بررسی اثر مصرف درشت مغذی‌ها بر ابتلا به پره‌دیابت در بستگان درجه‌ی اول مبتلایان به دیابت نوع 2

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 دانشجوی کارشناسی ارشد، گروه اپیدمیولوژی و آمار زیستی، دانشکده‌ی بهداشت، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 استادیار، گروه اپیدمیولوژی و آمار زیستی، دانشکده‌ی بهداشت، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 مرکز تحقیقات غدد و متابولیسم، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

4 استاد، مرکز تحقیقات غدد و متابولیسم، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: مطالعات نشان داده‌اند که قبل از بروز دیابت نوع 2، همواره یک دوره پره‌دیابت روی می‌دهد. اصلاح شیوه‌ی زندگی به منظور پیشگیری یا به تأخیر انداختن این دوره پیشنهاد شده است. عملکرد تغذیه‌ای از اجزای شیوه‌ی زندگی است. مصرف درشت مغذی‌ها می‌تواند بر روی متابولیسم چربی و گلوکز تأثیر بگذارد و از این طریق، موجب تغییرات افزایش مقاومت به انسولین شود.روش‌ها: مطالعه‌ی حاضر یک مطالعه‌ی هم‌گروهی 9 ساله از بستگان درجه‌ی اول بیماران مبتلا به دیابت نوع 2 بود. اطلاعات تغذیه‌ای، عوامل خونی، شاخص‌های دموگرافیک و شاخص‌های آنتروپومتریک بیماران ثبت ‌شد. برای بررسی ارتباط بین مصرف درشت مغذی‌ها و متغیر پاسخ وضعیت پره‌دیابت، از مدل شکنندگی در بقا استفاده گردید.یافته‌ها: خطر تکرار پره‌دیابت در افراد با مصرف کربوهیدرات با حذف اثر سایر مخدوشگرها، به طور معنی‌داری افزایش می‌یابد (نسبت خطر = 04/1). همچنین خطر تکرار پره‌دیابت برای افرادی با چربی دریافتی بین 35-25 واحد، 52/1 بیشتر از افرادی با چربی دریافتی کمتر از 25 واحد بود و خطر برای افراد با چربی دریافتی بیش از 35 واحد، 22/2 بیشتر از افراد با چربی کمتر از 25 بود. خطر تکرار پره‌دیابت در افراد مصرف‌ کننده‌ی پروتئین نیز با تعدیل سایر متغیرهای مخدوشگر، به طور معنی‌داری افزایش یافت (نسبت خطر = 05/1).نتیجه‌گیری: مصرف درشت مغذی‌ها می‌تواند بر روی متابولیسم چربی و گلوکز تأثیر بگذارد و از این طریق، موجب تغییرات افزایش مقاومت به انسولین شود. مصرف این عامل، از عوامل تأثیرگذار در کنترل تکرار وضعیت پره‌دیابت می‌باشد. 

کلیدواژه‌ها

عنوان مقاله [English]

The Effects of Macronutrient Intake on the Risk of Pre-Diabetes in First-Degree Relatives of Patients with Type 2 Diabetes

نویسندگان [English]

  • Akram Yazdani 1
  • Marjan Mansourian 2
  • Elham Faghihimani 3
  • Maryam Zareh 3
  • Masoud Amini 4
1 MSc Student, Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
2 Assistant Professor, Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
3 Isfahan Endocrinology and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
4 Professor, Isfahan Endocrinology and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Previous studies showed that pre-diabetes often occurs prior to the incidence of type 2 diabetes. Accordingly, lifestyle modification has been suggested to prevent or delay the development of diabetes. The purpose of this study was to identify the impact of macronutrients consumption on recurrent events of pre-diabetes.Methods: This historical cohort study was performed for 9 years on first-degree relatives of patients with type 2 diabetes  attending to Isfahan endocrine and metabolism research center, Iran. The attendees completed laboratory tests including standard 75 g 2-hour current oral glucose tolerance test (OGTT). The outcome variables were the recurrence of a pre-diabetes event during follow-up and the assessed explanatory variables included protein, fat and carbohydrates intake, and a broad set of potential confounding variables were age categories, sex, overweight (body mas index or BMI), large waist-to-hip ratio (WHR), high-density lipoprotein (HDL), triglycerides, total cholesterol, high blood pressure, and low fiber intake. We considered the shared gamma frailty model to evaluate the association between recurrent pre-diabetes and explanatory variables. The R-software (version 2.15.2) was used to fit the models.Findings: Individuals with greater carbohydrate had a significantly higher hazard of recurrent pre-diabetes (hazard ratio = 1.04), adjusted by other variables. The hazards of recurrent pre-diabetes for individuals with fat intake of 25-35 unit were 1.52 higher than individuals with fat intake of lower than 25 unit; and for individuals with fat intake of more than 35 unit, hazards were 2.22 higher than individuals with fat intake of lower than 25 unit. Individuals with greater protein had a significantly higher hazard of recurrent pre-diabetes (hazard ratio = 1.05), adjusted by other variables.Conclusion: Macronutrient consumption can affect the metabolism of fat and glucose and cause changes in insulin resistance. The results of this study showed that macronutrients are effective in controlling diabetes. Further studies are recommended to achieve more accurate results. 

کلیدواژه‌ها [English]

  • Carbohydrate
  • Fat
  • Macronutrient
  • Pre-diabetes
  • Protein

مراجع

  1. Azizi F, Janghorbani M, Hatami H. Epidemiology and control of common disease in Iran. 3rd ed Tehran, Iran: Khosravi Publication; 2009. [In Persian].
  2. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH). National Diabetes InformationClearinghouse (NDIC). Bethesda, MD: NIH Publication; 1994.
  3. American Diabetes Association. Diabetes 1996: vital statistics. Alexandria, VA: ADA, 1996.
  4. Fowler MJ. Microvascular and macrovascular complications of diabetes. Clin Diabetes 2008; 26(2): 77-82.
  5. Delavari A, Mahdavi-Hazaveh A, Nowrozinejad A, Yarahmadi Sh. Planning of diabetes control in Iran. Tehran, Iran: Ministry of Health and Medical Education, Undersecretary for Health Disease Management Center; 2004. [In Persian].
  6. Alavi NM, Ghofranipour F, Ahmadi F, Emami A. Developing a culturally valid and reliable quality of life questionnaire for diabetes mellitus. East Mediterr Health J 2007; 13(1): 177-85.
  7. Ghavami H, Ahmadi F, Meamarian R, Entezami H. Effects of applying continuous care model on fasting blood glucose and HgbA1c levels in diabetic patients. Koomesh J 2005; 6(3): 179-86. [In Persian].
  8. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 2003;26(Suppl 1):S5-20.
  9. American Diabetes Association. Standards of medical care in diabetes-2010. Diabetes Care 2010; 33(Suppl 1): S11-S61.
  10. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care 1998; 21(9): 1414-31.
  11. Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J. harrison's principles of internal medicine. 18th ed. New York, NY: McGraw-Hill; 2011.
  12. Altobelli E1, Valenti M, Chiarelli F, Verrotti A, Ruggeri B, Di Orio F. Family history and risk of insulin-dependent diabetes mellitus: a population-based case-control study. Epidemiol Prev. 1998; 22(1): 26-9. [In Italian]
  13. Altobelli E, Chiarelli F, Valenti M, Verrotti A, Blasetti A, Di OF. Family history and risk of insulin-dependent diabetes mellitus: a population-based case-control study. Acta Diabetol 1998; 35(1): 57-60.
  14. Jeppesen J, Schaaf P, Jones C, Zhou MY, Chen YD, Reaven GM. Effects of low-fat, high-carbohydrate diets on risk factors for ischemic heart disease in postmenopausal women. Am J Clin Nutr 1997; 65(4): 1027-33.
  15. Storlien LH, Baur LA, Kriketos AD, Pan DA, Cooney GJ, Jenkins AB, et al. Dietary fats and insulin action. Diabetologia 1996; 39(6): 621-31.
  16. Papakonstantinou E, Panagiotakos DB, Pitsavos C, Chrysohoou C, Zampelas A, Skoumas Y, et al. Food group consumption and glycemic control in people with and without type 2 diabetes: the ATTICA study. Diabetes Care 2005; 28(10): 2539-40.
  17. Parker B, Noakes M, Luscombe N, Clifton P. Effect of a high-protein, high-monounsaturated fat weight loss diet on glycemic control and lipid levels in type 2 diabetes. Diabetes Care 2002; 25(3): 425-30.
  18. van Dam RM, Willett WC, Rimm EB, Stampfer MJ, Hu FB. Dietary fat and meat intake in relation to risk of type 2 diabetes in men. Diabetes Care 2002; 25(3): 417-24.
  19. Brehm BJ, Lattin BL, Summer SS, Boback JA, Gilchrist GM, Jandacek RJ, et al. One-year comparison of a high-monounsaturated fat diet with a high-carbohydrate diet in type 2 diabetes. Diabetes Care 2009; 32(2): 215-20.
  20. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346(6): 393-403.
  21. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344(18): 1343-50.
  22. Box-Steffensmeier JM, De BS. Repeated events survival models: the conditional frailty model. Stat Med 2006; 25(20): 3518-33.
  23. Yaturu S, Bridges JF, Dhanireddy RR. Preliminary evidence of genetic anticipation in type 2 diabetes mellitus. Med Sci Monit 2005; 11(6): CR262-CR265.
  24. Lindstrom J, Louheranta A, Mannelin M, Rastas M, Salminen V, Eriksson J, et al. The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care 2003; 26(12): 3230-6.
  25. Riserus U, Willett WC, Hu FB. Dietary fats and prevention of type 2 diabetes. Prog Lipid Res 2009; 48(1): 44-51.
  26. Feskens EJ, Loeber JG, Kromhout D. Diet and physical activity as determinants of hyperinsulinemia: the Zutphen Elderly Study. Am J Epidemiol 1994; 140(4): 350-60.
  27. Lundgren H, Bengtsson C, Blohme G, Isaksson B, Lapidus L, Lenner RA, et al. Dietary habits and incidence of noninsulin-dependent diabetes mellitus in a population study of women in Gothenburg, Sweden. Am J Clin Nutr 1989; 49(4): 708-12.
  28. Feskens EJ, Kromhout D. Cardiovascular risk factors and the 25-year incidence of diabetes mellitus in middle-aged men. The Zutphen Study. Am J Epidemiol 1989; 130(6): 1101-8.
  29. Samaha FF, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med 2003; 348(21): 2074-81.
  30. Kiehm TG, Anderson JW, Ward K. Beneficial effects of a high carbohydrate, high fiber diet on hyperglycemic diabetic men. Am J Clin Nutr 1976; 29(8): 895-9.
  31. Simpson HC, Simpson RW, Lousley S, Carter RD, Geekie M, Hockaday TD, et al. A high carbohydrate leguminous fibre diet improves all aspects of diabetic control. Lancet 1981; 1(8210): 1-5.
  32. Simpson RW, McDonald J, Wahlqvist ML, Atley L, Outch K. Macronutrients have different metabolic effects in nondiabetics and diabetics. Am J Clin Nutr 1985; 42(3): 449-53.
  33. Estrich D, Ravnik A, Schlierf G, Fukayama G, Kinsell L. Effects of Co-ingestion of fat and protein upon carbohydrate-induced hyperglycemia. Diabetes 1967; 16(4): 232-7.
  34. Barnard ND, Cohen J, Jenkins DJ, Turner-McGrievy G, Gloede L, Green A, et al. A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. Am J Clin Nutr 2009; 89(5): 1588S-96S.
  35. Gerhard GT, Ahmann A, Meeuws K, McMurry MP, Duell PB, Connor WE. Effects of a low-fat diet compared with those of a high-monounsaturated fat diet on body weight, plasma lipids and lipoproteins, and glycemic control in type 2 diabetes. Am J Clin Nutr 2004; 80(3): 668-73.
  36. Wycherley TP, Noakes M, Clifton PM, Cleanthous X, Keogh JB, Brinkworth GD. A high-protein diet with resistance exercise training improves weight loss and body composition in overweight and obese patients with type 2 diabetes. Diabetes Care 2010; 33(5): 969-76.
  37. Brinkworth GD, Noakes M, Parker B, Foster P, Clifton PM. Long-term effects of advice to consume a high-protein, low-fat diet, rather than a conventional weight-loss diet, in obese adults with type 2 diabetes: one-year follow-up of a randomised trial. Diabetologia 2004; 47(10): 1677-86.
  38. Rodriguez-Villar C, Perez-Heras A, Mercade I, Casals E, Ros E. Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus. Diabet Med 2004; 21(2): 142-9.
  39. Parillo M, Rivellese AA, Ciardullo AV, Capaldo B, Giacco A, Genovese S, et al. A high-monounsaturated-fat/low-carbohydrate diet improves peripheral insulin sensitivity in non-insulin-dependent diabetic patients. Metabolism 1992; 41(12): 1373-8.
مجله دانشکده پزشکی اصفهان
دوره 32، شماره 301 - شماره پیاپی 301
مهر و آبان 1393
صفحه 1475-1486

فایل ها

سابقه مقاله

  • تاریخ دریافت: 16 خرداد 1393
  • تاریخ بازنگری: 12 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

هم رسانی

ارجاع به این مقاله

آمار