Bahadoran Zahra, Mirmiran Parvin, Azizi Fereidoun
Micronutrients Research Center, Research Institute for Endocrine Disorders, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Nutrition and Endocrine Research Center, Research Institute for Endocrine Disorders, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Nutrition and Endocrine Research Center, Research Institute for Endocrine Disorders, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Clin Nutr ESPEN. 2025 Aug;68:548-556. doi: 10.1016/j.clnesp.2025.05.046. Epub 2025 Jun 4.
We investigated the potential effect of adherence to a healthy diet on the probability of reversion to normal glucose regulation (NGR) among different phenotypes of prediabetes (Pre-DM), a heterogeneous metabolic disorder affecting glucose metabolism, i.e., isolated impaired fasting glucose (i-IFG; fasting glucose 100-125 mg/dL with normal glucose tolerance), isolated impaired glucose tolerance (i-IGT; 2-h post-load glucose 140-199 mg/dL with normal fasting glucose) and combined IFG-IGT (meeting both criteria).
Adherence of 1456 individuals with Pre-DM to a healthy diet was assessed using the Alternate Healthy Eating Index (AHEI) at baseline, and the participants were followed for a median of 5.8 years. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95 % confidence intervals (CIs) for Pre-DM reversion to NGR across the categories of adhering to AHEI (i.e., low and high-adherence of AHEI) and per each 10-increment of AHEI. The estimated time to Pre-DM reversion was compared among low- and high-adherence to AHEI using a log-rank test.
The mean age of the participants was 47.2 ± 12.8, and 52.5 % were men. Overall rate of Pre-DM reversion was 46.8 %, with rates of 53.6, 55.1, and 15.7 % in i-IGT, i-IFG, and IFG-IGT, respectively. After adjustment of diabetes risk score, high-adherence to AHEI increased the probability of a reversion to NGR, HR = 1.31, 95 % CI = 1.13-1.51. Considering Pre-DM phenotypes, subjects with combined IFG-IGT showed a greater benefit from high adherence to AHEI compared to those with isolated phenotypes, HR = 2.33 and 95 % CI = 1.27-4.30. Furthermore, the mean of estimated time to reversion to NGR from IFG-IGT showed a marginally significant trend toward being shorter, 6.2 y (5.1-6.2) vs. 8.4 y (8.0-8.8) and P = 0.051.
Adherence of individuals with Pre-DM to healthy diet effectively increased the probability of reversion to NGR, and the observed effect was stronger in subjects with combined IFG-IGT than the isolated phenotypes.
我们研究了坚持健康饮食对不同类型的糖尿病前期（Pre-DM）患者恢复正常血糖调节（NGR）可能性的潜在影响。糖尿病前期是一种影响葡萄糖代谢的异质性代谢紊乱疾病，即单纯空腹血糖受损（i-IFG；空腹血糖100 - 125mg/dL且糖耐量正常）、单纯糖耐量受损（i-IGT；餐后2小时血糖140 - 199mg/dL且空腹血糖正常）以及空腹血糖受损合并糖耐量受损（同时符合上述两项标准）。
在基线时使用替代健康饮食指数（AHEI）评估1456例糖尿病前期患者对健康饮食的依从性，并对参与者进行了中位数为5.8年的随访。采用Cox比例风险模型计算不同AHEI依从性类别（即AHEI低依从性和高依从性）以及AHEI每增加10分时糖尿病前期恢复至NGR的风险比（HR）和95%置信区间（CI）。使用对数秩检验比较AHEI低依从性和高依从性患者恢复至NGR的估计时间。
参与者的平均年龄为47.2±12.8岁，男性占52.5%。糖尿病前期总体恢复率为46.8%，其中i-IGT、i-IFG和IFG-IGT的恢复率分别为53.6%、55.1%和15.7%。在调整糖尿病风险评分后，高依从AHEI增加了恢复至NGR的可能性，HR = 1.31，95%CI = 1.13 - 1.51。考虑糖尿病前期的不同类型，与单纯类型的患者相比，空腹血糖受损合并糖耐量受损的患者从高依从AHEI中获益更大，HR = 2.33，95%CI = 1.27 - 4.30。此外，从IFG-IGT恢复至NGR的估计平均时间显示出略微显著的缩短趋势，分别为6.2年（5.1 - 6.2）和8.4年（8.0 - 8.8），P = 0.051。
糖尿病前期患者坚持健康饮食可有效增加恢复至NGR的可能性，并且观察到的这种效果在空腹血糖受损合并糖耐量受损的患者中比单纯类型的患者更强。
