高蛋白减肥饮食在 2 型糖尿病肥胖患者中的应用。

High protein weight loss diets in obese subjects with type 2 diabetes mellitus.

机构信息

Commonwealth Scientific & Industrial Research Organisation (CSIRO), Australia; Clinical Research Excellence (CRE) in Nutritional Physiology, University of Adelaide, Discipline of Medicine, Australia.

Commonwealth Scientific & Industrial Research Organisation (CSIRO), Australia; University of South Australia, Australia; Clinical Research Excellence (CRE) in Nutritional Physiology, University of Adelaide, Discipline of Medicine, Australia.

出版信息

Nutr Metab Cardiovasc Dis. 2014 May;24(5):554-62. doi: 10.1016/j.numecd.2013.11.003. Epub 2013 Dec 2.

DOI:10.1016/j.numecd.2013.11.003

PMID:24374004

Abstract

BACKGROUND AND AIM

Diets where carbohydrate has been partially exchanged for protein have shown beneficial changes in persons with type 2 diabetes but no studies have enrolled people with albuminuria. We aim to determine if a high protein to carbohydrate ratio (HPD) in an energy reduced diet has a beneficial effect on metabolic control and cardiovascular risk factors without negatively affecting renal function.

METHOD AND RESULTS

Adult, overweight participants with type 2 diabetes, with albuminuria (30-600 mg/24 h or an albumin-to-creatinine ratio of 3.0-60 mg/mmol), and estimated GFR of >40 ml/min/1.73 m(2) were enrolled. Participants were randomized to an HPD or an SPD. Protein:fat:carbohydrate ratio was 30:30:40% of energy for the HPD and 20:30:50% for the SPD. Main outcomes were renal function, weight loss, blood pressure, serum lipids and glycaemic control. We recruited 76 volunteers and 45 (35 men and 10 women) finished. There were no overall changes in renal function at 12 months and no significant differences in weight loss between groups (9.7 ± 2.9 kg and 6.6 ± 1.4 kg HPD and SPD group respectively; p = 0.32). Fasting blood glucose decreased significantly with no treatment effect. The decrease in HbA1c differed between treatments at 6 months (HPD -0.9 vs. SPD -0.3%; p = 0.039) but not at 12 months. HDL increased significantly with no treatment effects. There were no changes in LDL or blood pressure overall but DBP was lower in the HPD group (p = 0.024) at 12 months.

CONCLUSION

Weight loss improved overall metabolic control in this group of well controlled participants with type 2 diabetes regardless of diet composition.

摘要

背景和目的

用蛋白质部分替代碳水化合物的饮食已显示出对 2 型糖尿病患者有益的变化，但没有研究招募白蛋白尿患者。我们旨在确定能量减少饮食中高蛋白与碳水化合物的比例（HPD）是否对代谢控制和心血管危险因素有有益影响，而不会对肾功能产生负面影响。

方法和结果

纳入了患有 2 型糖尿病、白蛋白尿（30-600mg/24 小时或白蛋白与肌酐比值为 3.0-60mg/mmol）和估计肾小球滤过率（eGFR）>40ml/min/1.73m2 的成年超重参与者。参与者被随机分配到 HPD 或 SPD。HPD 的能量蛋白：脂肪：碳水化合物比例为 30:30:40%，而 SPD 为 20:30:50%。主要结局是肾功能、体重减轻、血压、血清脂质和血糖控制。我们招募了 76 名志愿者，其中 45 名（35 名男性和 10 名女性）完成了研究。12 个月时肾功能无总体变化，两组间体重减轻无显著差异（HPD 组为 9.7±2.9kg，SPD 组为 6.6±1.4kg；p=0.32）。空腹血糖显著下降，但无治疗效果。治疗 6 个月时，HbA1c 的下降在两组之间存在差异（HPD-0.9%vs.SPD-0.3%；p=0.039），但 12 个月时无差异。HDL 显著升高，无治疗作用。总体上 LDL 或血压无变化，但 HPD 组在 12 个月时舒张压（DBP）较低（p=0.024）。