12 个月强化生活方式干预对 2 型糖尿病成人肝脂肪变性的影响。
Effect of a 12-month intensive lifestyle intervention on hepatic steatosis in adults with type 2 diabetes.
机构信息
Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland, USA.
出版信息
Diabetes Care. 2010 Oct;33(10):2156-63. doi: 10.2337/dc10-0856. Epub 2010 Jul 27.
OBJECTIVE
Weight loss through lifestyle changes is recommended for nonalcoholic fatty liver disease (NAFLD). However, its efficacy in patients with type 2 diabetes is unproven.
RESEARCH DESIGN AND METHODS
Look AHEAD (Action for Health in Diabetes) is a 16-center clinical trial with 5,145 overweight or obese adults with type 2 diabetes, who were randomly assigned to an intensive lifestyle intervention (ILI) to induce a minimum weight loss of 7% or a control group who received diabetes support and education (DSE). In the Fatty Liver Ancillary Study, 96 participants completed proton magnetic resonance spectroscopy to quantify hepatic steatosis and tests to exclude other causes of liver disease at baseline and 12 months. We defined steatosis >5.5% as NAFLD.
RESULTS
Participants were 49% women and 68% white. The mean age was 61 years, mean BMI was 35 kg/m(2), mean steatosis was 8.0%, and mean aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were 20.5 and 24.2 units/l, respectively. After 12 months, participants assigned to ILI (n = 46) lost more weight (-8.5 vs. -0.05%; P < 0.01) than those assigned to DSE and had a greater decline in steatosis (-50.8 vs. -22.8%; P = 0.04) and in A1C (-0.7 vs. -0.2%; P = 0.04). There were no significant 12-month changes in AST or ALT levels. At 12 months, 26% of DSE participants and 3% (1 of 31) of ILI participants without NAFLD at baseline developed NAFLD (P < 0.05).
CONCLUSIONS
A 12-month intensive lifestyle intervention in patients with type 2 diabetes reduces steatosis and incident NAFLD.
目的
生活方式改变引起的体重减轻被推荐用于非酒精性脂肪性肝病（NAFLD）。然而，其在 2 型糖尿病患者中的疗效尚未得到证实。
研究设计与方法
Look AHEAD（糖尿病患者健康行动）是一项 16 中心临床试验，共纳入 5145 例超重或肥胖的 2 型糖尿病患者，他们被随机分配到强化生活方式干预组（ILI），以诱导至少 7%的体重减轻，或对照组接受糖尿病支持和教育（DSE）。在脂肪性肝病辅助研究中，96 例患者完成了质子磁共振波谱以量化肝脂肪变性，并在基线和 12 个月时进行了排除其他肝病病因的检查。我们将脂肪变性>5.5%定义为 NAFLD。
结果
参与者中 49%为女性，68%为白人。平均年龄为 61 岁，平均 BMI 为 35kg/m²，平均脂肪变性为 8.0%，平均天门冬氨酸氨基转移酶（AST）和丙氨酸氨基转移酶（ALT）分别为 20.5 和 24.2 单位/L。12 个月后，接受 ILI 治疗的患者（n=46）体重减轻更多（-8.5% vs. -0.05%；P<0.01），脂肪变性减少更明显（-50.8% vs. -22.8%；P=0.04），糖化血红蛋白（A1C）降低更明显（-0.7% vs. -0.2%；P=0.04）。AST 和 ALT 水平在 12 个月时无显著变化。在 12 个月时，DSE 组有 26%的患者和无基线 NAFLD 的 ILI 组的 3%（31 例中的 1 例）患者发生了 NAFLD（P<0.05）。
结论
在 2 型糖尿病患者中进行 12 个月的强化生活方式干预可减少脂肪变性和新发 NAFLD。
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