Department of Nutrition and Health, Nestlé Research Centre, Lausanne, Switzerland.
Nutrition. 2010 Feb;26(2):141-5. doi: 10.1016/j.nut.2009.07.002.
Changes in lifestyle are considered to play an important role in the etiology of obesity and type 2 diabetes, and improvements in diet and physical activity are the first-choice treatment for these metabolic diseases. Since the dietary recommendations of almost 40 y ago that fat should be decreased and that carbohydrate should be increased, recommendations for a healthy diet, except for minor amendments, have not changed that much. It is generally considered that caloric restriction is more important than changes in the macronutrient composition of the diet for weight loss and body weight control. Although this is true, there is increasing evidence that changes in the macronutrient composition of the diet (decreasing carbohydrate and increasing unsaturated fats and/or protein) play a role that facilitates weight loss, increases insulin sensitivity and glucose tolerance, and improves cardiovascular risk factors, such as blood pressure, blood lipid profile, and inflammatory markers, often independent of weight loss. Low-carbohydrate diets, whether they be high in unsaturated fats and/or protein, are not recommended by the American Diabetes Association; however, despite this the Joslin Diabetes Center currently advocates a diet composition of approximately 40% carbohydrate, 30% fat, and 30% protein energy for overweight and obese adults with type 2 diabetes or prediabetes or those at high risk of developing type 2 diabetes. Hopefully, future studies will indicate whether diets with a more equilibrated macronutrient composition than presently recommended are more appropriate for body weight and metabolic control.
生活方式的改变被认为在肥胖和 2 型糖尿病的病因学中起着重要作用，改善饮食和增加身体活动是治疗这些代谢性疾病的首选方法。自近 40 年前提出的饮食建议，即减少脂肪和增加碳水化合物以来，除了一些小的修正外，健康饮食的建议并没有太大变化。一般认为，热量限制对于减肥和体重控制比饮食中宏量营养素组成的变化更为重要。虽然这是事实，但越来越多的证据表明，饮食中宏量营养素组成的变化（减少碳水化合物、增加不饱和脂肪和/或蛋白质）在促进减肥、提高胰岛素敏感性和葡萄糖耐量以及改善心血管危险因素方面发挥着作用，如血压、血脂谱和炎症标志物，通常与体重减轻无关。美国糖尿病协会不推荐低碳水化合物饮食，无论其是否富含不饱和脂肪和/或蛋白质；然而，尽管如此，约林糖尿病中心目前仍提倡超重和肥胖的 2 型糖尿病或糖尿病前期患者或有发展为 2 型糖尿病高风险的患者的饮食组成约为 40%的碳水化合物、30%的脂肪和 30%的蛋白质能量。希望未来的研究能表明，与目前推荐的饮食相比，宏量营养素组成更均衡的饮食是否更适合控制体重和代谢。
