膳食干预对肥胖合并非酒精性脂肪性肝病儿童糖脂代谢的影响  

Effect of dietary intervention on glycolipid metabolism in obese children with nonalcoholic fatty liver disease

作　　者：盛俊霞[1] 章海华[1] 黄荣水 Jun-Xia Sheng Hai-Hua Zhang Rong-Shui Huang(Yuhang District Second People＇s Hospital of Hangzhou City, Hangzhou 311121, Zhejiang Province, China)

机构地区：[1]杭州市余杭区第二人民医院,浙江省杭州市311121

出　　处：《世界华人消化杂志》2017年第24期2224-2229,共6页World Chinese Journal of Digestology

摘　　要：目的观察肥胖合并非酒精性脂肪性肝病(nonalc-oholic fatty liver disease,NAFLD)儿童糖脂代谢的变化及膳食干预对其的影响.方法选择2015-03/2016-12肥胖合并NAFLD儿童97例及健康体检儿童49例,比较2组儿童糖代谢指标[空腹、餐后30 min、1、2 h血糖及胰岛素水平、胰岛素抵抗指数(homeostatic model assessment-insulin resistance,HOMA-IR)、脂代谢指标水平血清胆固醇(cholesterol,TC)、甘油三酯(triglyeride,TG)、低密度脂蛋白胆固醇(low-density lipoprotein,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein,HDL-C)、体质量指标(body mass index,BMI)、腰臀比(waist-to-hip ratio,WHR)].患儿组进行膳食干预6 mo,比较干预前后患儿糖、脂代谢指标、体质量指标及肝酶指标(谷丙转氨酶(alanine transaminase,ALT)、谷草转氨酶(aspartate transaminase,AST)水平的变化.结果最终有85例患儿完成了本研究.患儿组脂代谢指标(血清TC、TG、LDL-C水平)、各时间点胰岛素水平及HOMA-IR均明显高于健康对照组(P<0.01,P<0.05),而血清HDL-C则明显低于健康对照组(P<0.05).干预后,患儿的餐后30 min、1、2 h胰岛素、HOMA-IR、血清TC、TG、LDL-C水平、体质量指标(BMI、WHR)及肝酶指标(ALT、AST水平)均较干预前明显下降(P<0.01,P<0.05),而血清HDL-C水平则明显上升(P<0.05),干预后空腹胰岛素水平较干预前差异无统计学意义(P>0.05).结论肥胖合并NAFLD患儿存在明显的糖脂代谢紊乱,膳食干预对其体质量指数、糖脂代谢及肝酶指标均有一定的改善作用.AIM To investigate the changes in glycolipid metabolism in obese children with nonalcoholic fatty liver disease（NAFLD） and the effect of dietary intervention on glycolipid metabolism.METHODS Ninety-seven obese children with NAFLD were included in an experimental group and 49 healthy children were selected as a control group. The levels of glucose metabolism indexes（fasting, 30-min, 1-h, and 2-h blood glucose and insulin）, lipid metabolism indexes [total cholesterol（TC）, triglyeride（TG）, low-density lipoprotein（LDL-C）, and high-density lipoprotein（HDL-C）], body mass index（BMI）, waist-to-hip ratio（WHR）, and liver enzymes [alanine transaminase（ALT） and aspartate transaminase（AST）] were compared between the two groups. Children in the experiment group were given dietary intervention for 6 mo. The changes in glucose metabolism indexes, lipid metabolism indexes, and BMI were compared before and after intervention.RESULTS Eighty-five patients completed the study. The levels of TC, TG, LDL-C, serum insulin, and homeostatic model assessment-insulin resistance（HOMA-IR） at the four time points were significantly higher in the experiment group than in the control group（P 〈 0.01 or P 〈 0.05）, while the level of serum HDL-C in the experiment group was significantly lowerthan that in the control group（P 〈 0.05）. After intervention, the levels of TG, TC, LDL-C, serum insulin and HOMA-IR at three time points（30 min, 1 h, and 2 h）, BMI, WHR, and liver enzymes（ALT and AST） decreased significantly（P 〈 0.01, P 〈 0.05）, while the level of serum HDL-C increased significantly（P 〈 0.05）.CONCLUSION Obese children with NAFLD have obvious glycolipid metabolic disorders. Dietary intervention can improve glycolipid metabolism, BMI and liver enzymes in obese children with NAFLD.

关 键 词：膳食干预 儿童肥胖 非酒精性脂肪性肝病 血脂 胰岛素抵抗 

分 类 号：R725.7[医药卫生—儿科]