Eating two larger meals a day (breakfast and lunch) is more effective than six smaller meals in a reduced-energy regimen for patients with type 2 diabetes: a randomised crossover study
Eating two larger meals a day (breakfast and lunch) is more effective than six smaller meals in a reduced-energy regimen for patients with type 2 diabetes: a randomised crossover study
复制标题
DOI：
10.1007/s00125-014-3253-5
复制
发表时间：
2014-08-01
期刊：
影响因子：
8.2
通讯作者：
Pelikanova, Terezie
中科院分区：
文献类型：
--
作者：
Kahleova, Hana;Belinova, Lenka;Pelikanova, Terezie
目的/假设本研究的目的是比较六餐（A6 方案）与每天两餐（早餐和午餐）（B2 方案）对体重、肝脂肪含量 (HFC)、胰岛素抵抗和 β 细胞功能的影响。 方法 在一项随机、开放、交叉、单中心研究（在捷克共和国布拉格进行）中，我们分配了 54 名接受口服降糖药治疗的 2 型糖尿病患者，包括男性和女性，年龄30-70 岁，BMI 27-50 kg/m(2) 和 HbA(1c) 6-11.8% (42-105 mmol/mol)，遵循两种低能量饮食方案 A6 和 B2，各持续 12 周。试验组的随机化和分配（n = 27 和 n = 27）是通过中央计算机系统进行的。两种方案的能量需求的单独计算均基于以下公式：（静息能量消耗 x 1.5）-a 欧元千分之 2,092 kJ。两种方案的饮食具有相同的常量营养素和能量含量。 HFC通过质子磁共振波谱法测量。胰岛素敏感性通过等血糖-高胰岛素钳夹测量，并通过数学模型计算为口服葡萄糖胰岛素敏感性（OGIS）。在标准膳食测试中通过 C 肽解卷积评估 β 细胞功能，并通过数学模型进行量化。对于统计分析，使用 2 x 2 交叉方差分析。结果 意向治疗分析包括所有参与者 (n = 54)。两种方案的体重均下降（p < 0.001），B2 的体重下降幅度更大（-2.3 kg；A6 的 95% CI -2.7, -2.0 kg vs -3.7 kg；B2 的 95% CI -4.1, -3.4 kg；p < 0.001）。两种治疗方案的 HFC 均下降（p < 0.001），B2 的下降幅度更大（A6 为 -0.03%；95% CI -0.033%，-0.027%，A6 为 -0.04%；95% CI -0.041%，B2 为 -0.035%；p = 0.009）。两种治疗方案中的空腹血糖和 C 肽水平均下降（p < 0.001），B2 的下降幅度更大（分别为 p = 0.004 和 p = 0.04）。 B2 方案的空腹血浆胰高血糖素下降 (p < 0.001)，而 A6 方案 (p < 0.001) 则空腹血浆胰高血糖素增加 (p = 0.04)。两种治疗方案中的 OGIS 均增加（p < 0.01），B2 治疗方案中的 OGIS 增加（p = 0.01）。两种方案均未观察到不良事件。仅吃早餐和午餐可降低体重、HFC、空腹血糖、C 肽和胰高血糖素，并增加 OGIS，超过将相同热量限制分为六餐的情况。这些结果表明，对于低能量饮食的 2 型糖尿病患者来说，吃更多的早餐和午餐可能比白天吃六顿小餐更有益。临床试验注册号 NCT01277471 已完成。捷克共和国布拉格卫生部和查尔斯大学机构资助 NT/11238-4 - GAUK 编号 702312。
Aims/hypothesis The aim of the study was to compare the effect of six (A6 regimen) vs two meals a day, breakfast and lunch (B2 regimen), on body weight, hepatic fat content (HFC), insulin resistance and beta cell function.Methods In a randomised, open, crossover, single-centre study (conducted in Prague, Czech Republic), we assigned 54 patients with type 2 diabetes treated with oral hypoglycaemic agents, both men and women, age 30-70 years, BMI 27-50 kg/m(2) and HbA(1c) 6-11.8% (42-105 mmol/mol), to follow two regimens of a hypoenergetic diet, A6 and B2, each for 12 weeks. Randomisation and allocation to trial groups (n = 27 and n = 27) were carried out by a central computer system. Individual calculations of energy requirements for both regimens were based on the formula: (resting energy expenditure x 1.5) -aEuro parts per thousand 2,092 kJ. The diet in both regimens had the same macronutrient and energy content. HFC was measured by proton magnetic resonance spectroscopy. Insulin sensitivity was measured by isoglycaemic-hyperinsulinaemic clamp and calculated by mathematical modelling as oral glucose insulin sensitivity (OGIS). Beta cell function was assessed during standard meal tests by C-peptide deconvolution and was quantified with a mathematical model. For statistical analysis, 2 x 2 crossover ANOVA was used.Results The intention-to-treat analysis included all participants (n = 54). Body weight decreased in both regimens (p < 0.001), more for B2 (-2.3 kg; 95% CI -2.7, -2.0 kg for A6 vs -3.7 kg; 95% CI -4.1, -3.4 kg for B2; p < 0.001). HFC decreased in response to both regimens (p < 0.001), more for B2 (-0.03%; 95% CI -0.033%, -0.027% for A6 vs -0.04%; 95% CI -0.041%, -0.035% for B2; p = 0.009). Fasting plasma glucose and C-peptide levels decreased in both regimens (p < 0.001), more for B2 (p = 0.004 and p = 0.04, respectively). Fasting plasma glucagon decreased with the B2 regimen (p < 0.001), whereas it increased (p = 0.04) for the A6 regimen (p < 0.001). OGIS increased in both regimens (p < 0.01), more for B2 (p = 0.01). No adverse events were observed for either regimen.Eating only breakfast and lunch reduced body weight, HFC, fasting plasma glucose, C-peptide and glucagon, and increased OGIS, more than the same caloric restriction split into six meals. These results suggest that, for type 2 diabetic patients on a hypoenergetic diet, eating larger breakfasts and lunches may be more beneficial than six smaller meals during the day.Trial registration ClinicalTrials.gov number, NCT01277471, completed.Funding Grant NT/11238-4 from Ministry of Health, Prague, Czech Republic and the Agency of Charles University - GAUK No 702312.