适度低碳水化合物饮食对超重/肥胖新诊断2型糖尿病患者心血管危险因素的影响

The effects of a moderate low carbohydrate diet on cardiovascular risk factors in overweight/obese patients with newly-diagnosed type 2 diabetes mellitus

目的探讨适度低碳水化合物饮食(MLCD)对超重/肥胖新诊断2型糖尿病(T2DM)患者心血管危险因素及10年心血管疾病风险的影响。方法连续入选2016年4月~2017年5月于中山大学附属第八医院(深圳福田)内分泌科首次诊断为T2DM的患者38例,在药物治疗的基础上,分为高碳水化合物、低脂饮食对照组及MLCD组,观察经24周不同饮食方案后患者各个临床指标和10年心血管疾病风险的改变情况。结果基线状态时两组患者的各指标差异无统计学意义(P>0.05)。24周后两组患者体重(BW)、体质指数(BMI)、腰围(WC)、空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、三酰甘油(TG)、胰岛素(Ins)及尿微量蛋白/肌酐比值(UACR)均较基线时显著降低(P<0.05);对照组,24周后TC较基线时显著下降(P<0.05);MLCD组,24周后HDL-C较基线时显著升高,(P<0.05);两组间SD-BG差异有统计学意义(P<0.05)。两组间24周与基线时ΔSBP、ΔDBP、ΔFPG、ΔTC、ΔLDL-C、ΔCr、Δe GFR、ΔIns及ΔUACR差异无统计学意义(P>0.05);ΔBW、ΔBMI、ΔWC、ΔHb A1c、ΔTG、ΔHDL-C差异具有统计学意义(P<0.05);24周后两组患者10年心血管疾病风险均较基线时明显下降,MLCD组的风险下降更为明显(P<0.05)。结论 24周的MLCD更加有效的降低超重/肥胖新诊断T2DM患者心血管危险因素、10年心血管疾病风险及平稳降糖。

Objective To investigate the effects of a moderate low carbohydrate diet(MLCD)on improving cardiovascular risk factors and 10-year cardiovascular disease risk in newly-diagnosed overweight/obese type 2 diabetes mellitus(T2DM)patients.Methods A total of 38 overweight/obese patients with newly-diagnosed T2DM were selected.The subjects were divided into high carbohydrate control group,low fat diet control group and MLCD group.Body weight(BW),body mass index(BMI),waist circumference(WC),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FPG),glycated hemoglobin(HbA1c),total cholesterol(TC),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),serum creatinine(Cr),insulin(Ins),urinary albumin-to-creatinine ratio(UACR),standard deviation-blood glucose(SD-BG)and 10-year cardiovascular disease(CVD)risk were measured.Results No statistical difference of all the cardiovascular risk factors was found between the two groups at baseline(P>0.05).BW,BMI,WC,FPG,HbA1c,TG,Ins and UACR were significantly decreased in both groups than those at baseline after 24-weeks(P<0.05).TC was significantly decreased in control group after 24-weeks while HDL-C was significantly increased in MLCD group(P<0.05).Statistical difference was found in SD-BG between the two groups(P<0.05).There were no significant difference inΔSBP,ΔDBP,ΔFPG,ΔTC,ΔLDL-C,ΔCr,ΔeGFR,ΔIns andΔUACR between the two groups(P>0.05).The difference betweenΔBW,ΔBMI,ΔWC,ΔHbA1c,ΔTG andΔHDL-C were statistically significant(P<0.05).10-year cardiovascular disease risk was decreased significantly in both groups after 24-weeks,the risk reduction in MLCD group was more pronounced(P<0.05).Conclusion 24-weeks of MLCD can be more effective in decreasing cardiovascular risk factors,10-year cardiovascular disease risk and steadily lowering blood glucose in newly-diagnosed overweight/obese T2DM patients.