极低碳水化合物饮食对肥胖症患者心血管危险因素的影响

The effects of a very low carbohydrate diet intervention on improving cardiovascular risk factors in obese subjects

目的 观察极低碳水化合物饮食（VLCD）治疗对单纯性肥胖患者心血管危险因素的影响.方法 观察35例肥胖患者经VLCD治疗8周后,体重、腰围及血压改善的同时,空腹血糖（FPG）、空腹胰岛素（FIns）、血脂谱、尿微量白蛋白/肌酐（UACR）、C反应蛋白（CRP）、TNFα、脂联素（adiponectin）等心血管危险因素的改变.另采集35例健康志愿者作为基线对照组.结果 基线时肥胖组较正常对照组有更显著的心血管危险因素（P值均＜0.05）.试验结束时肥胖患者的体重与腰围分别减少了（8.5 ±0.7）kg与（6.6±1.1）cm（P值均＜0.01）;收缩压、舒张压、FIns、TC、TG等指标均较前显著降低（P值均＜0.05）;FPG、LDL-C及HDL-C等的改变无统计学意义;UACR、CRP、TNFα分别减少了（1.86 ±0.86） μg/mg、（1.15 ±0.45） mg/L及（0.94 ±0.21）ng/L（P值均＜0.05）;脂联素水平增加了（2.12 ±0.59）mg/L（P ＜0.01）.结论 8周的VLCD治疗肥胖症可有效减重并显著改善多种心血管危险因素.

Objective To investigate the effects of a very low carbohydrate diet （VLCD） on improving cardiovascular risk factors in obese individuals.Methods A 8-week VLCD was given to 35 healthy obese subjects and the control group was consisted of 35 healthy volunteers.Multi-cardiovascular risk factors were investigated,including weight,waist circumference,BMI,blood pressure,fasting plasma glucose （FPG）,fasting insulin （FIns）,lipid profiles,urinary albumin-creatinine ratio （UACR）,C-reactive protein（CRP）,TNFα and adiponectin.Results At the baseline of the study,compared with the healthy control group,all the cardiovascular risk factors were significantly more deteriorated in the obese subjects （all P values 〈 0.05）.At the end of the study,the obese subjects showed significant decrease in their mean weight and waist circumference [（8.5 ± 0.7） kg and （6.6 ± 1.1） cm,respectively; all P values 〈 0.01].Significant decrease was also found in the levels of systolic blood pressure （SBP）,diastolic blood pressure （DBP）,FIns,TC and TG （all P values 〈 0.05）,while no significant change of FPG,HDL-C and LDL-C.The levels of UACR,CRP and TNFα were all significantly decreased [（1.86 ± 0.86） μg/mg,（1.15 ± 0.45） mg/L and （0.94 ± 0.21） ng/L,respectively; all P values 〈 0.05],while the level of adiponectin was significantly increased [（2.12 ± 0.59） mg/L,P 〈 0.01].Conclusion VLCD is an effective intervention in obese subjects which could improve the cardiovascular risk factors by the modest weight loss.