【摘要】 目的分析2型糖尿病患者的宏量营养素摄入与炎症和胰岛素抵抗的关系。方法选取广州某三甲医院的2型糖尿病门诊患者进行膳食调查、体格测量和生化指标检测,分析膳食、炎症、胰岛素抵抗间的相关性,进行多重线性回归分析影响胰岛素抵抗和β细胞分泌的膳食因素。结果 262名调查对象中,能量摄入过多者占51.5%,蛋白质摄入不足者占62.2%,超重肥胖组的碳水化合物摄入量及供能比高于体重正常组。碳水化合物摄入不足者的FINS水平高于摄入适量和过多者,脂肪摄入不足者的FPG和FINS水平分别低于摄入适量和过多者,蛋白质摄入过多者的FPG和IL-6水平均低于摄入不足和适量者。血浆IL-6水平与HOMA-IR、脂肪摄入量及供能比呈正相关,与HOMA-B呈负相关;HMGB1水平与HOMA-IR和脂肪供能比呈正相关,与HOMA-B呈负相关。校正可能的混杂因素后,HOMA-IR与脂肪摄入量呈正相关(β=0.135,P<0.05),在体重正常者中与脂肪和蛋白质摄入量呈正相关(β值分别为0.208和0.274,P<0.05);HOMA-B与脂肪和蛋白质摄入量呈负相关(β值分别为-0.152和-0.142,P<0.05),在体重正常者中与蛋白质摄入量呈负相关,在超重肥胖者中与脂肪供能比呈负相关(β值分别为-0.229和-0.168,P<0.05)。结论脂肪和蛋白质摄入水平与2型糖尿病中胰岛素抵抗和β细胞分泌功能有关,且脂肪摄入可能通过调节血浆IL-6或HMGB1水平发挥作用。更多还原

【Abstract】 Objective To explore the association among macronutrients intake, inflammatory biomarkers and insulin resistance in patients with type 2 diabetes mellitus. Methods Out-patients with type 2 diabetes mellitus were enrolled from a general hospital in Guangzhou, followed by dietary surveys, measurement of anthropometric parameters and detection of biochemical indexes. Correlation analysis was conducted among dietary factors, inflammatory biomarkers and insulin resistance. Multiple linear regression models were developed to test the association between macronutrients intake and insulin resistance. Results Of the 262 subjects, 51.5% had excessive intake of energy, and 62.2% had insufficient intake of protein. Both carbohydrate intake and the percentage of energy from it were higher in subjects with overweight or obesity than those with normal weight. Level of fasting insulin(FINS) was higher in subjects with insufficient intake of carbohydrate than those with appropriate and excessive intake, and levels of FPG and FINS in subjects with insufficient intake of fat were lower than those with appropriate or excessive intake, respectively, while levels of FPG and plasma IL-6 were higher in subjects with excessive intake of protein than those with insufficient and appropriate intake. Level of plasma IL-6 was positively correlated with HOMA-IR, fat intake and percentage of energy from it, respectively, so was level of plasma HMGB1 with HOMA-IR and percentage of energy from fat, while both of these biomarkers were negatively correlated with HOMA-B. After adjusted for potential confounders, HOMA-IR was positively associated with fat intake(β=0.135, P<0.05), so were it with fat and protein intake in subjects with normal weight( β was 0.208 and 0.274 respectively, P<0.05). HOMA-B was negatively associated with fat and protein intake(β was-0.152 and-0.142 respectively, P<0.05), so were it with protein intake in subjects with normal weight and with percentage of energy from fat in subjects with overweight and obesity(β was-0.229 and-0.168 resspectively, P<0.05). Conclusion The fat and protein intake may have associations with insulin resistance and β cell secretion in type 2 diabetes mellitus, and the fat intake and percentage of energy from it may play their roles through regulations of plasma IL-6 or HMGB1, respectively.更多还原