Pascale R W, Wing R R, Butler B A, Mullen M, Bononi P
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
Diabetes Care. 1995 Sep;18(9):1241-8. doi: 10.2337/diacare.18.9.1241.
The aim of this randomized trial was to compare the effects of a behavioral intervention focusing on either calorie restriction alone or calorie plus fat restriction on weight loss and changes in lipids and glycemic control in individuals with non-insulin-dependent diabetes mellitus (NIDDM) or a family history of diabetes.
We recruited 44 obese women with NIDDM and 46 obese women with a family history of NIDDM and randomly assigned these subjects to calorie restriction (CAL) or to calorie plus fat restriction (CAL + FAT). All subjects participated in a 16-week behavioral weight loss program, with training in diet, exercise, and behavior modification. Subjects assigned to the CAL condition were given a 1,000-1,500 kcal/day goal and self-monitored calories consumed. Subjects assigned to the CAL+FAT condition had the same calorie goal, but were also given a fat goal (grams of fat/day), to produce a diet with < 20% of calories from fat; this group monitored both calories and fat grams.
Among NIDDM subjects, weight loss of the subjects in the CAL+FAT condition was significantly greater than subjects in the CAL condition (7.7 vs. 4.6 kg) and the CAL+FAT condition group also maintained their weight loss better at the 1-year follow-up (5.2 vs. 1.0 kg). Significant decreases in glucose, high-density lipoprotein (HDL) cholesterol, and total cholesterol were seen after 16 weeks of treatment among NIDDM subjects; these changes were similar in CAL and CAL+FAT groups, but a greater proportion of subjects in CAL condition required oral hypoglycemic medication. At the 1-year follow-up, all parameters had returned to baseline. No significant differences in weight loss or physiological changes were seen between CAL and CAL+FAT conditions in subjects with a family history of diabetes.
These results suggest that using the combination of calorie and fat restriction may help promote weight loss in obese NIDDM patients. No other long-term benefits of this regimen were observed.
本随机试验旨在比较单纯热量限制或热量加脂肪限制的行为干预对非胰岛素依赖型糖尿病（NIDDM）患者或有糖尿病家族史个体的体重减轻、血脂变化及血糖控制的影响。
我们招募了44名患有NIDDM的肥胖女性和46名有NIDDM家族史的肥胖女性，并将这些受试者随机分为热量限制组（CAL）或热量加脂肪限制组（CAL + FAT）。所有受试者都参加了一个为期16周的行为减肥计划，包括饮食、运动和行为改变方面的培训。分配到CAL组的受试者设定了每天1000 - 1500千卡的热量目标，并自行监测摄入的热量。分配到CAL + FAT组的受试者有相同的热量目标，但同时也有脂肪目标（每天脂肪克数），以产生脂肪供能占比低于20%的饮食；该组同时监测热量和脂肪克数。
在NIDDM受试者中，CAL + FAT组受试者的体重减轻显著大于CAL组（7.7千克对4.6千克），并且在1年随访时CAL + FAT组体重减轻维持得更好（5.2千克对1.0千克）。NIDDM受试者在治疗16周后，血糖、高密度脂蛋白（HDL）胆固醇和总胆固醇显著下降；CAL组和CAL + FAT组的这些变化相似，但CAL组中有更大比例的受试者需要口服降糖药。在1年随访时，所有参数都恢复到了基线水平。有糖尿病家族史的受试者中，CAL组和CAL + FAT组在体重减轻或生理变化方面没有显著差异。
这些结果表明，联合热量和脂肪限制可能有助于促进肥胖NIDDM患者的体重减轻。未观察到该方案的其他长期益处。
