Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg Campus, Copenhagen, Denmark.
Nat Rev Endocrinol. 2020 Oct;16(10):545-555. doi: 10.1038/s41574-020-0381-5. Epub 2020 Jul 20.
Evidence from observational studies and randomized trials suggests that prediabetes and type 2 diabetes mellitus (T2DM) can develop in genetically susceptible individuals in parallel with weight (that is, fat) gain. Accordingly, studies show that weight loss can produce remission of T2DM in a dose-dependent manner. A weight loss of ~15 kg, achieved by calorie restriction as part of an intensive management programme, can lead to remission of T2DM in ~80% of patients with obesity and T2DM. However, long-term weight loss maintenance is challenging. Obesity and T2DM are associated with diminished glucose uptake in the brain that impairs the satiating effect of dietary carbohydrate; therefore, carbohydrate restriction might help maintain weight loss and maximize metabolic benefits. Likewise, increases in physical activity and fitness are an important contributor to T2DM remission when combined with calorie restriction and weight loss. Preliminary studies suggest that a precision dietary management approach that uses pretreatment glycaemic status to stratify patients can help optimize dietary recommendations with respect to carbohydrate, fat and dietary fibre. This approach might lead to improved weight loss maintenance and glycaemic control. Future research should focus on better understanding the individual response to dietary treatment and translating these findings into clinical practice.
观察性研究和随机试验的证据表明，在遗传易感个体中，糖尿病前期和 2 型糖尿病（T2DM）可以与体重（即脂肪）增加同时发生。因此，研究表明，体重减轻可以以剂量依赖的方式产生 T2DM 的缓解。通过热量限制作为强化管理计划的一部分实现的约 15kg 的体重减轻，可以使约 80%的肥胖和 T2DM 患者的 T2DM 得到缓解。然而，长期保持体重减轻是具有挑战性的。肥胖和 T2DM 与大脑中葡萄糖摄取减少有关，这会损害膳食碳水化合物的饱腹感作用；因此，碳水化合物限制可能有助于维持体重减轻并最大限度地提高代谢益处。同样，增加身体活动和健康水平也是与热量限制和体重减轻相结合使 T2DM 缓解的重要因素。初步研究表明，一种使用治疗前血糖状态对患者进行分层的精确饮食管理方法可以帮助优化碳水化合物、脂肪和膳食纤维的饮食建议。这种方法可能会导致更好的体重减轻维持和血糖控制。未来的研究应重点更好地了解个体对饮食治疗的反应，并将这些发现转化为临床实践。
