Shah M, Garg A
Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas, USA.
Diabetes Care. 1996 Oct;19(10):1142-52. doi: 10.2337/diacare.19.10.1142.
The current American Diabetes Association guidelines for nutrition recommend a moderate increase in monounsaturated fats and a reduced intake of carbohydrate in patients with diabetes in whom high-carbohydrate diets deteriorate glycemic control and lipoprotein levels. High-fat diets, however, are believed to promote obesity, and some investigators may have reservations recommending such diets. This review thus investigates the role of diet composition in promoting obesity or achieving weight loss and its implications in patients with diabetes. Epidemiological studies show some evidence that fat intake is more importantly related to body weight than carbohydrate intake, but conclusions are weak because confounding variables, such as physical activity, smoking, and energy intake, were generally not controlled for. Metabolic studies under isoenergic conditions report no change in energy balance when fat intake is increased, but report a negative fat balance with substantial increase carbohydrate intake. During overfeeding, excess fat intake is stored as fat, whereas excess carbohydrate is mostly oxidized in the short term but can lead to substantial gain in fat stores because of reduced fat oxidation and considerable de novo lipogenesis in the long term. Spontaneous energy intake, however, is higher on an unrestricted high-fat diet compared with a high-carbohydrate diet, but the long-term effects are not known. Weight-loss intervention studies show that a hypocaloric high-carbohydrate diet is not associated with more weight loss than a high-fat hypocaloric diet. In conclusion, a high-monounsaturated fat diet to control glycemic control and lipoprotein levels in patients with diabetes should not affect weight loss or maintenance, provided that energy intake is carefully controlled.
美国糖尿病协会当前的营养指南建议，对于那些高碳水化合物饮食会使血糖控制和脂蛋白水平恶化的糖尿病患者，适度增加单不饱和脂肪的摄入量并减少碳水化合物的摄入量。然而，高脂饮食被认为会促进肥胖，一些研究人员可能对推荐此类饮食有所保留。因此，本综述探讨了饮食组成在促进肥胖或实现体重减轻中的作用及其对糖尿病患者的影响。流行病学研究表明，有证据显示脂肪摄入量比碳水化合物摄入量与体重的关系更为重要，但由于通常未对身体活动、吸烟和能量摄入等混杂变量进行控制，结论并不有力。等能量条件下的代谢研究报告称，增加脂肪摄入量时能量平衡无变化，但碳水化合物摄入量大幅增加时则报告脂肪平衡为负。在过度喂养期间，过量的脂肪摄入会以脂肪形式储存，而过量的碳水化合物短期内大多会被氧化，但从长期来看，由于脂肪氧化减少和大量从头脂肪生成，可能会导致脂肪储存大量增加。然而，与高碳水化合物饮食相比，无限制的高脂饮食会使自发能量摄入量更高，但长期影响尚不清楚。减肥干预研究表明，低热量的高碳水化合物饮食与高脂肪低热量饮食相比，在减重方面并无差异。总之，对于糖尿病患者，为控制血糖和脂蛋白水平而采用的高单不饱和脂肪饮食，只要仔细控制能量摄入，就不应影响体重减轻或维持。
