补充维生素D对肥胖患者减重效能和胰岛素抵抗的影响  

Effects of vitamin D supplementation on weight loss efficacy and insulin resistance in people withobesity

作　　者：高新颖 李周慧灵 侯党敏 杜美洋 张艳菊 王新诚 李超[3] 张饰 徐靖[3] 李春君 Gao Xinying;Li Zhouhuiling;Hou Dangmin;Du Meiyang;Zhang Yanju;Wang Xincheng;Li Chao;Zhang Shi;Xu Jing;Li Chunjun(Graduate School of Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China;Department of Health Mamagement Center and Endocrinology,Tianjin Union Medical Center,Tianjin 300121,China;General Surgery,Tianjin Union Medical Center,Tianjin 300121,China)

机构地区：[1]天津中医药大学研究生院,天津301617 [2]天津市人民医院健康管理中心内分泌科,天津300121 [3]天津市人民医院普通外科,天津300121

出　　处：《中华健康管理学杂志》2024年第11期830-836,共7页Chinese Journal of Health Management

基　　金：天津市卫生健康科技项目(TJWJ2022MS019)。

摘　　要：目的探讨补充维生素D对肥胖患者减重效能和胰岛素抵抗(IR)的影响。方法本研究为随机对照试验, 连续选取2023年3—12月在天津市人民医院肥胖门诊就诊的190例肥胖伴维生素D缺乏患者, 根据随机数表法分为对照组和维生素D组(各95例)。对照组给予限能量高蛋白饮食联合中等强度运动, 维生素D组在对照组基础上添加维生素D补充剂, 14 000 U/周, 干预时间持续24周。中途两组由于各种原因出组25例, 最终对照组79例、维生素D组86例纳入分析。采用独立样本t检验和秩和检验比较两组基线和干预后血清25-羟维生素D[25(OH)D]浓度、体重、体重指数、脂肪量、内脏脂肪面积、空腹血糖、空腹胰岛素及糖化血红蛋白(HbA_(1c))等指标差异, 采用稳态模型胰岛素抵抗指数(HOMA-IR)来评估IR程度, 分析补充维生素D对肥胖患者减重效能和IR的影响。结果干预前两组血清25(OH)D浓度差异无统计学意义(P>0.05);干预后维生素D组血清25(OH)D浓度显著高于对照组[(30.90±7.55)比(16.00±4.34)μg/L](t=-15.35;P<0.001)。干预后两组体重、体重指数、脂肪量、内脏脂肪面积、空腹血糖、空腹胰岛素、HbA_(1c)、HOMA-IR均显著低于干预前[对照组:(93.32±13.47)比(98.95±14.31)kg、(33.74±5.09)比(35.80±5.52)kg/m^(2)、(39.77±11.87)比(44.12±12.79)kg、(183.76±40.95)比(204.01±32.18)m^(2)、5.00(4.55, 5.67)比5.24(4.68, 6.42)mmol/L、16.78(13.94, 24.30)比22.56(15.95, 31.2)mU/L、5.55%±0.53%比6.05%±0.99%、4.11(3.14, 5.57)比5.51(3.61, 8.49);维生素D组:(88.14±17.66)比(104.43±22.02)kg、(31.02±5.10)比(36.66±5.98)kg/m^(2)、(35.51±12.87)比(46.67±13.33)kg、(166.50±49.50)比(213.64±40.14)m^(2)、4.70(4.35, 5.07)比5.17(4.77, 6.30)mmol/L、13.18(9.87, 18.84)比21.67(15.78, 32.74)mU/L、5.43%±0.48%比6.21%±1.22%、2.88(1.99, 4.21)比5.19(3.82, 9.27)], 且维生素D组体重、体重指数、脂肪量、内脏脂肪面积、空腹血糖、空腹胰岛素、HOMA-IR�Objective To investigate the effect of vitamin D supplementation on weight loss efficacy and insulin resistance(IR)in obese patients.Methods It was a randomized controlled trial.A total of 190 obese patients with vitamin D deficiency were selected from the obesity clinic of Tianjin Union Medical Center from March to December in 2023.The patients were divided into control group(95 cases)and vitamin D group(95 cases)according to random number table.The control group was given energy-limited high-protein diet combined with moderate intensity exercise,and the vitamin D group was supplemented with vitamin D on the basis of the control group,14000 U/week for 24 weeks.A total of 25 dropped out of the study from the two groups for various reasons.Finally,79 cases in the control group and 86 cases in the vitamin D group were included in the analysis.Independent sample t test and rank sum test were used to compare serum 25 hydroxyvitamin D[25(OH)D]level,body weight,body mass index,fat mass,visceral fat area,fasting blood glucose,fasting insulin and glycated hemoglobin(HbA_(1c))between the two groups at baseline and after intervention.Homeostasis model insulin resistance index(HOMA-IR)was used to evaluate the degree of insulin resistance(IR),and the effects of vitamin D supplementation on weight loss efficiency and IR in those patients were analyzed.Results There was no significant differences in serum 25(OH)D level between the two groups before intervention(P>0.05);the serum 25(OH)D level in the vitamin D group was significantly higher than that in the control group after intervention[(30.90±7.55)vs(16.00±4.34)μg/L](t=-15.35,P<0.001).The body weight,body mass index,fat mass,visceral fat area,fasting blood glucose,fasting insulin,HbA_(1c)c and HOMA-IR were all significantly lower after the intervention than those before the intervention in both groups[control group:(93.32±13.47)vs(98.95±14.31)kg,(33.74±5.09)vs(35.80±5.52)kg/m^(2),(39.77±11.87)vs(44.12±12.79)kg,(183.76±40.95)vs(204.01±32.18)m^(2),5.00(4.55,5.67)vs

关 键 词：维生素D 肥胖 脂肪量 内脏脂肪面积 胰岛素抵抗 

分 类 号：R589.2[医药卫生—内分泌] R587.1[医药卫生—内科学] R151.41[医药卫生—临床医学]