目的 评估不同宏量营养素（蛋白质、脂肪和碳水化合物）干预对健康人血糖波动的影响,为糖尿病的预防和管理提供科学依据。方法 本研究采用了单中心、开放标签、自身对照试验设计,共招募了9名健康成年志愿者,年龄为（24.44±1.67）岁。试验采用了葡萄糖溶液、脂肪溶液、蛋白质溶液三种等能量（80 kcal）干预溶液（250 ml）,并设等体积的水为对照,受试者在午餐和晚餐前20~25 min摄入干预溶液,用动态血糖监测仪实时监测血糖波动。试验期为15 d,包括引入期、各干预期和对照饮水期。观察指标包括血糖波动幅度、血糖曲线增量面积、血糖峰值时间、血糖目标范围内时间等。数据分析采用描述性统计分析以及配对t检验、独立样本t检验、Wilcoxon sign-rank检验和Kruskal-Wallis H检验。结果 与水对照组相比,蛋白组、脂肪组和碳水化合物组三个干预组合并（n=27）营养干预效果为：晚餐后4 h血糖曲线增量面积显著降低（P=0.025）,晚餐后到达血糖峰值时间显著增加（P=0.017）,同时葡萄糖目标范围内时间（TIR）显著增加（P=0.001）。各组与干预前相比,蛋白组晚餐后到达血糖峰值时间显著延长（P=0.012）,2 h连续净交叠升糖指数（CONGA2）显著降低（P=0.035）;脂肪组TIR显著改善（P=0.010）,但血糖曲线下面积（AUC）和平均血糖（MEAN）显著增加;碳水化合物组午餐后和晚餐后4 h血糖曲线增量面积显著降低（P<0.001）,TIR和CONGA2显著改善（P<0.05）。结论 餐前营养素干预有效改善了健康人血糖波动,餐前蛋白质干预在改善血糖波动方面表现优于脂肪和碳水化合物。
Abstract
Objective To evaluate the effects of different macronutrients (protein, fat, and carbohydrate) intervention on blood glucose fluctuation in healthy individuals, providing scientific evidence for the prevention and management of diabetes. Methods A single-center, open-label, self-controlled trial was designed, and 9 healthy adult volunteers were recruited, including 4 males and 5 females, with an average age of (24.44±1.67) years. Participants were administered 20-25 minutes before lunch and dinner glucose solution, fat solution, or protein solution, which provided the same energy content (80 kcal) in 250 ml volume. The water was treated as the control. The blood glucose fluctuations were observed by a continuous blood glucose monitor. The trial lasted for 15 days, including introduction, intervention, and control periods. Blood glucose fluctuation magnitude, blood glucose curve incremental area, blood glucose peak time, and time within glucose target range were calculated. Paired t-test, independent t-test, Wilcoxon signed-rank test, or Kruskal-Wallis H test were performed. Results Compared to the water control group, the combined intervention by protein, fat, and carbohydrate (n=27) showed a significant reduction in incremental area of blood glucose curve at 4 hours after dinner (P=0.025), a significant increase in peak time of postprandial blood glucose after dinner (P=0.017), and a significant increase in time within glucose target range (P=0.001). Compared to the pre-intervention levels, the peak time of postprandial blood glucose after dinner was significantly extended (P=0.012), and continuous overlapping net glycemic action for 2 hours (CONGA2) significantly decreased in the protein group (P=0.035). A significant improvement in time within glucose target range (P=0.010) was observed, but area under the blood glucose curve for entire day (AUC) and mean blood glucose level for entire day (MEAN) significantly increased in the fat group. In the carbohydrate group, incremental area of blood glucose curve at 4 hours was significantly decreased after lunch and dinner (P<0.001), and time within glucose target range and CONGA2 significantly improved (P<0.05). Conclusion Pre-meal macronutrient interventions effectively improve blood glucose fluctuations in healthy individuals, in which pre-meal protein intervention shows a better action.
关键词
餐前干预 /
宏量营养素 /
血糖波动 /
动态血糖监测
Key words
pre-meal intervention /
macro nutrients /
blood glucose fluctuation /
continuous blood glucose monitoring
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基金
温州市科技局基础性科研项目（No.Y2020004）
