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转载 糖尿病患者少食多餐完全没有必要

王新军 副主任医师 海南医学院第一附属医院 内分泌科
2013-09-30 1184人已读
王新军 副主任医师
海南医学院第一附属医院
Background and aims: Caloric restriction is crucial in the treatment of type 2 diabetes (T2D), typically (but not necessarily) apportioned into five or six small meals during the day. It has been shown that a large isocaloric mixed meal causes a greater postprandial thermogenic response than the same food consumed in six smaller portions. The aim of our study was to compare the effect of six vs. two meals a day with the same caloric restriction on body weight, HbA1c and resting energy expenditure in subjects with T2D. 海南医学院第一附属医院内分泌科王新军
背景和目的:2型糖尿病(T2D)治疗中热量限制是非常重要,典型的方法是(但也不一定)将一天中总热量分为5或6次少量进餐。已有证据表明等热量的大量混合餐比相同食物分为6小份消耗导致更多的餐后产热效应。我们研究的目的是比较2型糖尿病患者在相同热量限制下,一天6次进餐与一天两次进餐对体重、HbA1c和静息能量消耗的影响。
Materials and methods: In a randomised, crossover study, we assigned 54 patients with T2D to follow two regimens of a hypocaloric diet (-500 kcal/day), each for 12 weeks: six meals a day (A), and two meals a day (B). The diet in both regimens had the same macronutrient and energy content. At weeks 0, 12 and 24, we measured subject weight, HbA1c and performed indirect calorimetry using metabolic monitor VMAX; Sensor Medics, Anaheim, CA, USA. Predicted resting energy expenditure (REE) was counted according to Harris-Benedict equation. For statistical analysis, 2x2 crossover ANOVA was used.
材料和方法:在一项随机交叉研究中,将54例2型糖尿病患者分到两种低热量饮食方案,每种方案12周:一天6次进餐(A)和一天2次进餐(B)。两种方案的食物有相同的常量营养元素和能量。在0、12和24周测量受试者体重、HbA1c,并使用代谢监测仪VMAX进行间接测热量测定。预测静息能量消耗(REE)依据Harris–Benedict方程计算。使用2×2交叉ANOVA进行统计分析。
Results: Body weight decreased in both regimens (p<0.001), more in B (-2.3; 95% CI -2.7 to -2.0 kg in A vs. -3.7; 95% CI -4.1 to -3.4 kg in B; p<0.001). Hb1Ac decreased in both regimens (p<0.001) with a trend toward a greater decrease in B (-0.23; 95% CI -0.27 to -0.19 % in A vs. -0.25; 95% CI -0.29 to -0.20 % in B; p=0.08). Fasting C-peptide decreased in both regimens (p<0.001), more in B (p=0.05: -0.14; 95% CI -0.18 to -0.1 vs. -0.05; 95% CI -0.09 to -0.01 nmol/L in A). Hb1Ac decreased in both regimens (p<0.001); the trend toward the greater decrease in B was not significant (p=0.08: -0.25; 95% CI -0.29 to -0.20 vs. -0.23; 95% CI -0.27 to -0.19 % in A). Plasma immunoreactive insulin, triglycerides and LDL-cholesterol decreased comparably in both regimens. No significant change in total or HDL-cholesterol was observed in either regimen. Respiratory quotient increased in both regimens (p<0.01) with a trend toward a greater increase in A (+0.06; 95% CI +0.04 to +0.07 in A vs. +0.04; 95% CI +0.02 to +0.05 in B; p=0.2). Measured REE decreased in both regimens (p<0.001) with a trend toward a greater decrease in A (-108.3; 95% CI -125.3 to -91.5 kcal/day in A vs. -90.8; 95% CI -107.5 to -74.3 kcal/day in B; p=0.3). If counted as percentage of the predicted REE according to Harris Benedict equation, REE decreased in both regimens (p<0.001), with a trend toward a greater decrease in A (-4.6; 95% CI -5.6 to -3.7% in A vs. -3.0; 95% CI -3.9 to -2.1% in B; p=0.08).
结果:两种方案的体重都下降(p<0.001),B方案体重下降更多(-2.3; A方案95% CI -2.7 to -2.0 kg vs. B方案-3.7; 95% CI -4.1 to -3.4 kg; p<0.001)。两种方案的HbA1c都下降(p<0.001) ,B方案HbA1c倾向于下降更多(A方案-0.23; 95% CI -0.27 to -0.19 % vs. B方案-0.25; 95% CI -0.29 to -0.20 % ; p=0.08). 。两种方案的空腹C肽都下降(p<0.001),B方案空腹C肽下降更多(p=0.05: B方案-0.14; 95% CI -0.18 to -0.1 vs.A方案 -0.05; 95% CI -0.09 to -0.01 nmol/L)。两种方案的HbA1c都下降,B方案HbA1c倾向于下降更多,但两种方案的差别没有统计学意义(p=0.08: -0.25; B方案95% CI -0.29 to -0.20 vs.A方案 -0.23; 95% CI -0.27 to -0.19 % )。两种方案的血浆免疫反应性胰岛素、甘油三酯和LDL胆固醇有同等程度的下降。两种方案的呼吸商都增加(p<0.01),A方案倾向于增加更多(A方案+0.06; 95% CI +0.04 to +0.07 vs. B方案+0.04; 95% CI +0.02 to +0.05; p=0.2)。两种方案的REE测量值都下降(p<0.001),A方案倾向于有更大幅度的下降(A方案-108.3; 95% CI -125.3 to -91.5 kcal/day vs. B方案-90.8; 95% CI -107.5 to -74.3 kcal/day; p=0.3)。假如依据Harris–Benedict方程计算预测REE百分比,两种方案REE都下降(p<0.001),A方案倾向于有下降更多(A方案-4.6; 95% CI -5.6 to -3.7% vs. B方案-3.0; 95% CI -3.9 to -2.1% in B; p=0.08).

Conclusion: Two meals a day reduced body weight, fasting glycemia and plasma C-peptide more than a diet with the same caloric restriction divided in six more frequent meals in patients with T2D. Our data suggest that fewer bigger meals may be better than smaller ones during the day for patients with T2D.
结论:2型糖尿病患者一天两次进餐与相同热量限制食物分成6次以上进餐相比,体重、空腹血糖和血浆C肽下降更多。提示2型糖尿病患者一天中少次多量进餐可能比少量多次进餐更好。

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王新军 副主任医师

海南医学院第一附属医院 内分泌科

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