Cheong Sian Hoe, McCargar Linda J, Paty Breay W, Tudor-Locke Catrine, Bell Rhonda C
University of Alberta, Edmonton, Alberta, Canada.
J Am Diet Assoc. 2009 Aug;109(8):1411-6. doi: 10.1016/j.jada.2009.05.012.
Practical lifestyle interventions are needed to help people with type 2 diabetes increase their physical activity and follow nutrition therapy guidelines. This study examined whether combining instructions to walk more and to eat more low-glycemic index (GI) foods (First Step First Bite Program) improved hemoglobin A1c and anthropometric and cardiovascular health outcomes in people with type 2 diabetes vs the First Step Program (instruction only on walking). Subjects were randomly assigned to the First Step Program or First Step First Bite Program (n=22 in each group) and attended four weekly group meetings with minimal follow-up during weeks 5 to 16. All subjects monitored steps per day throughout the study; First Step First Bite Program subjects also monitored daily intake of low-GI foods. At week 16 (n=19 per group), both groups had increased steps per day by approximately 3,000 compared with baseline (P<0.01). In the First Step Program vs First Step First Bite Program groups, respectively, waist girth decreased by 5.9+/-0.9 cm vs 3.7+/-0.5 cm and hip decreased by 3.7+/-0.6 cm vs 2.2+/-0.5 cm (P<0.01 over time, both groups). There was no significant difference between groups at week 16 for anthropometric or metabolic variables measured, including hemoglobin A1c. Both the First Step First Bite Program and First Step Program resulted in increased physical activity; First Step First Bite Program also increased daily intake of low-GI foods. Both groups experienced similar significant reductions in waist and hip girth. Thus, adding a low-GI component to a walking program in people with type 2 diabetes in good glycemic control did not improve anthropometric or metabolic outcomes. A great number and/or longer duration of low-GI foods may be required to observe improved clinical outcomes.
需要采取切实可行的生活方式干预措施，以帮助2型糖尿病患者增加身体活动并遵循营养治疗指南。本研究探讨了将增加步行量的指导与食用更多低血糖指数（GI）食物的指导相结合（“先迈第一步，再尝第一口”计划），与仅进行增加步行量指导的“先迈第一步”计划相比，是否能改善2型糖尿病患者的糖化血红蛋白以及人体测量和心血管健康指标。研究对象被随机分配至“先迈第一步”计划组或“先迈第一步，再尝第一口”计划组（每组22人），并参加了四周的每周一次小组会议，在第5至16周期间进行了最少的随访。在整个研究过程中，所有研究对象均监测每日步数；“先迈第一步，再尝第一口”计划组的研究对象还监测了低GI食物的每日摄入量。在第16周时（每组19人），与基线相比，两组的每日步数均增加了约3000步（P<0.01）。在“先迈第一步”计划组与“先迈第一步，再尝第一口”计划组中，腰围分别减少了5.9±0.9厘米和3.7±0.5厘米，臀围分别减少了3.7±0.6厘米和2.2±0.5厘米（两组随时间变化均P<0.01）。在第16周时，两组在包括糖化血红蛋白在内的人体测量或代谢变量方面无显著差异。“先迈第一步，再尝第一口”计划和“先迈第一步”计划均使身体活动增加；“先迈第一步，再尝第一口”计划还增加了低GI食物的每日摄入量。两组的腰围和臀围均有类似的显著减小。因此，在血糖控制良好的2型糖尿病患者的步行计划中增加低GI食物成分，并未改善人体测量或代谢指标。可能需要大量和/或更长时间食用低GI食物才能观察到临床指标的改善。
