主食习惯对食物血糖应答影响的对照试验研究

Staple food habits on glycemic response:a controlled feeding trial

目的通过对照试验,研究不同的主食习惯对食物血糖应答的影响。方法2020年11月,在山西省长治医学院招募从小习惯吃米食和习惯吃面食的志愿者各35名,对其进行两阶段的全膳食管理,在其他膳食供给一致的情况下,第一阶段(主食强化期,4周)维持原有主食习惯,第二阶段(主食互换期,4周)进行主食互换。采用动态葡萄糖监测系统对相当于50 g可利用碳水化合物的葡萄糖、馒头和米饭的血糖应答进行监测,对餐后120 min内每隔15 min的血糖值、血糖应答曲线下增量面积(incremental area under the curve,iAUC)和血糖生成指数(glycemic index,GI)进行分析。结果在主食强化期,米食习惯组对馒头的血糖应答值在餐后15 min(5.43±0.69 vs.5.14±0.50 mmol/L,P=0.047),30 min(6.63±0.98 vs.6.10±0.70 mmol/L,P=0.012),45 min(6.81±1.15 vs.6.21±0.67 mmol/L,P=0.011),60 min(6.03±0.96 vs.5.56±0.59 mmol/L,P=0.017)高于面食习惯组,且两组食用馒头后120 min内的血糖波动趋势不同。在主食互换期,经过4周的主食习惯改变,米食习惯组对馒头的120 min iAUC(83.24±30.15 vs.69.32±26.25 mmol·min/L,P=0.032)和GI值(88±24 vs.75±33,P=0.041)高于面食习惯组。比较两组自身在主食互换期与主食强化期的差异,米食习惯组对馒头(P=0.007)的血糖应答值增加,而面食习惯组对葡萄糖(P<0.001)、馒头(P<0.001)、米饭(P=0.018)的血糖应答值均增加。米食习惯组对馒头的120 min iAUC增加(83.24±30.15 vs.70.12±26.02 mmol·min/L,P=0.029),面食习惯组对米饭的120 min iAUC增加(69.75±32.32 vs.54.87±20.43 mmol·min/L,P=0.040)。结论不同主食习惯人群对同一种食物的血糖应答存在明显差异,且短期改变主食摄入就会导致不同饮食习惯的人群血糖应答差异。

OBJECTIVE To study the effects of staple food on the glycemic responses through a controlled feeding trial.METHODS In November 2020,two groups of volunteers with different staple food habits(the rice group,n=35,and the wheat group,n=35),were recruited from Changzhi Medical College in Shanxi Province.They were subjected to a two-stage feeding trial,in which their staple food habits were maintained in the first stage(staple food fortification period,4 weeks)and then swapped in the second stage(staple food swap period,4 weeks),while keeping the rest of the dietary components same.A continuous glucose monitoring system was used to monitor the glycemic response of glucose,steamed buns and steamed rice,equivalent to 50 g of available carbohydrate(CHO).Blood glucose level up to 120 minutes postprandial,incremental area under the curve(iAUC)and glycemic index(GI)were analyzed.RESULTS During the staple food fortification period,the glycemic response to steamed buns at 15 min(5.43±0.69 vs.5.14±0.50 mmol/L,P=0.047),30 min(6.63±0.98 vs.6.10±0.70 mmol/L,P=0.012),45 min(6.81±1.15 vs.6.21±0.67 mmol/L,P=0.011)and 60 min postprandial(6.03±0.96 vs.5.56±0.59 mmol/L,P=0.017)in the rice group were higher than the wheat group,and the trends for blood glucose fluctuation during the 120 minutes after consuming steamed buns were different between the two groups.During the staple food swap period,the 120 min iAUC(83.24±30.15 vs.69.32±26.25 mmol·min/L,P=0.032)and GI(88±24 vs.75±33,P=0.041)of the rice group to steamed buns were higher than the wheat group.Comparing the differences between the two groups in the staple food exchange period and the staple food intensification period,the rice group had an increased glycemic response to steamed buns(P=0.007),while the wheat group had an increased glycemic response to glucose(P<0.001),steamed buns(P<0.001)and steamed rice(P=0.018).The 120 min iAUC of steamed buns in the rice group increased(83.24±30.15 vs.70.12±26.02 mmol·min/L,P=0.029),and the 120 min iAUC of rice in the wheat group(69.75±32.32 vs.54.87±20.43 mmol·min/L,P=0.040)increased.CONCLUSION Even to the same food,there are significant differences in the glycemic responses of people with different staple food habits,and short-term changes in the intake of staple food will lead to differences in the glycemic response.