一项 2 型糖尿病患者三种不同饮食餐后效应的随机交叉试验。
A randomized cross-over trial of the postprandial effects of three different diets in patients with type 2 diabetes.
机构信息
Department of Medical and Health Sciences, Faculty of Health Science, Linköping University, Linköping, Sweden.
出版信息
PLoS One. 2013 Nov 27;8(11):e79324. doi: 10.1371/journal.pone.0079324. eCollection 2013.
BACKGROUND
In the clinic setting both fasting levels of glucose and the area under the curve (AUC) of glucose, by determination of HbA1c levels, are used for risk assessments, in type 2 diabetes (NIDDM). However little is known about postprandial levels, and hence AUC, regarding other traditional risk factors such as insulin and blood-lipids and how this is affected by different diets.
OBJECTIVE
To study postprandial effects of three diets, during a single day, in NIDDM.
METHODS
A low-fat diet (45-56 energy-% from carbohydrates), and a low-carbohydrate diet (16-24 energy-% from carbohydrates) was compared with a Mediterranean-style diet (black coffee for breakfast and the same total-caloric intake as the other two diets for lunch with red wine, 32-35 energy-% from carbohydrates) in a randomized cross-over design. Total-caloric intake/test-day at the clinic from food was 1025-1080 kCal in men and 905-984 kCal in women. The test meals were consumed at a diabetes ward under supervision.
RESULTS
Twenty-one participants were recruited and 19 completed the studies. The low-carbohydrate diet induced lower insulin and glucose excursions compared with the low-fat diet (p<0.0005 for both AUC). The insulin-response following the single Mediterranean-style lunch-meal was more pronounced than during the low-fat diet lunch (insulin increase-ratio of the low-fat diet: 4.35 ± 2.2, of Mediterranean-style diet: 8.12 ± 5.2, p = 0.001) while postprandial glucose levels were similar. The increase-ratio of insulin correlated with the elevation of the incretin glucose-dependent insulinotropic-polypeptide following the Mediterranean-style diet lunch (Spearman, r = 0.64, p = 0.003).
CONCLUSIONS
The large Mediterranean-style lunch-meal induced similar postprandial glucose-elevations as the low-fat meal despite almost double amount of calories due to a pronounced insulin-increase. This suggests that accumulation of caloric intake from breakfast and lunch to a single large Mediterranean style lunch-meal in NIDDM might be advantageous from a metabolic perspective.
TRIAL REGISTRATION
ClinicalTrials.gov NCT01522157 NCT01522157.
背景
在临床环境中，空腹血糖水平和糖化血红蛋白（HbA1c）水平的曲线下面积（AUC）均用于 2 型糖尿病（NIDDM）的风险评估。然而，人们对其他传统危险因素（如胰岛素和血液脂质）的餐后水平和 AUC 知之甚少，也不知道不同饮食对此的影响。
目的
研究 NIDDM 患者在一天内三种饮食的餐后影响。
方法
采用低脂肪饮食（45-56%的能量来自碳水化合物）和低碳水化合物饮食（16-24%的能量来自碳水化合物），并与地中海式饮食（早餐为黑咖啡，午餐与其他两种饮食的总热量相同，红酒 32-35%的能量来自碳水化合物）进行随机交叉设计比较。男性在诊所的每日总热量摄入/测试日为 1025-1080 kCal，女性为 905-984 kCal。测试餐在糖尿病病房监督下食用。
结果
共招募 21 名参与者，其中 19 名完成了研究。与低脂肪饮食相比，低碳水化合物饮食诱导的胰岛素和血糖波动较低（AUC 均<0.0005）。单一地中海式午餐后的胰岛素反应比低脂肪饮食午餐更为明显（低脂肪饮食：胰岛素增加比为 4.35±2.2，地中海式饮食：8.12±5.2，p=0.001），而餐后血糖水平相似。胰岛素的增加比与午餐后肠降血糖素依赖性胰岛素释放肽的升高呈正相关（Spearman，r=0.64，p=0.003）。
结论
尽管地中海式午餐的热量几乎是低脂肪餐的两倍，但由于胰岛素显著增加，餐后血糖升高与低脂肪餐相似。这表明，从代谢角度来看，NIDDM 患者将早餐和午餐的热量摄入累积到一顿大的地中海式午餐中可能是有利的。
试验注册
ClinicalTrials.gov NCT01522157 NCT01522157。
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