Department of Nutrition, Exercise and Sports, Københavns Universitet, Copenhagen, Denmark.
Department of Physiology, Faculty of Medicine, The University of Jeddah, Jeddah, Saudi Arabia.
Eur J Nutr. 2021 Dec;60(8):4473-4482. doi: 10.1007/s00394-021-02605-0. Epub 2021 Jun 8.
We previously reported beneficial glucoregulatory effects of a fully provided carbohydrate-reduced, high-protein (CRHP) diet in patients with type 2 diabetes mellitus (T2DM) in a crossover 2 × 6-week trial, in which patients maintained their body weight. Here, we investigated physiological changes during an additional 6-month period on a self-selected and self-prepared CRHP diet.
Twenty-eight patients with T2DM were instructed to consume a CRHP diet (30% of energy from carbohydrate and 30% from protein) for 24 weeks, after an initial 2 × 6-week trial when all food was prepared and provided to them. Patients received dietary advice every 2 weeks. At weeks 0, 6, 12 and 36, they underwent a 3-h intravenous glucose tolerance test, a 4-h mixed meal test, and a 48-h continuous glucose monitoring. Liver, muscle, pancreas, and visceral fat contents were measured by magnetic resonance imaging.
During the 24-week self-selected diet period (weeks 12-36), body weight, visceral fat, liver fat, and glycated haemoglobin were maintained at the same levels achieved at the end of the fully provided diet period, and were still lower than at baseline (P < 0.05). Postprandial insulinaemia and insulin secretion were significantly greater (P < 0.05). At week 36, fasting insulin and C-peptide levels increased (P < 0.01) and daily glycaemia decreased further (P < 0.05) when compared with the end of the fully provided diet period.
Substituting dietary carbohydrate for protein and fat has metabolic benefits in patients with T2DM. These beneficial effects are maintained or augmented over the next 6 months when patients self-select and self-prepare this diet in a dietitian-supported setting.
ClinicalTrials.gov NCT02764021.
我们之前报道过在一项交叉 2×6 周试验中，对于 2 型糖尿病（T2DM）患者，全提供碳水化合物减少、高蛋白（CRHP）饮食具有有益的糖调节作用，在此期间患者保持体重。在这里，我们研究了在自行选择和自行准备 CRHP 饮食的额外 6 个月期间的生理变化。
28 例 T2DM 患者被指示在初始的 2×6 周试验后，连续 24 周内食用 CRHP 饮食（碳水化合物供能 30%，蛋白质供能 30%），在此期间所有食物都由研究人员提供。患者每两周接受一次饮食建议。在 0、6、12 和 36 周时，患者进行了 3 小时静脉葡萄糖耐量试验、4 小时混合餐试验和 48 小时连续血糖监测。采用磁共振成像测量肝脏、肌肉、胰腺和内脏脂肪含量。
在 24 周的自行选择饮食期间（第 12-36 周），体重、内脏脂肪、肝脂肪和糖化血红蛋白维持在完全提供饮食期结束时达到的水平，且仍低于基线水平（P<0.05）。餐后胰岛素血症和胰岛素分泌显著增加（P<0.05）。与完全提供饮食期结束时相比，第 36 周时空腹胰岛素和 C 肽水平升高（P<0.01），日间血糖进一步降低（P<0.05）。
用蛋白质和脂肪替代膳食碳水化合物对 T2DM 患者具有代谢益处。在营养师支持的环境下，当患者自行选择和准备这种饮食时，这些有益的效果在接下来的 6 个月内得到维持或增强。
ClinicalTrials.gov NCT02764021。
