McAuley Kirsten, Mann Jim
Edgar National Centre for Diabetes Research, University of Otago, Dunedin, New Zealand.
J Lipid Res. 2006 Aug;47(8):1668-76. doi: 10.1194/jlr.R600015-JLR200. Epub 2006 May 23.
Interpreting the literature relating to the nutritional determinants of insulin resistance is complicated by the wide range of methods used to determine insulin sensitivity. Excess adiposity is unquestionably the most important determinant of insulin resistance, although the effect may be tempered by a relatively high proportion of lean body mass. Weight loss is associated with improved insulin sensitivity. Thus, diet-related factors that promote excessive energy intake may be regarded as promoters of insulin resistance. In the context of energy balance, diets characterized by high intakes of saturated fat and low intakes of dietary fiber are associated with reduced insulin sensitivity. Total fat intakes greater than the usually consumed range appear to promote insulin resistance, although the relative proportions of total fat and carbohydrate within the usual range appear unimportant. Monounsaturated fatty acids with a cis configuration and fiber-rich carbohydrate foods appear to be appropriate substitutes for saturated fatty acids and rapidly digested glycemic carbohydrates. In animal studies, n-3 unsaturated fatty acids have been shown to enhance insulin sensitivity and fructose and sucrose to increase insulin resistance. However, human data are limited. Large prospective studies currently being conducted should confirm the most appropriate macronutrient composition of diets for preventing and treating insulin resistance as well as establishing whether a range of candidate genes explains the variation in response to dietary change.
用于确定胰岛素敏感性的方法多种多样，这使得解读与胰岛素抵抗的营养决定因素相关的文献变得复杂。毫无疑问，肥胖是胰岛素抵抗最重要的决定因素，尽管瘦体重比例相对较高可能会缓和这种影响。体重减轻与胰岛素敏感性改善相关。因此，促进能量摄入过多的饮食相关因素可被视为胰岛素抵抗的促进因素。在能量平衡的背景下，以高饱和脂肪摄入和低膳食纤维摄入为特征的饮食与胰岛素敏感性降低有关。总脂肪摄入量超过通常的消费范围似乎会促进胰岛素抵抗，尽管在通常范围内总脂肪和碳水化合物的相对比例似乎并不重要。具有顺式构型的单不饱和脂肪酸和富含纤维的碳水化合物食物似乎是饱和脂肪酸和快速消化的血糖碳水化合物的合适替代品。在动物研究中，n-3不饱和脂肪酸已被证明可增强胰岛素敏感性，而果糖和蔗糖则会增加胰岛素抵抗。然而，人类数据有限。目前正在进行的大型前瞻性研究应能确定预防和治疗胰岛素抵抗的饮食中最合适的宏量营养素组成，并确定一系列候选基因是否能解释对饮食变化反应的差异。
