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膳食蛋白质摄入对肥胖患者胰岛素抵抗的影响:一项随机对照临床试验。

Effect of the intake of dietary protein on insulin resistance in subjects with obesity: a randomized controlled clinical trial.

机构信息

Department of Nutrition Physiology, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico.

Scientific Bonding Unit, Medicine Faculty UNAM-INMEGEN, Mexico City, Mexico.

出版信息

Eur J Nutr. 2021 Aug;60(5):2435-2447. doi: 10.1007/s00394-020-02428-5. Epub 2020 Nov 3.

Abstract

PURPOSE

We compared the effect of diets with different amounts and sources of dietary protein on insulin sensitivity (IS) in subjects with obesity and insulin resistance (IR).

METHODS

Eighty subjects with obesity (BMI ≥ 30 kg/m) and IR (Matsuda index < 4.3 and HOMA-IR ≥ 2.5) over 18 years old were randomized to four groups for a one-month period: a normal protein diet (< 20%) with a predominance of animal protein (Animal NP) or vegetable protein (Vegetable NP) and a high-protein diet (25-30%) with a predominance of animal protein (Animal HP) or vegetable protein (Vegetable HP). Baseline and final measurements of body weight, body composition, biochemical parameters, blood pressure (BP), resting energy expenditure and plasma amino acid profiles were performed.

RESULTS

Body weight, BMI and waist circumference decreased in all groups. Interestingly, the IS improved more in the Animal HP (Matsuda index; 1.39 vs 2.58, P = 0.003) and in the Vegetable HP groups (Matsuda index; 1.44 vs 3.14, P < 0.0001) after one month. The fat mass, triglyceride levels, C-reactive protein levels and the leptin/adiponectin index decreased; while, the skeletal muscle mass increased in the Animal and Vegetable HP groups. The BP decreased in all groups except the Animal NP group.

CONCLUSION

Our study demonstrates that a high-protein hypocaloric diets improves IS by 60-90% after one month in subjects with obesity and IR, regardless of weight loss and the source of protein, either animal or vegetable.

TRIAL REGISTRATION

The trial is registered at clinicaltrials.gov (NCT03627104), August 13, 2018.

摘要

目的

我们比较了不同数量和来源的膳食蛋白质对肥胖和胰岛素抵抗(IR)患者胰岛素敏感性(IS)的影响。

方法

80 名年龄在 18 岁以上、肥胖(BMI≥30kg/m)且 IR(Matsuda 指数<4.3 和 HOMA-IR≥2.5)的患者被随机分为四组,进行为期一个月的研究:正常蛋白质饮食(<20%),以动物蛋白(Animal NP)或植物蛋白(Vegetable NP)为主;高蛋白饮食(25-30%),以动物蛋白(Animal HP)或植物蛋白(Vegetable HP)为主。在基线和最后一次测量时,对体重、身体成分、生化参数、血压(BP)、静息能量消耗和血浆氨基酸谱进行了测量。

结果

所有组的体重、BMI 和腰围均降低。有趣的是,在 Animal HP 组(Matsuda 指数;1.39 对 2.58,P=0.003)和 Vegetable HP 组(Matsuda 指数;1.44 对 3.14,P<0.0001),IS 在一个月后改善更为明显。脂肪量、甘油三酯水平、C 反应蛋白水平和瘦素/脂联素指数降低,而 Animal 和 Vegetable HP 组的骨骼肌质量增加。除了 Animal NP 组,所有组的血压均降低。

结论

我们的研究表明,高蛋白低热量饮食在一个月内可使肥胖和 IR 患者的 IS 改善 60-90%,无论体重减轻和蛋白质来源是动物蛋白还是植物蛋白。

试验注册

该试验于 2018 年 8 月 13 日在 clinicaltrials.gov 注册(NCT03627104)。

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