School of Health and Exercise Sciences, University of British Columbia, Okanagan, Canada.
Am J Clin Nutr. 2019 May 1;109(5):1302-1309. doi: 10.1093/ajcn/nqy261.
The breakfast meal often results in the largest postprandial hyperglycemic excursion in people with type 2 diabetes.
Our purpose was to investigate whether restricting carbohydrates at breakfast would be a simple and feasible strategy to reduce daily exposure to postprandial hyperglycemia.
Adults with physician-diagnosed type 2 diabetes [n = 23; mean ± SD age: 59 ± 11 y; glycated hemoglobin: 6.7% ± 0.6%; body mass index (kg/m2): 31 ± 7] completed two 24-h isocaloric intervention periods in a random order. Participants consumed one of the following breakfasts: 1) a very-low-carbohydrate high-fat breakfast (LCBF; <10% of energy from carbohydrate, 85% of energy from fat, 15% of energy from protein) or 2) a breakfast with dietary guidelines-recommended nutrient profile (GLBF; 55% of energy from carbohydrate, 30% of energy from fat, 15% of energy from protein), with the same lunch and dinner provided. Continuous glucose monitoring was used to assess postprandial glucose responses over 24 h, and visual analog scales were used to assess ratings of hunger and fullness.
The LCBF significantly reduced postprandial hyperglycemia after breakfast (P < 0.01) and did not adversely affect glycemia after lunch or dinner. As such, overall postprandial hyperglycemia (24-h incremental area under the glucose curve) and glycemic variability (mean amplitude of glycemic excursions) were reduced with the LCBF (24-h incremental area under the glucose curve: -173 ± 361 mmol/L; P = 0.03; mean amplitude of glycemic excursions: -0.4 ± 0.8 mmol/L · 24 h; P = 0.03) compared with the GLBF. Premeal hunger was lower before dinner with the LCBF than with the GLBF (P-interaction = 0.03).
A very-low-carbohydrate high-fat breakfast lowers postbreakfast glucose excursions. The effects of this simple strategy appear to be sufficient to lower overall exposure to postprandial hyperglycemia and improve glycemic variability. Longer-term interventions are warranted. This trial was registered at clinicaltrials.gov as NCT02982330.
对于 2 型糖尿病患者来说，早餐往往会导致餐后血糖最大幅度的升高。
我们旨在研究限制早餐碳水化合物的摄入量是否是一种简单可行的策略，可以减少每日餐后高血糖的暴露。
患有经医生诊断的 2 型糖尿病的成年人[n=23；平均（±SD）年龄：59（±11）岁；糖化血红蛋白：6.7%（±0.6%）；体重指数（kg/m2）：31（±7）]以随机顺序完成了两个 24 小时等热量干预期。参与者摄入以下两种早餐之一：1）极低碳水化合物高脂肪早餐（LCBF；<10%的能量来自碳水化合物，85%的能量来自脂肪，15%的能量来自蛋白质）或 2）具有饮食指南推荐的营养谱的早餐（GLBF；55%的能量来自碳水化合物，30%的能量来自脂肪，15%的能量来自蛋白质），并提供相同的午餐和晚餐。连续血糖监测用于评估 24 小时内的餐后血糖反应，视觉模拟量表用于评估饥饿感和饱腹感。
LCBF 可显著降低早餐后的餐后高血糖（P<0.01），且不会对午餐或晚餐后的血糖产生不利影响。因此，LCBF 降低了整体餐后高血糖（24 小时葡萄糖曲线下增量面积）和血糖变异性（血糖波动幅度）（24 小时葡萄糖曲线下增量面积：-173±361 mmol/L；P=0.03；血糖波动幅度：-0.4±0.8 mmol/L·24 h；P=0.03），而 GLBF 则没有。与 GLBF 相比，LCBF 时晚餐前的餐前饥饿感较低（P 交互作用=0.03）。
极低碳水化合物高脂肪早餐可降低早餐后血糖波动。这种简单策略的效果似乎足以降低整体餐后高血糖的暴露，并改善血糖变异性。需要进行更长期的干预。本试验在 clinicaltrials.gov 上注册为 NCT02982330。
