Isharwal Sumit, Misra Anoop, Wasir J S, Nigam Priyanka
Department of Medicine (SI), All India Institute of Medical Sciences, New Delhi, India.
Indian J Med Res. 2009 May;129(5):485-99.
Insulin resistance is associated with type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD). These abnormalities have been aggravated because of imbalanced and excess nutrition in developed countries, and rapid nutritional and lifestyle transition occurring in developing countries. This review presents evidence linking dietary nutrients with insulin resistance and its metabolic correlates, and also describes these issues from a Asian Indians and South Asian perspective. Despite possible influences from genetic and perinatal factors, diet and physical activity are likely to have greater and often overriding influence in pathogenesis of the insulin resistance, the metabolic syndrome, and T2DM. In animal studies, a link has been established between dietary nutrients and insulin resistance. However, in human studies evidence is not as strong as in animals. Data suggest that dietary omega-3 polyunsaturated fatty acids (PUFAs) improve lipid profile and may have beneficial effect on insulin resistance. Dietary saturated fatty acids intake is positively associated with insulin resistance. Also, low glycaemic index foods and whole grain intake decrease insulin resistance. Importantly, high carbohydrate diets increase plasma triglycerides, cause hyperinsulinaemia and decreases low-density lipoprotein cholesterol. Among micronutrients, high magnesium and calcium intake have been reported to decrease insulin resistance. High intake of dietary carbohydrate and omega-6 PUFAs, low intake of omega-3 PUFAs and fiber, and high omega -6/omega-3 PUFAs ratio have been reported in South Asians. Our recent investigations have shown that increased dietary omega-6 PUFAs and saturated fat intake are significantly associated with fasting hyperinsulinaemia and sub-clinical inflammation, respectively. Such imbalanced diets contribute to high prevalence of insulin resistance, the metabolic syndrome and T2DM in South Asians and Asian Indians.
胰岛素抵抗与2型糖尿病（T2DM）和心血管疾病（CVD）相关。在发达国家，由于营养不均衡和过剩，以及发展中国家正在发生的快速营养和生活方式转变，这些异常情况已加剧。这篇综述展示了将膳食营养素与胰岛素抵抗及其代谢相关因素联系起来的证据，并且还从亚洲印度人和南亚人的角度描述了这些问题。尽管可能受到遗传和围产期因素的影响，但饮食和身体活动在胰岛素抵抗、代谢综合征和T2DM的发病机制中可能具有更大且往往是压倒性的影响。在动物研究中，已经建立了膳食营养素与胰岛素抵抗之间的联系。然而，在人体研究中，证据不如在动物研究中那么有力。数据表明，膳食中的ω-3多不饱和脂肪酸（PUFAs）可改善血脂状况，并且可能对胰岛素抵抗有有益影响。膳食饱和脂肪酸的摄入量与胰岛素抵抗呈正相关。此外，低血糖指数食物和全谷物摄入可降低胰岛素抵抗。重要的是，高碳水化合物饮食会增加血浆甘油三酯，导致高胰岛素血症，并降低低密度脂蛋白胆固醇。在微量营养素中，据报道高镁和钙摄入量可降低胰岛素抵抗。南亚人报告了高膳食碳水化合物和ω-6 PUFAs摄入量、低ω-3 PUFAs和纤维摄入量以及高ω-6/ω-3 PUFAs比值的情况。我们最近的研究表明，膳食中ω-6 PUFAs和饱和脂肪摄入量的增加分别与空腹高胰岛素血症和亚临床炎症显著相关。这种不均衡的饮食导致南亚人和亚洲印度人胰岛素抵抗、代谢综合征和T2DM的高患病率。
