Bell R A, Summerson J H, Konen J C
Section on Internal Medicine/Gerontology, Bowman Gray School of Medicine, Winston-Salem, North Carolina 27157, USA.
J Am Coll Nutr. 1995 Apr;14(2):144-51. doi: 10.1080/07315724.1995.10718486.
The relationship between diet and glycemic control was examined among a racially mixed population of male and female adults with non-insulin dependent diabetes mellitus (NIDDM).
Data from 3-day dietary records and glycosylated hemoglobin (HbA1c) were analyzed for two-hundred eighty two patients of a Family Practice Ambulatory Care Unit and a community-based health center in Winston-Salem, North Carolina. Correlations were calculated for individual nutrients to determine their strength of association with glycemic control. Analyses by tertiles of HbA1c were also conducted for each race/gender group. Regression analysis was used to determine independent dietary predictors of HbA1c.
For all subjects, energy, energy per kilogram of body weight, fat, carbohydrates saturated fat, and cholesterol were significantly correlated with HbA1c. Nutritional differences across tertile levels of HbA1c for all subjects were not significant. For black females, consumption of energy, protein and fat was significantly higher among upper tertile subjects compared to the lowest tertile; and intake of energy, protein, fat, and saturated fat was significantly correlated with HbA1c in this group. For black males, energy intake was highest among upper tertile subjects compared to those in the middle tertile, while energy per kilogram of body weight, and percent of calories from protein, were significantly correlated with HbA1c. For white males, energy intake expressed as a function of body weight was highest among subjects in the upper tertile and a significant positive correlation with HbA1c was observed. No relationship between nutritional intake and HbA1c was found among white females. Racial differences in nutrient intake were also compared for males and females in the upper tertile of HbA1c. Black females in the upper tertile consumed significantly more energy, protein, and significantly less dietary fiber per 1000 kilocalories. No significant differences were observed between black and white males in the upper tertile, although higher cholesterol consumption in black males compared to white males approached significance. Regression analysis revealed that total energy intake significantly predicted HbA1c for all subjects and all white subjects, while a similar observation was made for total fat intake among all black subjects and among black females.
These findings confirm that diet, especially total energy, is an important contributor to glycemic control. Dietary fat is also associated with glycemic control among blacks, especially black females, who are especially prone to more dire health consequences of NIDDM. Strict monitoring of diet should lead to improved glycemic control and less mortality and morbidity in this population.
在患有非胰岛素依赖型糖尿病（NIDDM）的成年男女种族混合人群中，研究饮食与血糖控制之间的关系。
对北卡罗来纳州温斯顿 - 塞勒姆一家家庭医疗门诊护理单元和一个社区健康中心的282名患者的3天饮食记录和糖化血红蛋白（HbA1c）数据进行分析。计算个体营养素之间的相关性，以确定它们与血糖控制的关联强度。还对每个种族/性别组按HbA1c三分位数进行分析。采用回归分析来确定HbA1c的独立饮食预测因素。
对于所有受试者，能量、每千克体重的能量、脂肪、碳水化合物、饱和脂肪和胆固醇与HbA1c显著相关。所有受试者HbA1c三分位数水平之间的营养差异不显著。对于黑人女性，HbA1c最高三分位数组的受试者与最低三分位数组相比，能量、蛋白质和脂肪的摄入量显著更高；该组中能量、蛋白质、脂肪和饱和脂肪的摄入量与HbA1c显著相关。对于黑人男性，HbA1c最高三分位数组的受试者能量摄入量高于中间三分位数组，而每千克体重的能量以及蛋白质热量百分比与HbA1c显著相关。对于白人男性，以体重为函数表示的能量摄入量在最高三分位数组的受试者中最高，且与HbA1c呈显著正相关。在白人女性中未发现营养摄入量与HbA1c之间的关系。还比较了HbA1c最高三分位数组中男性和女性的营养摄入种族差异。HbA1c最高三分位数组中的黑人女性每1000千卡消耗的能量、蛋白质显著更多，膳食纤维显著更少。最高三分位数组中的黑人男性和白人男性之间未观察到显著差异，尽管黑人男性的胆固醇摄入量高于白人男性，接近显著水平。回归分析显示，总能量摄入量显著预测了所有受试者和所有白人受试者的HbA1c，而在所有黑人受试者和黑人女性中，总脂肪摄入量也有类似情况。
这些发现证实饮食，尤其是总能量，是血糖控制的重要因素。饮食脂肪也与黑人，尤其是黑人女性的血糖控制有关，她们特别容易因NIDDM而面临更严重的健康后果。对饮食进行严格监测应能改善该人群的血糖控制，降低死亡率和发病率。
