The determinants of glycemic responses to diet restriction and weight loss in obesity and NIDDM
The determinants of glycemic responses to diet restriction and weight loss in obesity and NIDDM
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DOI：
10.2337/diacare.21.5.687
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发表时间：
1998-05-01
期刊：
影响因子：
16.2
通讯作者：
Chisholm, DJ
中科院分区：
文献类型：
--
作者：
Markovic, TP;Jenkins, AB;Chisholm, DJ
目的--研究减肥改善超重NIDDM患者血糖控制的机制，特别是能量限制、胰岛素敏感性改善、局部和整体脂肪组织减少之间的关系。研究设计和方法--对20名受试者进行高胰岛素葡萄糖钳夹试验（BMI = 32.0 +/- 0.5 [SEM] kg/m2，年龄= 48.4 +/- 2.7岁），在低能量（1，100 +/- 250 [SD] kcal/天）配方饮食之前和第4天（d4）和第28天（d28），葡萄糖耐量正常（NGT）（n = 10）或轻度NIDDM（n = 10）。身体成分的变化进行了评估，通过双能X射线吸收法和胰岛素分泌的变化进行了测量，胰岛素对静脉葡萄糖的反应，前后weightloss.RESULTS -在这两组，能量限制（d4）降低空腹血糖（FPG）。（Delta FPG：NGT = -0.4 +/- 0.2 mmol/l和NIDDM = -1.1 +/- 0.03 mmol/l，P = 0.002），这与碳水化合物摄入量减少独立相关（部分r = 0.64，P = 0.003）。在两组中，胰岛素抑制肝脏葡萄糖输出（HGO）的百分比在第4天显著增加（Δ HGO抑制：NGT = 28 +/- 15%和NIDDM = 32 +/-8%，P = 0.002）。到第28天，体重减轻6.3 +/- 0.4 kg，仅NIDDM组FPG进一步降低（第4天vs第28天）（P = 0.05），两组胰岛素敏感性均增加（P = 0.02）。只有腹部脂肪的减少与体重减轻后FPG（r = 0.51，P = 0.03）和胰岛素敏感性（r = 0.48，P = 0.05）的改善相关。相反，胰岛素的作用，只有很小的变化，在胰岛素secrety.CONCLUSIONS -无论是能量限制和减肥有有益的影响，胰岛素的作用和血糖控制肥胖和轻度NIDDM。能量限制的效果与个体常量营养素的变化有关，而减肥效果与腹部脂肪的变化有关。
OBJECTIVE - To examine the mechanisms by which weight loss improves glycemic control in overweight subjects with NIDDM, particularly the relationships between energy restriction, improvement in insulin sensitivity, and regional and overall adipose tissue loss.RESEARCH DESIGN AND METHODS - Hyperinsulinemic glucose clamps were performed in 20 subjects (BMI = 32.0 +/- 0.5 [SEM] kg/m(2), age = 48.4 +/- 2.7 years) with normal glucose tolerance (NGT) (n = 10) or mild NIDDM (n = 10) before and on the 4th (d4) and 28th (d28) days of a reduced-energy (1,100 +/- 250 [SD] kcal/day) formula diet. Body composition changes were assessed by dual energy x-ray absorptiometry and insulin secretory changes were measured by insulin response to intravenous glucose before and after weight loss.RESULTS - In both groups, energy restriction (d4) reduced fasting plasma glucose (FPG) (Delta FPG: NGT = -0.4 +/- 0.2 mmol/l and NIDDM = -1.1 +/- 0.03 mmol/l, P = 0.002), which was independently related to reduced carbohydrate intake (partial r = 0.64, P = 0.003). There was a marked d4 increase in percent of insulin suppression of hepatic glucose output (HGO) in both groups (Delta HGO suppression: NGT = 28 +/- 15% and NIDDM = 32 +/- 8%, P = 0.002). By d28, with 6.3 +/- 0.4 kg weight loss, FPG was further reduced (d4 vs, d28) in NIDDM only (P = 0.05), and insulin sensitivity increased in both groups (P = 0.02). Only loss of abdominal fat related to improvements in FPG (r = 0.51, P = 0.03) and insulin sensitivity after weight loss (r = 0.48, P = 0.05). In contrast to insulin action, there were only small changes in insulin secretion.CONCLUSIONS - Both energy restriction and weight loss have beneficial effects on insulin action and glycemic control in obesity and mild NIDDM. The effect of energy restriction is related to changes in individual macronutrients, whereas weight loss effects relate to changes in abdominal fat.