A. Shalimova, A. Isayeva, M. Vovchenko, L. Rieznik, O ...

ÌÅÄÈÖÈÍÀ ÑÜÎÃÎÄÍ² ² ÇÀÂÒÐÀ. 2019. ¹ 1 (82)

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https://doi.org/10.35339/msz.2019.82.01.07

© A. Shalimova, A. Isayeva, M. Vovchenko et al., 2019

UDC 616.1/.4-036.12:612.39

A. Shalimova, A. Isayeva, M. Vovchenko,L. Rieznik, O. Buriakovska, N. Emelyanova

Government Institution «L.T. Malaya Therapy National Institute of the National Academyof Medical Sciences of Ukraine», Kharkiv

EATING BEHAVIORAL REACTIONS OF PATIENTS WITH CHRONICNON-COMMUNICABLE DISEASES AND ITS CORRECTION

The peculiarities of the eating behavioral reactions of patients with chronic non-communicablediseases and the effect of group and individual therapy on them were evaluated. It wasestablished, that with a tendency to positive changes in eating behavior, conducting bothgroup and individual therapy for 1 year did not significantly change its indicators such asdaily consumption of salt, vegetables and fruits, smoking and alcohol consumption, whichconfirms the complexity of the impact on the specified risk factor for the development andprogression of chronic non-communicable diseases.Keywords: eating behavior, chronic non-communicable diseases, group therapy, individualtherapy.

IntroductionEating behavior is a set of human behavioral

actions that are an integral part of the lifestyleaimed at choosing food, the conditions and modeof eating for satisfaction of physiological,psychological and socio-economic needs [1–4].

Eating behavior is formed under the influenceof family, national, psychophysiological features,socio-cultural and ethical values, features ofmetabolism in the body and health. It depends onthe interaction of the feeling of hunger and satiety,appetite, the ratio of motivational and emotionalcomponents [5–8].

Currently, eating behavior is considered notonly as a component of lifestyle aimed at sa-tisfying physiological and psychological needs,which includes: choice, methods of cooking andeating, conditions and diet, but also as a significantadditional risk factor for the development ofchronic non-communicable diseases [4, 9–12]. Itis believed, that the study of the features of eatingbehavior and the development of programs for

its modification will improve the primary andsecondary prevention of chronic non-commu-nicable diseases [4, 7].

Taking into account the role of eating behaviorin the development and progression of chronicnon-communicable diseases, the aim of thestudy was to assess the features of food be-havioral reactions in patients with chronic non-communicable diseases and the impact on themof group and individual therapy.

Materials and methodsThe study included patients with high and very

high cardiovascular risk. The inclusion criteria forthe study were: signed informed consent; highand very high cardiovascular risk; the desire andopportunity to continue the drug therapy that waschosen in the hospital; absence of side effectsassociated with medication therapy; absence ofsignificant violations of the cognitive function; highlevel of adherence to medical treatment. Criteriafor exclusion from the study were: oncologicaldiseases; insulin-dependent diabetes mellitus;

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thyroid dysfunction; heart failure IV functionalclass; depressive disorders; disturbance of thelocomotor apparatus, which significantly limits thephysical activity; planned surgical intervention; theimpossibility for any reason to continue themedical therapy prescribed in hospital; acuteinflammatory processes.

Patients were divided into groups by ran-domization with sealed envelopes: 75 patients un-dergone group training in Schools of Health and75 patients undergone individual training. Totalduration of study in groups was 1 year. Groupsdid not differ in age and gender ratios.

Group training consisted of 9 classes withfrequency 1 time per month (duration was 1 hour).Each session consisted of 4 lectures (15 minuteseach) and was devoted to one of the most commonchronic non-infectious diseases: coronary arterydisease, arterial hypertension, diabetes mellitus,diseases of the musculoskeletal system, thyroidgland, age-associated lesions of the central nervoussystem. Particular attention was paid to the mainrisk factors of the disease and methods for theircorrection. Classes were conducted by a car-diologist, dietician and instructor of physicaleducation. At the beginning of the cycle, patientswere given methodical materials and an individualdiary. After each lesson, patients received tasksthat they performed in an individual diary.

Patients from an individual group also visitedthe clinic once a month. There were 9 visits intotal. The cardiologist, endocrinologist, dietician,dentist and instructor of medical physicaleducation communicated with the patient in turn(one by one). The duration of the individualconsultation with each specialist was 15 minutes.Patients also received tasks that were performedin an individual diary.

Eating behavior was evaluated using aquestionnaire developed by department staff. Thedaily consumption of kitchen salt (less than orequal to 5 g per day), vegetables and fruits (lessthan or equal to 500 g per day), the smoking factor(in the past and now), as well as the use of alcoholwere determined. These components of eatingbehavior were evaluated at the beginning of thestudy, as well as their changes under the influenceof group and individual therapy.

Results and their discussionEvaluation of attitudes towards smoking

showed that the majority of participants at thebeginning of group therapy (92 % of respondents)

to the question in the questionnaire «Do yousmoke?» answered «No», 2,7 % of respondentssaid that they smoke, and another 5,3 % smokedin the past, but left out. At the same time, theprevalence of smoking among women and menwas not significant differences.

Among the participants in individual therapy,the overwhelming majority of respondents deniedthe fact of smoking (90,7 %), 4,0 % noted thatthey smoke, and another 5,3 % smoked in thepast, but left out. As among the participants ofgroup therapy, in this group there were nosignificant gender differences in the prevalenceof smoking and the number of cigarettes that therespondents smoked during the day.

Analysis of another component of foodbehavioral reactions, namely, the moderate strongalcohol consumption, showed that the absolutemajority of respondents from both group andindividual therapy (94,7 and 92,0 % respectively)denied alcohol consumption both now and in thepast. At the same time, 82 % of respondents ingroup therapy and 78 % of participants inindividual therapy confirmed the periodic use oflow-alcohol beverages (beer and dry wine).

One component of the assessment of eatingbehavior was the analysis of daily consumptionof vegetables. It should be noted that accordingto the questionnaire, only 24 % of the respondentsof group therapy (before the start of therapy)responded that they consumed more than 500 gof vegetables per day, whereas in most patientsin the daily diet, vegetables were present in asmaller number. A similar distribution ofrespondents regarding the amount of vegetablesin the diet was also characteristic for the groupof individual therapy (only 20 % of respondentsnoted that they consume more than 500 g ofvegetables per day). Gender analysis of thepresence of vegetables in the daily ration showedthat among respondents who received enough(more than 500 g of vegetables per day), thepercentage of women was significantly higherthan men (74 and 26 %, p<0,05 in patients withgroup therapy and 78 and 22 %, p<0,05 in thegroup of individual therapy).

Another component of the analysis of eatingbehavior was the assessment of patients’awareness of the amount of salt consumed.Among the participants in group therapy at thebeginning of its implementation, only 29,3 % ofrespondents noted that they are aware of the

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amount of salt consumed and are trying to limittheir content to less than 5 g (incomplete teaspoon)in a daily ration. Similar data were noted at thebeginning of individual therapy: according to thequestionnaire, 33,3 % of respondents restrictedthe salt content in the daily ration.

Analysis of both variants of therapy showedthat the number of smokers did not change eitheramong the participants in the group therapy oramong the participants in the individual therapy.

Regarding the influence of both therapies onthe correction of another component of behavioralfood responses (alcohol consumption), it shouldbe noted that the number of patients who deniedthe use of strong alcohol after the group therapydid not increase significantly from 94,7 to 96,0 %(p>0,05), and the number of such patients in thegroup of individual therapy unreliable increasedfrom 92,0 to 94,7 % (p>0,05). At the same time, inthe group of patients with individual therapy, thenumber of people who confirmed the periodic useof low-alcohol beverages decreased (from 78 to64 %, p>0,05). Among respondents in grouptherapy, the percentage of patients who periodicallyused low-alcohol beverages did not change.

Analysis of daily consumption of vegetablesafter treatment showed that in patients with grouptherapy, the number of people who daily consumesmore than 500 g of vegetables per day did notincrease significantly from 24,0 to 29,3 %(p>0,05). When conducting individual therapy, thenumber of people who daily eat more than 500 gof vegetables per day has increased from 20 to28 %, but it is unreliable (p>0,05), as in the firstvariant of therapy. It should be noted that in bothgroups of patients, among those who increasedthe content of vegetables in the diet, women werepredominant (72 % of participants in grouptherapy and 78 % of participants in individualtherapy).

The assessment of the effect of the twotherapeutic options on the awareness of patientsabout the amount of salt consumed showed thatthe number of patients, both group and individualtherapy, limiting the amount of salt in the dailydiet, tended to increase, but the difference in therates before and after the therapy was notreliable: in patients with group therapy, the numberof people who restricted the salt content to 5 gper day increased from 29,3 and 34,7 %, and inpatients of individual therapy their number

increased from 33,3 to 40,0 %, p>0,05. It shouldbe noted gender differences in improving theawareness of patients about the amount of saltconsumed: in both therapies, women (76 % ingroup therapy and 84 % in individual therapy)dominated the diet for limiting daily salt intake.

Thus, despite the fact that the conduct of bothgroup and individual therapy, did not significantlyaffect the change in dietary behavior of patients,but there was a tendency for its positive changes.

The insufficiency of changes in the com-ponents of eating behavior can be attributed tothe fact that eating disorder relates to some ofthe most difficult in diagnostic and therapeuticaspects. Conducting group therapy, and evenindividual therapy for 1 year, was not sufficientto correct the disorder of eating behavior, as theimpact on the psychological component of theformation of these disorders requires a lengthyprogram. Eating behavior is formed in earlychildhood, in the family, partly due to genetics,but to a greater extent depends on the socio-cultural environment and the material state of man[3, 6, 12]. Therefore, changes can not be sudden,and medical methods of correction of metabolicdisorders are more and more relevant, even forpeople with low and moderate development ofcardiovascular complications.

The results can also be explained by thelimitations associated with the research design.The questionnaire evaluated the followingcomponents of eating behavior, such as theconsumption of kitchen salt, vegetables and fruits,the factor of smoking and the use of alcohol, inthe absence of information about all dietaryintakes of the daily diet, the number andmultiplicity of meals, the way of cooking, foodhabits and stress.

ConclusionsIn the presence of a tendency to positive

changes in eating behavior, both group andindividual therapy for 1 year did not significantlychange such indicators as daily consumption ofkitchen salt, vegetables and fruits, smoking andalcohol consumption, which confirms thecomplexity of the effect on the specified riskfactor development and progression of chronicnon-communicable diseases.

The prospect of the study is to find waysof a comprehensive and long-term impact on theformation of a proper dietary stereotype.

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À.Ñ. Øàëèìîâà, À.Ñ. Èñàåâà, Ì.Í. Âîâ÷åíêî, Ë.À. Ðåçíèê, À.À. Áóðÿêîâñêàÿ, Í.Þ. ÅìåëüÿíîâàÏÈÙÅÂÛÅ ÏÎÂÅÄÅÍ×ÅÑÊÈÅ ÐÅÀÊÖÈÈ ÏÀÖÈÅÍÒÎÂ Ñ ÕÐÎÍÈ×ÅÑÊÈÌÈÍÅÈÍÔÅÊÖÈÎÍÍÛÌÈ ÇÀÁÎËÅÂÀÍÈßÌÈ È ÈÕ ÊÎÐÐÅÊÖÈß

Îöåíèâàëè îñîáåííîñòè ïèùåâûõ ïîâåäåí÷åñêèõ ðåàêöèé ïàöèåíòîâ ñ õðîíè÷åñêèìè íåèíôåê-öèîííûìè çàáîëåâàíèÿìè è âëèÿíèå íà íèõ ãðóïïîâîé è èíäèâèäóàëüíîé òåðàïèè. Óñòàíîâëåíî, ÷òîïðè òåíäåíöèè ê ïîçèòèâíûì èçìåíåíèÿì ïèùåâîãî ïîâåäåíèÿ ïðîâåäåíèå êàê ãðóïïîâîé, òàê èèíäèâèäóàëüíîé òåðàïèè â òå÷åíèå 1 ãîäà äîñòîâåðíî íå èçìåíèëî òàêèå åãî ïîêàçàòåëè, êàê ñóòî÷-íîå ïîòðåáëåíèå ïîâàðåííîé ñîëè, îâîùåé è ôðóêòîâ, êóðåíèå è óïîòðåáëåíèå àëêîãîëÿ, ÷òî ïîä-òâåðæäàåò ñëîæíîñòü âëèÿíèÿ íà óêàçàííûé ôàêòîð ðèñêà ðàçâèòèÿ è ïðîãðåññèðîâàíèÿ õðîíè÷åñ-êèõ íåèíôåêöèîííûõ çàáîëåâàíèé.

Êëþ÷åâûå ñëîâà: ïèùåâîå ïîâåäåíèå, õðîíè÷åñêèå íåèíôåêöèîííûå çàáîëåâàíèÿ, ãðóïïîâàÿòåðàïèÿ, èíäèâèäóàëüíàÿ òåðàïèÿ.

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À.Ñ. Øàë³ìîâà, Ã.Ñ. ²ñàºâà, Ì.Ì. Âîâ÷åíêî, Ë.À. Ðºçí³ê, Î.Î. Áóðÿêîâñüêà, Í.Þ. ªìåëüÿíîâàÕÀÐ×ÎÂ² ÏÎÂÅÄ²ÍÊÎÂ² ÐÅÀÊÖ²¯ ÏÀÖ²ªÍÒ²Â ²Ç ÕÐÎÍ²×ÍÈÌÈ ÍÅ²ÍÔÅÊÖ²ÉÍÈÌÈÇÀÕÂÎÐÞÂÀÍÍßÌÈ ÒÀ ̄ ÕÍß ÊÎÐÅÊÖ²ß

Îö³íþâàëè îñîáëèâîñò³ õàð÷îâèõ ïîâåäiíêîâèõ ðåàêö³é ïàöiºíò³â ³ç õðîíi÷íèìè íåiíôåêö³éíèìèçàõâîðþâàííÿìè òà âïëèâ íà íèõ ãðóïîâî¿ é ³íäèâ³äóàëüíî¿ òåðàï³¿. Óñòàíîâëåíî, ùî çà òåíäåíöi¿ äîïîçèòèâíèõ çìií õàð÷îâî¿ ïîâåäiíêè ïðîâåäåííÿ ÿê ãðóïîâî¿, òàê i iíäèâiäóàëüíî¿ òåðàïi¿ ïðîòÿãîì1 ðîêó äîñòîâiðíî íå çìiíèëî òàêi ¿¿ ïîêàçíèêè, ÿê äîáîâå ñïîæèâàííÿ êóõîííî¿ ñîëi, îâî÷iâ òàôðóêòiâ, ïàëiííÿ i âæèâàííÿ àëêîãîëþ, ùî ïiäòâåðäæóº ñêëàäíiñòü âïëèâó íà çàçíà÷åíèé ôàêòîððèçèêó ðîçâèòêó i ïðîãðåñóâàííÿ õðîíi÷íèõ íåiíôåêöiéíèõ çàõâîðþâàíü.

Êëþ÷îâ³ ñëîâà: õàð÷îâà ïîâåäiíêà, õðîíi÷í³ íåiíôåêö³éíi çàõâîðþâàííÿ, ãðóïîâà òåðàïiÿ,iíäèâiäóàëüíà òåðàïiÿ.

Íàä³éøëà 25.03.19

Â³äîìîñò³ ïðî àâòîð³âØàë³ìîâà Àííà Ñåðã³¿âíà – äîêòîð ìåäè÷íèõ íàóê, ïðîôåñîð êàôåäðè âíóòð³øíüî¿ ìåäè-

öèíè ¹ 1 Õàðê³âñüêîãî íàö³îíàëüíîãî ìåäè÷íîãî óí³âåðñèòåòó, ïðîâ³äíèé íàóêîâèé ñï³âðîá³òíèêâ³ää³ëó êîìïëåêñíîãî çíèæåííÿ ðèçèêó õðîí³÷íèõ íå³íôåêö³éíèõ çàõâîðþâàíü ÄÓ «Íàö³îíàëü-íèé ³íñòèòóò òåðàï³¿ ³ìåí³ Ë.Ò. Ìàëî¿ ÀÌÍ Óêðà¿íè», ë³êàð-òåðàïåâò âèùî¿ êâàë³ô³êàö³éíî¿ êàòå-ãîð³¿, ë³êàð çàãàëüíî¿ ïðàêòèêè – ñ³ìåéíî¿ ìåäèöèíè âèùî¿ êâàë³ô³êàö³éíî¿ êàòåãîð³¿.

Àäðåñà: 61039, ì. Õàðê³â, ïð. Ëþáîâ³ Ìàëî¿, 2à, ÄÓ «Íàö³îíàëüíèé ³íñòèòóò òåðàï³¿ ³ìåí³Ë.Ò. Ìàëî¿ ÀÌÍ Óêðà¿íè».

Òåë.: +38(067)934-69-75.E-mail: [email protected]: https://orcid.org/0000-0002-1016-0740.

²ñàºâà Ãàííà Ñåðã³¿âíà – äîêòîð ìåäè÷íèõ íàóê, çàâ³äóâà÷ â³ää³ëó êîìïëåêñíîãî çíèæåííÿðèçèêó õðîí³÷íèõ íå³íôåêö³éíèõ çàõâîðþâàíü ÄÓ «Íàö³îíàëüíèé ³íñòèòóò òåðàï³¿ ³ìåí³ Ë.Ò. Ìàëî¿ÀÌÍ Óêðà¿íè».



Âîâ÷åíêî Ìàðèíà Ìèêîëà¿âíà – êàíäèäàò ìåäè÷íèõ íàóê, íàóêîâèé ñï³âðîá³òíèê â³ää³ëóêîìïëåêñíîãî çíèæåííÿ ðèçèêó õðîí³÷íèõ íå³íôåêö³éíèõ çàõâîðþâàíü ÄÓ «Íàö³îíàëüíèé ³íñòè-òóò òåðàï³¿ ³ìåí³ Ë.Ò. Ìàëî¿ ÀÌÍ Óêðà¿íè».



Ðºçí³ê Ëàðèñà Àðêàä³¿âíà – êàíäèäàò ìåäè÷íèõ íàóê, ñòàðøèé íàóêîâèé ñï³âðîá³òíèê â³ää³ëóêîìïëåêñíîãî çíèæåííÿ ðèçèêó õðîí³÷íèõ íå³íôåêö³éíèõ çàõâîðþâàíü ÄÓ «Íàö³îíàëüíèé ³íñòè-òóò òåðàï³¿ ³ìåí³ Ë.Ò. Ìàëî¿ ÀÌÍ Óêðà¿íè».



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Áóðÿêîâñüêà Îëåíà Îëåêñàíäð³âíà – ìîëîäøèé íàóêîâèé ñï³âðîá³òíèê â³ää³ëó êîìïëåêñ-íîãî çíèæåííÿ ðèçèêó õðîí³÷íèõ íå³íôåêö³éíèõ çàõâîðþâàíü ÄÓ «Íàö³îíàëüíèé ³íñòèòóò òåðàï³¿³ì. Ë.Ò. Ìàëî¿ ÍÀÌÍ Óêðà¿íè».

Àäðåñà: 61039, ì. Õàðê³â, ïð. Ëþáîâ³ Ìàëî¿, 2à, ÄÓ «Íàö³îíàëüíèé ³íñòèòóò òåðàï³¿ ³ìåí³Ë.Ò. Ìàëî¿ ÍÀÌÍ Óêðà¿íè».


ªìåëüÿíîâà Íàòàë³ÿ Þð³¿âíà – ë³êàð-ñòîìàòîëîã, êàíäèäàò ìåäè÷íèõ íàóê, íàóêîâèé ñï³âðî-á³òíèê â³ää³ëó êîìïëåêñíîãî çíèæåííÿ ðèçèêó õðîí³÷íèõ íå³íôåêö³éíèõ çàõâîðþâàíü ÄÓ «Íà-ö³îíàëüíèé ³íñòèòóò òåðàï³¿ ³ì. Ë.Ò. Ìàëî¿ ÍÀÌÍ Óêðà¿íè».

Àäðåñà: 61039, ì. Õàðê³â, ïð. Ëþáîâ³ Ìàëî¿, 2à, ÄÓ «Íàö³îíàëüíèé ³íñòèòóò òåðàï³¿ ³ìåí³Ë.Ò. Ìàëî¿ ÍÀÌÍ Óêðà¿íè».


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