Gumbiner B, Low C C, Reaven P D
Indiana University Center for Weight Management, National Institute for Fitness and Sport, Indianapolis 46202, USA.
Diabetes Care. 1998 Jan;21(1):9-15. doi: 10.2337/diacare.21.1.9.
To determine whether the lipoprotein response to weight loss in obese patients with type 2 diabetes can be improved by modifying the macronutrient composition of the commonly prescribed low-fat, high-carbohydrate (CHO) hypocaloric diet.
Nine obese patients with type 2 diabetes were treated with a monounsaturated fatty acid (MUFA)-enriched weight-reducing formula diet and compared with eight obese patients with type 2 diabetes treated with a low-fat, high-CHO weight-reducing formula diet. Weight loss ensued for 6 weeks, followed by 4 weeks of refeeding using isocaloric formulas enriched with MUFA or CHO, respectively. Fasting blood samples were obtained to measure plasma lipoproteins and LDL susceptibility to oxidation (measured as lag time: time required to induce in vitro formation of conjugated dienes).
At baseline, there were no differences between the groups in plasma lipids, lipoproteins, or LDL susceptibility to oxidation. Weight loss was similar between the groups. Dieting resulted in decreases in total plasma cholesterol, LDL, HDL, triglycerides, and apolipoproteins A and B (P < 0.05), but the MUFA group manifested a greater decrease in total cholesterol, triglycerides, and apolipoprotein B and a smaller decrease in HDL and apolipoprotein A than the CHO group (P < 0.05). Improvements in these parameters were sustained during refeeding. After dieting, lag time was prolonged in the MUFA group (208 +/- 10 min) compared with the CHO group (146 +/- 11 min; P < 0.05). Lag time was prolonged further during refeeding in the MUFA group (221 +/- 13 min, P = 0.10), while the CHO group remained unchanged (152 +/- 9 min, P < 0.05). Lag time correlated strongly with the oleic acid content of LDL after dieting and refeeding (r = 0.74 and r = 0.93, respectively; both P < 0.001).
Macronutrient content is an important determinant of the lipoprotein response to weight loss in obese patients with type 2 diabetes. MUFA-enriched hypocaloric diets potentiate the beneficial effects of weight loss to ameliorate cardiovascular risk factors in obese patients with type 2 diabetes.
确定通过改变常用的低脂、高碳水化合物（CHO）低热量饮食的宏量营养素组成，能否改善2型糖尿病肥胖患者体重减轻时的脂蛋白反应。
9例2型糖尿病肥胖患者采用富含单不饱和脂肪酸（MUFA）的减重配方饮食进行治疗，并与8例采用低脂、高CHO减重配方饮食治疗的2型糖尿病肥胖患者进行比较。体重减轻持续6周，随后分别使用富含MUFA或CHO的等热量配方进行4周的再喂养。采集空腹血样以测量血浆脂蛋白和低密度脂蛋白（LDL）的氧化易感性（以延迟时间衡量：诱导体外共轭二烯形成所需的时间）。
基线时，两组患者的血浆脂质、脂蛋白或LDL氧化易感性无差异。两组体重减轻情况相似。节食导致血浆总胆固醇、LDL、高密度脂蛋白（HDL）、甘油三酯以及载脂蛋白A和B降低（P<0.05），但MUFA组总胆固醇、甘油三酯和载脂蛋白B的降低幅度大于CHO组，HDL和载脂蛋白A的降低幅度小于CHO组（P<0.05）。再喂养期间这些参数的改善得以维持。节食后，MUFA组的延迟时间（208±10分钟）较CHO组（146±11分钟）延长（P<0.05）。MUFA组再喂养期间延迟时间进一步延长（221±13分钟，P=0.10），而CHO组保持不变（152±9分钟，P<0.05）。节食和再喂养后，延迟时间与LDL的油酸含量密切相关（分别为r=0.74和r=0.93；均P<0.001）。
宏量营养素含量是2型糖尿病肥胖患者体重减轻时脂蛋白反应的重要决定因素。富含MUFA的低热量饮食可增强体重减轻对改善2型糖尿病肥胖患者心血管危险因素的有益作用。
