Slyper Arnold H
J Pediatr Endocrinol Metab. 2013;26(7-8):617-29. doi: 10.1515/jpem-2012-0419.
There is compelling evidence that carbohydrate quality has important influences on cardiovascular disease, the metabolic syndrome, type 2 diabetes, and obesity. Cohort and interventional studies indicate that dietary fiber is an important determinant of satiation, satiety, and weight gain, and also protects against cardiovascular disease. Cohort studies have shown that vegetables and fruits protect against coronary heart disease, whereas whole grains provide protection against cardiovascular disease, type 2 diabetes, and weight gain. Dietary glycemia within the range eaten by most of the population seems not to have a significant influence on body weight, although it may influence waist circumference. There is strong evidence from interventional trials that dietary glycemia does influence insulin resistance and diabetes control. Moreover, replacing saturated fat with high-glycemic carbohydrate may increase cardiovascular risk. Soft drink consumption is a proven cause of weight gain, which may relate to the lack of satiation provided by these drinks. In large amounts, dietary fructose leads to greater adverse metabolic changes than equivalent amounts of glucose, although the extent to which fructose per se is contributing to many of the metabolic changes found in the obese, as distinct from the calories it provides, is still a matter of debate.
有确凿证据表明，碳水化合物质量对心血管疾病、代谢综合征、2型糖尿病和肥胖症有重要影响。队列研究和干预性研究表明，膳食纤维是饱腹感、满足感和体重增加的重要决定因素，还能预防心血管疾病。队列研究表明，蔬菜和水果可预防冠心病，而全谷物能预防心血管疾病、2型糖尿病和体重增加。大多数人所摄入范围内的膳食血糖似乎对体重没有显著影响，尽管它可能会影响腰围。干预试验有强有力的证据表明，膳食血糖确实会影响胰岛素抵抗和糖尿病控制。此外，用高血糖碳水化合物替代饱和脂肪可能会增加心血管疾病风险。饮用软饮料已被证实是体重增加的一个原因，这可能与这些饮料缺乏饱腹感有关。大量摄入时，膳食果糖比等量葡萄糖会导致更严重的不良代谢变化，尽管果糖本身在肥胖人群中所发现的许多代谢变化中究竟起多大作用（有别于它所提供的热量）仍存在争议。
