بررسی ارتباط کربوهیدرات رژیم غذایی و سندرم متابولیک

نوع مقاله : مقاله مروری

نویسندگان

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

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

چکیده

مقدمه: تغییرات سبک زندگی افراد جامعه به خصوص تغییرات رژیم غذایی و کاهش فعالیت‌های فیزیکی باعث افزایش روز افزون سندرم متابولیک گردیده است. نقش رژیم غذایی در اتیولوژی سندرم متابولیک کمتر مورد توجه قرار گرفته است و مطالعات اندکی در این زمینه در کشور انجام شده است. هدف مطالعه‌ی حاضر بررسی ارتباط کربوهیدرات دریافتی رژیم غذایی با بروز سندرم متابولیک بود.روش‌ها: با استفاده از موتور جستجوی Pubmed و واژگان کلیدی مانند Metabolic syndrome، Carbohydrate، Carbohydrate score، Refine grain و Whole grain مقالات با طراحی‌های مقطعی، کارآزمایی بالینی، کوهورت آینده‌نگر انتخاب شدند.یافته‌ها: بر اساس نتایج مطالعات بین دریافت غلات کامل با کاهش اجزای سندرم متابولیک از جمله چاقی شکمی، حساسیت به انسولین و دیس‌لپیدمی ارتباط وجود دارد و مصرف غلات تصفیه شده باعث شیوع بیشتر سندرم متابولیک می‌شود. بین درصد دریافت کربوهیدرات و چربی نسبت به کل انرژی دریافتی و افزایش خطر سندرم متابولیک ارتباط مستقیم دیده می‌شود.نتیجه‌گیری: ارتباط معکوس بین مصرف غلات کامل با سندرم متابولیک در حقیقت بیان‌گر اثرات محافظتی اجزای متشکله‌ی غلات کامل می‌باشد. عدم توجه به میزان و کیفیت کربوهیدرات مصرفی خطر ابتلا به بیماری‌های مزمن را افزایش می‌دهد. افرادی که درصد بیشتری از انرژی روزانه‌ی خود را کربوهیدرات یا چربی دریافت می‌کنند بیشتر در معرض ابتلا به سندرم متابولیک هستند. می‌توان گفت کاهش بار گلایسمیک در رژیم غذایی و جایگزین کردن غلات کامل، میوه و سبزی و استفاده از منابع گیاهی چربی و پروتئین به جای کربوهیدرات‌های تصفیه شده با بار گلایسمیک بالا به کنترل و کاهش بیماری‌های مزمن از جمله چاقی، سندرم متابولیک، دیابت و بیماری‌های قلبی-عروقی کمک می‌کند.

کلیدواژه‌ها

عنوان مقاله [English]

The Association between Carbohydrate Intake and Metabolic Syndrome

نویسندگان [English]

  • Fatemeh Shirani 1
  • Leila Azadbakht 2
1 MSc Student, Department of Community Nutrition, School of Nutrition and Food Science And Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
2 Associate Professor, Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Changes in lifestyle such as change in diet and physical inactivity have increased the risk of developing metabolic syndrome. The role of diet composition in the etiology of metabolic syndrome has not been studied thoroughly and few observational studies in Iran were conducted in this regard. The aim of the present study was to determine the association between dietary carbohydrate intake and the prevalence of metabolic syndrome.Methods: We searched PubMed databases using metabolic syndrome, carbohydrate, dietary carbohydrate scores, whole grain, and refined grain as keywords. Cross-sectional, clinical trial, and prospective cohort studies were included in this review.Findings: Based on previous studies, an inverse association exists between whole grain intake and components of metabolic syndrome such as abdominal obesity, insulin sensitivity, and dyslipidemia. Moreover, refined-grain intake is positively associated with the prevalence of metabolic syndrome. A positive association was also observed between the percentage of carbohydrate and fat to total energy intake and increased risk of metabolic syndrome. Conclusion: The inverse association between whole grain intake and metabolic syndrome indicated the protective effect of constituents of whole grain. Subjects with higher intake of carbohydrate or fat exhibited a higher risk of developing metabolic syndrome. Recommendations to reduce glycemic load in diet and using whole grains, fruits and vegetables, and vegetable sources of fat and protein instead of refined carbohydrates may reduce the risk of chronic diseases including obesity, metabolic syndrome, diabetes, and cardiovascular diseases.

کلیدواژه‌ها [English]

  • Metabolic Syndrome
  • Carbohydrate
  • Dietary carbohydrate scores
  • Whole grain
  • Refined grain

مراجع

  1. Ruotolo G, Howard BV. Dyslipidemia of the metabolic syndrome. Curr Cardiol Rep 2002; 4(6): 494-500.
  2. De Ferranti SD, Osganian SK. Epidemiology of paediatric metabolic syndrome and type 2 diabetes mellitus. Diab Vasc Dis Res 2007; 4(4): 285-96.
  3. Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature 2001; 414(6865): 813-20.
  4. Maddux BA, See W, Lawrence JC, Jr., Goldfine AL, Goldfine ID, Evans JL. Protection against oxidative stress-induced insulin resistance in rat L6 muscle cells by mircomolar concentrations of alpha-lipoic acid. Diabetes 2001; 50(2): 404-10.
  5. Wilson PW, D'Agostino RB, Parise H, Sullivan L, Meigs JB. Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation 2005; 112(20): 3066-72.
  6. Halpern A, Mancini MC. Treatment of obesity: an update on anti-obesity medications. Obes Rev 2003; 4(1): 25-42.
  7. Giugliano D, Ceriello A, Esposito K. Are there specific treatments for the metabolic syndrome? Am J Clin Nutr 2008; 87(1): 8-11.
  8. Sundstrom J, Riserus U, Byberg L, Zethelius B, Lithell H, Lind L. Clinical value of the metabolic syndrome for long term prediction of total and cardiovascular mortality: prospective, population based cohort study. BMJ 2006; 332(7546): 878-82.
  9. 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.
  10. Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001; 24(4): 683-9.
  11. 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.
  12. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002; 287(3): 356-9.
  13. Halpern A, Mancini MC, Magalhaes ME, Fisberg M, Radominski R, Bertolami MC, et al. Metabolic syndrome, dyslipidemia, hypertension and type 2 diabetes in youth: from diagnosis to treatment. Diabetol Metab Syndr 2010; 2: 55.
  14. Esmaillzadeh A, Kimiagar M, Mehrabi Y, Azadbakht L, Hu FB, Willett WC. Dietary patterns, insulin resistance, and prevalence of the metabolic syndrome in women. Am J Clin Nutr 2007; 85(3): 910-8.
  15. Groop L. Genetics of the metabolic syndrome. Br J Nutr 2000; 83 Suppl 1: S39-S48.
  16. Lidfeldt J, Nyberg P, Nerbrand C, Samsioe G, Schersten B, Agardh CD. Socio-demographic and psychosocial factors are associated with features of the metabolic syndrome. The Women's Health in the Lund Area (WHILA) study. Diabetes Obes Metab 2003; 5(2): 106-12.
  17. Hollenberg NK. Genetic versus environmental etiology of the metabolic syndrome among male and female twins. Curr Hypertens Rep 2002; 4(3): 178.
  18. Lopez-Uriarte P, Nogues R, Saez G, Bullo M, Romeu M, Masana L, et al. Effect of nut consumption on oxidative stress and the endothelial function in metabolic syndrome. Clin Nutr 2010; 29(3): 373-80.
  19. Davy BM, Melby CL. The effect of fiber-rich carbohydrates on features of Syndrome X. J Am Diet Assoc 2003; 103(1): 86-96.
  20. Azadbakht L, Mirmiran P, Esmaillzadeh A, Azizi F. Dairy consumption is inversely associated with the prevalence of the metabolic syndrome in Tehranian adults. Am J Clin Nutr 2005; 82(3): 523-30.
  21. Connor WE. Importance of n-3 fatty acids in health and disease. Am J Clin Nutr 2000; 71(1 Suppl): 171S-5S.
  22. Klimes I, Sebokova E. [The importance of diet therapy in the prevention and treatment of manifestations of metabolic syndrome X]. Vnitr Lek 1995; 41(2): 136-40.
  23. Esposito K, Marfella R, Ciotola M, Di PC, Giugliano F, Giugliano G, et al. Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA 2004; 292(12): 1440-6.
  24. Shenoy SF, Poston WS, Reeves RS, Kazaks AG, Holt RR, Keen CL, et al. Weight loss in individuals with metabolic syndrome given DASH diet counseling when provided a low sodium vegetable juice: a randomized controlled trial. Nutr J 2010; 9: 8.
  25. Strong WB, Malina RM, Blimkie CJ, Daniels SR, Dishman RK, Gutin B, et al. Evidence based physical activity for school-age youth. J Pediatr 2005; 146(6): 732-7.
  26. Pereira MA, Jacobs DR, Jr., Van HL, Slattery ML, Kartashov AI, Ludwig DS. Dairy consumption, obesity, and the insulin resistance syndrome in young adults: the CARDIA Study. JAMA 2002; 287(16): 2081-9.
  27. Mennen L, Lafay L, Feskens EJ, Novak M, Lepinary P, Balkau B. Possible protective effect of bread and dairy products on the risk of the metabolic syndrome. Nutr Res 2000; 20(3): 335-47.
  28. Meydani M. A Mediterranean-style diet and metabolic syndrome. Nutr Rev 2005; 63(9): 312-4.
  29. Babio N, Bullo M, Basora J, Martinez-Gonzalez MA, Fernandez-Ballart J, Marquez-Sandoval F, et al. Adherence to the Mediterranean diet and risk of metabolic syndrome and its components. Nutr Metab Cardiovasc Dis 2009; 19(8): 563-70.
  30. Mirmiran P, Noori N, Zavareh MB, Azizi F. Fruit and vegetable consumption and risk factors for cardiovascular disease. Metabolism 2009; 58(4): 460-8.
  31. Hosseinpour-Niazi S, Amiri Z, Mirmiran P, Azizi F. Dietary legumes intake and metabolicsyndrome and its component in adults. Iranian Journal of Endocrinology and Metabolism 2011; 12(6): 594-602.
  32. Azadbakht L, Mirmiran P, Esmaillzadeh A, Azizi T, Azizi F. Beneficial effects of a Dietary Approaches to Stop Hypertension eating plan on features of the metabolic syndrome. Diabetes Care 2005; 28(12): 2823-31.
  33. Azadbakht L, Surkan PJ, Esmaillzadeh A, Willett WC. The Dietary Approaches to Stop Hypertension eating plan affects C-reactive protein, coagulation abnormalities, and hepatic function tests among type 2 diabetic patients. J Nutr 2011; 141(6): 1083-8.
  34. Dickinson S, Brand-Miller J. Glycemic index, postprandial glycemia and cardiovascular disease. Curr Opin Lipidol 2005; 16(1): 69-75.
  35. Brand-Miller J, Dickinson S, Barclay A, Celermajer D. The glycemic index and cardiovascular disease risk. Curr Atheroscler Rep 2007; 9(6): 479-85.
  36. Liu S, Willett WC. Dietary glycemic load and atherothrombotic risk. Curr Atheroscler Rep 2002; 4(6): 454-61.
  37. Mursu J, Virtanen JK, Rissanen TH, Tuomainen TP, Nykanen I, Laukkanen JA, et al. Glycemic index, glycemic load, and the risk of acute myocardial infarction in Finnish men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Nutr Metab Cardiovasc Dis 2011; 21(2): 144-9.
  38. Buyken AE, Toeller M, Heitkamp G, Karamanos B, Rottiers R, Muggeo M, et al. Glycemic index in the diet of European outpatients with type 1 diabetes: relations to glycated hemoglobin and serum lipids. Am J Clin Nutr 2001; 73(3): 574-81.
  39. Marques-Lopes I, Ansorena D, Astiasaran I, Forga L, Martinez JA. Postprandial de novo lipogenesis and metabolic changes induced by a high-carbohydrate, low-fat meal in lean and overweight men. Am J Clin Nutr 2001; 73(2): 253-61.
  40. Reaven G. Metabolic syndrome: pathophysiology and implications for management of cardiovascular disease. Circulation 2002; 106(3): 286-8.
  41. Esmaillzadeh A, Azadbakht L. Different kinds of vegetable oils in relation to individual cardiovascular risk factors among Iranian women. Br J Nutr 2011; 105(6): 919-27.
  42. Esmaillzadeh A, Mirmiran P, Azizi F. Whole-grain consumption and the metabolic syndrome: a favorable association in Tehranian adults. Eur J Clin Nutr 2005; 59(3): 353-62.
  43. Bukkapatnam RN, Berglund L, Anuurad E, Devaraj S, Hyson D, Rafii F, et al. Postprandial metabolic responses to dietary glycemic index in hypercholesterolemic postmenopausal women. Prev Cardiol 2010; 13(1): 29-35.
  44. Steemburgo T, Dall'Alba V, Gross JL, Azevedo MJ. [Dietary factors and metabolic syndrome]. Arq Bras Endocrinol Metabol 2007; 51(9): 1425-33.
  45. McKeown NM, Meigs JB, Liu S, Wilson PW, Jacques PF. Whole-grain intake is favorably associated with metabolic risk factors for type 2 diabetes and cardiovascular disease in the Framingham Offspring Study. Am J Clin Nutr 2002; 76(2): 390-8.
  46. McKeown NM, Meigs JB, Liu S, Saltzman E, Wilson PW, Jacques PF. Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care 2004; 27(2): 538-46.
  47. Liu S, Stampfer MJ, Hu FB, Giovannucci E, Rimm E, Manson JE, et al. Whole-grain consumption and risk of coronary heart disease: results from the Nurses' Health Study. Am J Clin Nutr 1999; 70(3): 412-9.
  48. Jang Y, Lee JH, Kim OY, Park HY, Lee SY. Consumption of whole grain and legume powder reduces insulin demand, lipid peroxidation, and plasma homocysteine concentrations in patients with coronary artery disease: randomized controlled clinical trial. Arterioscler Thromb Vasc Biol 2001; 21(12): 2065-71.
  49. Lutsey PL, Jacobs DR, Jr., Kori S, Mayer-Davis E, Shea S, Steffen LM, et al. Whole grain intake and its cross-sectional association with obesity, insulin resistance, inflammation, diabetes and subclinical CVD: The MESA Study. Br J Nutr 2007; 98(2): 397-405.
  50. Juntunen KS, Laaksonen DE, Poutanen KS, Niskanen LK, Mykkanen HM. High-fiber rye bread and insulin secretion and sensitivity in healthy postmenopausal women. Am J Clin Nutr 2003; 77(2): 385-91.
  51. Katcher HI, Legro RS, Kunselman AR, Gillies PJ, Demers LM, Bagshaw DM, et al. The effects of a whole grain-enriched hypocaloric diet on cardiovascular disease risk factors in men and women with metabolic syndrome. Am J Clin Nutr 2008; 87(1): 79-90.
  52. Wirfalt E, Hedblad B, Gullberg B, Mattisson I, Andren C, Rosander U, et al. Food patterns and components of the metabolic syndrome in men and women: a cross-sectional study within the Malmo Diet and Cancer cohort. Am J Epidemiol 2001; 154(12): 1150-9.
  53. Liese AD, Schulz M, Fang F, Wolever TM, D'Agostino RB, Jr., Sparks KC, et al. Dietary glycemic index and glycemic load, carbohydrate and fiber intake, and measures of insulin sensitivity, secretion, and adiposity in the Insulin Resistance Atherosclerosis Study. Diabetes Care 2005; 28(12): 2832-8.
  54. Hare-Bruun H, Nielsen BM, Grau K, Oxlund AL, Heitmann BL. Should glycemic index and glycemic load be considered in dietary recommendations? Nutr Rev 2008; 66(10): 569-90.
  55. Dietary patterns associated with insulin resistance and metabolic syndrome in women. Iran J Diabetes Lipid Disord 2008; 7: 325-42.
  56. Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S, Franch HA, et al. Summary of American Heart Association Diet and Lifestyle Recommendations revision 2006. Arterioscler Thromb Vasc Biol 2006; 26(10): 2186-91.
  57. Mirmiran P, Saidpour A, Hosseinpour Niazi S, Azizi F. Glycemic index and glycemic load in relation with metabolic syndrome and its components. Iranian Journal of Endocrinology & Metabolism 2010; 11(6): 615-25.
  58. Sharman MJ, Gomez AL, Kraemer WJ, Volek JS. Very low-carbohydrate and low-fat diets affect fasting lipids and postprandial lipemia differently in overweight men. J Nutr 2004; 134(4): 880-5.
  59. Vrolix R, van Meijl LE, Mensink RP. The metabolic syndrome in relation with the glycemic index and the glycemic load. Physiol Behav 2008; 94(2): 293-9.
  60. Bessesen DH. The role of carbohydrates in insulin resistance. J Nutr 2001; 131(10): 2782S-6S.
  61. McAuley KA, Hopkins CM, Smith KJ, McLay RT, Williams SM, Taylor RW, et al. Comparison of high-fat and high-protein diets with a high-carbohydrate diet in insulin-resistant obese women. Diabetologia 2005; 48(1): 8-16.
  62. Vessby B, Uusitupa M, Hermansen K, Riccardi G, Rivellese AA, Tapsell LC, et al. Substituting dietary saturated for monounsaturated fat impairs insulin sensitivity in healthy men and women: The KANWU Study. Diabetologia 2001; 44(3): 312-9.
  63. Lovejoy JC, Smith SR, Champagne CM, Most MM, Lefevre M, DeLany JP, et al. Effects of diets enriched in saturated (palmitic), monounsaturated (oleic), or trans (elaidic) fatty acids on insulin sensitivity and substrate oxidation in healthy adults. Diabetes Care 2002; 25(8): 1283-8.
  64. Summers LK, Fielding BA, Bradshaw HA, Ilic V, Beysen C, Clark ML, et al. Substituting dietary saturated fat with polyunsaturated fat changes abdominal fat distribution and improves insulin sensitivity. Diabetologia 2002; 45(3): 369-77.
  65. Riserus U, Willett WC, Hu FB. Dietary fats and prevention of type 2 diabetes. Prog Lipid Res 2009; 48(1): 44-51.
  66. Floyd JC, Jr., Fajans SS, Conn JW, Knopf RF, Rull J. Insulin secretion in response to protein ingestion. J Clin Invest 1966; 45(9): 1479-86.
  67. Sargrad KR, Homko C, Mozzoli M, Boden G. Effect of high protein vs high carbohydrate intake on insulin sensitivity, body weight, hemoglobin A1c, and blood pressure in patients with type 2 diabetes mellitus. J Am Diet Assoc 2005; 105(4): 573-80.
  68. Halton TL, Willett WC, Liu S, Manson JE, Albert CM, Rexrode K, et al. Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med 2006; 355(19): 1991-2002.
  69. de Koning L, Fung TT, Liao X, Chiuve SE, Rimm EB, Willett WC, et al. Low-carbohydrate diet scores and risk of type 2 diabetes in men. Am J Clin Nutr 2011; 93(4): 844-50.
  70. 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.
  71. Mirmiran P, Noori N, Amirshekari G, Azizi F. Nutritional and anthropometrical predictors of the incidence of metabolic syndrome in adults. Iran J Endocrinol Metab 2007; 9(1): 19-28
  72. Halton TL, Liu S, Manson JE, Hu FB. Low-carbohydrate-diet score and risk of type 2 diabetes in women. Am J Clin Nutr 2008; 87(2): 339-46.
  73. Cabello-Saavedra E, Bes-Rastrollo M, Martinez JA, Diez-Espino J, Buil-Cosiales P, Serrano-Martinez M, et al. Macronutrient intake and metabolic syndrome in subjects at high cardiovascular risk. Ann Nutr Metab 2010; 56(2): 152-9.
  74. Brunner EJ, Wunsch H, Marmot MG. What is an optimal diet? Relationship of macronutrient intake to obesity, glucose tolerance, lipoprotein cholesterol levels and the metabolic syndrome in the Whitehall II study. Int J Obes Relat Metab Disord 2001; 25(1): 45-53.
  75. Skilton MR, Laville M, Cust AE, Moulin P, Bonnet F. The association between dietary macronutrient intake and the prevalence of the metabolic syndrome. Br J Nutr 2008; 100(2): 400-7.
  76. 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.
  77. Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB. The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med 2003; 163(4): 427-36.
  78. Haghighat Doust F, Zaribafan F, Esmaillzadeh A, Azadbakht L. The relationship between whole grain consumption and chronic diseases. Iran J Diabetes Lipid Disord 2010: 9: 207-17.
مجله دانشکده پزشکی اصفهان
دوره 29، شماره 157 - شماره پیاپی 157
آذر و دی 1390
صفحه 1563-1574

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  • تاریخ دریافت: 11 آذر 1390
  • تاریخ بازنگری: 11 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

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