高风险人群中饮食血糖指数、血糖负荷和纤维与 3 年体重维持和血糖状况的剂量依赖性关联：糖尿病预防研究 PREVIEW 的二次分析。
Dose-Dependent Associations of Dietary Glycemic Index, Glycemic Load, and Fiber With 3-Year Weight Loss Maintenance and Glycemic Status in a High-Risk Population: A Secondary Analysis of the Diabetes Prevention Study PREVIEW.
机构信息
Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
Department of Food and Nutrition, University of Helsinki, Helsinki, Finland.
出版信息
Diabetes Care. 2021 Jul;44(7):1672-1681. doi: 10.2337/dc20-3092. Epub 2021 May 27.
OBJECTIVE
To examine longitudinal and dose-dependent associations of dietary glycemic index (GI), glycemic load (GL), and fiber with body weight and glycemic status during 3-year weight loss maintenance (WLM) in adults at high risk of type 2 diabetes.
RESEARCH DESIGN AND METHODS
In this secondary analysis we used pooled data from the PREVention of diabetes through lifestyle Intervention and population studies in Europe and around the World (PREVIEW) randomized controlled trial, which was designed to test the effects of four diet and physical activity interventions. A total of 1,279 participants with overweight or obesity (age 25-70 years and BMI ≥25 kg ⋅ m) and prediabetes at baseline were included. We used multiadjusted linear mixed models with repeated measurements to assess longitudinal and dose-dependent associations by merging the participants into one group and dividing them into GI, GL, and fiber tertiles, respectively.
RESULTS
In the available-case analysis, each 10-unit increment in GI was associated with a greater regain of weight (0.46 kg ⋅ year; 95% CI 0.23, 0.68; < 0.001) and increase in HbA. Each 20-unit increment in GL was associated with a greater regain of weight (0.49 kg ⋅ year; 0.24, 0.75; < 0.001) and increase in HbA. The associations of GI and GL with HbA were independent of weight change. Compared with those in the lowest tertiles, participants in the highest GI and GL tertiles had significantly greater weight regain and increases in HbA. Fiber was inversely associated with increases in waist circumference, but the associations with weight regain and glycemic status did not remain robust in different analyses.
CONCLUSIONS
Dietary GI and GL were positively associated with weight regain and deteriorating glycemic status. Stronger evidence on the role of fiber is needed.
目的
在成年人预防 2 型糖尿病高危人群的体重减轻维持（WLM） 3 年内，检查饮食血糖指数（GI）、血糖负荷（GL）和纤维与体重和血糖状态的纵向和剂量依赖性关联。
研究设计和方法
在这项二次分析中，我们使用了通过生活方式干预和世界范围内的欧洲人群研究预防糖尿病（PREVIEW）随机对照试验的汇总数据，该试验旨在测试四种饮食和体育活动干预的效果。共有 1279 名超重或肥胖（年龄 25-70 岁，BMI≥25kg·m）和基线时患有前驱糖尿病的参与者被纳入研究。我们使用多调整线性混合模型进行重复测量，通过将参与者合并为一组，并分别将他们分为 GI、GL 和纤维三分位数，来评估纵向和剂量依赖性关联。
结果
在可用病例分析中，GI 每增加 10 个单位与体重增加（0.46kg·年；95%CI0.23，0.68；<0.001）和 HbA 升高有关。GL 每增加 20 个单位与体重增加（0.49kg·年；0.24，0.75；<0.001）和 HbA 升高有关。GI 和 GL 与 HbA 的关联与体重变化无关。与最低三分位组相比，GI 和 GL 最高三分位组的体重增加和 HbA 升高显著更大。纤维与腰围增加呈负相关，但在不同分析中，与体重恢复和血糖状态的关联并不稳健。
结论
饮食 GI 和 GL 与体重恢复和血糖状态恶化呈正相关。需要更强的证据来证明纤维的作用。
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