Shukla Alpana P, Andono Jeselin, Touhamy Samir H, Casper Anthony, Iliescu Radu G, Mauer Elizabeth, Shan Zhu Yuan, Ludwig David S, Aronne Louis J
Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, & Metabolism, Weill Cornell Medical College, New York, NY, USA.
Institute of Human Nutrition, Columbia University, New York, USA.
BMJ Open Diabetes Res Care. 2017 Sep 14;5(1):e000440. doi: 10.1136/bmjdrc-2017-000440. eCollection 2017.
There are limited data regarding the timing of carbohydrate ingestion during a meal and postprandial glucose regulation.
Sixteen subjects with type 2 diabetes mellitus (T2DM) consumed the same meal on 3 days in random order: carbohydrate first, followed 10 min later by protein and vegetables; protein and vegetables first, followed 10 min later by carbohydrate; or all components together. Blood was sampled for glucose, insulin, glucagon-like peptide-1 (GLP-1), and glucagon measurements at baseline (just before meal ingestion) and subsequently at 30 min intervals up to 180 min.
The incremental areas under the curve for glucose (iAUC) and incremental glucose peaks were 53% and 54% lower, respectively, when carbohydrate was consumed last compared with carbohydrate consumed first (3124.7±501.2 vs 6703.5±904.6 mg/dL×180min, p<0.001; 34.7±4.1 vs 75.0±6.5 mg/dL, p<0.001) and 44% and 40% lower, respectively, compared with the all components together condition (3124.7±501.2 vs 5587.1±828.7 mg/dL×180min, p=0.003; 34.7±4.1 vs 58.2±5.9 mg/dL, p<0.001). Postprandial insulin excursions were lower (iAUC: 7354.1±897.3 vs 9769.7±1002.1 µU/mL×min, p=0.003) and GLP-1 excursions higher (iAUC: 3487.56±327.7 vs 2519.11±494.8 pg/mL×min, p=0.019) following the carbohydrate-last meal order compared with carbohydrate first.
The carbohydrate-last meal pattern may be an effective behavioral strategy to improve postprandial glycemia.
关于进餐期间碳水化合物摄入时间与餐后血糖调节的数据有限。
16名2型糖尿病（T2DM）患者在3天内按随机顺序食用相同的餐食：先吃碳水化合物，10分钟后再吃蛋白质和蔬菜；先吃蛋白质和蔬菜，10分钟后再吃碳水化合物；或者同时食用所有成分。在基线（进餐前即刻）以及随后直至180分钟每隔30分钟采集血样，检测血糖、胰岛素、胰高血糖素样肽-1（GLP-1）和胰高血糖素。
与先吃碳水化合物相比，最后吃碳水化合物时，葡萄糖的曲线下增量面积（iAUC）和葡萄糖增量峰值分别降低了53%和54%（3124.7±501.2 vs 6703.5±904.6mg/dL×180分钟，p<0.001；34.7±4.1 vs 75.0±6.5mg/dL，p<0.001），与同时食用所有成分相比，分别降低了44%和40%（3124.7±501.2 vs 5587.1±828.7mg/dL×180分钟，p=0.003；34.7±4.1 vs 58.2±5.9mg/dL，p<0.001）。与先吃碳水化合物的餐食顺序相比，最后吃碳水化合物的餐食顺序餐后胰岛素波动较低（iAUC：7354.1±897.3 vs 9769.7±1002.1µU/mL×分钟，p=0.003），GLP-1波动较高（iAUC：3487.56±327.7 vs 2519.11±494.8pg/mL×分钟，p=0.019）。
最后吃碳水化合物的进餐模式可能是改善餐后血糖的一种有效行为策略。
