高蛋白饮食对肥胖和超重成年人三酰甘油和尿酸的影响：随机对照单盲研究

Effects of protein-enriched meal on triglyceride, uric acid and renal function among overweight and obese adults

目的探讨在减重过程中，高蛋白代餐饮食对肥胖和超重成年人血三酰甘油、尿酸及。肾功能的影响。方法招募成年超重和肥胖合并高三酰甘油血症者，排除糖尿病、慢性肾脏病、肝功能异常者，年龄18～55岁。按照数字随机表随机分为2组：（1）高蛋白代餐组（高蛋白组），给予高蛋白饮食，总蛋白供热比30％，（2）标准蛋白组，给予标准蛋白饮食，总蛋白供热比15％。能量摄入值参照Kateh—McArdle公式：基础代谢率=370＋21．6×瘦体组织（kg），并根据活动系数进行供给。分别在第0天（基线期）、4周（访视1）、8周（访视2）、12周（访视3）进行随访；0天，4周和12周监测其血脂（三酰甘油，胆固醇，低密度脂蛋白）及血尿酸、血肌酐和尿素氮变化水平。结果受试者94例，男性43例，女性51例。其中高蛋白组49例，平均（42．68±8．98）岁，标准蛋白组45例，平均（41．09±9．67）岁。高蛋白组和标准蛋白组体质指数（BMI）较基线期降低，但组间比较差异无统计学意义（P〉0．05）。两组的三酰甘油（mmol／L）在4周和12周均较基线期明显下降（基线期、4周、12周分别为：高蛋白组：2．18±1．18，1．77±0．82，1．86±0．83；标准蛋白组：2．60±2．67，2．03±1．28，1．92±0．79）（P〈0．05），但各时间点两组差异没有统计学意义。两组尿酸（mmol／L）水平在随访期间较基线均降低：高蛋白组在4周时较基线期下降明显（基线期、4周、12周分别为：高蛋白组：326．12±88．31，294．76±106．57，307．15±94．70；标准蛋白组：325．62±87．16，321．51±101．19，315．71±86．77）（P〈0．05）。肾功能指标中血肌酐和尿素氮水平与基线组相比略有升高，但仍位于正常范围，且组间差异无统计学意义。结论高蛋白和标准蛋白代餐均能降低超重和肥胖者体质指数，改善三酰甘油的指标，高蛋白代餐降低尿酸作用优于标准蛋白代餐。

Objective To investigate the effects of protein-enriched meal on uric acid and renal function among overweight and obese Chinese adults during weight loss. Methods People, 18-55 yearsold, with body mass index 25-35 kg/m： and triglycerides 1.7-5.4 mmol/L were enrolled. Major exclusion criteria were： type 2 diabetes, weight reducing surgery or use of weight loss drugs, chronic kidney disease, and hepatic dysfunction. A high-protein （HP） diet （protein energy ratio was 30%） or a standard-protein （SP） diet （protein energy ratio was 15%） was provided to eligible subjects for 12 weeks （84 days）. Energy intake was calculated by Katch-McArdle formula： basal metabolic rate=370＋21.6×lean body mass （kg） and coefficient of variation. All the subjects were followed up at day 0, week 4, week 8, and weekl2. The changes of triglyceride （TG）0 total cholesterin （TC）, low density lipoprotein （LDL）, uric acid （UA）, blood urine nitrogen （BUN） and creatinine （Cre） were determined at day 0, week 4, and week 12. Results Ninety-four subjects with HP （n=49） or SP （n=45） were enrolled, and seven subjects were withdrawn for refusing the following visit. The average age was （42.68±8.98） years in HP group, and （41.09±9.67） years in SP group （P〉0.05）. At week 12, the BMI drop was significant in both groups from baseline, but with no significant difference between the two groups. The decreases of TG （mmool/L） at 4 weeks and 12 weeks were significant compared with the baseline （0 d, 4weeks, 12 weeks： HP： 2.18±1.18, 1.77±0.82, 1.86±0.83; SP：2.60±2.67, 2.03±1.28, 1.92±0.79） （P〈0.05）,but with no significant difference between the two groups. Compared with the baseline, the decrease of UA （retool/L） at 4 weeks in HP group was significant （0 d, 4 weeks, 12 weeks： HP： 326.12± 88.31,294.76±106.57,307.15±94.70; SP： 325.62±87.16,321.51 ± 101.19,315.71±86.77） （P〈0.05）. The BUN and CRE in both groups increased slightly compared to baseline level, but remained in the normal range. Conclusion Comparison of HP and SP groups showed that renal function did not change significantly, the levels of UA in HP group deereased significantly than that in SP group.