Franz M J
Nutrition and Professional Education, International Diabetes Center, Minneapolis, MN 55416, USA.
J Am Diet Assoc. 1998 Oct;98(10 Suppl 2):S39-43. doi: 10.1016/s0002-8223(98)00709-3.
Type 2 diabetes, cardiovascular disease, and hypertension are comorbities associated with obesity. Treatment and prevention strategies for these comorbidities of obesity are often assumed to be the same-weight loss. Although many persons may lose weight initially, recidivism is a major concern. Therefore, medical nutrition therapy for obese persons with comorbidities should be refocused from weight loss to attaining and maintaining metabolic parameters--normal blood glucose levels, optimal lipid levels, and blood pressure levels within normal limits. Moderate weight loss is only one lifestyle strategy that can be recommended. Research has also supported other lifestyle strategies, including becoming more physically fit. In type 2 diabetes, a restricted energy diet even without weight loss, spacing of meals throughout the day, and fat intake modifications have been shown to improve glycemia. Dyslipidemia can be improved by reducing or changing the fat content of the diet. Blood pressure levels can be reduced by a diet high in fruits and vegetables and low in fat. Research is underway to determine if weight loss can prevent chronic disease; however, once comorbidities are present, lifestyle strategies should be directed toward the improvement of metabolic parameters associated with the comorbidity.
2型糖尿病、心血管疾病和高血压是与肥胖相关的合并症。对于这些肥胖合并症的治疗和预防策略通常被认为是相同的——即减肥。尽管许多人最初可能会体重减轻，但复发是一个主要问题。因此，对于患有合并症的肥胖者，医学营养治疗应从减肥重新聚焦于达到并维持代谢参数——正常血糖水平、最佳血脂水平以及血压在正常范围内。适度减肥只是可以推荐的一种生活方式策略。研究也支持其他生活方式策略，包括增强体质。在2型糖尿病中，即使不减肥，限制能量饮食、全天分餐以及调整脂肪摄入已被证明可改善血糖。通过减少或改变饮食中的脂肪含量可改善血脂异常。高水果和蔬菜、低脂肪饮食可降低血压水平。目前正在进行研究以确定减肥是否能预防慢性病；然而，一旦出现合并症，生活方式策略应旨在改善与合并症相关的代谢参数。
