Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK.
Diabetes Care. 2012 Feb;35(2):226-32. doi: 10.2337/dc11-1443. Epub 2012 Jan 16.
To assess the effect of dietary flavonoids on cardiovascular disease (CVD) risk in postmenopausal women with type 2 diabetes on established statin and hypoglycemic therapy.
Despite being medicated, patients with type 2 diabetes have elevated CVD risk, particularly postmenopausal women. Although dietary flavonoids have been shown to reduce CVD risk factors in healthy participants, no long-term trials have examined the additional benefits of flavonoids to CVD risk in medicated postmenopausal women with type 2 diabetes. We conducted a parallel-design, placebo-controlled trial with type 2 diabetic patients randomized to consume 27 g/day (split dose) flavonoid-enriched chocolate (containing 850 mg flavan-3-ols [90 mg epicatechin] and 100 mg isoflavones [aglycone equivalents)]/day) or matched placebo for 1 year.
Ninety-three patients completed the trial, and adherence was high (flavonoid 91.3%; placebo 91.6%). Compared with the placebo group, the combined flavonoid intervention resulted in a significant reduction in estimated peripheral insulin resistance (homeostasis model assessment of insulin resistance [HOMA-IR] -0.3 ± 0.2; P = 0.004) and improvement in insulin sensitivity (quantitative insulin sensitivity index [QUICKI] 0.003 ± 0.00; P = 0.04) as a result of a significant decrease in insulin levels (-0.8 ± 0.5 mU/L; P = 0.02). Significant reductions in total cholesterol:HDL-cholesterol (HDL-C) ratio (-0.2 ± 0.1; P = 0.01) and LDL-cholesterol (LDL-C) (-0.1 ± 0.1 mmol/L; P = 0.04) were also observed. Estimated 10-year total coronary heart disease risk (derived from UK Prospective Diabetes Study algorithm) was attenuated after flavonoid intervention (flavonoid +0.1 ± 0.3 vs. placebo 1.1 ± 0.3; P = 0.02). No effect on blood pressure, HbA(1c), or glucose was observed.
One-year intervention with flavan-3-ols and isoflavones improved biomarkers of CVD risk, highlighting the additional benefit of flavonoids to standard drug therapy in managing CVD risk in postmenopausal type 2 diabetic patients.
评估富含黄酮的饮食对正在服用他汀类药物和降糖药的 2 型糖尿病绝经后女性心血管疾病（CVD）风险的影响。
尽管接受了药物治疗，2 型糖尿病患者仍存在较高的 CVD 风险，尤其是绝经后女性。尽管饮食黄酮类化合物已被证明可降低健康参与者的 CVD 危险因素，但尚无长期试验研究富含黄酮类化合物对正在服用他汀类药物和降糖药的 2 型糖尿病绝经后女性 CVD 风险的额外益处。我们进行了一项平行设计、安慰剂对照试验，将 2 型糖尿病患者随机分为两组，分别每天服用 27 克（分剂量）富含黄酮的巧克力（含有 850 毫克黄烷-3-醇[90 毫克表儿茶素]和 100 毫克异黄酮[苷元当量]）或匹配的安慰剂，持续 1 年。
93 例患者完成了试验，且依从性很高（黄酮组 91.3%；安慰剂组 91.6%）。与安慰剂组相比，联合黄酮干预可显著降低外周胰岛素抵抗的估计值（稳态模型评估的胰岛素抵抗[HOMA-IR] -0.3 ± 0.2；P = 0.004）和改善胰岛素敏感性（定量胰岛素敏感性指数[QUICKI] 0.003 ± 0.00；P = 0.04），这是由于胰岛素水平显著降低（-0.8 ± 0.5 mU/L；P = 0.02）。总胆固醇：高密度脂蛋白胆固醇（HDL-C）比值（-0.2 ± 0.1；P = 0.01）和 LDL-C（-0.1 ± 0.1 mmol/L；P = 0.04）也显著降低。黄酮干预后，估计的 10 年总冠心病风险（根据英国前瞻性糖尿病研究算法得出）降低（黄酮组+0.1 ± 0.3 与安慰剂组 1.1 ± 0.3；P = 0.02）。血压、HbA1c 或血糖无变化。
黄酮醇和异黄酮的 1 年干预可改善 CVD 风险的生物标志物，这突出表明富含黄酮类化合物对绝经后 2 型糖尿病患者 CVD 风险管理标准药物治疗的额外益处。
