NGHIEN CU'U M 6 1 LI^N QUAN GIO'A CHl S6 K H 6 | C a T h i VA MOT S6 BENH MAN TJNH Cf NGU-dXI CAO TU6l TAI
VIEN L A O KHOA T R U N G LTONG.
Pham Duy Tirdng'', Nguyen Thj Cam Nhung^
'Tru&ng Dgi hpc YHd Npi 'Bpnh vipn Npi tiet Nghp An T O M T A T
Nghi&r CLFU nhim m6 IA mii IiSn quan gi&a chi s6 khkt co thi v^ m^t s6 b§nh man tinh d ngirdi cao tu6i tai Vi$n iao khoa trung u'ong. Thi6t kk nghiSn ci>u m6 tS ck ngang trSn 200 b#nh nhSn > 60 tuoi D^nh q\A tinh trgng dinh du5ng bang chf s6 kU&i co th4 (BMI), tinh trang bSnh t^t theo WHO v^i ICD10 va tinh trgng r6i loan lipid mSu theo phSn loai cua Gibson RS Kk qu^ cho th^y: Ty 1$ cdc cy mac bSnh tim mgch d nhdm binh thudng vS thi>a cSn - b6o phi cao han nhdm thi4u nSng lu'ang truing diln, cdc cy thi^u nang li/png IriKdng diSn m k b^nh h6 hip cao tion cdc cy c6 BMI mi>c binh thirdng vd thira cdn-b6o phi. Si/ khdc br?t c6 y nghTa th6ng kS (p < 0,05), Cdc tri s6 lipid huy^t thanh Oku tdng theo sy tdng cua BMI {nfing HDL-C thi gidm). Tri s6 cholesterol todn phin, trigiycerid. LDL-C trung binh trong nhbm thira cdn-bdo phi d^u cao hon so vdl nhOm binh thu'dng vd thi^u ndng luong tru'dng diln (p < 0.05).
Tip khod: chf s6 khoi co thi, bSnh tdt. lipid, ngu'O'i cao tu6i L D ^ T VAN DE
Cimg vdi xu hudng chung cua the gidi, ngudi cao tudi Viet Nam khdng ngimg tang len ve ca sd lugng va ty Ie [1]. Tudi gia ludn di kem vdi b?nh tat, ngudi cao tiidi sue de khang suy giam nen thudng mac cimg luc nhieu benh. Ngudi benh neu an udng hgp li khdng nhimg se lam tang hieu qua cua cac phuong phap dieu tri va cdn lam giam tai phat tiong mdt so benh man tinh. Da cd mpt so nghien cim tim hieu ve tinh hinh benh tat ciia ngudi cao tudi den kham sire khde va nam dieu tn d benh vien [2]. Tuy nhien, nghien cim ve mdi lien quan giiia tinh tt-ang dinh duong va mgt sd benh d ngudi cao tudi cdn rat it, chung tdi tien hanh nghien cuu vdi muc tieu: Md ta mdi lien quan giira chi sd khdi CO the va mot sd benh man tinh d ngudi cao tudi.
n . PHlTONG P H A P N G H I E N CUtJ
- Thdi gian nghien cihi: Tir thang 11/ 2009 den diang 5/2010.
2 J . Thiet ke nghien cuu
Nghien ciiu dugc thiet ke theo phuong phap md ta cat ngang. Phdng van true tiep ddi tugng nghien cim bang bd cau hdi dugc diiet ke sin de tim hieu tien sir benh tgt. Su dung can dien tir SECA vdi do chinh xac ddn 0,1 kg de xac djnh trgng lugng ca the, thudc do chieu cao diing (bang kim loai) chinh xac 0,1cm de do chieu cao. Phan tich kel qua dinh lirong Upid mau tren may AU 400 (Olympus - Nhat Ban)
2.4. Cd mSu
Dimg cdng thuc udc lugng mgt ty le trong quan the cho dieu tra cit ngang [3].
Z \ l - a / 2 ) ^ P ( l - P )
2.1. Doi tuvng:
La nhirng benh nhan ttidi tir tten 60, nSm dieu trj 1 tuan dau tai benh vien.
2.2. Dia diem va thoi gian
- Tai cac khoa Tim Mgch, Than Kinh, Ngi tdng hgp ciia Vien Lao Khoa Trung uong, quan Dong Da, Ha Ndi.
Trong dd: n: cd mau nghien ciiu, Z (i_a/2): h?
sd tin cay (=1,96), chgn a= 0,05, p: la ti 1? cac cu bj thieu nang lugng trudng dien tiong nghien ciiu Qordc (p= 15,0%), [4] e: Khoang sai lech mong mudn chon = 0,05. Tinh dugc: n = 196 ddi hrcmg.
Lam ttdn sd la 200.
*Tac gia: Phgm Duy Tudng ' Dia chi: Trudng Dai hgc Y Ha Ngi Dien thoai: 09I2396I25 Email: [email protected]
26 Tap chi Y hgc du phdng, Tap XXHl, sd 2 (137) Ngay nhan bai: 20/11/2012 Ngay giii phan bi$n: 22/11/2012 Ngay dang bai: 28/4/2013
2.5. Cdc chi tigu ddnh gia: erid huyet thanh cao (2,26 mmol/l).
- Danh gia tinh ttgng dinh dudng: Sir dung 2.6. Phvffng phap xir ly vi phan tich so lieu.
chi sd khdi ca the (BMI) theo khuyen cao ciia Xu ly va phan tich so li?u tren phan mem TCYTTG khuygn nghi cho ngudi Chau A nhu EPI- INFO 6.04. Cac test thdng ke y hgc thdng sau [3]: BMI 25; beo phi, BMI 23- 24,9: thira thudng (test T va x^) dugc sir dung, can, BMI 18,5- 22,9: binh thudng. BMI 18,5: Dgo due nghiin ciht; Nghien cim du<?csu cho thiSu nang Iugng trudng dien (CED). phep ciia b?nh vi?n, ddi tirgng nghien ciiu dugc
- Danh gia tinh trang b?nh tat: Theo WHO giai thich ve myc dich va tu nguyen tham gia, va ICD 10 [5]. dugc rut khdi nghien ciiu bat ki liic nao va mgi - Danh gia tinh ttgng rdi logn lipid mau: thdng tin chi sur dung cho myc dich nghien cim.
theo phan loai ciia Gibson RS. 1993 [6] : Cho-
lesterol huyfit thanh tdng sd 5,2 mmol/l, hoac HI. K E T QUA
Trigiycerid huy6t thanh 2,26 mmol/l, hoac ket 3.1. M6i IiSn quan giira chi so khoi co the va hgp ca Cholesterol cao (5,2 mmoI/1) va Triglyc- b^nh tat.
Bang 1. Sijf khac biet vk ty le b^nh t$t giu-a 3 nhom theo chi sd BMI cua ngudi cao tuoi
Nhom bfnh ^ ^ ^
Tim mach "
Npi tiet ctiuyen tioa Ho t i a p "
Tieu tioa Ttian tiet nieu Ttian Itinti CCT xu'ang ktiap Ktiac
BIUK 18,5 (CED) Thieu ncing iirp'ng tru'o'ng
diln (n=30) n 17 6 11 3 7 4 4 6
56,7
%
20,0 36,7 10,0 23,3 13,3 13,3 20,0
BM118,5-22,9 (BT) Binti ttlirvng
(n-128) n 83 34 22 21 23 22 23 6
64,8
%
26,6 17,2 16,4 17,9 17,2 17,9 4,7
BMI>23(TC-BP) Ttiira can-beo ptii
(n=42) n 33 13 10 2 6 7 6 2
78,6
%
30,9 . 23,8 4,8 14,3 16,7 14,3 4,8
** Sukhdc biet cdyngiiTa titdng ke vdip<0,05, testx
Ty le cac cu mac benh tim mach d nhdm binh cu cd BMI miic binh thudng va thua can-beo thudng va thua can - beo phi cao hon nhdm phi. Su khac biet cd y nghia thdng ke (p < 0,05).
thieu nang lugng trudng dien, cac cu thieu nang 3.2. Moi lien quan giira chi s6 khoi co the va Iugng trudng dien mac benh hd hap cao han cac tinh tr^ng roi loan lipid mau.
Bang 2. Chi so BMI va cac thanh phan Upid huyet thanh trung binh (X ± SD) (dan vj mmol/l)
DHi.. TV.' "^-^'^i 18,5-22,9 >23
BMI Thieu nang lu-ong Chung tru-o-ng dien „ =«« n = 7o ^ " = 134 n=19 = 86 n = 29
Cliolesteroi toan ptian '*
Trigiycerid '*
HDL-C ••
LDL-C **
3,96 1,21 1.12 2,51
1,72 0,51 0,62 1,27
4,7 1,26 1,69 0.85 1,07 0,38 2,82 1,06
5,51 0,9 2,42 1,04 1,01 0,17 3,07 0,89
4,77 1,34 1,78 0,93 1.06 0,39 2.83 1.06
** Sif khdc biet giira 3 nhom cdy nghTa thdng ke v&i p<0,05. test T
Cd 134 cu dugc Iam xet nghiem cac thanh lipid huyet thailh deu tang theo sir tang ciia BMI phan lipid mau. Bang tten cho thay cac tri sd (rieng HDL-C thi giam). Tri sd cholesterol toan
Tgp chi Y hgc dir phdng. Tap XXIII, sd 2 (137) 27
phan, trigiycerid, LDL-C trung binh trong nhdm thira can-beo phi deu cao ban so vdi nhdm binh thudng va thi8u nang lugng trudng diln, sy khac bi?t cd y nghTa thdng ke (p< 0,05).
IV. BAN LUAN
4.1. Tinh trang dinh dudng vk ty 1$ mac b^nh K6t qua nghien ciiu cho thay ty 1? cac cy mac benh tim mach d nhdm binh thudng va thira can - beo phi cao hon nhdm thieu nang lugng trudng dien, cac cu thicu nang lugng trudng dien mac b?nh hd hap cao hem c^c cy c6 BMI miic binh thudng va thira can-beo phi. Su khdc bi^t cd y nghTa thdng ke (p< 0,05).. Nghien ciiu cac cy cd tudi d Thanh Hda cho thay vdi mirc BMI< 18,5 thi cd 81% m^c b?nh [7]. Nhu vgy tinh trang thigu hyt dinh dudng keo dai dk din den ty le b?nh tat cao. Trong sd cac cu thira can-beo phi thi ty le mac benh tim mach va ngi tiet chuyen hda cao hon 2 nhdm cd BMI mirc binh thudng va thieu nang lugng trudng diln. K6t qua nay ciing tuong ty Dang Thu Thanh ty le mac benh tim mgch va noi tiet chuyen hda cao ttong nhdm cd BMI 23 (57,2% va 17,1%) cao hon cac cy BMK 23 (52,3 va 10,5%) [4]. Rd rang, mac du tuang ling vdi cac miic BMI khac nhau thi mac cac benh khac nhau, nhung nhin chung cac cy cd tinh ttgng thiSu nang lugng trudng dien. hay tinh ttgng thira can-beo phi deu de mac benh hon cac cy cd BMI mirc binh thudng.
4.2. Tinh trang dinh duvng va roi loan Lipid mau
Trong nhdm cac cu thira can-beo phi cd 72,4
% tang cholesterol, 44,8% cy tang ttiglycerid, 31% tang phdi hgp ca cholesterol va trigiycerid, cao ban han so vdi ty le tucmg iing d hai nhdm thieu nang lugng trudng dien va cd BMI d miic binh thudng (cd y nghTa thdng ke vdi p<0,05).
So vdi nghien ciiu ciia tac gia Nguyin Thi Lucmg Hgnh; ty le ddi tijgng tang cholesterol va trigiycerid trong nhdm BMI tir 23-24,9 la 51,6% va 45,2%, trong nhdm BMI tii 25-29,9 la 60,9% va 60%, dac biet trong nhdm cd BMI 30 la 66,7% va 83,3%. Nhu vay nghien cim cua tac gia nay cung thay ty le tang cholesterol va trigiycerid tang ty le thuan vdi BMI [8]. Nhu vgy cd mdi lien quan giiia tinh trgng rdi loan lipid mau vdi chi so BMI: BMI tang thi ty le rdi 28 Tap chi Y hgc du phdng,
loan lipid cung tang (p< 0,05).
V. K E T LUAN
- Ty le cac cy mac b?nh tim mach d nhdm binh thudng va thira can - beo phi cao hon nhdm thilu nang lugng trudng dien, cac cy thieu nang lugng trudng dien mac benh hd hap cao han cac cu cd BMI miic binh thudng va thira can-beo phi. Sy khac biet cd y nghTa thdng ke (p < 0,05).
- Cac tri sd lipid huylt thanh deu tang theo BMI (rieng HDL-C thi giam). Tn sd cholesterol toan phan, trigiycerid, LDL-C trung binh ttong nhdm thira can-beo phi deu cao ban so vdi nhdm binh thudng va thieu nang Iugng trudng diln (p
< 0,05).
TAI LIEU THAIVI K H A O
1. Ban chi dao Tdng dieu tta dan sd Trung uong, Tdng dieu tra dan sd Viet Nam 1989, Ha Ngi
1990, tt. 25-28.
2. Nguyen Thi Ha (2004), Tim hilu tinh hinh benh nhan tang huyet ap dieu tri tai Vien Lao khoa Benh vien Bach Mai ttong 3 nam tii 2001-2003, LVTN-BSYK- Dgi hgc Y Ha Ngi.
3. Bd Y Te-Vien dinh dudng (1998), Hudng din danh gia tinh hinh dinh dudng va thuc pham d mgt cgng dong, NXBYH, fr 59-60,72-73.
4. Dang Thu Thanh (2005), Tinh tt^ng dinh dudng va sue khde cua cac cu lao thimh cac mang den kham kiem tra siic khde tai Benh vi?n Hiru Nghi nam 2004-2005, LVTN- BSYK- Dgi hgc Y Ha Ndi.
5. Bd Yte (1998), Bang phan loai qudc tl benh tgtlandiir IO(ICD 10), HaNdi, 1998, ti. 24-
108.
6. Gibson RS (1993). Asessment of lipid statiis.
In: Gibson RS, eds. Nutritional Asessment a laboratory Manual, New York, Oxford Uni- versity Press, pp. 177-184.
7. Tran Dinh Toan (1997). Mgt sd chi tieu nhan ttac dinh dudng cua can bg vien chitc tten 45 tijdi qua 3 ian dilu tta 1990, 1993 va 1996, VSPD,s6l,tt61-65.
8. Nguyin Thi Luang Hanh (2008), Tmh ttang rdi loan dmh duang lipid va mgt sd ylu td lien quan d ngudi tii 25-75 tudi tai ngi thanh Ha Ngi nam 2008, LVTh.S - Dgi hgc Y Ha Ngi.
TgpXXin,s62(137)
RELATIONSHIP BETWEEN BODY MASS INDEX AND SOME OF CHRONIC DISEASES IN THE ELDERLY IN CENTRAL INSTITUTE OF GERONTOLOGY.
Pham Duy T\iong', Nguyen Thi Cam Nhung^
Ha Noi Medical University
^ Nghe An Endocrine Hospital The study aimed to describe the relationship between body mass index and some of chronic diseases in the elderly in Central Institute of Gerontology. Cross-sectional descriptive study design on 200 patients over 60 years old. Assess nufritional status by body mass index (BMI), disease status according to the WHO and ICD 10 and blood lipid disorder classified by Gibson RS. The results showed that: The rate of cardiovascular disease in normal and obesity groups were higher in chronic energy defi- ciency group, the chronic energy deficiency
group had the rate of respiratory disease were higher than normal and overweight -obese group. The difference is statistically significant (p <0,05).The serum lipid values were in- creased with the increase of BMI (particularly HDL-C, lower). Values of total cholesterol, ttiglycerides, LDL-C average in overweight- obese group were higher than normal group and chronic energy deficiency (p <0.05).
Keywords: body mass index, disease, lipid, elderly.
Tap chi Y hgc dy phdng, Tap XXUI, sd 2 (137) 29