| Summary: | 博士 === 輔仁大學 === 食品營養博士學位學程 === 101 === Background: Type 2 diabetes is a major global public health problem and its prevalence is rising with increases of age. In Taiwan, although older adults with diabetes in rural area take medication, they have a poorer diabetes management than that of their counterparts in the urban area. The objective of the present study to investigate the correlation of magnesium status with metabolic parameters and depression, and determine appropriate physical activity and dietary intake to achieve optimal metabolic control in older adults with type 2 diabetes of the rural area of Changhua Country. Furthermore, we investigate the correlation of serum uric acid with cardiovascular related factors, C-reaction protein, and renal function parameters in older adults with type 2 diabetes.
Method: This cross-sectional study involved 210 type 2 diabetes patients aged 65 years and above who resided in the rural area of Changhua Country. Participants were interviewed to obtain information on lifestyle, physical activity, 24-hour dietary recall and typical weekly dietary intake patterns. Assessment of depression was based on the diagnostic criteria for depression described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), of the American Psychiatric Association. Clinical variables measured included anthropometric measurements, blood pressure, blood routine examination, and biochemical determinations of blood and urine samples.
Results: Among all subjects, 88.6% had magnesium intake which was less than the dietary reference intake, and 37.1% had hypomagnesaemia. Older type 2 diabetes patients with metabolic syndromes and depression had lower magnesium intake (p < 0.05). A positive relationship was found between magnesium intake and high-density lipoprotein cholesterol (p < 0.05). Magnesium intake was inversely correlated with triglyceride, waist circumference, body fat percent and body mass index (p < 0.05). Serum magnesium was not significantly associated with metabolic parameters.
Moderate physical activity (either moderate leisure-time physical activity or moderate physical activity level) and diet with protein intake of ≧0.8 g/kg/day was associated with lower glycated hemoglobin and triglyceride, higher high-density lipoprotein, lower waist circumference, body mass index, and body fat, as well as better serum magnesium and albumin levels in older diabetic patients. In contrast, inadequate protein intake was correlated with higher glycated hemoglobin, triglyceride, body fat percentage, waist circumference, and body mass index. In addition, high physical activity with inadequate protein and magnesium intake may exacerbate magnesium deficiency, resulting in poor glycemic control in older diabetic patients. Moreover, low physical activity and inadequate protein intake was linked with poor glycemic control, lower high-density lipoprotein, and higher triglyceride, body fat percentage, waist circumference, and body mass index. In addition, patients with high triglyceride, central obesity, high body mass index, chronic kidney disease stage 3, high serum creatinine, and high blood urea nitrogen had high uric acid levels and prevalence of hyperuricemia (p<0.05). Serum uric acid was negatively correlated with HbA1C (p < 0.05).
Conclusion: The majority of older type 2 diabetic patients have low magnesium intake. Low magnesium intake was correlated with metabolic abnormalities and depression. Moderate physical activity and a diet with adequate protein may be the optimal recommendation to achieve better metabolic control in older adults with type 2 diabetes. In addition, serum uric acid was highly associated with metabolic control, nephropathy, and inflammatory markers in older adults with type 2 DM.
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