بررسی اثر مصرف رژیم غذایی با محدودیت متوسط کربوهیدرات بر عوامل خطر بیماری‌های قلبی- عروقی در زنان مبتلا به سندرم متابولیک

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 دانشجوی کارشناسی ارشد، گروه تغذیه‌ی جامعه، دانشکده‌ی تغذیه و علوم غذایی، مرکز تحقیقات امنیت غذایی و کمیته‌ی تحقیقات دانشجویی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 دانشیار، مرکز تحقیقات امنیت غذایی و گروه تغذیه‌ی جامعه، دانشکده‌ی تغذیه و علوم غذایی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 دانشیار، گروه فیزیولوژی، دانشکدهی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: افزایش اپیدمی‌ چاقی و سندرم متابولیک با کاهش میزان دریافت چربی و افزایش کربوهیدرات رژیم غذایی همراه بوده است. مطالعه‌ی حاضر با هدف بررسی اثر جایگزینی متوسط کربوهیدرات رژیم غذایی با چربی‌ها بر سندرم متابولیک صورت پذیرفت.روش‌ها: این مطالعه به روش کارآزمایی بالینی متقاطع بر روی 30 زن دارای اضافه وزن یا چاقی (شاخص توده‌ی بدنی بالای 25 کیلوگرم بر مترمربع) مبتلا به سندرم متابولیک انجام شد. شرکت کنندگان به طور تصادفی به دو گروه رژیم غذایی پرکربوهیدرات (65-60 درصد کربوهیدرات، 25-20 درصد چربی) و رژیم غذایی با محدودیت متوسط کربوهیدرات (47-43 درصد کربوهیدرات، 40-36 درصد چربی) تخصیص یافتند. هر مرحله‌ی مداخله 6 هفته و دوره‌ی Washout دو هفته به طول انجامید. در شروع و پایان هر مرحله فشارخون، شاخص‌های تن‌سنجی و بیوشیمیایی ارزیابی گردید.یافته‌ها: با وجود کاهش وزن مشابه، دور کمر (9/3- در مقابل 6/2- سانتی‌متر؛ 07/0 = P) و دور باسن (7/2- در مقابل 5/1- سانتی‌متر؛ 07/0 = P) طی رژیم غذایی با محدودیت متوسط کربوهیدرات بیش از رژیم پرکربوهیدرات کاهش یافت. بر خلاف رژیم غذایی پرکربوهیدرات، رژیم با محدودیت متوسط کربوهیدرات موجب تغییرات مطلوب در سطح تری‌گلیسرید (TG) (13/0 در مقابل 3/13- میلی‌گرم در دسی‌لیتر؛ 07/0 = P) و نسبت تری‌گلیسرید به HDL-C (High density lipoprotein-cholesterol) (1/0 در مقابل 9/0، 06/0=P) سرم شد. محدودیت متوسط کربوهیدرات رژیم غذایی در مقایسه با رژیم پرکربوهیدرات کاهش بیشتری در فشارخون سیستولیک (93/8- در مقابل 97/2- میلی‌متر جیوه؛ 06/0 = P) و دیاستولیک (7/12- در مقابل 77/1- میلی‌متر جیوه؛ 001/0 > P) ایجاد نمود. شیوع سندرم متابولیک تنها پیرو رژیم غذایی با محدودیت متوسط کربوهیدرات، به طور معنی‌داری کاهش یافت (03/0 > P).نتیجه‌گیری: شایسته است جایگزینی متوسط کربوهیدرات رژیم غذایی با چربی‌های غیراشباع، به عنوان راهکاری مؤثر جهت پیش‌گیری و درمان سندرم متابولیک توصیه گردد.

کلیدواژه‌ها

عنوان مقاله [English]

Effects of a Moderately-Restricted Carbohydrate Diet on Cardiovascular Risk Factors among Women with Metabolic Syndrome

نویسندگان [English]

  • Somayeh Rajaie 1
  • Leila Azadbakht 2
  • Majid Khazaei 3
  • Ahmad Esmaillzadeh 2
1 MSc Student, Department of Community Nutrition, School of Nutrition and Food Sciences and Food Security Research Center And Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
2 Associate Professor, Food Sciences and Food Security Research Center and Department of Community Nutrition, School of Nutrition, Isfahan University of Medical Sciences, Isfahan, Iran
3 Associate Professor, Department of Physiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: The growing epidemics of obesity and metabolic syndrome (MetS) have been accompanied with dietary fat restriction and carbohydrate elevation. We evaluated the efficacy of moderately-restricted carbohydrate diet on features of the MetS in women.Methods: In a randomized cross-over clinical trial, 30 overweight or obese (Body mass index > 25 kg/m2) women with the MetS were enrolled. Subjects were randomly allocated to receive either a high-carbohydrate (HC) (60-65% carbohydrates, 20-25% fats) or a moderately-restricted carbohydrate (MRC) (43-47% carbohydrate, 36-40% fats) diet. Diets were continued for 6 weeks followed by a 2-week washout period. Anthropometrics, blood pressure and biochemical variables were measured before and after each intervention period.Findings: Despite similar weight loss in both diets, the efficacy of MRC diet in reducing waist (-3.9 vs. -2.6 cm; P = 0.07) and hip circumferences (-2.7 vs. -1.5 cm; P = 0.07) was marginally greater compared with HC diet. In contrast to HC diet, MRC diet resulted in favorable changes in serum triglyceride (TG) concentrations (0.13 vs. -31.3 mg/dL; P = 0.07). This was also the case for TG to high density lipoprotein (HDL)-cholesterol ratio (-0.9 vs. -0.1; P = 0.06). The reductions in systolic blood pressure (-8.93 vs. -2.97 mmHg; P = 0.06) and diastolic blood pressure (-12.7 vs. -1.77 mmHg; P = 0.001) by MRC diet were higher than those by HC diet. The prevalence of MetS was significantly decreased only by MRC diet (P = 0.03). Conclusion: Partial replacement of dietary carbohydrates by unsaturated fats might be recommended as an effective strategy for treatment of MetS.

کلیدواژه‌ها [English]

  • Moderate carbohydrate restriction
  • Macronutrient
  • Metabolic Syndrome
  • Blood Pressure
  • Obesity

مراجع

  1. Ford ES. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care 2005; 28(7): 1769-78.
  2. Ford ES, Li C, Zhao G. Prevalence and correlates of metabolic syndrome based on a harmonious definition among adults in the US. J Diabetes 2010; 2(3): 180-93.
  3. Delavari A, Forouzanfar MH, Alikhani S, Sharifian A, Kelishadi R. First nationwide study of the prevalence of the metabolic syndrome and optimal cutoff points of waist circumference in the Middle East: the national survey of risk factors for noncommunicable diseases of Iran. Diabetes Care 2009; 32(6): 1092-7.
  4. Cameron AJ, Shaw JE, Zimmet PZ. The metabolic syndrome: prevalence in worldwide populations. Endocrinol Metab Clin North Am 2004; 33(2): 351-75.
  5. Volek JS, Phinney SD, Forsythe CE, Quann EE, Wood RJ, Puglisi MJ, et al. Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Lipids 2009; 44(4): 297-309.
  6. Johnson RJ, Segal MS, Sautin Y, Nakagawa T, Feig DI, Kang DH, et al. Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease. Am J Clin Nutr 2007; 86(4): 899-906.
  7. Feinman RD, Volek JS. Carbohydrate restriction as the default treatment for type 2 diabetes and metabolic syndrome. Scand Cardiovasc J 2008; 42(4): 256-63.
  8. Volek JS, Feinman RD. Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction. Nutr Metab (Lond) 2005; 2: 31.
  9. Tay J, Brinkworth GD, Noakes M, Keogh J, Clifton PM. Metabolic effects of weight loss on a very-low-carbohydrate diet compared with an isocaloric high-carbohydrate diet in abdominally obese subjects. J Am Coll Cardiol 2008; 51(1): 59-67.
  10. Nordmann AJ, Nordmann A, Briel M, Keller U, Yancy WS, Jr., Brehm BJ, et al. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med 2006; 166(3): 285-93.
  11. Kimiagar SM, Ghaffarpour M, Houshiar-Rad A, Hormozdyari H, Zellipour L. Food consumption pattern in the Islamic Republic of Iran and its relation to coronary heart disease. East Mediterr Health J 1998; 4(3): 539-47.
  12. Muzio F, Mondazzi L, Harris WS, Sommariva D, Branchi A. Effects of moderate variations in the macronutrient content of the diet on cardiovascular disease risk factors in obese patients with the metabolic syndrome. Am J Clin Nutr 2007; 86(4): 946-51.
  13. Pelkman CL, Fishell VK, Maddox DH, Pearson TA, Mauger DT, Kris-Etherton PM. Effects of moderate-fat (from monounsaturated fat) and low-fat weight-loss diets on the serum lipid profile in overweight and obese men and women. Am J Clin Nutr 2004; 79(2): 204-12.
  14. Berglund L, Lefevre M, Ginsberg HN, Kris-Etherton PM, Elmer PJ, Stewart PW, et al. Comparison of monounsaturated fat with carbohydrates as a replacement for saturated fat in subjects with a high metabolic risk profile: studies in the fasting and postprandial states. Am J Clin Nutr 2007; 86(6): 1611-20.
  15. Al-Sarraj T, Saadi H, Calle MC, Volek JS, Fernandez ML. Carbohydrate restriction, as a first-line dietary intervention, effectively reduces biomarkers of metabolic syndrome in Emirati adults. J Nutr 2009; 139(9): 1667-76.
  16. Azizi F, Salehi P, Etemadi A, Zahedi-Asl S. Prevalence of metabolic syndrome in an urban population: Tehran Lipid and Glucose Study. Diabetes Res Clin Pract 2003; 61(1): 29-37.
  17. Esmaillzadeh A, Mirmiran P, Azizi F. Comparative evaluation of anthropometric measures to predict cardiovascular risk factors in Tehranian adult women. Public Health Nutr 2006; 9(1): 61-9.
  18. Fleiss JL. The Design and Analysis of Clinical Experiments. London: John Wiley and Sons; 1986. p. 263-71.
  19. Stern SE, Williams K, Ferrannini E, DeFronzo RA, Bogardus C, Stern MP. Identification of individuals with insulin resistance using routine clinical measurements. Diabetes 2005; 54(2): 333-9.
  20. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000; 32(9 Suppl): S498-S504.
  21. Esposito K, Giugliano D. Mediterranean diet and the metabolic syndrome: the end of the beginning. Metab Syndr Relat Disord 2010; 8(3): 197-200.
  22. Rasmussen LG, Larsen TM, Mortensen PK, Due A, Astrup A. Effect on 24-h energy expenditure of a moderate-fat diet high in monounsaturated fatty acids compared with that of a low-fat, carbohydrate-rich diet: a 6-mo controlled dietary intervention trial. Am J Clin Nutr 2007; 85(4): 1014-22.
  23. Brehm BJ, Spang SE, Lattin BL, Seeley RJ, Daniels SR, D'Alessio DA. The role of energy expenditure in the differential weight loss in obese women on low-fat and low-carbohydrate diets. J Clin Endocrinol Metab 2005; 90(3): 1475-82.
  24. McLaughlin T, Carter S, Lamendola C, Abbasi F, Yee G, Schaaf P, et al. Effects of moderate variations in macronutrient composition on weight loss and reduction in cardiovascular disease risk in obese, insulin-resistant adults. Am J Clin Nutr 2006; 84(4): 813-21.
  25. McLaughlin T, Reaven G, Abbasi F, Lamendola C, Saad M, Waters D, et al. Is there a simple way to identify insulin-resistant individuals at increased risk of cardiovascular disease? Am J Cardiol 2005; 96(3): 399-404.
  26. Yu-Poth S, Zhao G, Etherton T, Naglak M, Jonnalagadda S, Kris-Etherton PM. Effects of the National Cholesterol Education Program's Step I and Step II dietary intervention programs on cardiovascular disease risk factors: a meta-analysis. Am J Clin Nutr 1999; 69(4): 632-46.
  27. Volek JS, Sharman MJ, Gomez AL, Scheett TP, Kraemer WJ. An isoenergetic very low carbohydrate diet improves serum HDL cholesterol and triacylglycerol concentrations, the total cholesterol to HDL cholesterol ratio and postprandial pipemic responses compared with a low fat diet in normal weight, normolipidemic women. J Nutr 2003; 133(9): 2756-61.
  28. Appel LJ, Sacks FM, Carey VJ, Obarzanek E, Swain JF, Miller ER, III, et al. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA 2005; 294(19): 2455-64.
  29. Shah M, Adams-Huet B, Garg A. Effect of high- carbohydrate or high-cis-monounsaturated fat diets on blood pressure: a meta-analysis of intervention trials. Am J Clin Nutr 2007; 85(5): 1251-6.
  30. Volek JS, Fernandez ML, Feinman RD, Phinney SD. Dietary carbohydrate restriction induces a unique metabolic state positively affecting atherogenic dyslipidemia, fatty acid partitioning, and metabolic syndrome. Prog Lipid Res 2008; 47(5): 307-18.
مجله دانشکده پزشکی اصفهان
دوره 29، شماره 171 - شماره پیاپی 171
بهمن و اسفند 1390
صفحه 2739-2755

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سابقه مقاله

  • تاریخ دریافت: 09 آذر 1390
  • تاریخ بازنگری: 12 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

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