营养失调与治疗杂志

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临床营养学 2020：学习识别初始饥饿 (IH) - Mario Ciampolini - 佛罗伦萨大学

马里奥·钱波里尼

背景：进食欲望可能是一种与条件性​​反应和非条件性身体感觉相关的决定，这些感觉反映了代谢生物标志物的变化。可被描述为饥饿的身体情绪通常具有受时间、社交行为和食物视觉影响的机制。血糖可能是当前能量可用性和饥饿的生物标志物。一般的大鼠和人类研究表明，血糖下降与自发饥饿感、代谢不足和进餐开始重叠。

目标：研究当进食行为（大部分）不受条件限制时，是否可以推迟进食决定，直到血糖降至较低水平。

方法：进行了为期 7 周的试点研究。招募了 158 名患有腹泻、腹痛和消化不良的成年人，并随机分为实验组（受过训练；n=80）和对照组（未受过训练；n=78）。实验组的受试者接受训练，忽略用餐时间，集中注意力于他们最早的饥饿感或不适感，以便用血糖仪实时测量血糖浓度（血糖，BG）。他们被教导用血糖值来控制饥饿感。对照组遵循他们的正常日常生活。在最后的分析环节（编制七天日记后），要求所有患者估计他们的餐前血糖，并通过葡萄糖自动分析仪抽取血样以实时测量血糖。

统计：汇总了同一年龄组的所有膳食观察结果。早餐为欧陆式，与午餐和晚餐分开调查，两者之间并无一致差异。在基线和干预期间调查了 5 个早餐池和 5 个午餐和晚餐池，共计 5787 顿饭。在 3 个膳食类别中检查了餐前血糖联系：1. 基线；2. 无饥饿，随后的膳食可能含有低或高含量的水果或蔬菜；3. IH，随后的膳食可能含有低或高含量的水果或蔬菜。

调查了以下两个问题：

1. 与无饥饿相比，IH的出现对BG的预测作用。

2. Fruit or vegetable acceptance was consequential to BG measurement, and a correlation can express a causal role only by BG on low-energy-dense food acceptance. During a meal, a predictive role of low-energy-dense food acceptance on BG might be considered. The relationships between BG and meal energy intake and low-energy food intake were investigated by linear regression analyses. Moreover, each pool under intervention was stratified per quartile of low energy food-acceptance, and BG was compared in quartiles. Here the purpose was to distinguish the predictive role of IH from that of low-energy food-acceptance with regard to BG decrease. Values are expressed as means + SD in the text and as means + SEM in figures. The significance of differences and correlation was analyzed by two-tailed t-test analysis and was set at P < 0.05 (Armitage and Berry, 1994). Custom made software was used to calculate meal contents, average BG, anthropometric measures, and to prepare tabulated data for statistical analyses. The statistical analysis was performed SAS 6.11 (The SAS Institute Milan).

Results: At the top of the 7-week training period, estimated and measured glycemic values were found to be linearly correlated within the trained group (r=0.82; p=0.0001) but not within the control (untrained) group (r=0.10; p=0.40). Fewer subjects within the trained group were hungry than those within the control group (p=0.001). The 18 hungry subjects of the skilled cluster had meaningfully lower glucose levels (80.1±6.3 mg/dL) than the 42 hungry control subjects (89.2±10.2 mg/dL; p=0.01). Additionally, the capable starving focuses likely their BG (78.1±6.7 mg/dL; approximation error: 3.2±2.4% of the measured BG) more accurately than the control group (75.9±9.8 mg/dL; estimation error: 16.7±11.0%; p=0.0001). In addiction the estimation error of the whole trained group (4.7 ± 3.6%) was significantly less than that of the control subjects (17.1±11.5%; p=0.0001).

Conclusion: Patients might be trained to accurately estimate their blood sugar and to acknowledge their sensations of initial hunger at low glucose concentrations. These results recommend that it's likely to find out a social difference between unconditioned and conditioned hunger, and to modulate intake to realize three IH arousals per day.

初始饥饿报告： 1 至 15 天的训练旨在学习餐前身体感觉的区别，即由条件因素（食欲）引起的感觉和仅在刺激初始饥饿的不良信号（餐后暂停）后出现的感觉。在超过 80% 的情况下，同一受试者的相同类型的感觉表示初始饥饿，有时 1 或 2 种其他类型与通常的感觉相关或取而代之。胃部感觉通常与认知活动的适度变化一起出现。推理感觉通常很轻微，甚至是短暂的，并且没有活动中断。在开始时，556 顿饭中有 11 顿血糖降至 3.0 mmol/l 以下，在干预（NS）下 1298 顿饭中有 44 顿血糖降至 3.0 mmol/l 以下。在 2 顿基线餐和 7 顿干预餐（NS）中观察到血糖降至 2.5 mmol/l 以下。没有报告昏厥或其他不适。进餐时间由最初的饥饿感决定，婴儿在几分钟后进餐或吃水果零食，年长受试者则在接下来的一个小时内进餐。保持社交习惯和既定的进餐时间，因此 11-30% 的进餐没有最初的饥饿感。在进餐时间，干预后 70-89% 的进餐计划显示成功，即最初的饥饿感出现在进餐前。干预期间，5 名幽门螺杆菌感染者在几天内出现强烈或疼痛的胃排空感。这种转变的上腹部洞察力与不可预测的血糖测量值有关，从高到过低。一些手工工人报告身体虚弱，并将此信号用作最初的饥饿感发作。进餐后体力和活动能力很快恢复，没有观察到体重减轻。不鼓励强迫性禁食、推迟进餐时间以增加饥饿感或忽略最初的饥饿感而减少进餐，在 6 名成年人中仅偶尔观察到。

传

Mario Ciampolini 曾担任佛罗伦萨大学（迈耶医院）儿科系三级转诊中心胃肠病学研究组主任 40 年。他曾在康奈尔大学与佛罗伦萨大学联合开展儿童能量消耗研究。

注：该研究部分在 2015 年 10 月 26 日至 28 日在美国伊利诺伊州芝加哥举行的第四届国际营养会议和展览会上发表。