Comparison of high-fat and high-protein diets with a high-carbohydrate diet in insulin-resistant obese women
Comparison of high-fat and high-protein diets with a high-carbohydrate diet in insulin-resistant obese women
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DOI：
10.1007/s00125-004-1603-4
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发表时间：
2005-01-01
期刊：
影响因子：
8.2
通讯作者：
Mann, JI
中科院分区：
文献类型：
--
作者：
McAuley, KA;Hopkins, CM;Mann, JI
目的/假设建议采用低饱和脂肪酸、富含全麦、蔬菜和水果的饮食，以降低肥胖、心血管疾病和 2 型糖尿病的风险。然而，人们对传统高碳水化合物、高纤维方法的高脂肪（“阿特金斯饮食”）和高蛋白（“区域饮食”）替代品产生了广泛的兴趣。我们报告了一项随机试验，该试验将这两种替代方法与超重胰岛素抵抗女性的传统饮食进行了比较。方法 96 名血糖正常、胰岛素抵抗女性 (BMI > 27 kg/m2) 被随机接受三种饮食干预措施之一：高碳水化合物、高纤维 (HC) 饮食、高脂肪 (HF) 阿特金斯饮食或 高蛋白（HP）区域饮食。实验方法旨在模仿临床实践中可能实现的目标：建议涉及有关食物选择的建议，并且在总能量方面没有规定。有监督减肥和体重维持阶段（各 8 周），但研究团队和参与者在研究的最后 8 周期间没有接触。结果根据身体成分以及心血管和糖尿病风险指标进行评估。结果三种饮食的体重、腰围、甘油三酯和胰岛素水平均有所下降，但除胰岛素外，HF 和 HP 组的下降幅度显着大于 HC 组。这些观察结果表明，流行饮食比标准饮食建议更大程度地降低了胰岛素抵抗。与 HC 饮食相比，HF 和 HP 饮食在多个参数上显示出显着（p<0.01）更大的降低，包括体重减轻（HF -2.8 kg，HF -2.7 kg）、腰围（HF -3.5 cm，HF -2.7 cm）和甘油三酯（HF -0.30 mmol/l，HF） −0.22 毫摩尔/升）。 HC 和 HP 饮食的个体中 LDL 胆固醇下降，但 HF 饮食的个体中 LDL 胆固醇倾向于波动，以至于 HP 组的总体水平显着低于 HF 组（-0.28 mmol/l，95% CI 0.04–0.52，p=0.02）。在采用 HF 饮食的受试者中，25% 的受试者 LDL 胆固醇增加了 >10%，而采用 HC 饮食的受试者中只有 13% 的受试者出现这种情况，而采用 HP 饮食的受试者中只有 3% 出现这种情况。结论/解释在常规实践中，低碳水化合物、高蛋白饮食可能是降低心血管疾病和 2 型糖尿病风险的最合适的总体方法。为了在 HC 饮食中获得类似的益处，可能有必要增加富含纤维的全麦、豆类、蔬菜和水果，并减少饱和脂肪酸，其程度比实施现行指南所实现的要大。 HF 方法在短期内似乎可以成功减肥，但应监测血脂水平。从长远来看，饮食的潜在有害影响仍然令人担忧。
Aims/hypothesisA diet low in saturated fatty acids and rich in wholegrains, vegetables and fruit is recommended in order to reduce the risk of obesity, cardiovascular disease and type 2 diabetes mellitus. However there is widespread interest in high-fat (“Atkins Diet”) and high-protein (“Zone Diet”) alternatives to the conventional high-carbohydrate, high-fibre approach. We report on a randomised trial that compared these two alternative approaches with a conventional diet in overweight insulin-resistant women.MethodsNinety-six normoglycaemic, insulin-resistant women (BMI >27 kg/m2) were randomised to one of three dietary interventions: a high-carbohydrate, high-fibre (HC) diet, the high-fat (HF) Atkins Diet, or the high-protein (HP) Zone Diet. The experimental approach was designed to mimic what might be achieved in clinical practice: the recommendations involved advice concerning food choices and were not prescriptive in terms of total energy. There were supervised weight loss and weight maintenance phases (8 weeks each), but there was no contact between the research team and the participants during the final 8 weeks of the study. Outcome was assessed in terms of body composition and indicators of cardiovascular and diabetes risk.ResultsBody weight, waist circumference, triglycerides and insulin levels decreased with all three diets but, apart from insulin, the reductions were significantly greater in the HF and HP groups than in the HC group. These observations suggest that the popular diets reduced insulin resistance to a greater extent than the standard dietary advice did. When compared with the HC diet, the HF and HP diets were shown to produce significantly (p<0.01) greater reductions in several parameters, including weight loss (HF −2.8 kg, HF −2.7 kg), waist circumference (HF −3.5 cm, HF −2.7 cm) and triglycerides (HF −0.30 mmol/l, HF −0.22 mmol/l). LDL cholesterol decreased in individuals on the HC and HP diets, but tended to fluctuate in those on the HF diet to the extent that overall levels were significantly lower in the HP group than in the HF group (−0.28 mmol/l, 95% CI 0.04–0.52,p=0.02). Of those on the HF diet, 25% showed a >10% increase in LDL cholesterol, whereas this occurred in only 13% of subjects on the HC diet and 3% of those on the HP diet.Conclusions/interpretationIn routine practice a reduced-carbohydrate, higher protein diet may be the most appropriate overall approach to reducing the risk of cardiovascular disease and type 2 diabetes. To achieve similar benefits on a HC diet, it may be necessary to increase fibre-rich wholegrains, legumes, vegetables and fruits, and to reduce saturated fatty acids to a greater extent than appears to be achieved by implementing current guidelines. The HF approach appears successful for weight loss in the short term, but lipid levels should be monitored. The potential deleterious effects of the diet in the long term remain a concern.