TCNCYH phu tru'dng 71 (6) - 2010
HIEU QUA BO SUNG CHAT XO POLYDEXTROSE
DEN TINH TRANG THL/A CAN - BEO PHI, TANG LIPID MAU 6 ST QUAN QUAN D O I TAI HA NOI
Pham Thj Thu Hu'dng^ N g u y i n Thj L a m \ N g u y i n PhUdng Hoa^
' Vien Dinh difdng Qudc gia, ^TrUdng Dai hoc Y Ha Ndi Muc tieu: Danh gia hieu qua cai thien,tinh trang thda can - beo phi va tang lipid mau bang bo sung chat xd Polydextrose. Doi tugng va phuang phap nghien citu: thd nghidm lam sang ngiu nhien cd doi chdng tren 108 sJ quan, nhdm can thiep sd dung 20g san pham Vi - tanl (20g Polydextrose)/ngay, nhdm ddi chdng dung 2 vien gia duac trong 4 thang. Ket qua: can nang trung binh cua ca hai nhdm deu giam so vdi ban dau, nhdm can thiep giam hdn so vdi nhdm chdng (p < 0,05). CM so BMI, vdng eo, vdng mdng, % md cd the cua dd'i tUdng thudc hai nhdm deu giam so vdi trade can thidp, nhdm can thidp giam nhieu han. Nong do cholesterol, triglycerld, LDL - C d nhdm can thiep giam so vdi ban dau va so vdi nhdrp chdng (p < 0,05) va nong do HDL - C tang (p < 0,05). Dd mem cua phan cung ddac cai thidn va lam tang do dS dang khi di dai tien cua cac dd'i tUdng d nhdm can thiep so vdi nhdm chdng (p < 0,01). Ket luan: bo sung 20g Polydextrose/
ngay da cai thi$n ddac cac chi sd nhan trie, sinh hda mau va do mem cua phan.
TiJf khoa: thiifa can - beo phi, tang lipid, Polydextrose
I.
DAT VAN
DERdi loan lipid m l u I I mpt trong nhOng ye'u to' nguy Cd phd bien gay benh mach v i n h , thudng phdi hdp vdi tinh trang thda can - beo phi. Nhieu nghien cdu cho thI'y ti le thOa can - beo phi dang tang nhanh chdng d Viet Nam ndi chung va trong ddi tupng cdng chdc ndi rieng. Vi vay, viec nghien cdu de tim ra d c g i i i phap gdp phan kiem solt rdi loan lipid m l u , can thiep thda d n - beo phi la c i n thie't. C I c nghien cdu thUc nghiem cho thay bd sung chat xP lam giam lipid m l u d nhOng ddi tUdng cd rdi loan, tuy nhien hieu q u i khac nhau tuy thudc vao loai chat xo, ndng dp lipid mau ban dau.
Td chdc NCEP (National Cholesterol Education Programme) cua Hoa Ky khuyen nghj nhu cau chat xd la 14g/1000kcal [10]. Nhieu nghien cdu ve chat xd vdi tac dung lam g i l m lipid mau da dupc tie'n hanh, trong dd cd Polydextrose. 6 Viet Nam, cho tdi nay chUa cd nhieu nghien cdu ve hieu q u i cua Polydextrose ddi vdi tinh trang rdi loan lipid m l u va tinh trang dinh dUdng. De tai
n l y tien hanh vdi muc tieu: Danh gia hieu qua cai thien tinh trang thCfa can - beo phi va tang lipid mau d si quan quan dpi bang bd sung chat xa Polydextrose.
II. DOI T U O N G VA PHUONG PHAP N G H I E N CLfu
1 . Ddi tu'dng nghien cufu
ST quan quan dpi, tudi tO 40 - 59, tU nguyen tham gia nghien cdu, cd BMI > 23, dUpc chan d o l n rdi loan lipid m l u (cholesterol > 5,2 mmol/L;
HDL - C < 0,9 mmol/L; LDL - C > 3,35 mmol/L;
triglycerid > 2,26 mmol/L), khdng mac benh cap tfnh va man tfnh, khdng tham gia bat ky che dp an kieng hoac chUdng trinh giam can hoac g i l m rdi loan lipid mau, tinh nguyen tham gia nghien cdu.
2. Thie't ke nghien ciifu: thd nghiem lam sang
ngau nhien cd ddi chdng. . 3. Dja diem va thdi gian nghien cufu: tai Quan
chung Phdng khdng - Khdng quan td thang 7 - 11/2008.
TCNCYHphu tru'dng 71 (6) - 2010
4. Mau nghien ciJu: 54 ddi tUpng chd mdi nhdm (da bao gdm 10% bd cuoc dU tfnh), tdng la 108 ngUdi cho ca 2 nhdm.
Chon miu: dieu tra sang Ipc 992 ddi tUdng sT quan quan dpi, chpn ra 108 dd'i tUdng du tieu chuan tham gia nghien cdu. Phan tang d c ddi tu'dng theo d c yeu td: mde dp thOa c i n - beo phi, cholesterol, LDL - C, HDL - C, tciglycerid. Trong mdi t i n g chpn n g l u nhien dd'i tUpng v i o nhdm can thiep va nhdm ddi chdng.
5. Vat lieu can thiep San pham can thiep:
- C h i t xd hoa tan Vi - tanl (Polydextrose) cua Cdng ty cd phan Viet Nam Ky nghe bpt my, xua't xd to Danico Sweeteners - Hoa Ky.
- Vien gia dUoc: Vien nang mem, cd trpng lUdng Ig/vien do cdng ty cd phan dUpc Hau Giang s i n xuat. Thanh p h i n mdi vien: 0,07 mg vitamin E.
Lieu lugng can thiep:
- Nhdm can thiep: ngay 2 lan mdi lan lOg Vi - tanl hda tan trong 100 ml nUdc am (> 70°C), dung trUdc hoac trong d c bOa an chinh (trUa, tdi).
- Nhdm chdng: 2 vien gia dupc/ngay, ud'ng vao budi s i n g (8 - 9h).
Thdi gian can thiep: 4 t h i n g .
6. Thu thap sd lieu
Thong tin ca nhan: phdng van d c thdng tin chung bang bp cau hdi: tinh trang sdc khde, tham gia the due the thao, d c thudc dang sd dung.
A^u'c tieu thu luang thUc thUc pham va tap quan an udng: sd dung phUdng phap hdi ghi mde tieu thu lUdng thUc pham 24 gid qua [ 1 , 6] va tan xuat tieu thu lUdng thUc thUc pham trong 4 thang can thiep [6].
Do cac chi sd nhan trac: can nang (CN), chieu cao ( C O , vdng eo (VE), vdng mdng (VM),
% md CO the, chi sd BMI [7] va ty sd V E / V M [2]
tai cac t h d i d i e m dieu tra ban dau va sau can t h i e p .
Cac chi sd lam sang, kham lam sang xac djnh sd bd benh ly thed yeu cau cua trUdc va sau can thiep; cpng tac vien ghi nhan d c dau hieu hang ngay vao bieu m l u theo ddi: tan suit di dai tien, mde dp de khd cua di dai tien; d c dau hieu khdng mong mud'n cua viec sd dung san pham nhU: bieu hien khd chju cua bung, rd'i loan tieu hda, trieu chdng ha dUdng huyet.
Cac chi so sinh hda mau: tai thdi diem trUdc va sau can thiep. Dinh lUpng cholesterol, triglyc- erid, HDL - C, LDL - C, apo A, apo B, glucose, acid uric, GOT, GPT, ure, creatinin; dinh lupng hdng cau, bach c i u , cdng thdc bach cau, tieu c i u , huyet sac to', hemoglobin tai benh vien Trung Udng Quan dpi 108.
7. Phan tich sd lieu
- Sd lieu khau phan: Sd dpng chUdng tnnh phan mem Acces (xay dUng dUa tren sd lieu cua b i n g thanh phan dinh dUdng thUc pham Viet Nam nam 2007).
- Phan tich d c sd lieu trUdc va sau can thiep:
sd dung chUdng trinh phan mem SPSS 10.0. Thuat t o l n Khi binh phUdng (x^) va t - test dUdc sd dung nham so s i n h sU k h I c biet giOa d c nhdm.
Nghien cdu sd dung mde y nghTa a = 0,05.
Cac ddi tugng khong phan tich ket qua: cd sd lupng chat xd va thdi gian sd dung dat < 70% yeu cau; sd dung thud'c giam lipid m l u trong thdi gian can thiep.
i n . K E T Q U A
1 . Dac diem cua cac ddi tugng nghien cffu TrUdc can thiep, trung binh cac chi sd lipid mau (cholesterol, triglycerid, HDL - C, LDL - C, apo A, apo B) va trung binh cac chi sd nhan trac (can nang, BMI, vdng eo, % mo cd the) cua hai
TCNCYH phu tru'dng 71 (6) - 2010
nhdm nghien cdu khac nhau khdng cd y nghTl thdng ke (p > 0,05). Q u i trinh can thiep hoan toan khdng cd sU dieu chinh che dd an cho d hai nhdm. Ke't q u i mde tieu thu lUdng thUc, thUc pham va g i l trj dinh dudng trong khau phan an giOa 2 nhdm va giOa hai giai doan (trOdc va sau can thiep) khdng cd su khac biet (p > 0,05).
2. Hieu qua cai thien cac chi sd nhan t r i e cua bo sung chat xo Polydextrose: sau can thiep, d n nang trung binh cua c l hai nhdm deu giam so vdi ban dau nhUng nhdm can thiep giam hdn so vdi nhdm chdng (- 0,89 kg so vdi - 0,59 kg; p < 0,05).
C I c chi so' trung binh BMI, vdng eo (VE), vdng mdng (VM), % md cd the the hien d b i n g 1:
> 1,55 LDL - C (mmol/l)
< 3 , 3 5 3 , 3 5 - 4 , 1 5
> 4 , 1 5
Bang
Chi sd
BMI (kg/m^) VE (cm) VM (cm) T^ sd VE/VM
% md cd the
1. Thay I
ddi i trung binh BMI
^Jhom can thi^p (n
)r± SD
3. Hieu qua cai thien cac chi sd li Bang 2. Chi Ch? sd
- 0 , 3 2 ±0,1.8 - 1 , 5 5 + 1,01 - 1,31 ± 0 , 9 1 0,0 ± 0,01 - 0,4 ± 0,45
va mo
= 54)
t sd chi sd nhan trie sau can Nhom chffng (n =
X~± SD
- - -
pid mau cua bd sung chat xo sd lipid mau trade va sau can
Nhom can thiep (n : Trffdc CT
n
%
= 54) SauCT
n
%
0,22 0,47 0,29 0,0 ± - 0 , 2
± 0 , 2 4
± 0 , 6 1
± 0 , 8 8 :0,01
± 0 , 8 1 Polydextrose thiep ciia hai
54)
nhom thiSp
pa
<
<
<
>
<
Nhom chffng (n = Trffdc CT
n / o n
'
• - test)
0,05 0,01 0,05 0,05 0,05
= 54) SauCT
%
Cholesterol (mmol/l)
< 5 , 2 5 , 2 - 6 , 2
> 6 , 2
4 30 20
7,4 55,6
37
16 29 9
29,6*
53,7 16,7'
5 30 19
9,3 55,6 35,2
7 23 24
13,0 42,6 44,4 Triglycerid (mmol/l)
< 1 , 7 1 , 7 - 2 , 2 6
> 2 , 3
14 9 31
25,9 16,7 57,4
22 14 18
4 9 , 7 ' 25,9 36,7*
20 9 25
37,0 16,7 46,3
12 8 34
22,2 14,8 63,0 HDL - C (mmpl/l)
< 0 , 9 0 , 9 - < 1,55
5 34
9,3 63
0 15
0,0
27,8= 29
13,0 53,7
4 21
7,4 38,9
15 27,6 39 72,2- 33,3
23 26
42,6 48,1 9,3
40 11
74,1 •' 20,4*
5,6
24 24
44,4 44,4 11,1
29
27 26
53,7
50,0 48,1 1,9
TCNCYHphu trWdng 71 (6) - 2010
Thay ddi mot sd chi tieu sinh hoa cua hai nhom ddi tffdng sau can thiep.
Cac chi so nhu glucose, acid uric, GOT, GPT, ure, creatinin cua d hai nhdm trUdc khi nghien cdu la tUdng-dUdng nhau (p > 0,05) va deu nam' trong gidi ban binh thudng. Sau can thiep, nhdm udng- itxix xd cd chi sd glucose mau v l acid uric mau g i l m so vdi ban d i u va so vdi nhdm chdng cd y nghTa thdng ke (p < 0,01). C I c chi sd khac cung giam hoac tang nhUng khdng cd y nghTa va deu nam trong gidi han binh thUdng (p > 0,05). 0 nhdm chdng, d c chi sd cd thay ddi, nhUng khdng cd y nghTa va deu nam trong gidi han binh thUdng (p > 0,05).
Thay ddi te bao ngoai vi d hai nhom ddi tffging trffdc va sau can thiep
CIc g i l trj cua te bao mau ngoai vi d hai nhdm trifdc khi can thiep la tUdng dUdng nhau (p > 0,05). Sau can thiep chi so' hdng cau, huyet s i c td cua c l hai nhdm deu tang so vdi ban dau cd y nghTa thd'ng ke (p < 0,05), tuy nhien sU khac nhau giOa hai nhdm khdng cd y nghTa thdng ke.
Tat ca d c chi so' k h I c thay ddi khdng cd y nghTa thdng ke va deu nam trong gidi han binh thudng, khdng cd bie'n ddi nao gay bat Ipi cho cd the.
Hieu qua cai thien cac dau hieu tieu hda cua bd sung chat xd Polydextrose
Ngay nhOng ngay dau can thiep chl't xd cung nhu trong sud't thdi gian can thiep khdng gap trifdng hpp nao budn ndn/ndn hoac chUdng bung.
Nhdm udng chat xd cd mde dp d l dang khi dai tien va dp mem cua phan difpc d i thien sau thdi gian can thiep cd y nghTa thdng ke so vdi nhdm chdng (p < 0 , 0 1 ) .
IV. BAN LUAN
Nghien cdu cho tha'y viec sd dung chat xP Polydextrose cd t i c dung d i thien d c chi sd nhan trac cua nhdm can thiep. Ke't q u i nay cung
tUdng tu nhu nghien cdu cua BetuI Cicek (2009) [5]. Mpt sd nghien cdu da g i i i thfch hieu q u i l l m g i l m can cua viec bd sung chat xd do giam hap thu lipid va g i l m nang lUpng khau phan [8|.
Giam can cd tac dung lam giam d c chi sd lipid m l u d nhOng ngUdi thda can - beo phi. Rdi loan lipid m l u lien quan vdi beo phi bao gdm tang triglycerid, tang cholesterol toan p h i n va LDL - C.
C I c chi sd nay cung cd the trd ve binh thudng sau khi g i l m can d mde dp vOa p h i i .
Trong nghien cdu nay, chdng tdi bd sung 20g Polydextrose trong thdi gian 4 thang cho 54 ddi tupng, ke't q u i nghien cdu cua chung tdi cho thay ndng dp cholesterol, triglycerid, LDL - C giam co y nghTa thd'ng ke so vdi ban d i u va so vdi nhdm chdng (p < 0,05). Trong khi dd ndng dp HDL - C tang cd y nghTa thd'ng ke (p < 0,05). C I c nghien cdu k h I c cung cho thay bd sung Polydextrose da d i thien d c chi so' lipid mau. Nghien cdu ciia Andizej (2006), nhan thay bd sung 30g Polydextrose/ngay trong 4 t u i n da giam LDL - C cd y nghTa thd'ng ke, trong khi khdng nhan tha'y hieu qua nay khi bd sung 15g/ ngay [41.
Polydextrose cd tac dung d i thien cac chi sd lipid mau cd the la do chat xp khau phan hda tan cd hieu qua dc che ha^p thu lipid l l m tang dao t h i i lipid qua phan v l lam giam lipid trong mau.
Nghien cdu cua Ogata (1997) tren chuot cho thay Polydextrose lam giam hl'p thu triglycerid va cholesterol, do lam g i l m van chuyen d c chat nay vao he bach huyet [9].
Ddi vdi sU thay ddi cac g i l tri cua te bao mau ngoai v i , ke't q u i nghien cdu chi ra tat d nhOng bie'n ddi nay deu nam trong gidi han binh thUdng, khdng cd bie'n ddi nao gay bat ldi cho cd the.
Nhu vay, c l cha't xd va vien gia dUpc deu khdng gay bat cd p h i n dng phu (cd hai) nao cho cd the. Trdng thUc te chdng tdi khdng gap bat cd sU phan dng tieu cUc nao ( c l chu quan va k h i c h quan) to cac dd'i tUdng nghien cdu.
TCNCYH phu trWdng 71 (6) - 2010
Dac biet, ke't q u i cdn chi ra bd sung 20g/ ngay Polydextrose giup d i thien dUdc dp mem cua phan, lam tang mde dp d l cua dai tien mpt c I c h cd y nghTa thd'ng ke, tuong tU ket q u i nghien cdu cua Achcur (1994) [31.
V. KET LUAN
Bo sung 20g/ngay Polydextrose trong thdi gian 4 t h i n g da cai thien dUOc d c chi so' nhan trac, chi sd sinh hda m l u (cholesterol toan p h i n , triglycerid, HDL - C, LDL - C, glucose) va dp mem cua phan.
C i n tuyen truyen cho ngUdi d i n trong cpng ddng t i c dung tdt cua chat xP Polydextrose trong phdng va d i l u tri thOa d n - beo phi, rdi loan lipid mau, kiem solt glucose m l u .
TAI LIEU THAM KHAO
1. Ha Huy Khoi (1997). PhUdng p h I p dich t l hpe dinh dudng. Nha xul't ban Y hpe.
2. Nguyin Thj Lam (2003). Thdng nha't phUdng p h I p ky thuat sd dung trong d i n h g i l thOa can - beo phi cua d c nhdm tudi k h I c nhau. Dinh dudng va thUc pham, 1 ; 1 7 - 19.
3. Achour L, Flourie B, Brief et al (1994).
Gastrointestinal effects and energy values of polydextrose in healthy non - obese men. Am J Clin Nutr,59; 1 3 6 2 - 1368.
4. Andizej Pronczuk, Hayes KC (2006).
Hypocholesterolemic effect B dietary polydextrose in gerbils and human (2006). Nutrition research.
26(1): pp. 2 7 - 3 1 .
5. BetuI Cicek, Perihan Arslan, Fehrettin Kelestimur (2009). The effects of oligofructose and polydexxtrose on metabolic control parameters in type 2 - diabetes. Pak J Med Sci, 25 (4): 573 - 578.
6. Gibson RS (1990). Principles of nutritional assessment. Oxford University press, 425 - 444.
7. I D I , WPRO (2000), "The Asia - Pacific prerspective: Redefining Obesity and its treatment". Heath communication Australia Pty Limited Febmary.
8. Mueller C M , Quintana R, Karim KS (2003).
And libitum very low - f a t diet result in weight loss a n d changes in n u t r i e n t inkakes in postmemnopausal women. J Am Diet Assoc, 103:
1 6 0 0 - 1 6 0 6 .
9. Ogata S, Fujimoto K, Iwakiri R et al (1997).
Effect of polydextrose on absorption of triglyceride and cholesterol in meseteric lymph - fistula rats.
Experimental biology and medicine, 215: 53 - 58.
10. Thomas G N , Sai - Yin Ho, Edward D et al ( 2 0 0 5 ) . "The US N a t i o n a l Cholesterol Education Programme A d u l t Treatment Panel III (NCEP ATP HI) prevalence of the metabolic syndrome in a Chinese population". Diabetes Re- search and Clinical Practice, 67: 251 - 257.
Summary
EFFECTIVENESS OF POLYDEXTROSE ON OVERWEIGHT - OBESITY AND LIPIDEMIA DISORDER IN MILITARY OFFICERS IN HANOI
Objectives: To evaluate the effectiveness of Polydextrose additional on overweight - obesity and lipidemia disorder. Methods: the randomized control trial in 108 military officers, the intervention group used 20g of Vitani (20g Polydextrose) per day and the control group used 2 placebo tablets during 4 months. Results: the mean of weight of both groups were lower than that at the beginning, however among the intervention group lower than the control (p < 0.05). The mean BMI index, waist and hip circumference, % body fat of both intervention and control groups were reduced (p < 0.05), and it is
TCNCYHphu trWdng 71 (6) - 2010
higher rate in the intervention group than the control. Cholesterol, triglycerides, LDL - C reduction compared with baseline and compared with the control (p < 0.05), while H D L - C concentrations increased (p < 0.05). The pliability of fecal also improved and increased the ease of bowel movement of the intervention than the control group (p < 0.01). Conclusions: 20g Polydextrose/day supplement help improved anthropometry indexes, blood biochemical indicators and the pliability of fecal.
Key words: overweight - obesity, lipidemia disorder, Polydextrose
KET THUC THAI SAN CUA PHU N Q NONG THON VA YEU TO NGUY CO
Nguyin Thj Kim Chuc, Nguyen Dffe Hinh TrUdng Dai hoc Y Ha Noi Cac kdt qua mang thai trong cdng dong la nhdng chi so y te quan trong. Muc tieu: phan tich ket qua mang thai cua phu nO tai mot quan the duoc theo ddi chat che, xac dinh cac nhdm nguy ca va de xuat bien phap phdng ngda. Doi tUgng va phuang phap nghien cdu: nghien cdu thuan tap dua tren cdng dong tai huyen Ba VI vdi 5838 trudng hap mang thai td 01/01/1999 den 30/6/2004. Ket qua cd 4152 (79%o) ca sinh sdng, 67 (l,3%o) trddng hap thai chet luu, 733 (14%o) lan pha thai va 282 (5,4%,) ca say thai. Nguy ca sinh tai nha cao ddi vdi phu nd thieu sd (OR = 1,85; 95%o Cl = 1,06 - 3,24) va phu nd cd van hda tieu hoc (OR = 7,36; 95%oCI = 3',54 - 15,30). Ket luan: nguy ca thai chet Idu cao ddi vdi dan tdc thieu sd (OR = 6,34;
95%o Cl = 1,33 - 30,29) va phu nO sinh tai nha (OR = 6,81; 95%o Cl = 2,40 - 19,30). Nguy ca pha thai tang theo tuoi me. Khuyen nghi: can quan tam den vi$c ta van va thac hien ke hoach hda gia dinh, cham sdc sClc khde ba me cho phu nd. Chinh sach can duac xay dung dinh hudng tdi cac nhdm cd nguy cd cao.
Til khoa: ke't thuc thai san, ye'u td nguy cd
I. DAT VAN DE
Ke't q u i mang thai trong q u I n the dan cii la mpt nhdm trong d c chi sd y te cpng ddng quan trpng de danh g i l tinh trang sdc khoe sinh s i n . C I c ket qua bat ldi khi mang thai nhU s l y thai va thai chet lifU tac dpng nghiem trpng den sdc khde ndi chung va sinh s i n cua ngUdi phu nO ndi rieng [1,2]. C I c ye'u t d nguy cd ddi vdi ke't q u i mang thai lien quan chat che vdi tien sd sinh s i n , benh tat dang mac, dieu kien kinh te xa hpi va cac tac nhan k h I c nhU k h i nang tiep can, chl't lUpng cham sdc sdc khde ba me [2, 4 ] .
•,' . Viet Nam la mpt trong nhOng nUdc cd ty le p h i thai cao nha't the gidi. Nam 1996, khoing 83 ca tren 1.000 phu nO tudi td 15 - 44 [8, 9]. Mac du khdng
phai la mpt ke't qua bat ldi, p h i thai v i n la mpt that bai trong sd dung d c phUdng p h I p ngOa thai [6].
Nghien cdu phan tfch I n h hudng cua d c yeu t d nhan khau hpe - xa hdi hpe de'n ket q u i thai san. Muc tieu: Phan tich cac hinh thdc kit thUc ciia tat ca trUdng hgp mang thai dugc bao cao trong mpt khu vUc dan cUnong thon dugc theo doi chat che, tif do xac djnh cac nhom nguy ca ddi vdi ke't qua thai san va de xuat cac bien phap phdng ngda.
II. DOI TUONG VA PHUONG PHAP NGHIEN CLfu
Nghien cdu dupc thUc hien tai Ba V i , mpt huyen cua tinh Ha Tay, nay thuoc Ha Npi, vdi sd