Henry R R, Wiest-Kent T A, Scheaffer L, Kolterman O G, Olefsky J M
Diabetes. 1986 Feb;35(2):155-64. doi: 10.2337/diab.35.2.155.
To determine the effects of very-low-calorie diets on the metabolic abnormalities of diabetes and obesity, we have studied 10 obese, non-insulin-dependent diabetic (NIDDM) and 5 obese, nondiabetic subjects for 36 days on a metabolic ward during consumption of a liquid diet of 300 kcal/day with 30 g of protein. Rapid improvement occurred in the glycemic indices of the diabetic subjects, with mean (+/- SEM) fasting plasma glucose falling from 291 +/- 21 to 95 +/- 6 mg/dl (P less than 0.001) and total glycosylated hemoglobin from 13.1 +/- 0.7% to 8.8 +/- 0.3% (P less than 0.001) (normal reference range 5.5-8.5%). Lipid elevations were normalized with plasma triglycerides reduced to less than 100 mg/dl and total plasma cholesterol to less than 150 mg/dl in both groups. Hormonal and substrate responses were also comparable between groups with reductions in insulin and triiodothyronine and moderate elevations in blood and urinary ketoacid levels without a corresponding rise in free fatty acids. Electrolyte balance for sodium, potassium, calcium, and phosphorus was initially negative but approached equilibrium by completion of the study. Magnesium, in contrast, remained in positive balance in both groups throughout. Total nitrogen loss varied widely among all subjects, ranging from 70 to 367 g, and showed a strong positive correlation with initial lean body mass (N = 0.83, P less than 0.001) and total weight loss (N = 0.87, P less than 0.001). The nondiabetic group, which had a significantly greater initial body weight and lean body mass than the diabetic group, also had a significantly greater weight loss of 450 +/- 31 g/day compared with 308 +/- 19 g/day (P less than 0.01) in the diabetic subjects. The composition of the weight lost at completion was similar in both groups and ranged from 21.6% to 31.3% water, 3.9% to 7.8% protein, and 60.9% to 74.5% fat. The contribution of both water and protein progressively decreased and fat increased, resulting in unchanged caloric requirements during the diet. This study demonstrates that short-term treatment with a very-low-calorie diet in both obese diabetic and nondiabetic subjects results in: safe and effective weight loss associated with the normalization of elevated glucose and lipid levels, a large individual variability in total nitrogen loss determined principally by the initial lean body mass, and progressive increments in the contribution of fat to weight loss with stable caloric requirements and no evidence of a hypometabolic response.
为了确定极低热量饮食对糖尿病和肥胖症代谢异常的影响，我们在代谢病房对10名肥胖的非胰岛素依赖型糖尿病（NIDDM）患者和5名肥胖的非糖尿病受试者进行了为期36天的研究，期间他们食用每天300千卡热量、含30克蛋白质的流质饮食。糖尿病受试者的血糖指标迅速改善，平均（±标准误）空腹血糖从291±21降至95±6毫克/分升（P<0.001），总糖化血红蛋白从13.1±0.7%降至8.8±0.3%（P<0.001）（正常参考范围5.5 - 8.5%）。两组的血脂升高均恢复正常，血浆甘油三酯降至100毫克/分升以下，总血浆胆固醇降至150毫克/分升以下。两组间激素和底物反应也相似，胰岛素和三碘甲状腺原氨酸减少，血和尿中酮酸水平适度升高，而游离脂肪酸无相应升高。钠、钾、钙和磷的电解质平衡起初为负，但在研究结束时接近平衡。相比之下，两组镁在整个过程中均保持正平衡。所有受试者的总氮损失差异很大，范围从70至367克，并且与初始瘦体重呈强正相关（N = 0.83，P<0.001）以及与总体重减轻呈强正相关（N = 0.87，P<0.001）。非糖尿病组初始体重和瘦体重明显高于糖尿病组，其体重减轻也明显更多，为450±31克/天，而糖尿病受试者为308±19克/天（P<0.01）。两组完成时体重减轻的组成相似，水占21.6%至31.3%，蛋白质占3.9%至7.8%，脂肪占60.9%至74.5%。水和蛋白质的贡献逐渐减少，脂肪增加，导致饮食期间热量需求不变。这项研究表明，在肥胖的糖尿病和非糖尿病受试者中，短期采用极低热量饮食治疗会导致：安全有效的体重减轻，同时血糖和血脂水平恢复正常；总氮损失个体差异很大，主要由初始瘦体重决定；脂肪对体重减轻的贡献逐渐增加，热量需求稳定，且无低代谢反应的证据。
