Garg A, Bantle J P, Henry R R, Coulston A M, Griver K A, Raatz S K, Brinkley L, Chen Y D, Grundy S M, Huet B A
Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas 75235-9052.
JAMA. 1994 May 11;271(18):1421-8. doi: 10.1001/jama.1994.03510420053034.
To study effects of variation in carbohydrate content of diet on glycemia and plasma lipoproteins in patients with non-insulin-dependent diabetes mellitus (NIDDM).
A four-center randomized crossover trial.
Outpatient and inpatient evaluation in metabolic units.
Forty-two NIDDM patients receiving glipizide therapy.
A high-carbohydrate diet containing 55% of the total energy as carbohydrates and 30% as fats was compared with a high-monounsaturated-fat diet containing 40% carbohydrates and 45% fats. The amounts of saturated fats, polyunsaturated fats, cholesterol, sucrose, and protein were similar. The study diets, prepared in metabolic kitchens, were provided as the sole nutrients to subjects for 6 weeks each. To assess longer-term effects, a subgroup of 21 patients continued the diet they received second for an additional 8 weeks.
Fasting plasma glucose, insulin, lipoproteins, and glycosylated hemoglobin concentrations. Twenty-four-hour profiles of glucose, insulin, and triglyceride levels.
The site of study as well as the diet order did not affect the results. Compared with the high-monounsaturated-fat diet, the high-carbohydrate diet increased fasting plasma triglyceride levels and very low-density lipoprotein cholesterol levels by 24% (P < .0001) and 23% (P = .0001), respectively, and increased daylong plasma triglyceride, glucose, and insulin values by 10% (P = .03), 12% (P < .0001), and 9% (P = .02), respectively. Plasma total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol levels remained unchanged. The effects of both diets on plasma glucose, insulin, and triglyceride levels persisted for 14 weeks.
In NIDDM patients, high-carbohydrate diets compared with high-monounsaturated-fat diets caused persistent deterioration of glycemic control and accentuation of hyperinsulinemia, as well as increased plasma triglyceride and very-low-density lipoprotein cholesterol levels, which may not be desirable.
研究饮食中碳水化合物含量变化对非胰岛素依赖型糖尿病（NIDDM）患者血糖和血浆脂蛋白的影响。
一项四中心随机交叉试验。
代谢病房的门诊和住院评估。
42例接受格列吡嗪治疗的NIDDM患者。
将一种碳水化合物占总能量55%、脂肪占30%的高碳水化合物饮食与一种碳水化合物占40%、脂肪占45%的高单不饱和脂肪饮食进行比较。饱和脂肪、多不饱和脂肪、胆固醇、蔗糖和蛋白质的含量相似。在代谢厨房制备的研究饮食作为受试者唯一的营养来源，每种饮食提供6周。为评估长期影响，21例患者组成的亚组继续接受第二种饮食8周。
空腹血糖、胰岛素、脂蛋白和糖化血红蛋白浓度。葡萄糖、胰岛素和甘油三酯水平的24小时变化曲线。
研究地点和饮食顺序均不影响结果。与高单不饱和脂肪饮食相比，高碳水化合物饮食使空腹血浆甘油三酯水平和极低密度脂蛋白胆固醇水平分别升高24%（P <.0001）和23%（P =.0001），使全天血浆甘油三酯、葡萄糖和胰岛素值分别升高10%（P =.03）、12%（P <.0001）和9%（P =.02）。血浆总胆固醇、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇水平保持不变。两种饮食对血浆葡萄糖、胰岛素和甘油三酯水平的影响持续14周。
在NIDDM患者中，与高单不饱和脂肪饮食相比，高碳水化合物饮食导致血糖控制持续恶化、高胰岛素血症加重，以及血浆甘油三酯和极低密度脂蛋白胆固醇水平升高，这可能是不理想的。
