Obez bireylerde farklı diyet inflamatuvar indeks skoruna sahip diyetlerin inflamatuvar parametreler ve uyku kalitesi üzerine etkisi
Abstract
Obezite, beraberinde gelişen kronik inflamasyon ile birlikte kardiyovasküler hastalıklar, diyabet, bazı kanser türleri ve uyku bozuklukları gibi birçok sağlık sorununa zemin hazırlayan, tedavisinde ilk ve en önemli basamağı tıbbi beslenme tedavisinin oluşturduğu kronik bir hastalıktır. Bu araştırma kesitsel ve deneysel periyod olmak üzere iki aşamadan oluşmaktadır. Araştırmanın ilk aşamasını oluşturan kesitsel periyotta, anti-inflamatuvar ve pro-inflamatuvar beslenen obez bireylerin belirlenerek diyet inflamatuvar indeksinin (Dİİ) inflamatuvar parametreler ve uyku kalitesi ile ilişkisinin değerlendirilmesi amaçlanmıştır. İkinci aşamayı oluşturan randomize kontrollü deneysel periyotta ise pro-inflamatuvar beslenen obez bireylerde farklı diyet inflamatuvar indeks skoruna sahip diyetlerin uygulanmasının inflamatuvar parametreler ve uyku kalitesi üzerine etkisinin incelenmesi amaçlanmıştır. Araştırma, Malatya ilinde bir devlet hastanesinin diyet polikliniğine Kasım 2021-Mayıs 2022 tarihleri arasında başvuran 124 (K: 75; E:49) sağlıklı obez gönüllü yetişkin ile yürütülmüştür. Kesitsel periyoda alınan katılımcıların üç günlük besin tüketim kayıtları alınmış ve Dİİ skorları hesaplanarak, antropometrik ölçümler, inflamatuvar parametreler ve uyku kalitesi puanları ile karşılaştırılmıştır. Kesitsel periyotta diyet inflamatuvar indeks skoru pozitif olan katılımcılar arasından 33 katılımcı (20 kadın, 13 erkek) deneysel periyoda dahil edilerek randomize olarak iki gruba ayrılmıştır. Anti-inflamatuvar diyet (AİD) grubuna (10 kadın, 6 erkek) anti-inflamatuvar diyet, kontrol diyet grubuna (KD) (10 kadın, 7 erkek) ise anti-inflamatuvar ve pro-inflamatuvar olmayan diyet sekiz hafta boyunca uygulanmış, katılımcıların dört ve sekizinci haftalarda yapılan kontrollerinde üç günlük besin tüketim kayıtları alınmış ve Dİİ skorları hesaplanarak, antropometrik ölçümler, inflamatuvar parametreler ve uyku kalitesi puanları alınmıştır. Kesitsel periyotta yaş ortalaması 42,20±11,00 yıl olan katılımcıların beden kütle indeksi (BKİ) ortalaması 35,78±3,45 (K:35,71±3,69; E:35,88±3,10) kg/m2'dir. Katılımcıların %13,7'si (n=17) anti-inflamatuvar beslenirken (Dİİ skor ortalaması: -0,59±0,54), %86,3'ü (n=107) pro-inflamatuvar beslenmektedir (Dİİ skor ortalaması: 1,75±1,01). Anti-inflamatuvar beslenen katılımcıların lenfosit ve monosit düzeyleri, pro-inflamatuvar beslenen katılımcılara göre anlamlı derecede yüksek bulunurken (sırasıyla p=0,031; p=0,034), diğer biyokimyasal ölçümler; fiziksel aktivite düzeyi ve uyku kalitesi için iki grup arasında anlamlı fark saptanmamıştır (p>0,05). Diyet inflamatuvar indeksi ile C-reaktif protein (CRP) (r=0,258; p=0,004) arasında pozitif yönlü zayıf ilişki; toplam kolesterol (r=-0,243; p=0,007) ve monosit (r=-0,221; p=0,013) arasında negatif yönlü ilişki saptanmıştır. Deneysel periyot süresince her iki diyet grubunun BKİ değerleri azalmış olup (AİD: 37,60±2,83'ten 34,36±3,20 kg/m2'ye (p<0,001); KD: 37,60±2,83'ten 34,36±3,20 kg/m2'ye (p<0,001) düşmüştür); AİD grubunun BKİ değerlerinin KD grubuna göre istatistiksel olarak önemli düzeyde daha fazla düştüğü saptanmıştır (p=0,033). Her iki diyet grubunun CRP değerleri azalmış olup (AİD: 9,65 mg/l'den 4,14 mg/l'ye (p<0,001); KD: 5,03 mg/l'den 4,30 mg/l'ye (p>0,05) düşmüştür); AİD grubunun CRP değerlerinin KD grubuna göre istatistiksel olarak önemli düzeyde daha fazla düştüğü saptanmıştır (p<0,001). Bunun yanında her iki diyet grubunun uyku kalitesi puanları azalmış olup (AİD: 8,13'ten 2,44'e (p<0,001); KD: 5,82'den 2,88'e (p<0,001) düşmüştür); AİD ve KD gruplarının uyku kalitesi puanlarında istatistiksel olarak anlamlı bir farklılık tespit edilmemiştir (p>0,05). Bu araştırmanın sonucunda, obez bireylerde tüketilen diyetin Dİİ skorunun inflamatuvar parametreler ile ilişkili olduğu ve anti-inflamatuvar diyet tüketiminin BKİ değerleri ve inflamatuvar parametreler üzerinde anlamlı bir fark oluşturduğu saptanmıştır. Bu doğrultuda obez bireylere yönelik uygulanan diyet tedavilerinde anti-inflamatuvar diyet tüketiminin vücut ağırlığı kaybı ve inflamasyon ile mücadelede etkili olabileceği düşünülerek, diyetisyenler tarafından kullanımı yaygınlaştırılmalıdır.
Obesity is a chronic disease that prepares the ground for many health problems such as cardiovascular diseases, diabetes, some types of cancer and sleep disorders, together with the chronic inflammation that develops, and the first and most important step in its treatment is medical nutrition therapy. This research consists of two phases: cross-sectional and experimental period. In the cross-sectional period, which constitutes the first stage of the study, it was aimed to determine the relationship between dietary inflammatory index and inflammatory parameters and sleep quality by determining obese individuals on anti-inflammatory and pro-inflammatory diets. In the randomized controlled experimental period constituting the second phase, it was aimed to examine the effect of applying diets with different diet inflammatory index scores on inflammatory parameters and sleep quality in obese individuals on a pro-inflammatory diet. The study was conducted with 124 (F: 75; M: 49) healthy obese volunteer adults who applied to the diet outpatient clinic of a state hospital in Malatya between November 2021 and May 2022. Three-day food consumption records of the participants in the cross-sectional period were taken and diet inflammatory index scores were calculated and compared with anthropometric measurements, inflammatory parameters and sleep quality scores. Among the participants with a positive dietary inflammatory index score in the cross-sectional period, 33 participants (20 females, 13 males) were included in the experimental period and randomly divided into two groups. Anti-inflammatory diet (AID) group (10 women, 6 men) was given anti-inflammatory diet, control diet group (KD) (10 women, 7 men) was administered anti-inflammatory and non-pro-inflammatory diet for eight weeks. The three-day food consumption records were taken and diet inflammatory index scores were calculated, anthropometric measurements, inflammatory parameters and sleep quality scores were obtained in the controls performed in the eighth weeks. In the cross-sectional period, the mean age of the participants was 42.20±11.00 years and the mean BMI was 35.78±3.45 (F: 35.71±3.69; M: 35.88±3.10) kg/m2. While 13.7% (n=17) of the participants were on an anti-inflammatory diet (mean DII score: -0.59±0.54), 86.3% (n=107) were on a pro-inflammatory diet (mean DII score: 1.75±1.01). While the lymphocyte and monocyte levels of the participants who were fed anti-inflammatory were found to be significantly higher than the participants who were fed pro-inflammatory (respectively, p=0.031; p=0.034), other biochemical measurements; there was no significant difference between the two groups for physical activity level and sleep quality (p>0.05). Positive and weak correlation between dietary inflammatory index and C-reactive protein (CRP) (r=0.258; p=0.004); a negative correlation was found between total cholesterol (r=-0.243; p=0.007) and monocytes (r=-0.221; p=0.013). During the experimental period, BMI values of both diet groups decreased (AID: 37.60±2.83 to 34.36±3.20 kg/m2 (p<0.001); LOE: 37.60±2.83 decreased to 34.36±3.20 kg/m2 (p<0.001)); It was determined that the BMI values of the AID group were statistically significantly lower than the KD group (p=0.033). CRP values of both diet groups were decreased (AID: from 9.65 mg/l to 4.14 mg/l (p<0.001); LO: from 5.03 mg/l to 4.30 mg/l' to (p>0.05)); It was determined that the CRP values of the AID group were statistically significantly lower than the KD group (p<0.001). In addition, the sleep quality scores of both diet groups decreased (AID: decreased from 8.13 to 2.44 (p<0.001); KD: decreased from 5.82 to 2.88 (p<0.001)); No statistically significant difference was found in the sleep quality scores of the AID and KD groups (p>0.05). As a result of this study, it was determined that the DII score of the diet consumed in obese individuals was associated with inflammatory parameters, and the consumption of anti-inflammatory diet created a significant difference on BMI values and inflammatory parameters. In this direction, considering that the consumption of anti-inflammatory diet in diet treatments for obese individuals may be effective in combating body weight loss and inflammation, its use should be expanded by dietitians.
Obesity is a chronic disease that prepares the ground for many health problems such as cardiovascular diseases, diabetes, some types of cancer and sleep disorders, together with the chronic inflammation that develops, and the first and most important step in its treatment is medical nutrition therapy. This research consists of two phases: cross-sectional and experimental period. In the cross-sectional period, which constitutes the first stage of the study, it was aimed to determine the relationship between dietary inflammatory index and inflammatory parameters and sleep quality by determining obese individuals on anti-inflammatory and pro-inflammatory diets. In the randomized controlled experimental period constituting the second phase, it was aimed to examine the effect of applying diets with different diet inflammatory index scores on inflammatory parameters and sleep quality in obese individuals on a pro-inflammatory diet. The study was conducted with 124 (F: 75; M: 49) healthy obese volunteer adults who applied to the diet outpatient clinic of a state hospital in Malatya between November 2021 and May 2022. Three-day food consumption records of the participants in the cross-sectional period were taken and diet inflammatory index scores were calculated and compared with anthropometric measurements, inflammatory parameters and sleep quality scores. Among the participants with a positive dietary inflammatory index score in the cross-sectional period, 33 participants (20 females, 13 males) were included in the experimental period and randomly divided into two groups. Anti-inflammatory diet (AID) group (10 women, 6 men) was given anti-inflammatory diet, control diet group (KD) (10 women, 7 men) was administered anti-inflammatory and non-pro-inflammatory diet for eight weeks. The three-day food consumption records were taken and diet inflammatory index scores were calculated, anthropometric measurements, inflammatory parameters and sleep quality scores were obtained in the controls performed in the eighth weeks. In the cross-sectional period, the mean age of the participants was 42.20±11.00 years and the mean BMI was 35.78±3.45 (F: 35.71±3.69; M: 35.88±3.10) kg/m2. While 13.7% (n=17) of the participants were on an anti-inflammatory diet (mean DII score: -0.59±0.54), 86.3% (n=107) were on a pro-inflammatory diet (mean DII score: 1.75±1.01). While the lymphocyte and monocyte levels of the participants who were fed anti-inflammatory were found to be significantly higher than the participants who were fed pro-inflammatory (respectively, p=0.031; p=0.034), other biochemical measurements; there was no significant difference between the two groups for physical activity level and sleep quality (p>0.05). Positive and weak correlation between dietary inflammatory index and C-reactive protein (CRP) (r=0.258; p=0.004); a negative correlation was found between total cholesterol (r=-0.243; p=0.007) and monocytes (r=-0.221; p=0.013). During the experimental period, BMI values of both diet groups decreased (AID: 37.60±2.83 to 34.36±3.20 kg/m2 (p<0.001); LOE: 37.60±2.83 decreased to 34.36±3.20 kg/m2 (p<0.001)); It was determined that the BMI values of the AID group were statistically significantly lower than the KD group (p=0.033). CRP values of both diet groups were decreased (AID: from 9.65 mg/l to 4.14 mg/l (p<0.001); LO: from 5.03 mg/l to 4.30 mg/l' to (p>0.05)); It was determined that the CRP values of the AID group were statistically significantly lower than the KD group (p<0.001). In addition, the sleep quality scores of both diet groups decreased (AID: decreased from 8.13 to 2.44 (p<0.001); KD: decreased from 5.82 to 2.88 (p<0.001)); No statistically significant difference was found in the sleep quality scores of the AID and KD groups (p>0.05). As a result of this study, it was determined that the DII score of the diet consumed in obese individuals was associated with inflammatory parameters, and the consumption of anti-inflammatory diet created a significant difference on BMI values and inflammatory parameters. In this direction, considering that the consumption of anti-inflammatory diet in diet treatments for obese individuals may be effective in combating body weight loss and inflammation, its use should be expanded by dietitians.
Description
Keywords
Beslenme ve Diyetetik, Nutrition and Dietetics