Parillo M, Riccardi G
Azienda Ospedaliera S. Sebastiano di Caserta, Via tescioni 1, 81100, Caserta, Italy.
Br J Nutr. 2004 Jul;92(1):7-19. doi: 10.1079/BJN20041117.
In the last 10 years nutritional research on diabetes has improved dramatically in terms of both number of studies produced and quality of methodologies employed. Therefore, it is now possible to attempt to provide the evidence on which nutritional recommendations for the prevention of type 2 diabetes could be based. We therefore performed a literature search and, among the papers published in indexed journals, we selected relevant epidemiological (mostly prospective) and controlled intervention studies. Lifestyle factors that have, so far, been consistently associated with increased risk of type 2 diabetes are overweight and physical inactivity. However, recent evidence from epidemiological studies has shown that the risk of type 2 diabetes is also associated with diet composition, particularly with: (1) low fibre intake; (2) a high trans fatty acid intake and a low unsaturated:saturated fat intake ratio; (3) absence of or excess alcohol consumption. All these factors are extremely common in Western populations and therefore the potential impact of any intervention on them is large: indeed, >90 % of the general population has one or more of these risk factors. The ability to correct these behaviours in the population is estimated to reduce the incidence of diabetes by as much as 87 %. Recent intervention studies have shown that type 2 diabetes can be prevented by lifestyle changes aimed at body-weight reduction, increased physical activity and multiple changes in the composition of the diet. Within this context, the average amount of weight loss needed is not large, about 5 % initial weight, which is much less than the weight loss traditionally considered to be clinically significant for prevention of type 2 diabetes. In conclusion, new emphasis on prevention by multiple lifestyle modifications, including moderate changes in the composition of the habitual diet, might limit the dramatic increase in incidence of type 2 diabetes envisaged worldwide.
在过去10年里，糖尿病营养研究在研究数量和所采用方法的质量方面都有了显著改善。因此，现在有可能尝试提供可作为预防2型糖尿病营养建议依据的证据。我们进行了文献检索，并在索引期刊发表的论文中，挑选了相关的流行病学研究（大多为前瞻性研究）和对照干预研究。到目前为止，一直与2型糖尿病风险增加相关的生活方式因素是超重和缺乏身体活动。然而，流行病学研究的最新证据表明，2型糖尿病风险还与饮食构成有关，尤其是：（1）膳食纤维摄入量低；（2）反式脂肪酸摄入量高以及不饱和脂肪与饱和脂肪摄入比例低；（3）不饮酒或饮酒过量。所有这些因素在西方人群中极为常见，因此任何干预对其产生的潜在影响都很大：实际上，超过90%的普通人群有一个或多个这些风险因素。据估计，纠正人群中的这些行为能够将糖尿病发病率降低多达87%。近期的干预研究表明，通过旨在减轻体重、增加身体活动以及对饮食构成进行多项改变的生活方式调整，可以预防2型糖尿病。在此背景下，所需的平均体重减轻幅度不大，约为初始体重的5%，这远低于传统上认为对预防2型糖尿病具有临床意义的体重减轻幅度。总之，通过多种生活方式改变（包括对习惯饮食构成进行适度改变）来预防糖尿病的新重点，可能会限制全球范围内预计的2型糖尿病发病率的急剧上升。
