Mortensen Lene S, Hartvigsen Merete L, Brader Lea J, Astrup Arne, Schrezenmeir Jürgen, Holst Jens J, Thomsen Claus, Hermansen Kjeld
Department of Endocrinology and Metabolism C, Aarhus University Hospital, Aarhus, Denmark.
Am J Clin Nutr. 2009 Jul;90(1):41-8. doi: 10.3945/ajcn.2008.27281. Epub 2009 May 20.
Enhanced and prolonged postprandial triglyceride responses involve increased cardiovascular disease risk in type 2 diabetes. Dietary fat and carbohydrates profoundly influence postprandial hypertriglyceridemia, whereas little information exists on the effect of proteins.
The objective was to compare the effects of the proteins casein, whey, cod, and gluten on postprandial lipid and incretin responses to a high-fat meal in persons with type 2 diabetes.
A crossover study was conducted in 12 patients with type 2 diabetes. Blood samples were collected over 8 h after ingestion of a test meal containing 100 g butter and 45 g carbohydrate in combination with 45 g casein (Cas-meal), whey (Whe-meal), cod (Cod-meal), or gluten (Glu-meal). We measured plasma concentrations of triglycerides, retinyl palmitate (RP), free fatty acids, insulin, glucose, glucagon, glucagon-like peptide 1, and glucose-dependent insulinotropic peptide.
The incremental area under the curve for triglyceride was significantly lower after the Whe-meal than after the other meals. The RP response was lower after the Whe-meal than after the Cas-meal and Cod-meal in the chylomicron-rich fraction and higher after the Whe-meal than after Cod- and Glu-meals in the chylomicron-poor fraction. Free fatty acids were most pronouncedly suppressed after the Whe-meal. The glucose response was lower after the Whe-meal than after the other meals, whereas no significant differences were found in insulin, glucagon, glucagon-like peptide 1, and glucose-dependent insulinotropic peptide responses.
The data suggest that as a supplement to a fat-rich meal in patients with type 2 diabetes, whey protein seems to outperform other proteins in terms of postprandial lipemia improvement, possibly because of the formation of fewer chylomicrons or increased clearance of chylomicrons. The trial was registered at ClinicalTrials.gov as NCT00817973.
2型糖尿病患者餐后甘油三酯反应增强且持续时间延长，会增加心血管疾病风险。膳食脂肪和碳水化合物对餐后高甘油三酯血症有深远影响，而关于蛋白质影响的信息较少。
比较酪蛋白、乳清蛋白、鳕鱼蛋白和面筋蛋白对2型糖尿病患者餐后脂质及肠促胰岛素对高脂餐反应的影响。
对12例2型糖尿病患者进行交叉研究。摄入含100g黄油、45g碳水化合物以及45g酪蛋白（酪蛋白餐）、乳清蛋白（乳清蛋白餐）、鳕鱼蛋白（鳕鱼蛋白餐）或面筋蛋白（面筋蛋白餐）的试验餐后8小时内采集血样。我们测量了血浆甘油三酯、视黄醇棕榈酸酯（RP）、游离脂肪酸、胰岛素、葡萄糖、胰高血糖素、胰高血糖素样肽1和葡萄糖依赖性促胰岛素多肽的浓度。
乳清蛋白餐后甘油三酯的曲线下增量面积显著低于其他餐。乳清蛋白餐后，富含乳糜微粒部分的RP反应低于酪蛋白餐和鳕鱼蛋白餐，而乳糜微粒较少部分的RP反应高于鳕鱼蛋白餐和面筋蛋白餐。乳清蛋白餐后游离脂肪酸受抑制最为明显。乳清蛋白餐后的血糖反应低于其他餐，而胰岛素、胰高血糖素、胰高血糖素样肽1和葡萄糖依赖性促胰岛素多肽反应未发现显著差异。
数据表明，作为2型糖尿病患者富含脂肪餐的补充剂，乳清蛋白在改善餐后血脂方面似乎优于其他蛋白质，这可能是因为形成的乳糜微粒较少或乳糜微粒清除增加。该试验已在ClinicalTrials.gov注册，注册号为NCT00817973。
