口服脂肪耐量试验的优化研究

Optimization of oral fat tolerance test

目的本研究旨在对比不同试验餐对餐后三酰甘油的影响,优化口服脂肪耐量试验标准餐配方和采血方案。方法本研究为前瞻性、开放标签、随机、交叉试验。2023年3月在河北省人民医院招募志愿者36名,经过健康查体和口服葡萄糖耐量试验,26名健康志愿者符合入选标准(男性11名,女性15名),平均年龄(39.08±4.56)岁。每位志愿者分别接受75 g蛋白餐、75 g脂肪餐、700 kcal固定热量高脂混合餐及根据10 kcal/kg体重调整热量的高脂混合餐试验,每次试验前普通饮食洗脱1周。在每次试验的空腹和餐后1、2、3、4、5、6 h采血,取血清检测三酰甘油、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血糖、胰岛素。分析不同试验餐餐后代谢指标随时间变化情况,比较两种混合餐的餐后代谢反应差异。结果蛋白餐、脂肪餐、固定热量高脂混合餐、调整热量高脂混合餐分别使餐后三酰甘油升高22.45%、115.40%、77.14%、63.63%,胰岛素升高560.43%、85.69%、554.18%、598.97%,总胆固醇、LDL-C、HDL-C降低5.64%~21.81%,血糖变化较小。代谢指标的主要变化发生在4 h以内。比较2种高脂混合餐后三酰甘油的特征,差异无统计学意义(P>0.05)。结论以700 kcal固定热量高脂混合餐为标准餐,在空腹和餐后1、2、3、4 h分别采血检测血脂水平,可作为口服脂肪耐量试验的优化方案。

Objective To compare the effects of different test meals on postprandial triglycerides and to optimize the standard meal composition and the blood sampling protocol for the oral fat tolerance test.Methods This study is a prospective,open-label,randomized,cross-over trial.In March 2023,36 volunteers were recruited in Hebei General Hospital.They underwent a health examination and oral glucose tolerance test.Twenty-six healthy volunteers(11 males and 15 females)were included in this study,with an average age of(39.08±4.56)years.Each volunteer received 75 g protein meal,75 g fat meal,700 kcal fixed-calorie high-fat mixed meal,and a high-fat mixed meal with energy adjusted based on 10 kcal/kg body weight.A one-week washout period of regular diet was applied before each trial.Blood was collected at fasting status and 1,2,3,4,5,and 6 hours after a meal to detect serum triglycerides,total cholesterol,low density lipoprotein-cholesterol(LDL-C),high density lipoprotein-cholesterol(HDL-C),glucose,and insulin.The variations of postprandial metabolic indicators over time following the consumption of different test meals were analyzed.The disparities in postprandial metabolic responses between the two types of mixed meals were compared.Results The protein meal,fat meal,fixed-calorie high-fat mixed meal,and adjusted-calorie high-fat mixed meal resulted in postprandial triglyceride increases of 22.45%,115.40%,77.14%,and 63.63%,and insulin increase of 560.43%,85.69%,554.18%,and 598.97%,respectively,and with reductions in total cholesterol,LDL-C,and HDL-C ranging from 5.64%-21.81%,respectively.The blood glucose changed slightly.Changes in metabolic indicators mainly occured within 4 hours.The comparison of the characteristics of postprandial triglycerides between the two high-fat mixed meals showed no statistically significant differences(P>0.05).Conclusion A standardize protocol with a 700 kcal fixed-calorie high-fat mixed meal as test meal,and blood lipid levels measured at fasting and at 1,2,3,and 4 hours after consumption,can serve as an optimized approach for oral fat tolerance test.