交替限食对超重或肥胖2型糖尿病患者血糖、体质量指数和血脂的影响

Effects of alternating food restriction on blood glucose,body mass index and blood lipids in overweight or obesity patients with type 2 diabetes mellitus

目的:探讨交替限食对超重或肥胖2型糖尿病患者血糖、体质量指数(BMI)和血脂的影响。方法:采用前瞻性研究的方法,选取2021年12月至2022年2月上海市嘉定区南翔医院300例血糖控制平稳的超重或肥胖2型糖尿病患者,按照随机数字表法分为交替限食组(采用交替限食疗法,发放平衡膳食餐盘,隔日减少30%热量摄入)、低碳水高蛋白组(采用低碳水化合物高蛋白质饮食疗法,发放低碳水化合物高蛋白质减脂餐盘,每日减少15%热量摄入)和平衡膳食组(采用平衡膳食疗法,发放平衡膳食餐盘),每组100例。三组均干预治疗6个月。于干预前、干预结束和干预后6个月测量患者身高、体质量,计算BMI;检测糖化血红蛋白(HbA 1c)、空腹血糖(FBG)、餐后2 h血糖(2 h PBG)、三酰甘油(TG)、总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)水平。 结果:最终完成研究280例,交替限食组90例,低碳水高蛋白组90例,平衡膳食组100例。三组干预前HbA 1c、FBG、2 h PBG、BMI、TG、TC和LDL-C比较差异无统计学意义( P>0.05)。干预结束,交替限食组和低碳水高蛋白组HbA 1c和FBG明显低于平衡膳食组[(6.50 ± 0.39)%和(6.67 ± 0.30)%比(6.79 ± 0.32)%、(6.47 ± 0.61)和(6.80 ± 0.30)mmol/L比(6.94 ± 0.37)mmol/L],交替限食组明显低于低碳水高蛋白组,差异有统计学意义( P<0.05);交替限食组和低碳水高蛋白组2 h PBG和BMI明显低于平衡膳食组[(8.83 ± 0.63)和(8.81 ± 0.70)mmol/L比(9.45 ± 0.85)mmol/L、(25.99 ± 2.13)和(26.53 ± 2.16)kg/m 2比(27.24 ± 2.24)kg/m 2],差异有统计学意义( P<0.05),交替限食组与低碳水高蛋白组比较差异无统计学意义( P>0.05)。干预后6个月,交替限食组HbA 1c、2 h PBG和BMI明显低于低碳水高蛋白组和平衡膳食组[(6.62 ± 0.29)%比(6.79 ± 0.19)%和(6.84 ± 0.23)%、(9.21 ± 0.53)mmol/L比(9.48 ± 0.66)和(9.55 ± 0.51)mmol/L、(25.60 ± 1.67)kg/m 2比(27.26 ± 2.42)和(27.79 ± 2.49)kg/m 2],差异有统计学意义( P<0.05),低碳水高蛋白组与平衡膳食组比较差异无统计学意义( P>0.05)。干预结束和干预后6个月,三组TG、TC和LDL-C比较差异有统计学意义( P<0.05);其中,交替限食组TG明显低于低碳水高蛋白组和平衡膳食组[(1.67 ± 0.70)mmol/L比(1.99 ± 0.89)和(2.49 ± 0.94)mmol/L、(1.70 ± 0.71)mmol/L比(2.04 ± 0.96)和(2.53 ± 1.08)mmol/L],差异有统计学意义( P<0.05),低碳水高蛋白组与平衡膳食组比较差异无统计学意义( P>0.05)。 结论:超重或肥胖2型糖尿病患者应用交替限食疗法既能降低血糖、改善血脂,又能降低BMI,且总体效果优于低碳水化合物高蛋白质饮食疗法。

Objective To explore the effect of alternating food restriction on blood glucose,body mass index(BMI)and blood lipids in overweight or obesity patients with type 2 diabetes mellitus.Methodss A prospective cohort study was used.Three hundred overweight or obesity type 2 diabetes mellitus patients with stable blood glucose control from December 2021 to February 2022 in Nanxiang Hospital,Jiading District of Shanghai City were selected.The patients were divided into alternating food restriction group(adopting alternating food restriction therapy,giving balanced meal plates,reducing 30%of calories intake every other day),low carbohydrate high protein group(adopting low carbohydrate and high protein therapy,giving low carbohydrate and high protein reduction meal plates,reducing 15%of calories intake every day)and balanced diet group(adopting balanced diet therapy,giving balanced meal plates)by random digits table method with 100 cases each.All three groups received intervention treatment for 6 months.The height and body mass before intervention and the end of intervention and 6 months after intervention were measured,and the BMI was calculated.The levels of glycosylated hemoglobin(HbAic),fasting blood glucose(FBG),2 h postprandial blood glucose(2 h PBG),triacylglycerol(TG),total cholesterol(TC)and low-density lipoprotein cholesterol(LDL-C)were measured.Results At the end,280 cases were completed the study.There were 90 cases in the alternating food restriction group,90 cases in the low carbohydrate high protein group,and 100 cases in the balanced diet group.There were no statistical differences in HbAic,FBG,2 h PBG,BMI,TG,TC and LDL-C before intervention among the three groups(P>0.05).At the end of the intervention,the HbAic and FBG in alternating food restriction group and low carbohydrate high protein group were significantly lower than those in balanced diet group:(6.50±0.39)%and(6.67±0.30)%vs.(6.79±0.32)%,(6.47±0.61)and(6.80±0.30)mmol/L vs.(6.94±0.37)mmol/L,the indexes in alternating food restriction group were significantly lower than those in low carbohydrate high protein group,and there were statistical dfference(P<0.05);the 2 h PBG and BMI in alternating food restriction group and the low carbohydrate high protein group were significantly lower than those in balanced diet group:(8.83±0.63)and(8.81±0.70)mmol/L vs.(9.45±0.85)mmol/L,(25.99±2.13)and(26.53±2.16)kg/m²vs.(27.24±2.24)kg/m',and there were statistical differences(P<0.05),there were no statistical differences in 2 h PBG and BMI between alternating food restriction group and the low carbohydrate high protein group(P>0.05).Six months after intervention,the HbAic,2 h PBG and BMI in alternating food restriction group were significantly lower than those in low carbohydrate high protein group and balanced diet group:(6.62±0.29)%vs.(6.79±0.19)%and(6.84±0.23)%,(9.21±0.53)mmol/L vs.(9.48±0.66)and(9.55±0.51)mmol/L,(25.60±1.67)kg/m²vs.(27.26±2.42)and(27.79±2.49)kg/m²,and there were statistical differences(P<0.05),there were no statistical differences in HbAic,2 h PBG and BMI between low carbohydrate high protein group and balanced diet group(P>0.05).At the end of intervention and 6 months after intervention,there were statistical differences in TG,TC and LDL-C among the three groups(P<0.05);among them,the TG in alternating food restriction group was significantly lower than that in low carbohydrate high protein group and the balanced diet group:(1.67±0.70)mmol/L vs.(1.99±0.89)and(2.49±0.94)mmol/L,(1.70±0.71)mmol/L vs.(2.04±0.96)and(2.53±1.08)mmol/L,and there were statistical differences(P<0.05),there was no statistical difference in TG between the low carbohydrate high protein group and balanced diet group(P>0.05).Conclusions The alternating food restriction therapy in overweight or obesity patients with type 2 diabetes mellitus can not only reduce blood glucose,improve blood lipids,but also reduce BMI,and the overall effect is better than that of low carbohydrate high protein therapy.