Tinker Lesley F, Bonds Denise E, Margolis Karen L, Manson JoAnn E, Howard Barbara V, Larson Joseph, Perri Michael G, Beresford Shirley A A, Robinson Jennifer G, Rodríguez Beatriz, Safford Monika M, Wenger Nanette K, Stevens Victor J, Parker Linda M
Women's Health Initiative, Fred Hutchinson Cancer Research Center, PO Box 19024, Mail Stop M3-A410, Seattle, WA 98109, USA.
Arch Intern Med. 2008 Jul 28;168(14):1500-11. doi: 10.1001/archinte.168.14.1500.
Decreased fat intake with weight loss and increased exercise may reduce the risk of diabetes mellitus in persons with impaired glucose tolerance. This study was undertaken to assess the effects of a low-fat dietary pattern on incidence of treated diabetes among generally healthy postmenopausal women.
A randomized controlled trial was conducted at 40 US clinical centers from 1993 to 2005, including 48,835 postmenopausal women aged 50 to 79 years. Women were randomly assigned to a usual-diet comparison group (n = 29,294 [60.0%]) or an intervention group with a 20% low-fat dietary pattern with increased vegetables, fruits, and grains (n = 19,541 [40.0%]). Self-reported incident diabetes treated with oral agents or insulin was assessed.
Incident treated diabetes was reported by 1303 intervention participants (7.1%) and 2039 comparison participants (7.4%) (hazard ratio, 0.96; 95% confidence interval, 0.90-1.03; P = .25). Weight loss occurred in the intervention group, with a difference between intervention and comparison groups of 1.9 kg after 7.5 years (P < .001). Subgroup analysis suggested that greater decreases in percentage of energy from total fat reduced diabetes risk (P for trend = .04), which was not statistically significant after adjusting for weight loss.
A low-fat dietary pattern among generally healthy postmenopausal women showed no evidence of reducing diabetes risk after 8.1 years. Trends toward reduced incidence were greater with greater decreases in total fat intake and weight loss. Weight loss, rather than macronutrient composition, may be the dominant predictor of reduced risk of diabetes.
随着体重减轻减少脂肪摄入并增加运动量，可能会降低糖耐量受损者患糖尿病的风险。本研究旨在评估低脂饮食模式对一般健康的绝经后女性接受治疗的糖尿病发病率的影响。
1993年至2005年在美国40个临床中心进行了一项随机对照试验，纳入48835名年龄在50至79岁的绝经后女性。女性被随机分配到常规饮食对照组（n = 29294 [60.0%]）或采用20%低脂饮食模式且增加蔬菜、水果和谷物摄入的干预组（n = 19541 [40.0%]）。评估自我报告的经口服药物或胰岛素治疗的新发糖尿病情况。
1303名干预组参与者（7.1%）和2039名对照组参与者（7.4%）报告了经治疗的新发糖尿病（风险比，0.96；95%置信区间，0.90 - 1.03；P = 0.25）。干预组出现了体重减轻，7.5年后干预组与对照组的体重差异为1.9千克（P < 0.001）。亚组分析表明，总脂肪供能百分比的更大幅度下降降低了糖尿病风险（趋势P值 = 0.04），在调整体重减轻因素后无统计学意义。
一般健康的绝经后女性采用低脂饮食模式8.1年后，没有证据表明能降低糖尿病风险。总脂肪摄入量的更大幅度下降和体重减轻使发病率降低的趋势更明显。体重减轻而非宏量营养素组成可能是糖尿病风险降低的主要预测因素。
