Meta分析2型糖尿病患者低碳水化合物饮食对体质指数及糖、脂代谢的影响  

Effects of Low-carbohydrate Diet on Body Mass Index and Glucose and Lipid Metabolism in Patients with Type 2 Diabetes Mellitus: a Meta-analysis

作　　者：苏晓杨 赵豫梅[1] 念馨[1] 宋滇平[1] SU Xiao-yang;ZHAO Yu-mei;NIAN Xin;SONG Dian-ping(Dept.of Endocrinology,The 1st Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650032,China)

机构地区：[1]昆明医科大学第一附属医院内分泌科

出　　处：《昆明医科大学学报》2019年第12期73-79,共7页Journal of Kunming Medical University

基　　金：国家自然科学基金资助项目(81660153);云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目[2017FE468(-197)]

摘　　要：目的系统评价2型糖尿病患者低碳水化合物饮食对体质指数及糖、脂代谢的影响。方法通过计算机检索Pub Med、EMBASE、Cochrane library、万方、CNKI数据库自建库至2018年10月发表的2型糖尿病患者低碳水化合物饮食的随机对照试验,设立纳入与排除标准,采用JADAD量表评价临床试验方法学质量、收集数据和使用Revman 5.3软件进行Meta分析并进行干预时间的亚组分析。结果 (1)纳入文献14篇,病例989例,其中试验组498例,对照组491例;(2)低碳水化合物饮食可减少腰围(MD=-2.27,95%CI:-3.91^-0.63,P=0.007);(3)<4个月低碳水化合物饮食降低BMI (MD=-2.43,95%CI:-3.70^-1.17,P=0.0002)、FPG(MD=-1.68,95%CI:-2.64^-0.72,P=0.0006)、HbA1c (MD=-1.22,95%CI:-2.32^-0.12,P=0.03)优于非低碳水化合物饮食,差异有统计学意义;但≥6个月低碳水化合物饮食BMI (MD=-1.42,95%CI:-4.17~1.33,P=0.31)、FPG (MD=-0.94,95%CI:-2.06~0.18,P=0.10)及HbA1c (MD=-0.76,95%CI:-1.77~0.24,P=0.14) 2组间差异无统计学意义;(4)≥6个月低碳水化合物饮食可降低TG (MD=-0.26,95%CI:-0.40^-0.13,P=0.0002)、HDL升高不如非低碳水化合物饮食明显(MD=0.20,95%CI:0.14~0.26,P<0.0001);对LDL的影响2组间无统计学差异(MD=0.01,95%CI:-0.08~0.09,P=0.91)。结论与非低碳水化合物饮食比:(1)短期的低碳水化合物饮食能减少腰围,降低BMI、FPG、HbA1c,但未见长期效果;(2)长期的低碳水化合物饮食可降低TG水平,但HDL升高不如非低碳水化合物饮食,2者对LDL的效力相当。Objective To systematically evaluate the effects of low-carbohydrate diet on BMI and glucose and lipid metabolism in patients with type 2 diabetes mellitus. Methods Electronic literature search was performed on Pub Med,EMBASE,Cochrane Library,CNKI database for the efficacy of low-carbohydrate diets on glucose and lipid metabolism in patients with type 2 diabetes mellitus since the database established to October 2018.We set the inclusion and exclusion criteria, used JADAD scale to evaluate clinical trial methodological quality, collected data and useed Revman 5.3 software to statistical analysis.Results (1) 14 articles and 989 cases were included in the literature,498 cases in the experimental group and 491 cases in the control group.(2) Low-carbohydrate diet reduced the waist(MD=-2.27, 95% CI:-3.91 to-0.63, P =0.007);(3) <4 months low carbohydrate diet reduced BMI(MD=-2.43, 95% CI:-3.70 to-1.17, P = 0.0002), FPG(MD=-1.68, 95% CI:-2.64 ^-0.72, P = 0.0006), HbA1c( MD=-1.22, 95% CI:-3.22^-0.12, P=0.03), was better than non-low-carbohydrate diet, the difference was statistically significant;but ≥6 months low Carbohydrate diet BMI(MD=-1.42, 95% CI:-4.17 to 1.33, P=0.31), FPG(MD=-0.94, 95% CI:-2.06 to 0.18, P = 0.10) and HbA1c(MD=-0.76, 95% CI:-1.77 to 0.24, P = 0.14) There was no significant difference between the two groups;(4) ≥ 6 months low carbohydrate diet reduced TG(MD =-0.26, 95% CI:-0.40 ^-0.13, P =0.0002), HDL elevation was not as good as non-low carbohydrate diet(MD=0.20, 95% CI: 0.14~0.26, P <0.00001);there was no statistical difference between the two groups(MD= 0.01, 95% CI:-0.08 to 0.09, P =0.91). Conclusions Compared with non-low-carbohydrate diets,(1) short-term low-carbohydrate diets can reduce waist circumference, BMI, FPG, and HbA1c, but there is no long-term effects;(2) long-term low-carbohydrate diet can reduce TG levels, but HDL rises not as high as a non-low-carbohydrate diet, both of which have no effect on LDL.

关 键 词：2型糖尿病 低碳水化合物饮食 体质指数 糖化血红蛋白 甘油三酯 高密度脂蛋白 

分 类 号：R587.1[医药卫生—内分泌]