.22
  • 발행 : 2011.05.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

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.

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.

키워드

참고문헌

  1. International Diabetes Federation. 2010. Diabetes facts. Available from http://www.idf.org/about-diabetes cited 2010 July 28.
  2. Ministry of Health, Welfare and Family affairs, Korea Centers for Disease Control & Prevention. 2010. 2008 Korean National Health and Nutrition Examination Survey. Available from http://knhanes.cdc.go.kr/include/lFrameNull. jsp?url=/board cited 2010 Oct 26.
  3. Korean Statistical Information Service. 2010. Deaths and causes of death statistics in 2009. Available from http:// www.kosis.kr/ cited 2010 Nov 3.
  4. Zeman FJ. 1991. Clinical Nutrition and Dietetics. 2nd ed. Macmillan Publishing Co, New York, NY, USA. p 399-402.
  5. Woo YJ, Lee HS, Kim WY. 2006. Individual diabetes nutrition education can help management for type II diabetes. Korean J Nutr 39: 641-648.
  6. Kim TY, Um SH, Kim WY, Chang NS. 2004. Group lunch visits at the public center improve glycemic control in older adults with type 2 diabetes mellitus. Korean J Nutr 37: 302-309.
  7. Wilson C, Acton K, Brown T, Gilliland S. 2003. Effects of clinical nutrition education and educator discipline on glycemic control outcomes in the Indian health service. Diabetes Care 26: 2500-2504. https://doi.org/10.2337/diacare.26.9.2500
  8. Lee YW, Hwang WS, Choe SJ, Lee DH, Kim DH, Lee EH, Hong EG, Noh HL, Chung YS, Lee KW, Kim HM. 2003. The effect of intensive education on glycemic control in type 2 diabetes patients. J Kor Soc Endocrinol 18: 63-72.
  9. Chung SO, Song OK, Ko JM, Wi JH, Lee TH, Yum JH, Cho DK, Son JH, Nam HW, Yoo HJ, Lee YN, Kim SG, Moon HK, Kim ES. 2000. The effect of teaching methods on the dietary compliance and hemoglobin A1c level in patients with diabetes mellitus. J Kor Diabetes Asso 124: 560-573.
  10. Kim JH, Chang SA. 2009. Effect of diabetes education program on glycemic control and self management for patients with type 2 diabetes mellitus. Korean Diabetes J 33: 518-525. https://doi.org/10.4093/kdj.2009.33.6.518
  11. Kang HJ, Sin EM, Kim KW. 2009. Evaluation of nutrition education for diabetes mellitus of older adults. Korean J Community Nutr 14: 734-745.
  12. Lee SY, Kim MJ, Kwon SJ. 2010. Effects of low glycemic index nutrition education on the blood glucose control in patients with type 2 diabetes mellitus. Korean J Nutr 43: 46-56. https://doi.org/10.4163/kjn.2010.43.1.46
  13. Oh JY, Kim SB. 2010. Development and effects analysis of nutrition education program for diabetes mellitus at community health center－focused on individual daily energy requirements and food exchange units－. Korean J Community Nutr 15: 485-497.
  14. Chon S, Kwon MK, Oh SJ, Woo JT, Kim SW, Kim JW, Kim YS. 2008. The relationship between antioxidant enzyme activities and diabetic microvascular complications in type 2 diabetic patients. J Kyung Hee Univ Med Cent 24: 90-97.
  15. Vincent AM, Russell JW, Low P, Feldman EL. 2004. Oxidative stress in the pathogenesis of diabetic neuropathy. Endocrine Reviews 25: 612-628. https://doi.org/10.1210/er.2003-0019
  16. Figueroa-Romero C, Sadidi M, Feldman EL. 2008. Mechanisms of disease: The oxidative stress theory of diabetic neuropathy. Rev Endocr Metab Disord 9: 301-314. https://doi.org/10.1007/s11154-008-9104-2
  17. Ha AW, Kim HM. 1999. The study of lipid-peroxidation, antioxidant enzymes, and the antioxidant vitamins in NIDDM patients with microvascular-diabetic complications. Korean J Nutr 32: 17-23.
  18. Collins AR, Raslova K, Somorovska M, Petrovska H, Ondrusova A, Vohnout B, Fabry R, Dusinska M. 1998. DNA damage in diabetes: correlation with a clinical marker. Free Radic Biol Med 25: 373-377. https://doi.org/10.1016/S0891-5849(98)00053-7
  19. Martin-Gallan P, Carrascosa A, Gussinye M, Dominguez C. 2003, Biomarkers of diabetes-associated oxidative stress and antioxidant status in young diabetic patients with or without subclinical complications. Free Radic Biol Med 34: 1563-1574. https://doi.org/10.1016/S0891-5849(03)00185-0
  20. Song F, Jia W, Yao Y, Hu Y, Lei L, Lin J, Sun X, Liu L. 2007. Oxidative stress, antioxidant status and DNA damage in patients with impaired glucose regulation and newly diagnosed type 2 diabetes. Clin Sci 112: 599-606. https://doi.org/10.1042/CS20060323
  21. Sardas S, Yilmaz M, Oztok U, Cakir N, Karakaya AE. 2001. Assessment of DNA strand breakage by comet assay in diabetic patients and the role of antioxidant supplementation. Mutat Res 490: 123-129. https://doi.org/10.1016/S1383-5718(00)00157-1
  22. Choi SW, Benzie IF, Lam CS. 2005. Inter-relationships between DNA damage, ascorbic acid and gycaemic control in type 2 diabetes mellitus. Diabetic Med 22: 1347-1353. https://doi.org/10.1111/j.1464-5491.2005.01647.x
  23. Kirkpatrick D. 1996. Great idea revisited: Techniques for evaluating training program. Training & Development 50: 54-59.
  24. Lee YM, Park HN. 2010. The effectiveness of Na education program in elementary school-six month follow-up study-. Korean J Community Nutr 15: 603-613.
  25. Son SM, Kim MJ. 2001. The effect of nutrition education program for various chronic disease in elderly visiting public health center. Korean J Community Nutr 6: 668-677.
  26. Yagi K. 1984. Assay for blood plasma or serum. Methods Enzymol 105: 328-331. https://doi.org/10.1016/S0076-6879(84)05042-4
  27. Aebi H. 1984. Catalase in vitro. Methods Enzymol 105: 121-126. https://doi.org/10.1016/S0076-6879(84)05016-3
  28. Flohe L, Otting F. 1984. Superoxide dismutase assays. Methods Enzymol 105: 93-104. https://doi.org/10.1016/S0076-6879(84)05013-8
  29. Paglia DE, Valentine WN. 1967. Studies on the quantitative and qualitative characterization of erythrocyte glutathione peroxidase. J Lab Clin Med 70: 158-169.
  30. Bieri JG, Brown ED, Smith JC. 1985. Determination of individual carotenoids in human plasma by high performance liquid chromatography. J Liq Chromatogr 8: 473-484. https://doi.org/10.1080/01483918508067094
  31. Singh NP, McCoy MT, Tice RR, Schneider EL. 1988. A simple technique for quantitation of low levels of DNA damage in individual cells. Exp Cell Res 175: 184-191. https://doi.org/10.1016/0014-4827(88)90265-0
  32. Will JC, Byers T. 1996. Does diabetes mellitus increase the requirement for vitamin C? Nutr Rev 54: 193-202.
  33. Sharma A, Kharb S, Chugh SN, Kakkar R, Singh GP. 2000. Evaluation of oxidative stress before and after control of glycemia and after vitamin E supplementation on diabetic patients. Metabolism 49: 160-162. https://doi.org/10.1016/S0026-0495(00)91117-X
  34. Sundaram RK, Bhaskar A, Vijayalingam S, Viswanatthan M, Mohan R, Shanmugasundaram KR. 1996. Antioxidant status and lipid peroxidation in type II diabetes with and without complicaitons. Clin Sci 90: 255-260. https://doi.org/10.1042/cs0900255
  35. Muruganandam A, Drouilard C, Thibert RJ, Cheung RM, Draisey TF, Mutus B. 1992. Glutathione metabolic enzyme activities in diabetic platelets as a function of glycemic control. Thromb Res 67: 385-397. https://doi.org/10.1016/0049-3848(92)90268-F
  36. Griesmacher A, Kinderhauser M, Andert S, Schreiner W, Toma C, Knoebl P, Pietschmann P, Prager R, Schnack C, Schernthaner G. 1995. Enhanced serum levels of TBARS in diabetes mellitus. Am J Med 98: 469-475. https://doi.org/10.1016/S0002-9343(99)80347-7
  37. Baynes JW, Thorpe SR. 2000. Glycoxidation and lipoxidation in atherogenesis. Free Radic Biol Med 28: 1708-1716. https://doi.org/10.1016/S0891-5849(00)00228-8
  38. Inoguchi T, Li P, Umeda F, Yu HY, Kakimoto M, Imamura M, Aoki T, Etoh T, Hashimoto T, Naruse M, Sano H, Utsumi H, Nawata H. 2000. High glucose level and free fatty acid stimulate reactive oxygen species production through protein kinase C-dependent activation of NAD(P)H oxidase in cultured vascular cells. Diabetes 49: 1939-1945. https://doi.org/10.2337/diabetes.49.11.1939
  39. Dincer Y, Akcay T, Ilkova H, Alademir Z, Ozbay G. 2003. DNA damage and antioxidant defense in peripheral leukocytes of patients with type 1 diabetes mellitus. Mutat Res 527: 49-55. https://doi.org/10.1016/S0027-5107(03)00073-3
  40. Lean ME, Noroozu M, Kelly I, Burns J, Talwar D, Sattar N, Crozier A. 1999. Dietary flavonols protect diabetic human lymphocytes against oxidative damage to DNA. Diabetes 48: 176-181. https://doi.org/10.2337/diabetes.48.1.176
  41. Ford ES, Will JC, Bowman BA, Narayan KM. 1999. Diabetes mellitus and serum carotenoids: findings from the Third National Health and Nutrition Examination Survey. Am J Epidem 149: 168-176. https://doi.org/10.1093/oxfordjournals.aje.a009783

피인용 문헌

  1. Changes in Phenolic Composition, Antioxidant and Antidiabetic Properties of Jeju Citrus sudachi as Influenced by Maturity vol.25, pp.11, 2015, https://doi.org/10.5352/JLS.2015.25.11.1311
  2. Effects of Nutrition Education on Improvement of Blood Glucose in Type 2 Diabetic Patients with Low Income vol.43, pp.1, 2014, https://doi.org/10.3746/jkfn.2014.43.1.141
  3. Increased in vitro Anticancer Effects of Potassium Bamboo Salt vol.41, pp.9, 2012, https://doi.org/10.3746/jkfn.2012.41.9.1248
  4. Nutritional Assessment and Mineral Content of Wild and Cultured Catfish Silurus asotus vol.27, pp.5, 2015, https://doi.org/10.13000/JFMSE.2015.27.5.1364
  5. Benefits of Nutrition Consultation for Preventing Diabetes According to HbA1c Levels in Overweight and Obese Women vol.19, pp.2, 2013, https://doi.org/10.14373/JKDA.2013.19.2.112
  6. Current Status and Effects of Nutrition Education Programs for Diabetic Patients in Korea vol.19, pp.2, 2018, https://doi.org/10.4093/jkd.2018.19.2.106
  7. Effects of Korean diet control nutrition education on cardiovascular disease risk factors in patients who underwent cardiovascular disease surgery vol.51, pp.3, 2018, https://doi.org/10.4163/jnh.2018.51.3.215
  8. Effect of Diabetic Dietary Education Program on Diabetes Knowledge and Dietary Behaviors of Elderly Diabetic Patients vol.33, pp.5, 2011, https://doi.org/10.9724/kfcs.2017.33.5.601
  9. 구강 내 자당 및 포도당 잔류 경과 시간에 따른 칼륨과 마그네슘 농도 변화 vol.19, pp.11, 2011, https://doi.org/10.5392/jkca.2019.19.11.424