不同禁食模式干预单纯性肥胖的作用观察

Effects Observation of Different Fasting Patterns on Intervention of Simple Obesity

目的评价不同禁食模式干预单纯性肥胖的效果及安全性,并探究作用机制。方法采用随机对照试验方法,选择84例单纯性肥胖患者,随机分为3组,每组28例,A组采用持续禁食联合益生元与中药茶饮干预,B组采用间歇禁食联合益生元与中药茶饮干预,C组采用持续禁食联合益生元干预。分别在干预前、干预第7天及14天采集指标,比较各组干预前后和组间的减重效果、生理、生化等指标的差异及肠道菌群变化。结果(1)各组完成情况:A、B两组各完成25例,C组完成22例。(2)减重相关指标:经过14 d干预,3组体质量指标均有不同程度降低,A组减重率高于C组、体脂率低于C组;B组代谢率高于A组。(3)心血管相关指标:干预后A、B、C 3组血压均显著降低,A、C两组心率(Heart rate,HR)在第7天升高,A组HR高于同期B组水平,第14天HR恢复至干预前水平。干预后3组血脂及同型半胱氨酸(Homocysteine,Hcy)、超敏C反应蛋白(Hypersensitive C-reactive protein,hs-CRP)有不同程度降低,B组hs-CRP水平低于A组,A组总胆固醇(Total cholesterol,TC)、甘油三酯(Triglyceride,TG)水平低于C组。(4)血糖相关指标:干预后,3组空腹血糖(Fasting blood glucose,FBG)、空腹胰岛素(Fasting insulin,FINS)、胰岛素抵抗指数(Homeostatic model assessment for insulin resistance,HOMA-IR)均有不同程度降低,A组FBG低于C组。(5)脏器功能相关指标:干预中期3组肝肾功能指标均出现波动,B组波动幅度相对较低。(6)炎症因子相关指标:干预后3组富含半胱氨酸的酸性分泌蛋白(Secreted protein acidic and rich in cysteine,SPARC)、白介素-6(Interleukin-6,IL-6)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、干扰素-β(Interferon-β,IFN-β)均有不同程度降低,A组SPARC水平低于C组,A组IL-6水平低于B、C两组,A组IFN-β低于B组。(7)肠道菌群:各组干预后肠道菌群丰度及组成发生明显改变,物种多样性增加,菌群功能改变,炎症因子变化与肠道菌群变化存在相关性。结论3种禁食模式对于体重控制、改善心血管危险因素,降低炎症反应、调节肠道菌群等方面均可产生有益影响。从干预效果方面考虑,联合使用中药茶饮能够让参与者获益更多。观察期内未发现间歇禁食与持续禁食存在明显效果差异。3种干预模式均未出现严重不良反应,中药茶饮与益生元联合禁食纳入日常饮食具有推广价值。禁食对代谢及炎症标志物的改善可能与肠道菌群的调节密切相关。

Objective To evaluate the efficacy and safety of different fasting patterns on intervention of simple obesity and explore the mechanism.Methods Using the randomized controlled trial method,84 patients with simple obesity were randomly divided into three groups,28 cases in each group.Group A used continuous fasting combined with prebiotics and Chinese medicinal tea intervention,group B used intermittent fasting combined with prebiotics and Chinese medicinal tea intervention,and group C used continuous fasting combined with prebiotic intervention.The indicators were collected before the intervention,on the 7th day and 14th day of the intervention,and the differences in weight loss effects,physiology,biochemistry and other indexes and the changes of gut flora before and after the intervention and between groups were compared.Results(1)Completion of each group:25 cases were completed in group A and B,and 22 cases were completed in group C.(2)Weight loss related indexes:After 14 days of intervention,body weight indexes of the three groups were reduced to various degrees.The weight loss rate of group A was higher than that of group C,and the body fat percentage was lower than that of group C.The metabolic rate of group B was higher than that of group A.(3)Cardiovascular-related indicators:After the intervention,the blood pressure of group A,B and C was significantly reduced,the heart rate(HR)of group A and C increased on the 7th day.The HR of group A was higher than that of group B in the same period,and the HR returned to the pre-intervention level on the 14th day.After the intervention,the three groups had different degrees of blood lipids,homocysteine(Hcy)and hypersensitive C-reactive protein(hs-CRP),the levels of hs-CRP in group B were lower than those in group A,and the levels of total cholesterol(TC)and triglyceride(TG)in group A were lower than those in group C.(4)Blood glucose-related indicators:After the intervention,the levels of fasting blood glucose(FBG),fasting insulin(FINS)and homeostatic model assessment for insulin resistance(HOMA-IR)of the three groups were reduced to varying degrees,and the FBG of group A was lower than that of group C.(5)Organ function related indicators:The liver and kidney function indicators of the three groups were fluctuated in the middle of the intervention,and the fluctuation range of group B was relatively low.(6)Inflammatory factor related indicators:After the intervention,the levels of secreted protein acidic and rich in cysteine(SPARC),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and interferon-β(IFN-β)were reduced to different degrees,with the SPARC level in group A was lower than that in group C,the level of IL-6 in group A was lower than that in group B and group C,and the IFN-βin group A was lower than that in group B.(7)Gut flora:After intervention,the abundance and composition of gut flora in each group were significantly changed.The species diversity was increased in all groups after intervention.The gut flora function was also changed according to bioinformatics analysis.The changes in inflammatory factors were correlated with changes in gut flora.Conclusions All three fasting patterns had beneficial effects on body weight control,improvement of cardiovascular risk factors,reduction of inflammatory response and regulation of gut flora.However,in terms of body weight loss,participants are benefited more from the combination of Chinese medicinal tea.No significant difference was found between intermittent fasting and continuous fasting during the observation period.There were no serious adverse reactions in the three intervention modes,so Chinese medicinal tea and prebiotics combined with fasting into daily diet are worthy of promoting.The improvement of metabolic and inflammatory markers may be closely related to the regulation of gut flora.