Berk K A, Oudshoorn T P, Verhoeven A J M, Mulder M T, Roks A J M, Dik W A, Timman R, Sijbrands E J G
Department of Internal Medicine, Division of Vascular Medicine and Pharmacology, PO-Box 2040, 3000 CA, Rotterdam, The Netherlands.
Department of Immunology, PO-Box 2040, 3000 CA, Rotterdam, The Netherlands.
Clin Nutr ESPEN. 2016 Oct;15:101-106. doi: 10.1016/j.clnesp.2016.06.011. Epub 2016 Jul 25.
BACKGROUND & AIMS: Overweight and obesity increase cardiovascular mortality in patients with type 2 diabetes (T2D). In a recent trial, however, diet-induced weight loss did not reduce the cardiovascular risk of patients with T2D, possibly due to the parallel intensive medical treatment. We investigated the effect of diet-induced weight loss on cardiovascular risk factors in overweight and obese patients with T2D, and whether this effect was influenced by the use of statins, ACE inhibitors, metformin and duration of T2D.
Patients with T2D and BMI >27 were subjected to an energy-restricted diet during 4 months. Before and after intervention, plasma levels of sICAM-1, sVCAM-1, hsCRP, vWF and classical biomarkers were measured. The association of the change in biomarker levels with medication use and T2D history, corrected for age, sex and change in insulin dose, was tested by matched linear regression analyses.
In 131 patients, the diet resulted in weight loss of 10.2 kg (95%CI 9.2, 11.3; p < 0.001), improved median levels of HbA1 (-7.0 mmol/mol (95%CI -8.5, -5.0); p < 0.001), LDL cholesterol (-0.2 mmol/L (95%CI -0.4, -0.1); p < 0.001), sICAM-1 (-22.4 ng/mL (95%CI -37.1, -8.7); p = 0.001), vWF (-3.9 IU/mL (95%CI -6.4, -1.4); p = 0.003) and hs-CRP (-0.6 mg/L (95%CI -1.2, -0.2); p = 0.007), but did not affect sVCAM-1 levels (1.6 ng/mL (95%CI -41.5, 48.6); p = 0.949). Duration of T2D and medical treatment were not associated with these effects, except for an association between statin use and change in sVCAM-1, where statin users improved more.
Diet-induced weight loss reduced the levels of biomarkers of endothelial dysfunction and inflammation in overweight and obese patients with T2D independently of medication use and T2D duration. Even on intensive medical drug treatment as well as after a long history of T2D, patients may still profit from diet-induced weight reduction.
超重和肥胖会增加2型糖尿病（T2D）患者的心血管死亡率。然而，在最近一项试验中，饮食诱导的体重减轻并未降低T2D患者的心血管风险，这可能是由于同时进行了强化药物治疗。我们研究了饮食诱导的体重减轻对超重和肥胖T2D患者心血管危险因素的影响，以及这种影响是否受他汀类药物、血管紧张素转换酶（ACE）抑制剂、二甲双胍的使用以及T2D病程的影响。
BMI>27的T2D患者接受为期4个月的能量限制饮食。在干预前后，测量可溶性细胞间黏附分子-1（sICAM-1）、可溶性血管细胞黏附分子-1（sVCAM-1）、高敏C反应蛋白（hsCRP）、血管性血友病因子（vWF）的血浆水平以及经典生物标志物。通过匹配线性回归分析，检测生物标志物水平变化与药物使用和T2D病史之间的关联，并对年龄、性别和胰岛素剂量变化进行校正。
131例患者通过饮食实现了10.2kg的体重减轻（95%CI 9.2，11.3；p<0.001），糖化血红蛋白（HbA1）的中位数水平改善（-7.0 mmol/mol（95%CI -8.5，-5.0）；p<0.001），低密度脂蛋白胆固醇（LDL胆固醇）（-0.2 mmol/L（95%CI -0.4，-0.1）；p<0.001），sICAM-1（-22.4 ng/mL（95%CI -37.1，-8.7）；p=0.001），vWF（-3.9 IU/mL（95%CI -6.4，-1.4）；p=0.003）和hs-CRP（-0.6 mg/L（95%CI -1.2，-0.2）；p=0.007），但未影响sVCAM-1水平（1.6 ng/mL（95%CI -41.5，48.6）；p=0.949）。除了他汀类药物使用与sVCAM-1变化之间存在关联（他汀类药物使用者改善更明显）外，T2D病程和药物治疗与这些影响无关。
饮食诱导的体重减轻可降低超重和肥胖T2D患者内皮功能障碍和炎症的生物标志物水平，且与药物使用和T2D病程无关。即使在强化药物治疗以及T2D病程较长的情况下，患者仍可能从饮食诱导的体重减轻中获益。
