短期主食限制与主食替代饮食模式对肥胖人群代谢水平的影响-东南大学学报医学版

短期主食限制与主食替代饮食模式对肥胖人群代谢水平的影响

单位：1. 东南大学公共卫生学院营养与食品卫生学系环境医学工程教育部重点实验室, 江苏南京 210009;
2. 北京市营养源研究所, 北京 100069

分类号：R589.2;R153.9

出版年·卷·期（页码）：2022·41·第四期（476-483）

摘要：

目的：探讨短期主食限制与主食替代饮食模式对肥胖人群代谢水平的影响。方法：招募30名肥胖受试者，随机分为对照组和试验组，每组15人，男女比例一致。对照组控制每日主食摄入量在200 g内。试验组遵循主食替代饮食方案：以蛋白营养粉替代每日早、晚两餐主食，午餐主食摄入量控制在100 g之内，三餐之间给予果蔬植物粉维持饱腹感，并每日补充鱼油凝胶糖果5.64 g。连续干预30 d，动态调整并控制受试者每日碳水化合物摄入量在50~150 g·d^-1，能量在900~1 500 kcal·d^-1（1 kcal=4.186 8 kJ）范围内。结果：对照组与试验组每日能量摄入[（1 191.49±272.04） kcal·d^-1vs.（1 187.00±306.06） kcal·d^-1]和碳水化合物摄入[（117.35±29.78） g·d^-1 vs.（113.17±39.60） g·d^-1]水平保持一致。试验组体重、腰围、臀围、体脂率下降幅度均显著高于对照组（P<0.05）。试验组血清总胆固醇、甘油三酯水平下降幅度高于对照组。试验组受试者空腹血糖和糖化血红蛋白水平下降幅度高于对照组。试验组空腹胰岛素水平下降幅度高于对照组，但差异无统计学意义。两组血清高敏C反应蛋白和髓过氧化物酶水平均呈下降趋势，试验组高敏C反应蛋白水平降低幅度显著高于对照组（P<0.05）。干预前后受试者肝肾功能无变化。结论：短期主食限制和主食替代方案对肥胖人群体重控制和代谢指标改善均有效，而采用蛋白营养粉替代主食的饮食模式在降低体重、腰围、臀围、体脂率和调节血脂、血糖代谢水平及降低心血管疾病风险方面效果更佳。

Objective: To explore the effects of short-term staple food restriction diet and short-term staple food replacement diet on the metabolic level of obese people. Methods: Thirty obese subjects were recruited and randomly divided into control group and test group, with 15 persons in each group. The proportion of men and women was the same. The daily intake of staple food in the control group was controlled within 200 g. The test group followed the staple food replacement diet scheme: the protein powder was used to replace the staple food of the morning and evening meals, the intake of the staple food for lunch was controlled within 100 g, the plant powder was given between meals to maintain the sense of satiety, and 5.64 g of fish oil Gelatinized Confection was supplemented daily. After continuous intervention for 30 days, the subjects' daily carbohydrate intake was dynamically adjusted and controlled within the range of 50~150 g·d^-1 and energy within the range of 900~1 500 kcal·d^-1. Results: The daily energy intake[(1 191.49±272.04) kcal·d^-1vs. (1 187.00±306.06) kcal·d^-1]and carbohydrate intake[(117.35±29.78)g·d^-1 vs.(113.17±39.60) g·d^-1] levels of the control group and the test group were consistent. The decrease of body weight, waist circumference, hip circumference and body fat rate in the test group were significantly higher than those in the control group (P<0.05). The decrease of serum total cholesterol and triglyceride in the test group was higher than that in the control group. The decrease of fasting blood glucose and glycosylated hemoglobin in the test group was higher than that in the control group. The decrease of fasting insulin in the test group was greater than that in the control group, but the difference was not statistically significant. Serum high-sensitivity C-reactive protein and myeloperoxidase in both groups showed a downward trend, and the decrease of high-sensitivity C-reactive protein in the test group was significantly higher than that in the control group (P<0.05). There was no change in the liver and kidney functions during the intervention. Conclusion: The short-term staple food restriction diet and staple food replacement diet are both effective in weight control and metabolic index improvement in obese people. The dietary model of using protein powder instead of staple food is more effective in reducing body weight, waist circumference, hip circumference, body fat rate, and in regulating blood lipids and blood glucose metabolism levels and reducing the risk of cardiovascular diseases compared with simply food intaking control.

参考文献：

[1] CHEN Y, PENG Q, YANG Y, et al.The prevalence and increasing trends of overweight, general obesity, and abdominal obesity among Chinese adults:a repeated cross-sectional study[J].BMC Public Health, 2019, 19(1):1293.
[2] 中国营养学会.中国居民膳食指南科学研究报告(2021)[R].2021, 13-14.
[3] SUN S, HE J, SHEN B, et al. Obesity as a "self-regulated epidemic":coverage of obesity in Chinese newspapers[J]. Eating and Weight Disorders, 2021, 26(2):569-584.
[4] ARROYO-JOHNSON C, MINCEY K D. Obesity epidemiology worldwide[J]. Gastroenterology Clinics, 2016, 45(4):571-579.
[5] OECD/WHO.Health at a glance:Asia/Pacific 2020:measuring progress towards universal heacth coverage[M].Paris:OECD Publishing, 2020.
[6] GARVEY W T, MECHANICK J I, BRETT E M, et al. American association of clinical endocrinologists and American college of endocrinology comprehensive clinical practice guidelines formedical care of patients with obesity[J]. Endocrine Practice, 2016, 22:1-203.
[7] JENSEN M D, RYAN D H, APOVIAN C M, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society[J]. J Am Coll Cardiol, 2014, 63(25 Part B):2985-3023.
[8] TCHANG B G, SAUNDERS K H, IGEL L I. Best practices in the management of overweight and obesity[J]. Medical Clinics, 2021, 105(1):149-174.
[9] BAZZANO L A, HU T, REYNOLDS K, et al.Effects of low-carbohydrate and low-fat diets:a randomized trial[J].Ann Intern Med, 2014, 161(5):309-318.
[10] BURGESS B, RAYNOR H A, TEPPER B J. PROP nontaster women lose more weight following a low-carbohydrate versus a low-fat diet in a randomized controlled trial[J].Obesity (Silver Spring), 2017, 25(10):1682-1690.
[11] GARDNER C D, TREPANOWSKI J F, DEL GOBBO L C, et al.Effect of low-fat vs. low-carbohydrate diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion:the DIETFITS randomized clinical trial[J].JAMA, 2018, 319(7):667-679.
[12] McCLAIN A D, OTTEN J J, HEKLER E B, et al.Adherence to a low-fat vs. low-carbohydrate diet differs by insulin resistance status[J].Diabetes Obes Metab, 2013, 15(1):87-90.
[13] SWIFT D L, JOHANNSEN N M, LAVIE C J, et al.Effects of clinically significant weight loss with exercise training on insulin resistance and cardiometabolic adaptations[J].Obesity (Silver Spring), 2016, 24(4):812-819.
[14] HAMES K C, COEN P M, KING W C, et al.Resting and exercise energy metabolism in weight-reduced adults with severe obesity[J].Obesity (Silver Spring), 2016, 24(6):1290-1298.
[15] NINDL B C, PIERCE J R, RARICK K R, et al.Twenty-hour growth hormone secretory profiles after aerobic and resistance exercise[J].Med Sci Sports Exerc, 2014, 46(10):1917-1927.
[16] LIANG M, PAN Y, ZHONG T, et al.Effects of aerobic, resistance, and combined exercise on metabolic syndrome parameters and cardiovascular risk factors:a systematic review and network meta-analysis[J].Rev Cardiovasc Med, 2021, 22(4):1523-1533.
[17] KWON H R, MIN K W, AHN H J, et al.Effects of Aerobic exercise vs. resistance training on endothelial function in women with type 2 diabetes mellitus[J].Diabetes Metab J, 2011, 35(4):364-373.
[18] CARDOSO C G, GOMIDES R S, QUEIROZ A C, et al.Acute and chronic effects of aerobic and resistance exercise on ambulatory blood pressure[J].Clinics (Sao Paulo), 2010, 65(3):317-325.
[19] YANG Z Y, SCOTT CATHERINE A, MAO C, et al.Resistance exercise versus aerobic exercise for type 2 diabetes:a systematic review and meta-analysis[J].Sports Medicine, 2013, 44(4):487-499.
[20] WROBEL M, ROKICKA D, CZUBA M, et al.Aerobic as well as resistance exercises are good for patients with type 1 diabetes[J].Diabetes Res Clin Pract, 2018, 144:93-101.
[21] VILLARROYA F, CEREIJO R, VILLARROYA J, et al.Brown adipose tissue as a secretory organ[J].Nat Rev Endocrinol, 2017, 13(1):26-35.
[22] HALBERG N, WERNSTEDT-ASTERHOLM I, SCHERER P E.The adipocyte as an endocrine cell[J].Endocrinol Metab Clin North Am, 2008, 37(3):753-768.
[23] HAUNER H.Secretory factors from human adipose tissue and their functional role[J].Proc Nutr Soc, 2005, 64(2):163-169.
[24] KALAM F, GABEL K, CIENFUEGOS S, et al.Alternate day fasting combined with a low-carbohydrate diet for weight loss, weight maintenance, and metabolic disease risk reduction[J].Obes Sci Pract, 2019, 5(6):531-539.
[25] LARSEN R N, MANN N J, MACLEAN E, et al.The effect of high-protein, low-carbohydrate diets in the treatment of type 2 diabetes:a 12 month randomised controlled trial[J].Diabetologia, 2011, 54(4):731-740.
[26] ROSS L J, BYRNES A, HAY R L, et al.Exploring the highs and lows of very low carbohydrate high fat diets on weight loss and diabetes-and cardiovascular disease-related risk markers:a systematic review[J].Nutr Diet, 2021, 78(1):41-56.
[27] RUTH M R, PORT A M, SHAH M, et al.Consuming a hypocaloric high fat low carbohydrate diet for 12 weeks lowers C-reactive protein, and raises serum adiponectin and high density lipoprotein-cholesterol in obese subjects[J].Metabolism, 2013, 62(12):1779-1787.
[28] MENTE A, DEHGHAN M, RANGARAJAN S, et al.Association of dietary nutrients with blood lipids and blood pressure in 18 countries:a cross-sectional analysis from the PURE study[J].Lancet Diabetes Endo, 2017, 5(10):774-787.
[29] BOSSE J D, LIN H Y, SLOAN C, et al.A low-carbohydrate/high-fat diet reduces blood pressure in spontaneously hypertensive rats without deleterious changes in insulin resistance[J].Am J Physiol Heart Circ Physiol, 2013, 304(12):H1733-1742.
[30] PIRILLO A, NORATA G D, CATAPANO A L.LOX-1, OxLDL, and atherosclerosis[J].Mediators Inflamm, 2013, 2013:152786.
[31] 张茜, 郭健.髓过氧化物酶的检测及在心血管疾病中的临床意义[J].临床检验杂志, 2009(2):155-157.
[32] SHIEH C, DRAUCKER C B.Self-monitoring lifestyle behavior in overweight and obese pregnant women:qualitative findings[J].Clin Nurse Spec, 2018, 32(2):81-89.
[33] RAYNOR H A, THOMAS J G, CARDOSO C C, et al.Examining the pattern of new foods and beverages consumed during obesity treatment to inform strategies for self-monitoring intake[J].Appetite, 2019, 132:147-153.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录