Iannuzzi Arcangelo, Licenziati Maria Rosaria, Vacca Maria, De Marco Donata, Cinquegrana Giorgio, Laccetti Marco, Bresciani Alessandro, Covetti Giuseppe, Iannuzzo Gabriella, Rubba Paolo, Parillo Mario
Department of Internal Medicine, A. Cardarelli Hospital, Via A Cardarelli 9, 80131 Naples, Italy.
Heart Vessels. 2009 Nov;24(6):419-24. doi: 10.1007/s00380-008-1138-6. Epub 2009 Nov 22.
Childhood obesity is associated with an increased carotid intima-media thickness (IMT) and stiffness. Increased carotid wall thickening and rigidity are considered markers of subclinical atherosclerosis. The aim of the present study was to test the effect of two hypocaloric diets of varying glycemic index on weight loss and markers of subclinical atherosclerosis in obese children. Seventy consecutive obese children attending the Outpatient Weight Clinic of the Department of Pediatrics were invited to participate in an intensive dietary protocol. Twenty-six accepted and were randomly assigned to two different groups: the first group followed a hypocaloric low-glycemic index diet and the second a hypocaloric high-glycemic index diet. Anthropometric measures and biochemical tests were performed in all children. Quantitative B-mode ultrasound scans were used to measure intima-media thickness (IMT) and diameters of the common carotid artery. Considering both groups together, at 6 months, body mass index decreased from 28.3 +/- 3.1 to 25.8 +/- 3.3 kg/m(2), systolic blood pressure from 119 +/- 12 to 110 +/- 11 mmHg (P< 0.001), diastolic blood pressure from 78 +/- 8 to 74 +/- 7 mmHg (P< 0.001), IMT from 0.48 +/- 0.05 to 0.43 +/- 0.07 mm (P< 0.001), stiffness from 3.57 +/- 1.04 to 2.98 +/- 0.94 mm (P = 0.002), and high-sensitivity C-reactive protein from 1.5 +/- 0.9 (values log transformed) to 0.4 +/- 1.1 (P < 0.001). No differences were detectable in fasting serum triglycerides, total cholesterol, and high-density lipoprotein cholesterol. Insulin resistance (calculated by the HOmeostatic Model Assessment index [HOMA] score) significantly reduced only in the low-glycemic-index diet group (P < 0.04). In conclusion, this study confirms a benefit of hypocaloric diets on carotid IMT and stiffness in obese children and demonstrates, for the first time, an amelioration of insulin sensitivity in obese children after a low-glycemic index diet. These results justify the advice to obese children to follow a low-glycemic index diet in order to improve their cardiometabolic profile.
儿童肥胖与颈动脉内膜中层厚度（IMT）增加及血管僵硬度增加有关。颈动脉壁增厚和僵硬加剧被认为是亚临床动脉粥样硬化的标志。本研究的目的是测试两种不同血糖指数的低热量饮食对肥胖儿童体重减轻及亚临床动脉粥样硬化标志物的影响。连续邀请了70名在儿科门诊体重诊所就诊的肥胖儿童参加强化饮食方案。26名儿童接受邀请并被随机分为两组：第一组遵循低热量低血糖指数饮食，第二组遵循低热量高血糖指数饮食。对所有儿童进行了人体测量和生化检测。使用定量B型超声扫描测量内膜中层厚度（IMT）和颈总动脉直径。综合两组来看，6个月时，体重指数从28.3±3.1降至25.8±3.3kg/m²，收缩压从119±12降至110±11mmHg（P<0.001），舒张压从78±8降至74±7mmHg（P<0.001），IMT从0.48±0.05降至0.43±0.07mm（P<0.001），血管僵硬度从3.57±1.04降至2.98±0.94mm（P = 0.002），高敏C反应蛋白从1.5±0.9（对数转换值）降至0.4±1.1（P<0.001）。空腹血清甘油三酯、总胆固醇和高密度脂蛋白胆固醇未检测到差异。胰岛素抵抗（通过稳态模型评估指数[HOMA]评分计算）仅在低血糖指数饮食组显著降低（P<0.04）。总之，本研究证实了低热量饮食对肥胖儿童颈动脉IMT和血管僵硬度有益，并首次证明了肥胖儿童在食用低血糖指数饮食后胰岛素敏感性得到改善。这些结果证明了建议肥胖儿童遵循低血糖指数饮食以改善其心脏代谢状况的合理性。
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