Effects of a low-glycemic load vs low-fat diet in obese young adults - A randomized trial
Effects of a low-glycemic load vs low-fat diet in obese young adults - A randomized trial
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DOI：
10.1001/jama.297.19.2092
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发表时间：
2007-05-16
影响因子：
120.7
通讯作者：
Ludwig, David S.
中科院分区：
文献类型：
--
作者：
Ebbeling, Cara B.;Leidig, Michael M.;Ludwig, David S.
研究背景：饮食治疗肥胖的临床试验结果不一致，可能是由于研究参与者之间固有的生理差异。目的：确定胰岛素分泌是否影响两种流行饮食的减肥效果。设计、设置和参与者：肥胖年轻人随机试验（年龄18-35岁; n= 73），2004年9月至2006年12月在马萨诸塞州波士顿进行，包括6个月强化干预期和12个月随访期。在基线时测定口服75 g葡萄糖后30分钟的血清胰岛素浓度，作为胰岛素分泌的指标。在6个月、12个月和18个月时评估结局。缺失的数据进行了插补conservatives. InterventionsA低血糖负荷（40%碳水化合物和35%脂肪）与低脂（55%碳水化合物和20%脂肪）dietes.Main Outcome Measures体重，体脂肪百分比确定的双能X射线吸收法，心血管疾病的危险factors.Results体重和体脂肪百分比的变化并没有不同的饮食组整体。然而，口服葡萄糖后30分钟的胰岛素浓度是一种效应修饰因子（组x时间x 30分钟时的胰岛素浓度：体重P=.02，体脂百分比P=.01）。对于那些在30分钟时胰岛素浓度高于中位数（57.5 μ IU/mL; n= 28）的人，低血糖负荷饮食产生了更大的体重下降（-5.8 vs-1.2 kg; P=. 004)体脂率（-2.6%vs-0.9%; P=. 03)比低脂饮食更有效。对于那些胰岛素浓度低于中位数水平30分钟的饮食组（n= 28），这些终点无显著差异。口服葡萄糖后30分钟的胰岛素浓度不是心血管疾病风险因素的显著影响因素。在整个队列中，血浆高密度脂蛋白胆固醇和甘油三酯浓度改善更多的低血糖负荷饮食，而低密度脂蛋白胆固醇浓度改善更多的低脂diet.Conclusions饮食减肥试验的变异性可能部分归因于激素反应的差异。降低血糖负荷对于胰岛素分泌高的个体实现体重减轻尤其重要。不管胰岛素分泌如何，低血糖负荷饮食对高密度脂蛋白胆固醇和甘油三酯浓度具有有益作用，但对低密度脂蛋白胆固醇浓度没有作用。
Context The results of clinical trials involving diet in the treatment of obesity have been inconsistent, possibly due to inherent physiological differences among study participants.Objective To determine whether insulin secretion affects weight loss with 2 popular diets.Design, Setting, and Participants Randomized trial of obese young adults ( aged 18-35 years; n= 73) conducted from September 2004 to December 2006 in Boston, Mass, and consisting of a 6-month intensive intervention period and a 12-month follow-up period. Serum insulin concentration at 30 minutes after a 75-g dose of oral glucose was determined at baseline as a measure of insulin secretion. Outcomes were assessed at 6, 12, and 18 months. Missing data were imputed conservatively.Interventions A low - glycemic load (40% carbohydrate and 35% fat) vs low-fat (55% carbohydrate and 20% fat) diet.Main Outcome Measures Body weight, body fat percentage determined by dual-energy x-ray absorptiometry, and cardiovascular disease risk factors.Results Change in body weight and body fat percentage did not differ between the diet groups overall. However, insulin concentration at 30 minutes after a dose of oral glucose was an effect modifier ( group x time x insulin concentration at 30 minutes: P=.02 for body weight and P=.01 for body fat percentage). For those with insulin concentration at 30 minutes above the median (57.5 mu IU/mL; n= 28), the low - glycemic load diet produced a greater decrease in weight ( - 5.8 vs - 1.2 kg; P=. 004) and body fat percentage ( - 2.6% vs - 0.9%; P=. 03) than the low-fat diet at 18 months. There were no significant differences in these end points between diet groups for those with insulin concentration at 30 minutes below the median level ( n= 28). Insulin concentration at 30 minutes after a dose of oral glucose was not a significant effect modifier for cardiovascular disease risk factors. In the full cohort, plasma high-density lipoprotein cholesterol and triglyceride concentrations improved more on the low - glycemic load diet, whereas low-density lipoprotein cholesterol concentration improved more on the low-fat diet.Conclusions Variability in dietary weight loss trials may be partially attributable to differences in hormonal response. Reducing glycemic load may be especially important to achieve weight loss among individuals with high insulin secretion. Regardless of insulin secretion, a low - glycemic load diet has beneficial effects on high-density lipoprotein cholesterol and triglyceride concentrations but not on low-density lipoprotein cholesterol concentration.