I型糖尿病患者的饮食摄入量与营养建议的比较

Citro G, Maioli A, Lo Pomo F, Pistone S, Vinci M L, Sacco V

Divisione Endocrinologia e Diabetologia, Azienda Ospedaliera San Carlo, Potenza.

Minerva Gastroenterol Dietol. 1998 Sep;44(3):141-7.

BACKGROUND

The management of type I diabetes mellitus requires a careful balance between nutrient intake, energy expenditure and dose and timing of insulin. According to the recommendations of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) the calories should be prescribed according to energy needs to achieve and maintain a desirable body weight. Many studies have shown that diets in which carbohydrates provide 50-60% of total energy are associated with improved blood glucose control and lower levels of LDL cholesterol. Whenever acceptable to the patients, natural foods containing unrefined carbohydrate should be substituted for the highly refined carbohydrates that are low in fiber. The high risk of macrovascular disease in patients with diabetes dictates a need to restrict total fat (25-30% of total energy) and cholesterol intake (300 mg/day). ADA and EASD suggest that reduction of protein intake (0.8 g/kg/day) may reduce proteinuria and progression to renal failure during the earliest stages of diabetic nephropathy.

METHODS

The goal of this study was to describe macronutrient intakes in type I diabetic patients of our Centre by a validated 3 day record.

RESULTS

Mean energy intake was 2022+/-427 Kcal/die (vs 2596+/-501 recommended intake). Average protein intake was well above the level of 0.8 g/kg/day required to ensure an adequate protein intake in type I diabetes mellitus. Total fats contributed 29.8+/-7.4 of total energy (vs 27% recommended intake) and saturated fat provided significantly more than 10% of energy. Carbohydrates intake was above 50% of total energy but fiber intakes was substantially lower than the recommendation (12.7+/-5.5 vs 20.1+/-6.6 g/day).

CONCLUSIONS

These data indicate current problems in the nutritional intake of type I diabetes mellitus; in fact the majority of our group of patients are not meeting the recommended dietary intakes for protein, total fat, saturated fat and fiber.

背景

1型糖尿病的管理需要在营养摄入、能量消耗以及胰岛素剂量和注射时间之间谨慎地保持平衡。根据美国糖尿病协会（ADA）和欧洲糖尿病研究协会（EASD）的建议，应根据能量需求来规定热量，以达到并维持理想体重。许多研究表明，碳水化合物提供总能量50 - 60%的饮食与改善血糖控制及降低低密度脂蛋白胆固醇水平有关。只要患者能够接受，应使用含未精制碳水化合物的天然食物替代纤维含量低的高度精制碳水化合物。糖尿病患者发生大血管疾病的高风险表明需要限制总脂肪（占总能量的25 - 30%）和胆固醇摄入量（300毫克/天）。ADA和EASD建议，在糖尿病肾病的最早阶段，减少蛋白质摄入量（0.8克/千克/天）可能会减少蛋白尿并延缓肾衰竭的进展。

方法

本研究的目的是通过一份经验证有效的3天饮食记录来描述本中心1型糖尿病患者的常量营养素摄入量。

结果

平均能量摄入量为2022±427千卡/天（与推荐摄入量2596±501千卡/天相比）。平均蛋白质摄入量远高于1型糖尿病患者确保充足蛋白质摄入所需的0.8克/千克/天的水平。总脂肪占总能量的29.8±7.4%（与推荐摄入量27%相比），饱和脂肪提供的能量明显超过10%。碳水化合物摄入量超过总能量的50%，但纤维摄入量远低于推荐水平（12.7±5.5克/天与20.1±6.6克/天相比）。