能量限制的低碳水化合物、高不饱和脂肪/低饱和脂肪饮食与 2 型糖尿病的高碳水化合物、低脂肪饮食的效果比较：一项为期 2 年的随机临床试验。

Effects of an energy-restricted low-carbohydrate, high unsaturated fat/low saturated fat diet versus a high-carbohydrate, low-fat diet in type 2 diabetes: A 2-year randomized clinical trial.

机构信息

Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Adelaide, Australia.

Discipline of Medicine, University of Adelaide, Adelaide, Australia.

出版信息

Diabetes Obes Metab. 2018 Apr;20(4):858-871. doi: 10.1111/dom.13164. Epub 2017 Dec 20.

DOI:10.1111/dom.13164

PMID:29178536

Abstract

AIM

To examine whether a low-carbohydrate, high-unsaturated/low-saturated fat diet (LC) improves glycaemic control and cardiovascular disease (CVD) risk factors in overweight and obese patients with type 2 diabetes (T2D).

METHODS

A total of 115 adults with T2D (mean [SD]; BMI, 34.6 [4.3] kg/m ; age, 58 [7] years; HbA1c, 7.3 [1.1]%) were randomized to 1 of 2 planned energy-matched, hypocaloric diets combined with aerobic/resistance exercise (1 hour, 3 days/week) for 2 years: LC: 14% energy as carbohydrate, 28% as protein, 58% as fat (<10% saturated fat); or low-fat, high-carbohydrate, low-glycaemic index diet (HC): 53% as CHO, 17% as protein, 30% as fat (<10% saturated fat). HbA1c, glycaemic variability (GV), anti-glycaemic medication effect score (MES, calculated based on the potency and dosage of diabetes medication), weight, body composition, CVD and renal risk markers were assessed before and after intervention.

RESULTS

A total of 61 (LC = 33, HC = 28) participants completed the study (trial registration: http://www.anzctr.org.au/, ANZCTR No. ACTRN12612000369820). Reductions in weight (estimated marginal mean [95% CI]; LC, -6.8 [-8.8,-4.7], HC, -6.6 [-8.8, -4.5] kg), body fat (LC, -4.3 [-6.2, -2.4], HC, -4.6 [-6.6, -2.7] kg), blood pressure (LC, -2.0 [-5.9, 1.8]/ -1.2 [-3.6, 1.2], HC, -3.2 [-7.3, 0.9]/ -2.0 [-4.5, 0.5] mmHg), HbA1c (LC, -0.6 [-0.9, -0.3], HC, -0.9 [-1.2, -0.5] %) and fasting glucose (LC, 0.3 [-0.4, 1.0], HC, -0.4 [-1.1, 0.4] mmol/L) were similar between groups (P ≥ 0.09). Compared to HC, the LC achieved greater reductions in diabetes medication use (MES; LC, -0.5 [-0.6, -0.3], HC, -0.2 [-0.4, -0.02] units; P = 0.03), GV (Continuous Overall Net Glycemic Action calculated every 1 hour (LC, -0.4 [-0.6, -0.3], HC, -0.1 [-0.1, 0.2] mmol/L; P = 0.001), and 4 hours (LC, -0.9 [-1.3, -0.6], HC, -0.2 [-0.6, 0.1] mmol/L; P = 0.02)); triglycerides (LC, -0.1 [-0.3, 0.2], HC, 0.1 [-0.2, 0.3] mmol/L; P = 0.001), and maintained HDL-C levels (LC, 0.02 [-0.05, 0.1], HC, -0.1 [-0.1, 0.01] mmol/L; P = 0.004), but had similar changes in LDL-C (LC, 0.2 [-0.1, 0.5], HC, 0.1 [-0.2, 0.4] mmol/L; P = 0.85), brachial artery flow mediated dilatation (LC, -0.5 [-1.5, 0.5], HC, -0.4 [-1.4, 0.7] %; P = 0.73), eGFR and albuminuria.

CONCLUSIONS

Both diets achieved comparable weight loss and HbA1c reductions. The LC sustained greater reductions in diabetes medication requirements, and in improvements in diurnal blood glucose stability and blood lipid profile, with no adverse renal effects, suggesting greater optimization of T2D management.

摘要

目的

研究低碳水化合物、高不饱和/低饱和脂肪饮食（LC）是否能改善超重和肥胖 2 型糖尿病（T2D）患者的血糖控制和心血管疾病（CVD）风险因素。

方法

共有 115 名 T2D 患者（平均[标准差]；BMI，34.6[4.3]kg/m2；年龄，58[7]岁；HbA1c，7.3[1.1]%）被随机分配到 2 种计划能量匹配、低热量的饮食中，同时进行有氧运动/抗阻运动（1 小时，每周 3 天），持续 2 年：LC：碳水化合物占 14%，蛋白质占 28%，脂肪占 58%（<10%饱和脂肪）；或低脂、高碳水化合物、低血糖生成指数饮食（HC）：CHO 占 53%，蛋白质占 17%，脂肪占 30%（<10%饱和脂肪）。在干预前后评估了 HbA1c、血糖变异性（GV）、抗血糖药物效果评分（MES，根据糖尿病药物的效力和剂量计算）、体重、身体成分、CVD 和肾脏风险标志物。

结果

共有 61 名（LC=33，HC=28）参与者完成了研究（试验注册：http://www.anzctr.org.au/，ANZCTR No. ACTRN12612000369820）。体重（估计边缘均值[95%CI]；LC，-6.8[-8.8，-4.7]，HC，-6.6[-8.8，-4.5]kg）、体脂（LC，-4.3[-6.2，-2.4]，HC，-4.6[-6.6，-2.7]kg）、血压（LC，-2.0[-5.9，1.8]/-1.2[-3.6，1.2]，HC，-3.2[-7.3，0.9]/-2.0[-4.5，0.5]mmHg）、HbA1c（LC，-0.6[-0.9，-0.3]，HC，-0.9[-1.2，-0.5]%）和空腹血糖（LC，0.3[-0.4，1.0]，HC，-0.4[-1.1，0.4]mmol/L）在两组之间相似（P≥0.09）。与 HC 相比，LC 组在糖尿病药物使用方面的降幅更大（MES；LC，-0.5[-0.6，-0.3]，HC，-0.2[-0.4，-0.02]单位；P=0.03），GV（每 1 小时计算的连续总体净血糖作用（LC，-0.4[-0.6，-0.3]，HC，-0.1[-0.1，0.2]mmol/L；P=0.001）和 4 小时（LC，-0.9[-1.3，-0.6]，HC，-0.2[-0.6，0.1]mmol/L；P=0.02））和血脂谱（LC，-0.1[-0.3，0.2]，HC，0.1[-0.2，0.3]mmol/L；P=0.001），并保持 HDL-C 水平（LC，0.02[-0.05，0.1]，HC，-0.1[-0.1，0.01]mmol/L；P=0.004），但 LDL-C 变化相似（LC，0.2[-0.1，0.5]，HC，0.1[-0.2，0.4]mmol/L；P=0.85）、肱动脉血流介导的扩张（LC，-0.5[-1.5，0.5]，HC，-0.4[-1.4，0.7]%）、eGFR 和白蛋白尿。