适度低碳水化合物饮食对 2 型糖尿病患者优先腹部脂肪减少和心血管危险因素的影响。
Effects of a moderate low-carbohydrate diet on preferential abdominal fat loss and cardiovascular risk factors in patients with type 2 diabetes.
机构信息
Department of Clinical Nutrition, Haimoto Clinic, Yayoi, Kasugai, Aichi, Japan;
出版信息
Diabetes Metab Syndr Obes. 2011;4:167-74. doi: 10.2147/DMSO.S19635. Epub 2011 Apr 29.
BACKGROUND
Reports have shown that visceral adipose tissue (VAT) is more closely linked to cardiovascular risk factors (CRFs) than subcutaneous adipose tissue (SAT). We aimed to elucidate preferential abdominal fat loss and the correlations between abdominal fat reductions and changes in CRFs achieved with a moderate low-carbohydrate diet (LCD) in patients with type 2 diabetes (T2DM).
PATIENTS AND METHODS
Fifty-two outpatients (28 men and 24 women, mean age ± SD: 60.0 ± 10.5 years) with hemoglobin A(1c) (HbA(lc)) levels ≥ 6.5% were on an LCD for 6 months. Over a 6-month period, we measured their abdominal fat distribution (using CT) and assessed CRFs, including body mass index (BMI), HbA(1c), fasting blood glucose (FBG), serum insulin, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride levels.
RESULTS
The patients showed good compliance with the LCD (1812 ± 375 kcal/day, % carbohydrate:fat:protein = 35:40:19 for men; 1706 ± 323 kcal/day, % carbohydrate:fat:protein = 41:36:21 for women). Significant decreases (P = 0.05) in BMI and HbA(1c) levels were observed, along with an increase in HDL-C (P = 0.021) in men and a decrease in LDL-C (P = 0.001) in women. VAT (-21.6 cm(2), P < 0.001 in men; -19.6 cm(2), P < 0.001 in women) and SAT (-13.5 cm(2), P = 0.004 in men; -19.1 cm(2), P = 0.003 in women) significantly decreased. The loss of VAT (%ΔVAT) was greater than that of SAT (%ΔSAT) in women (P = 0.022). A similar but not significant predominance of VAT loss was detected in men (P = 0.111). In women, the %ΔSAT significantly correlated with changes in FBG (ΔFBG) (r = 0.417) and HDL-C (ΔHDL) (r = -0.720), as was %ΔVAT with changes in triglyceride (ΔTG) (r = 0.591).
CONCLUSION
Six months of a moderate LCD resulted in preferential VAT loss only in women, with significant correlations between %ΔSAT and both ΔHDL and ΔFBG, as well as between %ΔVAT and ΔTG. Our results suggest that an LCD has the potential to reduce abdominal fat in patients with T2DM and deterioration of serum lipid profiles.
背景
有报道表明，内脏脂肪组织（VAT）与心血管风险因素（CRFs）的相关性比皮下脂肪组织（SAT）更为密切。我们旨在阐明中度低碳水化合物饮食（LCD）在 2 型糖尿病（T2DM）患者中更倾向于减少腹部脂肪，并阐明腹部脂肪减少与 CRFs 变化之间的相关性。
患者和方法
52 例门诊患者（28 名男性和 24 名女性，平均年龄±标准差：60.0±10.5 岁）的血红蛋白 A（1c）（HbA（1c））水平≥6.5%接受了 6 个月的 LCD。在 6 个月的时间内，我们测量了他们的腹部脂肪分布（使用 CT），并评估了 CRFs，包括体重指数（BMI）、HbA（1c）、空腹血糖（FBG）、血清胰岛素、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）和甘油三酯水平。
结果
患者对 LCD 有很好的依从性（男性 1812±375kcal/天，碳水化合物：脂肪：蛋白质=35:40:19%；女性 1706±323kcal/天，碳水化合物：脂肪：蛋白质=41:36:21%）。观察到 BMI 和 HbA（1c）水平显著下降（P=0.05），男性 HDL-C 增加（P=0.021），女性 LDL-C 降低（P=0.001）。VAT（男性-21.6cm2，P＜0.001；女性-19.6cm2，P＜0.001）和 SAT（男性-13.5cm2，P=0.004；女性-19.1cm2，P=0.003）明显减少。女性 VAT 的减少百分比（%ΔVAT）大于 SAT（%ΔSAT）（P=0.022）。男性 VAT 减少也有类似但不显著的优势（P=0.111）。在女性中，%ΔSAT 与 FBG（ΔFBG）（r=0.417）和 HDL-C（ΔHDL）（r=-0.720）的变化显著相关，而%ΔVAT 与甘油三酯（ΔTG）（r=0.591）的变化显著相关。
结论
6 个月的中度 LCD 仅导致女性 VAT 优先减少，%ΔSAT 与 ΔHDL 和 ΔFBG 之间以及%ΔVAT 与 ΔTG 之间均存在显著相关性。我们的结果表明，LCD 有可能降低 T2DM 患者的腹部脂肪和血清脂质谱的恶化。
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