Athithan Lavanya, Gulsin Gaurav S, Henson Joseph, Althagafi Loai, Redman Emma, Argyridou Stavroula, Parke Kelly S, Yeo Jian, Yates Thomas, Khunti Kamlesh, Davies Melanie J, McCann Gerry P, Brady Emer M
Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK.
Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, General Hospital, Leicester, UK.
Ther Adv Endocrinol Metab. 2023 Oct 6;14:20420188231193231. doi: 10.1177/20420188231193231. eCollection 2023.
South Asians (SA) constitute a quarter of the global population and are disproportionally affected by both type 2 diabetes (T2D) and heart failure. There remains limited data of the acceptability and efficacy of low-energy meal replacement plans to induce remission of T2D in SA.
The objective of this exploratory secondary analysis of the DIASTOLIC study was to determine if there was a differential uptake, glycometabolic and cardiovascular response to a low-energy meal replacement plan (MRP) between SA and White European (WE) people with T2D.
Obese adults with T2D without symptomatic cardiovascular disease were allocated a low-energy (~810 kcal/day) MRP as part of the DIASTOLIC study (NCT02590822). Comprehensive multiparametric cardiovascular magnetic resonance imaging, echocardiography, cardiopulmonary exercise testing and metabolic profiling were undertaken at baseline and 12 weeks. A comparison of change at 12 weeks between groups with baseline adjustment was undertaken.
Fifteen WE and 12 SAs were allocated the MRP. All WE participants completed the MRP 8/12 (66%) SAs. The degree of concentric left ventricular remodelling was similar between ethnicities. Despite similar weight loss and reduction in liver fat percentage, SA had a lower reduction in Homeostatic Model Assessment for Insulin Resistance [-5.7 (95% CI: -7.3, -4.2) -8.6 (-9.7, -7.6), = 0.005] and visceral adiposity compared to WE [-0.43% (-0.61, -0.25) -0.80% (-0.91, -0.68), = 0.002]. Exercise capacity increased in WE with no change observed in SA. There was a trend towards more reverse remodelling in WE compared to SAs.
Compliance to the MRP was lower in SA WE. Overall, those completing the MRP saw improvements in weight, body composition and indices of glycaemic control irrespective of ethnicity. Whilst improvements in VAT and insulin resistance appear to be dampened in SA WE, given the small sample, larger studies are required to confirm or challenge this potential ethnic disparity.
NCT02590822.
南亚人占全球人口的四分之一，在2型糖尿病（T2D）和心力衰竭方面受到的影响尤为严重。关于低能量代餐计划在南亚人中诱导T2D缓解的可接受性和有效性的数据仍然有限。
这项对舒张期研究的探索性二次分析的目的是确定患有T2D的南亚人和白人欧洲人（WE）对低能量代餐计划（MRP）的接受程度、糖代谢和心血管反应是否存在差异。
作为舒张期研究（NCT02590822）的一部分，将没有症状性心血管疾病的肥胖T2D成年人分配到低能量（约810千卡/天）的MRP组。在基线和12周时进行全面的多参数心血管磁共振成像、超声心动图、心肺运动测试和代谢谱分析。对两组在基线调整后的12周变化进行比较。
15名WE参与者和12名南亚参与者被分配到MRP组。所有WE参与者都完成了MRP，8/12（66%）的南亚参与者完成了MRP。不同种族之间同心性左心室重构的程度相似。尽管体重减轻和肝脏脂肪百分比降低相似，但与WE相比，南亚人的胰岛素抵抗稳态模型评估降低幅度较小[-5.7（95%CI：-7.3，-4.2）对-8.6（-9.7，-7.6），P = 0.005]，内脏脂肪减少幅度也较小[-0.43%（-0.61，-0.25）对-0.80%（-0.91，-0.68），P = 0.002]。WE的运动能力增加，而南亚人没有变化。与南亚人相比，WE有更多逆向重构的趋势。
南亚人对MRP的依从性低于WE。总体而言，无论种族如何，完成MRP的人在体重、身体成分和血糖控制指标方面都有改善。虽然南亚人内脏脂肪组织（VAT）和胰岛素抵抗的改善似乎比WE要小，但鉴于样本量小，需要更大规模的研究来证实或质疑这种潜在的种族差异。
NCT02590822。
