膳食结构与2型糖尿病患者胰岛素抵抗的相关性研究

目的 对2型糖尿病（T2DM）患者的膳食结构进行分析,探讨膳食中三大营养物质的摄入量及其所占能量供给比例与胰岛素抵抗之间的关系.方法 160例T2DM患者,根据膳食情况调查分为高碳水化合物组（高CHO组）、高蛋白高脂肪组和正常比例膳食对照组,检测葡萄糖代谢指标、血脂谱和胰岛素水平,计算胰岛素抵抗指数（HOMA-IR）.结果 T2DM组每日CHO、脂肪和蛋白质摄入量、每日摄入食物所产生的总热量及蛋白质热量/总热量均显著高于非糖尿病组（P＜0.01）;相关性分析表明,HOMA-IR与空腹血糖（FPG）、日摄入CHO量等呈正相关（P＜0.01）;多因素回归分析表明,日摄入CHO量、膳食中脂肪提供热量所占比例等是HOMA-IR的影响因素.结论 高脂肪高蛋白饮食对2型糖尿病患者糖、脂代谢的影响尤为明显,日摄入CHO总量及膳食中脂肪所占能量供给比例等与胰岛素抵抗密切相关.

Relevance Analysis of Diet Structure and Insulin Resistance for Patients with Type 2 Diabetes Mellitus

OBJECTIVE To explore the intake of the three nutrients in diet and the relationship between their energy supply ratios and insulin resistance by analyzing the diet structures of patients with type 2 diabetes mellitus（T2DM）. METHODS A total of 160 T2DM patients were divided into high carbohydrate group（high CHO group）, high fat and protein group and normal diet ratio group according to their diet conditions so as to detect the glucose metabolism indexes, blood lipid profile and insulin level and calculate the homeo- stasis model assessment of insulin resistance（HOMA-IR）. RESULTS T2DM group was evidently higher than non-T2DM group in dai- ly CHO, lipid and protein intakes, daily total energy, protein energy/total energy from diet（P〈0.01）. Relevance analysis showed that HOMA-IR was in positive association with fast plasma glucose （FPG） and daily CHO intake（P〈0.01） while multivariate analysis indi- cated that the ratios of daily CHO intake and energy from fat were the influencing factors of HOMA-IR. CONCLUSION Diet with high fat and protein were more critical for the glucose and fat metabolism of T2DM patients, and daily CHO intake and the fat ratio in total energy supply were closely related with insulin resistance.