Application Of Low Glycaemic Index Enteral Nutrition In Elderly Obese Patients With Type 2 Diabetes Mellitus

This study consists of two parts,which includes an analysis of the nutritional status of elderly obese patients with type 2 diabetes mellitus(T2DM)and the application of low glycaemic index enteral nutrition for nutritional therapy.The object is to study the influencing factors of malnutrition and sarcopenia and the changes of body weight,glucose and lipid metabolism,the inflammatory level,intestinal flora and intestinal mucosal barrier function after nutritional therapy,and provide evidence and ideas for the implementation of medical nutrition intervention.Part Ⅰ Nutritional status analysis of elderly obese patients with T2DMObjectiveTo investigate the influencing factors of malnutrition and sarcopenia in elderly obese patients with T2 DM.Methods107 elderly obese patients with T2 DM were selected as research subjects.According to geriatric nutritional risk index(GNRI),they were divided into non-malnutrition group and malnutrition group.The related indexes of the two groups were compared,and the influencing factors of GNRI were analyzed by multiple linear regression.Patients were divided into non-sarcopenia group and sarcopenia group according to whether sarcopenia occurred or not.The related indexes of the two groups were compared,and the risk factors of sarcopenia were analyzed by binary logistic regression.Results1.GNRI was positively correlated with body weight,body mass index(BMI),calf circumference(CC),grip strength(GS),hemoglobin(HGB),albumin(ALB),fat mass(FM),percentage body fat(PBF),visceral fat area(VFA)and appendicular skeletal muscle index(ASMI)(P < 0.05),and negatively correlated with the duration of diabetes mellitus(P < 0.05).Hemoglobin(HBG),phase angle(PA)and ASMI were independent influencing factors of GNRI(P < 0.05)..2.ASMI was positively correlated with body weight,BMI,GNRI,CC,GS,intracellular water(ICW),extracellular water(ECW),total body water(TBW),protein(PRO),fat free mass(FFM),body cell mass(BCM)and PA(P < 0.05),and negatively correlated with PBF and VFA(P < 0.05).Decreased BMI and increased VFA were independent risk factors for elderly obese patients with type 2 diabetes mellitus complicated with sarcopenia(P < 0.05).ConclusionGNRI was positively correlated with ASMI,and ASMI was an independent influencing factor of GNRI,suggesting a close relationship between malnutrition and sarcopenia in elderly obese patients with T2 DM.Part Ⅱ Effects of low GI enteral nutrition on glucose and lipid metabolism and intestinal flora in elderly obese patients with T2DMObjectiveTo investigate the effects of enteral nutrition preparation with low GI on weight control,glucose and lipid metabolism,chronic inflammation,intestinal flora and intestinal mucosal barrier in elderly obese with T2 DM patients.MethodsForty elderly obese with T2 DM patients were selected as research subjects and randomly divided into control group(n=20)and intervention group(n=20).Both groups were provided with individualized medical nutrition therapy for 8 weeks.Low GI enteral nutrition was used instead of breakfast and dinner in the intervention group.The differences in glucolipid metabolism,chronic inflammation,intestinal flora and intestinal mucosal barrier indicators were compared between the two groups before and after therapy.ResultsEight weeks after treatment,compared with the control group,the levels of BMI,WC,waist-to-hip ratio(WHR),fasting blood glucose(FPG),2-hour postprandial plasma glucose(2h PG),glycosylated hemoglobin(Hb A1c),triglyceride(TG),interleukin-6(IL-6),C-reactive protein(CRP),diamine oxidase(DAO),D-lactic acid and bacterial endotoxin in the intervention group were significantly decreased(P <0.05).The proportion of Bacteroidetes in the intervention group was significantly higher than that in the control group,while the proportion of Firmicutes was significantly lower,with statistical significance.(P < 0.05).ConclusionLow GI enteral nutrition can improve weight management,glucose and lipid metabolism and relieve chronic inflammation,also can regulate intestinal flora and improve intestinal mucosal barrier in elderly obese patients with T2 DM.Table 11 Reference 197...