Gow Megan L, Baur Louise A, Johnson Nathan A, Cowell Chris T, Garnett Sarah P
Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia.
Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Corner of Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW, 2145, Australia.
Diabetologia. 2017 Mar;60(3):406-415. doi: 10.1007/s00125-016-4163-5. Epub 2016 Nov 26.
AIMS/HYPOTHESIS: The aim of the study was to investigate whether a very-low-energy diet (VLED) is a feasible and acceptable treatment option for type 2 diabetes in children and adolescents, and whether adherence can lead to rapid weight loss, reversal of type 2 diabetes and reduced liver fat as seen in adult studies.
Eight participants with type 2 diabetes and obesity, aged 7-16 years, non-medicated (n = 1) or treated with metformin (n = 7) and in some cases insulin (n = 3), followed a VLED (<3360 kJ/day) for 8 weeks, then transitioned to a hypocaloric diet (∼6300 kJ/day) that they followed to 34 weeks. HbA, fasting glucose and 2 h post-glucose load plasma glucose (2hG) were determined from fasting blood and an OGTT. Liver fat concentration was quantified using proton magnetic resonance spectroscopy. Adherence was defined as ≥5% weight loss during the 8 week VLED.
Adherers (n = 5) and non-adherers (n = 3) had median weight loss of 7.5% and 0.5%, respectively, at 8 weeks. Overall, HbA (mean [SE] 8.1% [0.7%] to 6.6% [0.5%]; p = 0.004) and 2hG (15.6 [1.6] mmol/l to 11.3 [1.0] mmol/l; p = 0.009) were significantly reduced at 8 weeks compared with baseline. Liver fat was also significantly reduced from baseline (14.7% [2.2%]) to 8 weeks (5.8% [1.7%]; p = 0.001). Only three out of eight participants met non-alcoholic fatty liver disease (NAFLD) criteria (≥5.5%) at 8 weeks, compared with eight out of eight at baseline. The three participants on insulin therapy at baseline were able to cease therapy during the 8 week VLED. At 34 weeks, adherers (n = 5) achieved 12.3% weight loss, none met NAFLD criteria and four did not meet American Diabetes Association criteria for type 2 diabetes.
CONCLUSIONS/INTERPRETATION: A VLED appears to be a feasible treatment option for some youth with type 2 diabetes on metformin therapy. Youth who agree to participate and adhere to a VLED achieve rapid weight loss, dramatic reductions in liver fat and reversal of type 2 diabetes. This highlights the capacity of a VLED to be used as a first-line treatment option in newly diagnosed youth. A larger trial with a control group and longer follow-up will be required to encourage a change in standard treatment.
Australian New Zealand Clinical Trial Registration Number (ACTRN) ACTRN12616000375459 ( www.ANZCTR.org.au/ACTRN12616000375459.aspx ).
目的/假设：本研究旨在调查极低能量饮食（VLED）对于儿童及青少年2型糖尿病患者是否是一种可行且可接受的治疗选择，以及坚持该饮食方案是否能像成人研究中那样带来快速减重、2型糖尿病逆转和肝脏脂肪减少。
8名年龄在7至16岁、患有2型糖尿病和肥胖症的参与者，其中1人未接受药物治疗，7人接受二甲双胍治疗，部分（3人）还使用胰岛素治疗，他们遵循极低能量饮食（<3360千焦/天）8周，然后过渡到低热量饮食（约6300千焦/天）并持续至34周。通过空腹血样和口服葡萄糖耐量试验（OGTT）测定糖化血红蛋白（HbA）、空腹血糖和葡萄糖负荷后2小时血浆葡萄糖（2hG）。使用质子磁共振波谱法定量肝脏脂肪浓度。坚持的定义为在8周极低能量饮食期间体重减轻≥5%。
在8周时，坚持者（n = 5）和非坚持者（n = 3）的体重减轻中位数分别为7.5%和0.5%。总体而言，与基线相比，8周时糖化血红蛋白（平均值[标准误]从8.1%[0.7%]降至6.6%[0.5%]；p = 0.004）和2hG（从15.6[1.6]毫摩尔/升降至11.3[1.0]毫摩尔/升；p = 0.009）显著降低。肝脏脂肪也从基线时的14.7%[2.2%]显著降至8周时的5.8%[1.7%]；p = 0.001。8周时，8名参与者中只有3人符合非酒精性脂肪性肝病（NAFLD）标准（≥5.5%），而基线时8人全部符合。3名基线时接受胰岛素治疗的参与者在8周极低能量饮食期间能够停止治疗。在34周时，坚持者（n = 5）体重减轻了12.3%，无人符合NAFLD标准，4人不符合美国糖尿病协会2型糖尿病标准。
结论/解读：极低能量饮食似乎是一些接受二甲双胍治疗的2型糖尿病青年患者的可行治疗选择。同意参与并坚持极低能量饮食的青年实现了快速减重、肝脏脂肪显著减少以及2型糖尿病逆转。这凸显了极低能量饮食作为新诊断青年患者一线治疗选择的潜力。需要进行一项有对照组且随访时间更长的更大规模试验，以推动标准治疗的改变。
澳大利亚和新西兰临床试验注册号（ACTRN）ACTRN12616000375459（www.ANZCTR.org.au/ACTRN126160003754
