在 PREVIEW 生活方式干预研究中，报告和估计的蛋白质和能量摄入变化与胰岛素抵抗、糖化血红蛋白和 BMI 的变化之间的关联。
Associations of changes in reported and estimated protein and energy intake with changes in insulin resistance, glycated hemoglobin, and BMI during the PREVIEW lifestyle intervention study.
机构信息
Department of Nutrition and Movement Sciences, NUTRIM-School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands.
MRC/Arthritis Research UK (ARUK) Centre for Musculoskeletal Ageing Research, ARUK Centre for Sport, Exercise, and Osteoarthritis, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Division of Physiology, Pharmacology, and Neuroscience, School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom.
出版信息
Am J Clin Nutr. 2021 Nov 8;114(5):1847-1858. doi: 10.1093/ajcn/nqab247.
BACKGROUND
Observed associations of high-protein diets with changes in insulin resistance are inconclusive.
OBJECTIVES
We aimed to assess associations of changes in both reported and estimated protein (PRep; PEst) and energy intake (EIRep; EIEst) with changes in HOMA-IR, glycated hemoglobin (HbA1c), and BMI (in kg/m2), in 1822 decreasing to 833 adults (week 156) with overweight and prediabetes, during the 3-y PREVIEW (PREVention of diabetes through lifestyle intervention and population studies In Europe and around the World) study on weight-loss maintenance. Eating behavior and measurement errors (MEs) of dietary intake were assessed. Thus, observational post hoc analyses were applied.
METHODS
Associations of changes in EIEst, EIRep, PEst, and PRep with changes in HOMA-IR, HbA1c, and BMI were determined by linear mixed-model analysis in 2 arms [high-protein-low-glycemic-index (GI) diet and moderate-protein-moderate-GI diet] of the PREVIEW study. EIEst was derived from energy requirement: total energy expenditure = basal metabolic rate × physical activity level; PEst from urinary nitrogen, and urea. MEs were calculated as [(EIEst - EIRep)/EIEst] × 100% and [(PRep - PEst)/PEst] × 100%. Eating behavior was determined using the Three Factor Eating Questionnaire, examining cognitive dietary restraint, disinhibition, and hunger.
RESULTS
Increases in PEst and PRep and decreases in EIEst and EIRep were associated with decreases in BMI, but not independently with decreases in HOMA-IR. Increases in PEst and PRep were associated with decreases in HbA1c. PRep and EIRep showed larger changes and stronger associations than PEst and EIEst. Mean ± SD MEs of EIRep and PRep were 38% ± 9% and 14% ± 4%, respectively; ME changes in EIRep and En% PRep were positively associated with changes in BMI and cognitive dietary restraint and inversely with disinhibition and hunger.
CONCLUSIONS
During weight-loss maintenance in adults with prediabetes, increase in protein intake and decrease in energy intake were not associated with decrease in HOMA-IR beyond associations with decrease in BMI. Increases in PEst and PRep were associated with decrease in HbA1c.This trial was registered at clinicaltrials.gov as NCT01777893.
背景
高蛋白饮食与胰岛素抵抗变化之间的关联尚无定论。
目的
我们旨在评估报告和估计的蛋白质（PRep；PEst）和能量摄入（EIRep；EIEst）的变化与 HOMA-IR、糖化血红蛋白（HbA1c）和体重指数（BMI）变化之间的关联，在减肥维持的 PREVIEW（通过生活方式干预和人群研究预防糖尿病在欧洲和世界各地）研究中，1822 名超重和糖尿病前期患者减少到 833 名成年人（第 156 周）。评估了饮食摄入的饮食行为和测量误差（MEs）。因此，应用了观察后分析。
方法
通过线性混合模型分析，在 PREVIEW 研究的 2 个组[高蛋白-低血糖指数（GI）饮食和中蛋白-中 GI 饮食]中，确定了 EIEst、EIRep、PEst 和 PRep 的变化与 HOMA-IR、HbA1c 和 BMI 的变化之间的关联。EIEst 由能量需求得出：总能量消耗=基础代谢率×体力活动水平；PEst 来自尿氮和尿素。ME 计算为[(EIEst-EIRep)/EIEst]×100%和[(PRep-PEst)/PEst]×100%。使用三因素饮食问卷确定饮食行为，检查认知饮食限制、抑制和饥饿。
结果
PEst 和 PRep 的增加以及 EIEst 和 EIRep 的减少与 BMI 的减少相关，但与 HOMA-IR 的减少无关。PEst 和 PRep 的增加与 HbA1c 的减少相关。与 PEst 和 EIEst 相比，PRep 和 EIRep 显示出更大的变化和更强的关联。EIRep 和 PRep 的平均±SD ME 分别为 38%±9%和 14%±4%；EIRep 和 En%PRep 的 ME 变化与 BMI 和认知饮食限制呈正相关，与抑制和饥饿呈负相关。
结论
在糖尿病前期成年人的减肥维持期间，蛋白质摄入量的增加和能量摄入量的减少与 BMI 减少相关，但与 HOMA-IR 减少无关。PEst 和 PRep 的增加与 HbA1c 的减少有关。这项试验在 clinicaltrials.gov 上注册为 NCT01777893。
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