Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia; IEL-Nutritional Epidemiology, University of Bonn, DONALD Study at the Research Institute of Child Nutrition, Germany.
Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia.
Clin Nutr. 2015 Feb;34(1):89-94. doi: 10.1016/j.clnu.2014.01.015. Epub 2014 Jan 29.
BACKGROUND & AIMS: The optimal dietary approach for weight loss and improving insulin sensitivity in adolescents is unknown. This study aimed to explore the association between the estimated insulin demand of the diet, as measured by glycemic and insulin load, weight loss, percentage body fat and insulin sensitivity index (ISI) in obese adolescents with clinical features of insulin resistance and/or prediabetes after a 3 month lifestyle and metformin intervention.
Secondary data analysis of 91 adolescents (median age 12.7 years (range 10.1-17.4) participating in a randomized controlled trial, known as RESIST; ACTRN12608000416392. Weight change between baseline and 3 months was measured by BMI expressed as percentage of the 95th centile (BMI %95). Body composition was measured by dual energy X-ray absorptiometry and ISI was determined by an oral glucose tolerance test.
Higher dietary glycemic load and insulin load were associated with less weight loss (BMI %95), adjusted for sex and pubertal stage, β = 0.0466, P = 0.007 and β = 0.0124, P = 0.040, respectively. Inclusion of total energy intake in the model explained observed associations between dietary glycemic load and insulin load and change in BMI %95. Neither dietary glycemic load nor insulin load were associated with changes in percentage body fat or ISI. Dietary glycemic index and macronutrient content (% of total energy) were not associated to changes in BMI %95, percentage body fat or ISI.
Reduced energy diet contributes to weight loss in obese, insulin resistant adolescents. Diets with a lower insulin demand were associated with a lower energy intake and may hence assist with weight loss.
目前尚不清楚对于减肥和改善胰岛素敏感性而言，青少年的最佳饮食方法是什么。本研究旨在探讨肥胖青少年在接受生活方式和二甲双胍干预 3 个月后，饮食的胰岛素需求量（通过血糖和胰岛素负荷来衡量）与体重减轻、体脂百分比和胰岛素敏感指数（ISI）之间的关系，这些青少年具有胰岛素抵抗和/或糖尿病前期的临床特征。
对 91 名青少年（中位年龄 12.7 岁（10.1-17.4 岁））的二次数据进行分析，这些青少年参与了一项名为 RESIST 的随机对照试验；ACTRN12608000416392。通过 BMI 表示第 95 百分位数的百分比（BMI %95）测量基线和 3 个月之间的体重变化。通过双能 X 射线吸收法测量身体成分，通过口服葡萄糖耐量试验确定 ISI。
调整性别和青春期阶段后，较高的饮食血糖负荷和胰岛素负荷与体重减轻（BMI %95）呈负相关，β=0.0466，P=0.007 和 β=0.0124，P=0.040。在模型中纳入总能量摄入可以解释饮食血糖负荷和胰岛素负荷与 BMI %95 变化之间的观察到的关联。饮食血糖负荷和胰岛素负荷均与体脂百分比或 ISI 的变化无关。饮食血糖指数和宏量营养素含量（占总能量的百分比）与 BMI %95、体脂百分比或 ISI 的变化无关。
低能量饮食有助于肥胖、胰岛素抵抗的青少年减轻体重。胰岛素需求量较低的饮食与较低的能量摄入有关，因此可能有助于减肥。
