McClenaghan Neville H
School of Biomedical Sciences, University of Ulster, Cromore Road, Coleraine BT52 1SA, UK.
Nutr Res Rev. 2005 Dec;18(2):222-40. doi: 10.1079/NRR2005109.
Insulin resistance underlies type 2 diabetes, CVD and the metabolic syndrome, driven by changes in diet, lifestyle, energy over-consumption and obesity. Nutritional recommendations for insulin resistance remain an area of controversy, particularly the quantity and types of dietary carbohydrate. The present review gives an overview of insulin resistance, its relationship to impaired insulin secretion and the metabolic syndrome, research methodologies used to measure insulin action and the epidemiological and intervention studies on the relationship between dietary carbohydrate and insulin resistance. Epidemiological studies provide little evidence to suggest that total dietary carbohydrate predicts risk of type 2 diabetes, and high-carbohydrate, high-fibre diets with low-glycaemic index (GI) may even contribute to diabetes prevention. Despite inherent limitations associated with techniques used to measure insulin resistance and dietary assessment, most intervention studies reveal an increase in glucose tolerance or insulin sensitivity with high-carbohydrate, low-fat diets in non-diabetic and diabetic individuals. When energy is restricted the source or reduced content of carbohydrate does not appear to be as important as fat for body weight. Thus, low energy intake is key to weight loss and augmentation of insulin sensitivity. Given this, widespread adoption of popular low-carbohydrate high-fat diets highlights the necessity to evaluate dietary interventions regarding safety and metabolic effects. While current evidence supports FAO/WHO recommendations to maintain a high-carbohydrate diet with low-GI foods, the relationships between carbohydrate and insulin sensitivity remains an important research area. Emerging technologies should further enhance understanding of gene-diet interactions in insulin resistance, providing useful information for future nutrition policy decisions.
胰岛素抵抗是2型糖尿病、心血管疾病和代谢综合征的基础，由饮食、生活方式、能量摄入过多和肥胖等因素的变化所驱动。针对胰岛素抵抗的营养建议仍是一个存在争议的领域，尤其是膳食碳水化合物的数量和类型。本综述概述了胰岛素抵抗、其与胰岛素分泌受损及代谢综合征的关系、用于测量胰岛素作用的研究方法以及关于膳食碳水化合物与胰岛素抵抗关系的流行病学和干预研究。流行病学研究几乎没有证据表明膳食总碳水化合物能预测2型糖尿病风险，高碳水化合物、高纤维且低血糖指数（GI）的饮食甚至可能有助于预防糖尿病。尽管用于测量胰岛素抵抗和膳食评估的技术存在固有局限性，但大多数干预研究表明，非糖尿病和糖尿病个体采用高碳水化合物、低脂肪饮食时，葡萄糖耐量或胰岛素敏感性会增加。当能量摄入受限，碳水化合物的来源或含量减少对体重的影响似乎不如脂肪重要。因此，低能量摄入是减肥和提高胰岛素敏感性的关键。鉴于此，广泛采用流行的低碳水化合物高脂肪饮食凸显了评估膳食干预措施安全性和代谢影响的必要性。虽然目前的证据支持粮农组织/世卫组织关于维持高碳水化合物、低GI食物饮食的建议，但碳水化合物与胰岛素敏感性之间的关系仍是一个重要的研究领域。新兴技术应进一步加深对胰岛素抵抗中基因与饮食相互作用的理解，为未来的营养政策决策提供有用信息。
