營養教育介入對第2型糖尿病素食者維生素B12營養狀態之影響

由於維生素B12多存於動物性食物，素食者可能面臨維生素B12營養失衡的問題；另近年有研究顯示，糖尿病常使用的降血糖藥物（metformin）亦可能會引起維生素B12缺乏。因此，本研究目的為給予維生素B12營養強化教育介入，對其維生素B12營養狀態及營養知識、態度及行為之影響。本研究於新陳代謝科門診募集50位素食糖尿病人為受試者，素食定義為須維持一年以上之蛋素、奶素、蛋奶素或全素。本研究收集受試者之基本資料及利用問卷測量其營養教育介入前後之營養認知與態度評分，並以24小時飲食回憶與飲食行為問卷了解營養教育前後之飲食攝取行為。於營養教育介入前後測量受試者之體位、血液生化值（空腹血糖、糖化血色素、血脂）及血清維生素B12濃度。結果發現，營養教育介入後可顯著改善血清維生素B12濃度≤ 250 pmol/L受試者原本較低的血清維生素B12濃度（180.1 ±41.5 pmol/L vs. 211.5 ± 43.7 pmol/L，p = 0.001）；同時其營養知識（p < 0.001）、態度（p < 0.001）及行為分數（p < 0.001）皆有顯著改善的情形，尤其是菇類（p = 0.015）與藻類（p < 0.001）攝取頻率在營養教育後顯著增加。故本研究之結論為給予素食糖尿病人強化維生素B12 營養教育介入，或許藉由增加菇類或藻類攝取，可有效改善其維生素B12 營養狀況。

Vitamin B12 is mostly in animal foods, as a result, vegetarians may have higher risk for vitamin B12 defeciency. In addition, recent studies have indicated that metformin therapy may also cause vitamin B12 deficiency in type 2 diabetes patients. Thus, the purpose of this study was to investigate the effects of nutrition education on glucose, vitamin B12 status, nutrients intakes, and nutrition knowledge, attitude and behavior in vegetarians with type 2 diabetes. We recruited 50 diabetic vegetarians as subjects from Endocrinology Clinic. The inclusion criteria for vegetarian subjects were that the subjects consumed no meat or fish, although they were allowed to consume dairy products or eggs, and had maintained a vegetarian diet for at least one year. In the present study, we collected the demographic characteristics and used questionnaires to assess the scores of nutrition knowledge and attitudes before and after nutrition education intervention. To measure the behaviors of dietary intakes, we used 24-hour recalls and dietary behavior questionnaire. Biochemical parameters (fasting glucose, hemoglobin A1c, lipid profiles) and serum vitamin B12 were measured before and after nutrition education intervention. After nutrition education, subjects with lower serum vitamin B12 concentration (≤ 250 pmol/L) had significantly increased in the level (180.1 ± 41.5 pmol/L vs. 211.5 ± 43.7 pmol/L, p = 0.001). The scores of nutritional knowledge (p < 0.001), attitude (p < 0.001) and behavioralscores (p < 0.001) were also significantly increased after nutrition education, particlularly in the frequency of intakes of mushroom (p = 0.015) and algae (p < 0.001). In conclusion, diabetic vegetarians may significantly improve their lower vitamin B12 status through increasing the intake of mushrooms and algae after nutrition education.