Department of Diabetology, Dr Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India.
Department of Foods Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, India.
Indian J Med Res. 2018 Nov;148(5):531-538. doi: 10.4103/ijmr.IJMR_1698_18.
Dietary carbohydrates form the major source of energy in Asian diets. The carbohydrate quantity and quality play a vital function in the prevention and management of diabetes. High glycaemic index foods elicit higher glycaemic and insulinaemic responses and promote insulin resistance and type 2 diabetes (T2D) through beta-cell exhaustion. This article reviews the evidence associating dietary carbohydrates to the prevalence and incidence of T2D and metabolic syndrome (MS) in control of diabetes and their role in the complications of diabetes. Cross-sectional and longitudinal studies show that higher carbohydrate diets are linked to higher prevalence and incidence of T2D. However, the association seems to be stronger in Asian-Indians consuming diets high in carbohydrates and more marked on a background of obesity. There is also evidence for high carbohydrate diets and risk for MS and cardiovascular disease (CVD). However, the quality of carbohydrates is also equally important. Complex carbohydrates such as brown rice, whole wheat bread, legumes, pulses and green leafy vegetables are good carbs. Conversely, highly polished rice or refined wheat, sugar, glucose, highly processed foods such as cookies and pastries, fruit juice and sweetened beverages and fried potatoes or French fries are obviously 'bad' carbs. Ultimately, it is all a matter of balance and moderation in diet. For Indians who currently consume about 65-75 per cent of calories from carbohydrates, reducing this to 50-55 per cent and adding enough protein (20-25%) especially from vegetable sources and the rest from fat (20-30%) by including monounsaturated fats (e.g. groundnut or mustard oil, nuts and seeds) along with a plenty of green leafy vegetables, would be the best diet prescription for the prevention and management of non-communicable diseases such as T2D and CVD.
亚洲饮食中的碳水化合物主要提供能量。碳水化合物的数量和质量在糖尿病的预防和管理中起着至关重要的作用。高血糖指数的食物会引起更高的血糖和胰岛素反应，通过β细胞衰竭促进胰岛素抵抗和 2 型糖尿病（T2D）。本文综述了与饮食碳水化合物相关的证据，这些证据与 T2D 和代谢综合征（MS）的流行和发病率有关，以及它们在糖尿病并发症中的作用。横断面和纵向研究表明，高碳水化合物饮食与 T2D 的高流行率和发病率有关。然而，这种关联在食用高碳水化合物饮食的亚洲印度人中似乎更强，在肥胖的背景下更为明显。也有证据表明高碳水化合物饮食与 MS 和心血管疾病（CVD）的风险有关。然而，碳水化合物的质量也同样重要。糙米、全麦面包、豆类、豆类和绿叶蔬菜等复杂碳水化合物是优质碳水化合物。相反，高度精制的大米或精制小麦、糖、葡萄糖、高度加工的食品，如饼干和糕点、果汁和甜饮料以及炸薯条或法式炸薯条，显然是“坏”碳水化合物。归根结底，饮食的平衡和适度才是最重要的。对于目前摄入约 65-75%卡路里来自碳水化合物的印度人来说，将其减少到 50-55%，并通过添加足够的蛋白质（20-25%），特别是来自植物来源的蛋白质，以及其余的脂肪（20-30%），包括单不饱和脂肪（例如花生油或芥子油、坚果和种子），同时摄入大量绿叶蔬菜，将是预防和管理非传染性疾病（如 T2D 和 CVD）的最佳饮食方案。
