胰岛素与能量限制对2型糖尿病患者蛋白质热效应的影响

McGill Nutrition and Food Science Centre, Royal Victoria Hospital, Montreal, Quebec, Canada.

Obes Res. 2001 Apr;9(4):241-50. doi: 10.1038/oby.2001.28.

OBJECTIVE

The objective of this study was to test whether the thermic effect of oral protein is blunted in poorly controlled type 2 diabetes and is corrected by normalization of glycemia with insulin and 28 days of a very-low-energy diet.

RESEARCH METHODS AND PROCEDURES

Resting energy expenditure (REE) and the thermic effect of 90 g of oral protein were measured, using indirect calorimetry, in nine (five women and four men) obese diabetic people [weight, 108 +/- 10 kg; waist circumference, 123 +/- 8 cm; body mass index, 40 +/- 3 kg/m(2)] who were hyperglycemic on day 8 or euglycemic with insulin on day 16 of a weight-maintaining diet and euglycemic on day 28 of a very low energy diet (VLED). Results were compared with those of seven (six women and one man) weight- and body mass index-matched obese nondiabetic subjects with a waist circumference of 111 +/- 6 cm. Substrates and hormonal responses were determined concurrently.

RESULTS

Fasting glucose was normalized in the diabetic subjects with insulin from day 9 of VLED onward. Weight decreased in both groups by 9.9 +/- 0.9 kg with VLED. REE was 8 +/- 2% lower with insulin treatment and decreased by another 14 +/- 3% with VLED in the diabetic and by 15 +/- 1% in the nondiabetic subjects by week 4. After the protein meal, the thermic response was significantly (p < 0.05) less with hyperglycemia than with insulin-induced euglycemia, as percentage above REE (15.3 +/- 1.4 compared with 21.2 +/- 1.5%), as percentage of the energy content of the meal (19.5 +/- 1.5 compared with 25.2 +/- 1.7%), as kilocalories per 405 minutes (86 +/- 5 compared with 110 +/- 7), and less than in nondiabetic obese controls (21.0 +/- 2.2% above REE, 24.4 +/- 1.7% of energy of meal). After the VLED, the thermic effect of protein was significantly higher in both groups only as percentage above REE. The initial glucagon response was greater with hyperglycemia compared with euglycemia and post-VLED but not compared with the nondiabetic subjects. Hyperglycemia was associated with 21 +/- 4% greater urinary urea nitrogen excretion and urinary glucose losses of 134 +/- 50 mmol/d.

DISCUSSION

This study shows a blunted thermic effect of protein in obese hyperglycemic type 2 diabetic subjects compared with matched nondiabetic subjects that can be corrected with insulin- or energy restriction-induced euglycemia.

目的

本研究旨在测试口服蛋白质的热效应在控制不佳的2型糖尿病患者中是否减弱，以及通过胰岛素使血糖正常化和进行28天极低能量饮食后这种效应是否得到纠正。

研究方法与步骤

使用间接测热法，对9名（5名女性和4名男性）肥胖糖尿病患者[体重，108±10千克；腰围，123±8厘米；体重指数，40±3千克/米²]进行静息能量消耗（REE）和90克口服蛋白质热效应的测量。这些患者在维持体重饮食的第8天血糖升高，在第16天使用胰岛素后血糖正常，在极低能量饮食（VLED）的第28天血糖正常。将结果与7名（6名女性和1名男性）体重和体重指数匹配、腰围为111±6厘米的肥胖非糖尿病受试者的结果进行比较。同时测定底物和激素反应。

结果

从VLED第9天起，糖尿病患者使用胰岛素后空腹血糖正常化。两组患者在VLED期间体重均下降了9.9±0.9千克。糖尿病患者在胰岛素治疗后REE降低了8±2%，在VLED第4周时又降低了14±3%，非糖尿病受试者降低了15±1%。进食蛋白质餐后，与胰岛素诱导的血糖正常相比，高血糖时的热反应显著降低（p<0.05），以高于REE的百分比表示（分别为15.3±1.4%和21.2±1.5%），以占餐能量含量的百分比表示（分别为19.5±1.5%和25.2±1.7%），以每405分钟的千卡数表示（分别为86±5和110±7），且低于非糖尿病肥胖对照组（高于REE 21.0±2.2%，占餐能量的24.4±1.7%）。VLED后，两组中蛋白质的热效应仅以高于REE的百分比表示时显著更高。与血糖正常和VLED后相比，高血糖时初始胰高血糖素反应更大，但与非糖尿病受试者相比无差异。高血糖与尿尿素氮排泄增加21±4%以及尿糖损失134±50毫摩尔/天相关。