McLaughlin Tracey, Carter Susan, Lamendola Cindy, Abbasi Fahim, Yee Gail, Schaaf Patricia, Basina Marina, Reaven Gerald
Stanford University School of Medicine, Stanford, CA 94305, USA.
Am J Clin Nutr. 2006 Oct;84(4):813-21. doi: 10.1093/ajcn/84.4.813.
Obese, insulin-resistant persons are at risk of cardiovascular disease. How best to achieve both weight loss and clinical benefit in these persons is controversial, and recent reports questioned the superiority of low-fat diets.
We aimed to ascertain the effects of moderate variations in the carbohydrate and fat content of calorie-restricted diets on weight loss and cardiovascular disease risk in obese, insulin-resistant persons.
Fifty-seven randomly assigned, insulin-resistant, obese persons completed a 16-wk calorie-restricted diet with 15% of energy as protein and either 60% and 25% or 40% and 45% of energy as carbohydrate and fat, respectively. Baseline and postweight-loss insulin resistance; daylong glucose, insulin, and triacylglycerol concentrations; fasting lipid and lipoprotein concentrations; and markers of endothelial function were quantified.
Weight loss with 60% or 40% of energy as carbohydrate (5.7 +/- 0.7 or 6.9 +/- 0.7 kg, respectively) did not differ significantly, and improvement in insulin sensitivity correlated with the amount of weight lost (r = 0.50, P < 0.001). Subjects following the diet with 40% of energy as carbohydrate had greater reductions in daylong insulin and triacylglycerol (P < 0.05) and fasting triacylglycerol (0.53 mmol/L; P = 0.04) concentrations, greater increases in HDL-cholesterol concentrations (0.12 mmol/L; P < 0.01) and LDL particle size (1.82 s; P < 0.05), and a greater decrease in plasma E-selectin (5.6 ng/L; P = 0.02) than did subjects following the diet with 60% of energy as carbohydrate.
In obese, insulin-resistant persons, a calorie-restricted diet, moderately lower in carbohydrate and higher in unsaturated fat, is as efficacious as the traditional low-fat diet in producing weight loss and may be more beneficial in reducing markers for cardiovascular disease risk.
肥胖且胰岛素抵抗的人群存在心血管疾病风险。如何在这类人群中最好地实现体重减轻和临床获益存在争议，并且近期报告对低脂饮食的优越性提出了质疑。
我们旨在确定限制热量饮食中碳水化合物和脂肪含量的适度变化对肥胖且胰岛素抵抗人群体重减轻和心血管疾病风险的影响。
57名随机分配的胰岛素抵抗肥胖者完成了一项为期16周的限制热量饮食，其中蛋白质提供15%的能量，碳水化合物和脂肪分别提供60%和25%的能量，或者分别提供40%和45%的能量。对基线和减重后的胰岛素抵抗；全天血糖、胰岛素和三酰甘油浓度；空腹血脂和脂蛋白浓度；以及内皮功能标志物进行了量化。
以60%或40%能量作为碳水化合物的减重效果（分别为5.7±0.7或6.9±0.7千克）无显著差异，胰岛素敏感性的改善与减重幅度相关（r = 0.50，P < 0.001）。以40%能量作为碳水化合物的饮食组受试者全天胰岛素和三酰甘油浓度（P < 0.05）以及空腹三酰甘油浓度（0.53毫摩尔/升；P = 0.04）的降低幅度更大，高密度脂蛋白胆固醇浓度（0.12毫摩尔/升；P < 0.01）和低密度脂蛋白颗粒大小（1.82 s；P < 0.05）的增加幅度更大，血浆E选择素降低幅度（5.6纳克/升；P = 0.02）比以60%能量作为碳水化合物的饮食组受试者更大。
在肥胖且胰岛素抵抗的人群中，碳水化合物含量适度降低、不饱和脂肪含量较高的限制热量饮食在减重方面与传统低脂饮食同样有效，并且在降低心血管疾病风险标志物方面可能更有益。
