2型糖尿病有效饮食方式：低饱和脂肪酸饮食

  近日，一篇发表在国际杂志Diabetes Care上的研究报告中，来自南澳大利亚大学等处的研究人员进行了一项随机比对临床试验，旨在评估低碳水化合物及饱和脂肪饮食对2型糖尿病患者病症的控制策略。
  文章中，研究者Grant D.Brinkworth教授表示，我们对比了低碳水化合物、高不饱和脂肪酸/低饱和脂肪酸饮食（LC）同高水平未精制碳水化合物、低脂肪饮食(HC)对2型糖尿病患者(T2DM)在血糖控制及心血管疾病风险因子上的效应及影响。
  研究者对115名肥胖个体进行分组研究，这些个体的BMI指数在30.2至38.6之间，年龄在51岁至65岁区间；研究者将这些研究对象随机分为低热量LC饮食组或能量匹配的HC饮食组，同时对研究对象辅以长达24周结构化锻炼；最后研究者们测定了参与者机体的糖基化血红蛋白、血糖变异性、抗血糖药物的改变情况及个体的血脂、血压水平。
  结果显示，共有93名参与者完成了24周的跟踪调查，所有研究组个体的完成率（LC组：79%；HC组：82%）及体重减轻比率相似，研究个体的血压和低密度脂蛋白胆固醇水平均发生了下降。LC组研究对象甘油三酯、抗血糖药物影响评分及患心血管疾病风险指数下降较为明显；LC可以促使研究组个体的糖基化血红蛋白明显下降，而同时会增加给高密度脂蛋白胆固醇的水平。
  最后研究者Jeannie表示，所有的饮食方式均会对研究个体的临床血糖控制及心血管疾病风险标志物有实质性地改善；相比HC组研究对象，LC组研究对象在心血管疾病风险及抗血糖药物作用中获益更明显，这就揭示，低饱和脂肪酸的LC饮食或许是2型糖尿病患者的有效饮食疗法。（转化医学网360zhyx.com）
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A Very Low-Carbohydrate, Low–Saturated Fat Diet for Type 2 Diabetes Management: A Randomized Trial
Diabetes Care   doi: 10.2337/dc14-0845
Jeannie Tay1,2,3, Natalie D. Luscombe-Marsh1, Campbell H. Thompson2, Manny Noakes1, Jon D. Buckley4, Gary A. Wittert2, William S. Yancy Jr.5,6 and Grant D. Brinkworth1⇑
OBJECTIVE To comprehensively compare the effects of a very low-carbohydrate, high–unsaturated/low–saturated fat diet (LC) with those of a high–unrefined carbohydrate, low-fat diet (HC) on glycemic control and cardiovascular disease (CVD) risk factors in type 2 diabetes (T2DM).
RESEARCH DESIGN AND METHODS Obese adults (n = 115, BMI 34.4 ± 4.2 kg/m2, age 58 ± 7 years) with T2DM were randomized to a hypocaloric LC diet (14% carbohydrate [<50 g/day], 28% protein, and 58% fat [<10% saturated fat]) or an energy-matched HC diet (53% carbohydrate, 17% protein, and 30% fat [<10% saturated fat]) combined with structured exercise for 24 weeks. The outcomes measured were as follows: glycosylated hemoglobin (HbA1c), glycemic variability (GV; assessed by 48-h continuous glucose monitoring), antiglycemic medication changes (antiglycemic medication effects score [MES]), and blood lipids and pressure.
RESULTS A total of 93 participants completed 24 weeks. Both groups achieved similar completion rates (LC 79%, HC 82%) and weight loss (LC −12.0 ± 6.3 kg, HC −11.5 ± 5.5 kg); P ≥ 0.50. Blood pressure (−9.8/−7.3 ± 11.6/6.8 mmHg), fasting blood glucose (−1.4 ± 2.3 mmol/L), and LDL cholesterol (−0.3 ± 0.6 mmol/L) decreased, with no diet effect (P ≥ 0.10). LC achieved greater reductions in triglycerides (−0.5 ± 0.5 vs. −0.1 ± 0.5 mmol/L), MES (−0.5 ± 0.5 vs. −0.2 ± 0.5), and GV indices; P ≤ 0.03. LC induced greater HbA1c reductions (−2.6 ± 1.0% [−28.4 ± 10.9 mmol/mol] vs. −1.9 ± 1.2% [−20.8 ± 13.1 mmol/mol]; P = 0.002) and HDL cholesterol (HDL-C) increases (0.2 ± 0.3 vs. 0.05 ± 0.2 mmol/L; P = 0.007) in participants with the respective baseline values HbA1c >7.8% (62 mmol/mol) and HDL-C <1.29 mmol/L.
CONCLUSIONS Both diets achieved substantial improvements for several clinical glycemic control and CVD risk markers. These improvements and reductions in GV and antiglycemic medication requirements were greatest with the LC compared with HC. This suggests an LC diet with low saturated fat may be an effective dietary approach for T2DM management if effects are sustained beyond 24 weeks.