|摘要: ||近年來國人高血壓盛行率仍居高不下。文獻指出，進行有效之營養教育介入，將有助於控制血壓並延緩高血壓合併症的發生。本研究目的在應用所發展出的一套社區型得舒飲食營養教案（名為「DASH in Taiwan」），進行介入研究以探討其有效性。受試對象為一般社區成年民眾共76名，包括實驗介入組40名（含男性15名、女性25名；平均年齡為62.9±12.6歲），及對照組36名（含男性8名、女性28名；平均年齡為65.9±13.8歲）。實驗介入組之受試者參與條件為高血壓前期者、或有高血壓但未服用藥物者，並需排除罹患腎臟或糖尿病等相關病史之對象。此教案課程設計以跨理論模式為基礎，執行為期四週的衛教活動。在有效性評估上，課程介入前（前測）、第四次課程時（後測）、及課程結束一年後時（追蹤後測），進行血壓與體重測量、收集尿液檢體以量測其鈉、鉀、鎂、鈣、與肌酸酐數值、收集24小時飲食回憶記錄、以及填寫知識及行為有關評估問卷。研究結果顯示，在衛教介入後，血壓明顯下降：收縮壓與舒張壓分別為4.0 mmHg（p<0.05）及4.7 mmHg（p<0.001），且介入一年後血壓仍維持在下降趨勢:收縮壓與舒張壓分別為2.6mmHg（p =0.053）及4.4mmHg（p<0.001）。尿鉀/肌酸酐排出顯著增加上（p<0.05），而體重則皆無顯著變化。在飲食攝取行為方面，低脂或脫脂奶類（p<0.01）、全穀根莖類（p<0.01）、豆家禽魚類（p<0.01）、蔬菜類（p<0.01）、水果類（p<0.01）及核果種子類（p<0.01）等攝取量皆顯著增加。在介入一年後的追蹤後測時，發現以水果攝取量更顯著增加外（p<0.01），其它皆維持介入後測的飲食攝取行為。在飲食行為改變階段方面，以「增加蔬菜的攝取量」（p<0.01）、「增加水果的攝取量」（p<0.01）、「以低脂或脫脂奶類代替全脂奶類」（p<0.001）、「少吃紅肉或以改吃白肉或豆類方式代替」（p<0.001）、「增加全穀類食物」（p<0.001）、「增加澱粉根莖類食物」（p<0.001）、「減少食物中烹調用油量」（p<0.01）等飲食行為，在介入後測時顯著由「非行動階段」往「行動階段」移動；且在介入一年後皆維持介入後的飲食行為改變階段。除此，在「每天攝取一些核果種子類」攝取行為，其追蹤後測相較於前測比較時，亦能達顯著往「行動階段」前進趨勢（p<0.05）。在心理社會因素方面，介入組對執行得舒飲食的好處具有中至高度的認同感，對執行障礙有中度認同感，且有中至高度的自信心能促進飲食行為改變。而在高血壓和食物份量知識上，在介入後測與一年後的追蹤後測，均較前測有顯著增加。本研究的結論為，運用社區型得舒飲食營養教案「DASH in Taiwan」從事社區高血壓防治飲食營養教育活動，可有助於血壓的降低，並有效促進飲食行為改變、增進營養相關知識，且這些獲致的健康效益具中長期的維持能力。|
In recent years, the high prevalence of hypertension in Taiwan is continuously a critical issue. A number of studies indicate that an effective nutrition education might help to better control of blood pressure and the effects of hypertensive complications. This present study aimed to evaluate the effectiveness of a theory-based, nutrition education program, entitled “DASH (Dietary Approaches to Stop Hypertension) in Taiwan”, in community settings. A total of 76 subjects of community residents were recruited with the average age of 64.3±13.2 years. Of them, there were two groups: one was the intervention group (called DASH group) with 40 subjects (15 males, 25 females) aged 36 to 86 years (average age of 62.9±12.6 years); the other group was the control group with 36 subjects (8 males, 28 females) aged 39 to 90 years (average age of 65.9±13.8 years). The criteria for subjects in intervention group were the people who were with prehypertension and not taking medications for hypertension, and also without a history of disease relative to kidney disease or diabetes. This community nutrition education program was designed based on the Transtheoretical Model (TTM), composed of four weekly nutrition education sessions. Evaluations of the effectiveness of program were performed at the time before the intervention (called pre-test), in the fourth session (called post-test), and one year after the end of intervention (called follow-up post-test). Blood pressure and body weight were measured. Urine samples were also gathered to measure the biochemical values on sodium, potassium, magnesium , calcium, and creatinine. Data of 24-hour dietary recall were collected. Nutrition knowledge and stages of dietary behavior change were assessed by the questionnaire. The results showed that after the intervention of nutrition education program (post-test), blood pressures were significantly reduced by 4.0 mmHg (p<0.05) for systolic blood pressure (SBP), and by 4.7 mmHg (p<0.001) for diastolic blood pressure (DBP). At the time of one year after the intervention (follow-up post-test) the reductions of blood pressures somewhat remained by 2.6 mmHg (p=0.053) for SBP and by 4.4 mmHg (p<0.001) for DBP. The urine potassium-creatinine ratio (K/C) increased significantly (p<0.05). However, no significant change was found for body weight. Several dietary consumptions of food groups increased significantly after the nutrition education intervention, including group of low-fat or fat-free dairy products (p<0.01), group of whole-grain &roots (p<0.01), group of soy products, fish, and poultry (p<0.01), vegetables (p<0.01), fruits (p<0.01), and group of nuts & seeds (p<0.01). After one-year follow-up, intake of fruits increased significantly even more (p<0.01), and the increment of consumptions of all other food groups except fruits remained at the time of one year follow-up. In the stages of behavioral change (non-action stage vs. action stage), the significant behavioral improvements towards the action stage were shown after the intervention (post-test) in the dietary modifications of “increasing vegetables” (p<0.01), “increasing fruits” (p<0.01), “increasing low-fat or fat-free dairy products” (p<0.001), “replacing red meat with soy products, fish, and poultry” (p<0.001), “increasing whole-grain products” (p<0.001), and “increasing roots products” (p<0.001). These behavioral changes remained still on the same stages at the time of one year after. The behavioral stage of dietary consumptions of nuts & seeds, comparing follow-up post-test to the pretest, significantly moved towards the action stage (p<0.05). Besides, there was a moderate to high level of agreement regarding to perceived benefits of DASH diet, a moderate level to perceived barriers and a high level to self-efficacy among the subjects in intervention group. In the nutrition knowledge scores on hypertension and food portions, both the post-test and follow-up post-test of intervention group were significantly increased comparing to the pretest. In conclusion, this community-based, nutrition education program of “DASH in Taiwan” might help to decrease the blood pressure, to promote the dietary behavioral changes effectively, and to improve the nutrition knowledge, with a moderate to long-term effects of maintenance.