Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes
Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes
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DOI：
10.7326/0003-4819-142-6-200503150-00006
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发表时间：
2005-03-15
影响因子：
39.2
通讯作者：
Stein, TP
中科院分区：
文献类型：
--
作者：
Boden, G;Sargrad, K;Stein, TP
背景资料：目前尚不清楚低碳水化合物、高蛋白、高脂肪饮食如何导致2型糖尿病患者体重减轻或如何影响血糖水平。目的：确定严格的低碳水化合物饮食对肥胖2型糖尿病患者体重、身体水分、能量摄入和消耗、血糖控制、胰岛素敏感性和脂质水平的影响。设计：住院患者比较2种饮食。设置：一所大学医院的综合临床研究中心，患者：10名肥胖的2型糖尿病患者，干预：连续7天的饮食，随后14天的低碳水化合物饮食，测量：体重、水分和成分，能量摄入和消耗，饮食满意度，血红蛋白A（1c），胰岛素敏感性，24小时尿酮排泄，结果：低碳水化合物饮食组的平均能量摄入量从3111千卡/天下降到2164千卡/天。平均能量不足1027 kcal/d（中位数737 kcal/d）完全解释了14天内体重减轻1.65 kg（中位数1.34 kg）。平均24小时血糖水平曲线正常化，平均血红蛋白A（1c）从7.3%降至6.8%，胰岛素敏感性改善约75%。平均血浆甘油三酯和胆固醇水平降低（变化分别为-35%和-10%）。局限性：该研究受到持续时间短、参与者人数少和缺乏严格对照组的限制。在一小组患有2型糖尿病的肥胖患者中，低碳水化合物饮食2周后，导致自发减少能量摄入到适合其身高的水平;体重减轻完全是由于热量摄入减少; 24小时血糖曲线、胰岛素敏感性和血红蛋白A（1c）显著改善;血浆胆固醇和胆固醇水平降低。然而，这种饮食的长期影响仍然不确定。
Background: it is not known how a low-carbohydrate, high-protein, high-fat diet causes weight loss or how it affects blood glucose levels in patients with type 2 diabetes.Objective: To determine effects of a strict low-carbohydrate diet on body weight, body water, energy intake and expenditure, glycemic control, insulin sensitivity, and lipid levels in obese patients with type 2 diabetes.Design: Inpatient comparison of 2 diets.Setting: General clinical research center of a university hospital.Patients: 10 obese patients with type 2 diabetes.Intervention: Usual diets for 7 days followed by a low-carbohydrate diet for 14 days.Measurements: Body weight, water, and composition; energy intake and expenditure; diet satisfaction; hemoglobin A(1c); insulin sensitivity; 24-hour urinary ketone excretion; and plasma profiles of glucose, insulin, leptin, and ghrelin.Results: on the low-carbohydrate rate diet, mean energy intake decreased from 3111 kcal/d to 2164 kcal/d. The mean energy deficit of 1027 kcal/d (median, 737 kcal/d) completely accounted for the weight loss of 1.65 kg in 14 days (median, 1.34 kg in 14 days). Mean 24-hour plasma profiles of glucose levels normalized, mean hemoglobin A(1c) decreased from 7.3% to 6.8%, and insulin sensitivity improved by approximately 75%. Mean plasma triglyceride and cholesterol levels decreased (change, -35% and -10%, respectively).Limitations: The study was limited by the short duration, small number of participants, and lack of a strict control group.Conclusion: in a small group of obese patients with type 2 diabetes, a low-carbohydrate diet followed for 2 weeks resulted in spontaneous reduction in energy intake to a level appropriate to their height; weight loss that was completely accounted for by reduced caloric intake; much improved 24-hour blood glucose profiles, insulin sensitivity, and hemoglobin A(1c); and decreased plasma triglycericle and cholesterol levels. The long-term effects of this diet, however, remain uncertain.