血清晚期糖基化终产物水平升高与营养不良（主观全面评定法）评分与II型糖尿病视网膜病变严重程度之间的相互关系。

Interrelationship of elevated serum Advanced Glycation End-product levels and malnutrition (Subjective Global Assessment) scores with the severity of retinopathy in type II diabetes.

作者信息

Sharma Yashodhara, Saxena Sandeep, Saxena Anita, Mishra Arvind, Natu Shankar Madhav

机构信息

Department of Ophthalmology, King George Medical University, Lucknow, Uttar Pradesh, India.

出版信息

Clin Nutr ESPEN. 2015 Feb;10(1):e42-e48. doi: 10.1016/j.clnesp.2014.12.002. Epub 2015 Jan 28.

DOI:10.1016/j.clnesp.2014.12.002

PMID:28531446

Abstract

BACKGROUND AND AIMS

Hyperglycemia in diabetes causes endogenous formation of Advanced Glycation End-products (AGEs) which accumulate in various body parts including retina causing diabetic retinopathy. AGEs also originate from exogenous dietary sources contributing to the body's AGE pool. Currently, curing of diabetic retinopathy is mainly focused on medication, surgical or laser interventions and not much emphasis is given on preventing or halting its occurrence or advancement to more severe stages, nutritionally. Planning a 'low glycemic index-low AGE' diet therapy for diabetic subjects can reduce endogenous and exogenous origin AGEs in the body and help in controlling retinopathy. Sound and accurate assessment of nutritional status is a crucial step for planning a therapeutic diet for this condition. As this aspect has not gained sufficient attention till now we are assessing the association of serum Advanced Glycation End-product (AGE) levels with the severity of diabetic retinopathy and for the first time estimating the nutritional status of subjects with this eye disorder for long term patient care.

METHODS

This was a tertiary care centre-based, case-control study involving sixty three consecutive cases with diabetes divided as 21 cases with diabetes but no retinopathy, 21 cases with non proliferative diabetic retinopathy (NPDR), 21 cases with proliferative diabetic retinopathy (PDR) along with 21 healthy controls. Serum AGE levels of all the cases and controls were evaluated by Enzyme Linked Immuno Sorbent Assay (ELISA) and nutritional status was assessed by anthropometric measurements and SGA scores.

RESULTS

Serum AGE levels were found significantly elevated in PDR group when compared with no retinopathy (p < 0.05) and control (p < 0.001) group. Control group was also significantly different from (p < 0.05) from NPDR group. Increase in SGA scores was statistically significant amongst the four study groups though other indices of nutritional status showed no definite trend with the increasing severity of retinopathy.

CONCLUSION

Our study shows that serum AGE levels are potential risk markers of diabetic retinopathy and SGA can be used as a regular tool for the assessment of nutritional status of diabetic retinopathy subjects which will help planning a 'low glycemic index-low AGE' therapeutic diet for halting this morbidity.

摘要

背景与目的

糖尿病中的高血糖会导致晚期糖基化终产物（AGEs）的内源性形成，这些产物会在包括视网膜在内的身体各个部位积累，从而引发糖尿病视网膜病变。AGEs也来源于外源性饮食，会增加体内的AGE池。目前，糖尿病视网膜病变的治疗主要集中在药物、手术或激光干预上，在营养方面，对于预防或阻止其发生或发展到更严重阶段的重视程度不够。为糖尿病患者规划“低血糖指数-低AGE”饮食疗法可以减少体内内源性和外源性来源的AGEs，并有助于控制视网膜病变。对营养状况进行合理准确的评估是针对这种情况规划治疗性饮食的关键步骤。由于到目前为止这方面尚未得到足够的关注，我们正在评估血清晚期糖基化终产物（AGE）水平与糖尿病视网膜病变严重程度之间的关联，并首次评估患有这种眼部疾病的患者的营养状况，以便进行长期的患者护理。

方法

这是一项基于三级护理中心的病例对照研究，连续纳入63例糖尿病患者，分为21例无视网膜病变的糖尿病患者、21例非增殖性糖尿病视网膜病变（NPDR）患者、21例增殖性糖尿病视网膜病变（PDR）患者以及21例健康对照。通过酶联免疫吸附测定（ELISA）评估所有病例和对照的血清AGE水平，并通过人体测量和主观全面评定（SGA）评分评估营养状况。