인슐린비의존형 당뇨병환자에서 당질 및 지방 섭취량의 변화가 혈당 및 지질에 미치는 영향

Abstract

Background: The objective of this study was to assess the effects of decreased intake of dietary carbohydrate and increased intake of fat on glucose and lipid metabolism in patients with non-insulin dependent diabetes mellitus(NIDDM). Methods: Fifty-six NIDDM patients were divided into two groups: control diet group(n=28, 60 and 20% of total energy from carbohydrate and fat, respectively), modified diet group(n=28, 55 and 25% of total energy from carbohydrate and fat, respectively). Plasma glucose and lipid metabolic parameters were monitored. In modified diet group, two cans(400 kcal) of high-fat nutrition formula were substituted for high-carbohydrate foods and provided daily for 8 weeks, High-fat nutrition formula was composed of 30% of total energy from carbohydrate, 20% from protein and 50% from fat(80% of fat as monounsatrated fatty acid). In control diet group, patients received two cans(400kcal) of normal-fat nutrition formuia as a placebo, which was composed of 60% of total energy from carbohydrate, 20% from protein and 20% from fat. Two enteral nutrition formulas were same with respect to the contents of dietary fiber, vitamins and minerals. Results: In the begining, the levels of fasting and postprandial glucose, glycated hemoglobin, triglyceride, HDL, LDL total-cholesterol, and the response areas of glucose, insulin and free fatty acid to oral glucose tolerance test were not different between two groups, but C-peptide response area was lower in modified diet group than in control diet group. After 8 weeks, modified diet decreased fasting and postprandial glucose and tended to decrease glycated hemoglobin; it a1so increased insulin and C-peptide response areas, and decreased glucose response area. However, in control group, there were no changes in those concentrations. Compared with initial values, at 8 weeks the levels of serum triglyceride, HDL, LDL, total-cholesterol and free fatty acid area were not changed in both control and modified diet groups. Conclusion: The results indicated that reduction of carbohydrate propotion from 60 to 55% of total energy and increased fat intake from 20 to 25% as monounsaturated fat could improve glycemic control in Korean NIDDM patients.