Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; Department of Clinical Nutrition, Landspitali University Hospital, Reykjavik, Iceland.
Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland.
Clin Nutr. 2020 Apr;39(4):1085-1091. doi: 10.1016/j.clnu.2019.04.010. Epub 2019 Apr 25.
Oral nutrition support is frequently used in treatment of malnutrition in patients with chronic obstructive pulmonary disease (COPD). Considering the use of corticoidsteroids in patients with COPD, little is known about the effect on postprandial glucose response and if they might interfere with glucose control. Our aims were to compare the effect of a liquid oral nutritional supplement (ONS) and semi solid inbetween meal snack (snack) on postprandial glucose and energy- and protein intake, and to compare the effect of timing of each intervention on postprandial glucose and energy- and protein intake.
Patients with COPD (n = 17) admitted to the Department of Pulmonary Medicine, Iceland and defined as at low or medium nutritional risk (score 0-3) were recruited. In a randomised cross-over design, subjects consumed ONS or snack either in a fasting state (study 1) or following breakfast (study 2) and postprandial glucose responses were assessed at regular intervals for two hours (t = 15, t = 30, t = 45, t = 60, t = 90, t = 120 min). Energy- and protein intake was estimated using a validated plate diagram sheet. Wilcoxon Signed-Rank test was used to compare the two interventions.
In study 2, following breakfast, postprandial glucose was significantly higher after consuming ONS than the snack after 60 min (9.7 ± 2.4 mmol/L vs. 8.2 ± 3.2 mmol/L, p = 0.013 and 120 min 9.2 ± 3.2 mmol/L vs. 7.9 ± 2.4 mmol/L, p = 0.021, respectively). No difference was found in postprandial glucose concentrations between ONS and the snack when consumed after overnight fasting (study 1). No difference in energy or protein intake from hospital food was seen between supplement types neither in study 1 or 2.
Lower postprandial glucose concentrations were associated with the snack compared to ONS when taken after a meal compared to either type directly after overnight fasting. The clinical relevance of higher postprandial blood glucose after consuming a liquid ONS after breakfast compared with a semi solid snack needs to be studied further.
口服营养支持常用于治疗慢性阻塞性肺疾病（COPD）患者的营养不良。鉴于 COPD 患者常使用皮质类固醇，关于其对餐后血糖反应的影响以及是否会干扰血糖控制的信息知之甚少。我们的目的是比较液体口服营养补充剂（ONS）和半固体加餐之间对餐后血糖以及能量和蛋白质摄入的影响，并比较每种干预措施的时间对餐后血糖以及能量和蛋白质摄入的影响。
招募了因 COPD 入住冰岛肺病科且被定义为低或中营养风险（评分 0-3）的患者（n=17）。采用随机交叉设计，受试者在空腹状态下（研究 1）或早餐后（研究 2）摄入 ONS 或加餐，在两小时内定期评估餐后血糖反应（t=15、t=30、t=45、t=60、t=90、t=120 分钟）。使用经过验证的餐盘图来估计能量和蛋白质的摄入量。采用 Wilcoxon 符号秩检验比较两种干预措施。
在研究 2 中，早餐后，ONS 组的餐后血糖在 60 分钟（9.7±2.4mmol/L 比 8.2±3.2mmol/L，p=0.013）和 120 分钟（9.2±3.2mmol/L 比 7.9±2.4mmol/L，p=0.021）时明显高于加餐组。ONS 组和加餐组在隔夜禁食后摄入时，餐后血糖浓度无差异（研究 1）。研究 1 和 2 中，两种补充剂类型的医院食物的能量和蛋白质摄入均无差异。
与直接在夜间禁食后摄入相比，ONS 组在餐后摄入时与加餐相比，餐后血糖浓度较低。与半固体加餐相比，ONS 组在早餐后摄入后，餐后血糖升高的临床相关性需要进一步研究。
