Strychar Irene, Ishac Alain, Rivard Michèle, Lussier-Cacan Suzanne, Beauregard Hugues, Aris-Jilwan Nahla, Radwan Farouk, Yale Jean-François
Université de Montréal Hospital Center, Notre-Dame Hospital, Montreal, Quebec, Canada.
J Am Diet Assoc. 2003 Apr;103(4):467-74. doi: 10.1053/jada.2003.50066.
Controversy persists regarding the use of a high-monounsaturated-fat diet in people with type 1 diabetes. The purpose of this study was to compare the effects of a high-monounsaturated-fat diet containing 43% to 46% carbohydrates and 37% to 40% fat (17% to 20% monounsaturated fat) with those of a high-carbohydrate diet containing 54% to 57% carbohydrates and 27% to 30% fat (10% to 13% monounsaturated fat) on the quantitative and qualitative lipoprotein profile in type 1 diabetes.
A randomized crossover study was conducted. Two months before the dietary trial, subjects were monitored on their intensive insulin regimen to normalize glycemic and lipid levels.
Twenty-six individuals followed each diet for 2 months. Eight subjects lost or gained >2 kg, and three had the same dietary intakes during the two diets. For the remaining 15, seven adhered to the two diet prescriptions and eight followed one of the two diets.
Analysis of variance for crossover design (intent-to-treat group of 26) and Wilcoxon signed rank test (group of seven) were used to assess differences between the two diets.
For the intent-to-treat group (n=26), low-density lipoprotein cholesterol, although within normal range, was lower by 7% (P=.034) at the end of the high-monounsaturated-fat diet. The other 17 lipid parameters tested were not statistically significant. For those who adhered to the two diets (n= 7), lower plasma total triglycerides by 18% (P=.027), lower very low-density lipoprotein triglycerides by 26% (P=.043), lower very low-density lipoprotein cholesterol by 48% (P=.043), higher apolipoprotein A1 by 7% (P=.018), smaller low-density lipoprotein particle size by 1% (P=.043), and longer low-density lipoprotein oxidation lag time by 25% (P=.043) were found after the high-monounsaturated-fat diet.
APPLICATIONS/CONCLUSIONS: A high-monounsaturated-fat diet seemed to have a favorable effect on fasting lipoprotein profile in people with type 1 diabetes. Further research is needed with a larger sample to recommend a high-monounsaturated-fat diet as an alternative diet therapy in type 1 diabetes.
关于1型糖尿病患者采用高单不饱和脂肪饮食仍存在争议。本研究的目的是比较含43%至46%碳水化合物和37%至40%脂肪（17%至20%单不饱和脂肪）的高单不饱和脂肪饮食与含54%至57%碳水化合物和27%至30%脂肪（10%至13%单不饱和脂肪）的高碳水化合物饮食对1型糖尿病患者脂蛋白定量和定性谱的影响。
进行了一项随机交叉研究。在饮食试验前两个月，对受试者的强化胰岛素治疗方案进行监测，以使血糖和血脂水平正常化。
26名个体每种饮食各遵循2个月。8名受试者体重减轻或增加超过2千克，3名在两种饮食期间饮食摄入量相同。对于其余15名受试者，7名严格遵循两种饮食方案，8名遵循两种饮食中的一种。
采用交叉设计方差分析（意向性治疗组26名）和Wilcoxon符号秩检验（7名受试者组）评估两种饮食之间的差异。
对于意向性治疗组（n = 26），高单不饱和脂肪饮食结束时，低密度脂蛋白胆固醇虽在正常范围内，但降低了7%（P = 0.034）。所检测的其他17项血脂参数无统计学意义。对于严格遵循两种饮食的受试者（n = 7），高单不饱和脂肪饮食后，血浆总甘油三酯降低18%（P = 0.027），极低密度脂蛋白甘油三酯降低26%（P = 0.043），极低密度脂蛋白胆固醇降低48%（P = 0.043），载脂蛋白A1升高7%（P = 0.018），低密度脂蛋白颗粒大小减小1%（P = 0.043），低密度脂蛋白氧化滞后时间延长25%（P = 0.043）。
应用/结论：高单不饱和脂肪饮食似乎对1型糖尿病患者的空腹脂蛋白谱有有利影响。需要更大样本的进一步研究，以推荐高单不饱和脂肪饮食作为1型糖尿病的替代饮食疗法。
