基于互联网+膳食的海南中老年人高血压精准防控策略研究

At present, the epidemiological trend of hypertension in China is severe. However, there is still lack of strong evidence for the association between hypertension and local tropical foods in Hainan population due to the lack of high-quality dietary survey results. In previous study, we found that the modified food frequency questionnaire (FFQ) by using computer aided image technology could overcome the shortcomings of misestimating food weight compared with the traditional dietary survey methods, but there was still a problem of recall bias. This study aims to develop an computerized application (APP) with the function of dietary survey and nutrition management based on the Android system and pervious products, at the same time to establish diet-hypertension early warning model, to explore the characteristics of tropical diet in Southern China area and the association with hypertension, and to test the reliability and validity by food weight method and the biological indicators of serum folic acid and 24 hours urinary sodium levels. Then, a randomized controlled intervention trial of precise prevention and control strategy by using "Internet+ diet" APP would be conducted on the middle aged and elderly population at high-risk of hypertension in Hainan. The supports of big data collected by "Internet+ diet" APP with real-time diet and physical activities monitoring function and the diet-hypertension early warning model would provide the individualized precise hypertension prevention and control advices and evaluate the effect of intervention. The primary prevention of hypertension on real-time self management could be implemented by individualized intervention using "Internet+ diet" approaches. The study results are of great significance for the development of precise hypertension prevention and control strategy in Hainan and even Southern China area.

当前我国高血压流行趋势严峻，但海南的高血压患病特点是否与当地具有热带特色的饮食存在关联仍缺乏有力的证据支持，主要原因是缺乏高质量的膳食调查结果。课题组前期发现采用计算机辅助图像技术改良食物频率法可克服传统膳食调查方法重量估计不准的缺陷，但仍存在回忆偏倚问题。本课题拟在前期基础上研发基于安卓系统的膳食调查及营养管理应用APP，同时建立膳食-高血压预警模型，探讨华南地区热带膳食特点及其与高血压的关联性，以称重法和血清叶酸、24小时尿钠等生物学指标进行信度、效度验证。随后，以海南中老年高血压高危人群为研究对象进行“互联网+膳食”精准防治策略干预试验，依托APP即时监测膳食、运动情况并以后台大数据和预警模型为支撑，进行个体化高血压精准防控，评价干预效果。基于互联网+的膳食-高血压精准防治策略可通过膳食即时自我管理实现高血压的一级预防，其结果对海南甚至华南区域的高血压精准防控具有重大意义。

本课题研发了基于安卓系统的膳食调查及营养管理应用APP，并招募120名研究对象，以称重法和血清叶酸、24小时尿钠等生物学指标对APP进行内容效度和重测信度检验。结果显示，APP膳食记录法的信度和效度均较好，与称重法的能量和22种营养素摄入量均为显著正相关（P＜0.05），Pearson相关系数为0.225~0.946,平均值为0.702；重测的能量和24种营养素均为显著正相关，Pearson相关分析r为0.303~0.945,平均值为0.716。同时，课题分析了海南中老年人膳食特点及其与高血压的关联性，并以海口市15家社区的295名55-74岁高血压高危人群为研究对象，随机分为空白组、传统组和互联网+组进行“互联网+膳食”精准防治策略干预试验。结果发现：1）不同膳食可影响中老年人的血压情况，尤其是钠盐的摄入；2）在不同血压水平分组下（正常血压组与正常高值组）仅碳水化合物和钠的摄入量差异有统计学意义；3）24h尿钠与收缩压和舒张压均有显著相关性（P＜0.05），24h尿钠量每增加1mmol，收缩压和舒张压分别增加0.135mmHg、0.068mmHg；4） “互联网+膳食”精准防治策略干预后，互联网+组各项健康行为较干预前均有统计学意义（P＜0.05），干预后合理饮食率表现为互联网+组（39.6%）＞传统组（22.1%）＞空白组（16.3%），饮酒率表现为互联网+组（28.7%）＜传统组（49.5%）＜空白组（67.3%），规律运动率表现为互联网+组（36.6%）＞传统组（18.9%）＞空白组（16.3%），差异均有统计学意义（P＜0.05）；5）与本组干预前比较，干预后互联网+组的叶酸升高、24h尿钠降低、DBP降低；空白组的SBP、DBP、24h尿钠均升高，且干预后互联网+组和传统组的SBP、DBP均小于空白组，差异均有统计学意义（均有P＜0.05）。本研究证实，基于互联网+的膳食-高血压精准防治策略可通过膳食即时自我管理实现高血压的一级预防，其结果对海南甚至华南区域的高血压精准防控具有重大意义。