低碳水化合物过渡至高营养密度的膳食模式减重效果评价
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摘要
背景医疗界迫切需要开发真实、有效,且能长期坚持的饮食干预方式,以达到长期控制体质量的目的。目的评估"低碳水化合物过渡至高营养密度"的膳食模式1~6个月的减重效果。方法选取2015年6月—2017年1月于广州医科大学附属第二医院临床营养科门诊就诊的患者145例为研究对象。第1个月内将碳水化合物摄入限制在50 g/d,此后逐渐增加碳水化合物比例,在第3个月时碳水化合物摄入达110 g/d,3个月内的能量摄入则在静息能量消耗结合其活动度的推荐量基础上,减少500 kcal/d;第1、2月提供"代餐食品"代替主食。第4~6个月,不再限制热量和碳水化合物摄入,给予以低精制碳水化合物为基础的"高营养密度食物宝塔"教育。记录干预1、3、6个月后患者体质量。结果第1个月末完成率为93.8%(136/145),体质量较干预前下降(3.77±1.76)kg(t配对=10.61,P<0.01);减重成功率为38.2%(52/136),总减重成功率为35.8%(52/145)。第3个月末完成率为74.5%(108/145),体质量较干预前下降(6.67±3.50)kg(t配对=10.89,P<0.01);减重成功率为80.5%(87/108),总减重成功率为60.0%(87/145)。第6个月末完成率为67.6%(98/145),体质量较干预前下降(7.85±4.12)kg(t配对=4.77,P<0.01);减重成功率为85.7%(84/98),总减重成功率为57.9%(84/145)。结论从低碳水化合物过渡至高营养密度的膳食模式是一种有效、可行的减重膳食模式,值得推广。
Background Practical,effective,and long-term adherence dietary interventions are urgently needed in overweight and obese patients in order to achieve long-term weight control.Objective To evaluate the effect of the weight loss diet pattern of gradual transition from low-carbohydrate diet to high-nutrient-dense diet in 1-6 months.Methods We enrolled 145 overweight and obese outpatients who received treatment from Department of Clinical Nutrition,the Second Affiliated Hospital of Guangzhou Medical University during June 2015 to January 2017.The interventions given to them were as follows:carbohydrate intake was limited to 50 g/d in the 1 st month,and thereafter the carbohydrate intake gradually increased.Carbohydrate intake was increased to 110 g/d in the 3 rd month.Energy intake level for the first 3 months was designed to be 500 kcal/d reduction based on recommended energy consumption calculated by initial resting metabolic rate and activities level.In the 1 st and 2 nd months of intervention,substitute food was provided instead of conventional staple food.From the 4 th to 6 th months of intervention,there was no limit for the intake of calories and carbohydrates and education of "high-nutrient-dense foods pagoda" was implemented based on low refined carbohydrate diet.Body weight was measured and recorded at the end of the 1 st,3 rd,6 th months of intervention.Results Of the participants,93.8%(136/145) completed the 1 st month of intervention,their mean body weight decreased by(3.77±1.76) kg compared with before the intervention(tpaired=10.61,P< 0.01),with a success rate of weight loss of 38.2%(52/136);the success rate of weight loss for all the participants was 35.8%(52/145).Totaled 74.5%(108/145) of the participants completed the first 3 months of intervention,their mean body weight decreased by(6.67±3.50)kg compared with before the intervention(tpaired= 10.89,P<0.01),with a success rate of weight loss of 80.5%(87/108);the success rate of weight loss for all the participants was 60.0%(87/145).A total of 67.6%(98/145) of the participants completed the whole 6-month intervention,their mean body weight decreased by(7.85±4.12) kg compared with before the intervention(tpaired = 4.77,P<0.01),with a success rate of weight loss of 85.7%(84/98);the success rate of weight loss for all the participants was 57.9%(84/145).Conclusion The pattern of gradual transition from low-carbohydrate diet to highnutrient-dense diet is effective and feasible,which deserves further clinical application.
Background Practical,effective,and long-term adherence dietary interventions are urgently needed in overweight and obese patients in order to achieve long-term weight control.Objective To evaluate the effect of the weight loss diet pattern of gradual transition from low-carbohydrate diet to high-nutrient-dense diet in 1-6 months.Methods We enrolled 145 overweight and obese outpatients who received treatment from Department of Clinical Nutrition,the Second Affiliated Hospital of Guangzhou Medical University during June 2015 to January 2017.The interventions given to them were as follows:carbohydrate intake was limited to 50 g/d in the 1 st month,and thereafter the carbohydrate intake gradually increased.Carbohydrate intake was increased to 110 g/d in the 3 rd month.Energy intake level for the first 3 months was designed to be 500 kcal/d reduction based on recommended energy consumption calculated by initial resting metabolic rate and activities level.In the 1 st and 2 nd months of intervention,substitute food was provided instead of conventional staple food.From the 4 th to 6 th months of intervention,there was no limit for the intake of calories and carbohydrates and education of "high-nutrient-dense foods pagoda" was implemented based on low refined carbohydrate diet.Body weight was measured and recorded at the end of the 1 st,3 rd,6 th months of intervention.Results Of the participants,93.8%(136/145) completed the 1 st month of intervention,their mean body weight decreased by(3.77±1.76) kg compared with before the intervention(tpaired=10.61,P< 0.01),with a success rate of weight loss of 38.2%(52/136);the success rate of weight loss for all the participants was 35.8%(52/145).Totaled 74.5%(108/145) of the participants completed the first 3 months of intervention,their mean body weight decreased by(6.67±3.50)kg compared with before the intervention(tpaired= 10.89,P<0.01),with a success rate of weight loss of 80.5%(87/108);the success rate of weight loss for all the participants was 60.0%(87/145).A total of 67.6%(98/145) of the participants completed the whole 6-month intervention,their mean body weight decreased by(7.85±4.12) kg compared with before the intervention(tpaired = 4.77,P<0.01),with a success rate of weight loss of 85.7%(84/98);the success rate of weight loss for all the participants was 57.9%(84/145).Conclusion The pattern of gradual transition from low-carbohydrate diet to highnutrient-dense diet is effective and feasible,which deserves further clinical application.
引文
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[2]JENSEN M D,RYAN D H,APOVIAN C M,et al.2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society[J].J Am Coll Cardiol,2014,63(25 Pt B):2985-3023.DOI:10.1016/j.jacc.2013.11.004.
[3]NORDMANN A J,NORDMANN A,BRIEL M,et al.Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors:a meta-analysis of randomized controlled trials[J].Arch Intern Med,2006,166(3):285-293.
[4]MOZAFFARIAN D,HAO T,RIMM E B,et al.Changes in diet and lifestyle and long-term weight gain in women and men[J].N Engl J Med,2011,364(25):2392-2404.DOI:10.1056/NEJMoa1014296.
[5]中华人民共和国卫生部疾病控制司.中国成人超重和肥胖症预防控制指南[M].北京:人民卫生出版社,2006:1-46.Department of Disease Control,Ministry of Health,PRC.Guidelines for the prevention and control of overweight and obesity in Chinese adults[M].Beijing:People's Medical Publishing House,2006:1-46.
[6]FREEDMAN M R,KING J,KENNEDY E.Popular diets:a scientific review[J].Obes Res,2001,9(Suppl 1):1-10.DOI:10.1038/oby.2001.113.
[7]GEORGE A B.Obesity in adults:Dietary therapy[EB/OL].(2017-03-01)[2017-06-27].https://www.uptodate.com/contents/obesity-in-adults-dietary-therapy.
[8]GROSS L S,LI L,FORD E S,et al.Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the United States:an ecologic assessment[J].Am J Clin Nutr,2004,79(5):774-779.
[9]SIMIN L,WALTER C W.Dietary carbohydrates[EB/OL].(2017-09-11)[2017-06-27].https://www.uptodate.com/contents/zh-Hans/dietary-carbohydrates.
[10]HESSION M,ROLLAND C,KULKARNI U,et al.Systematic review of randomized controlled trials of low-carbohydrate vs.low-fat/low-calorie diets in the management of obesity and its comorbidities[J].Obes Rev,2009,10(1):36-50.DOI:10.1111/j.1467-789X.2008.00518.x.
[11]HU T,MILLS K T,YAO L,et al.Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors:a meta-analysis of randomized controlled clinical trials[J].Am J Epidemiol,2012,176(Suppl 7):S44-54.DOI:10.1093/aje/kws264.
[12]BUENO N B,DE MELO I S,DE OLIVEIRA S L,et al.Very-low-carbohydrate ketogenic diet v.low-fat diet for longterm weight loss:a meta-analysis of randomised controlled trials[J].Br J Nutr,2013,110(7):1178-1187.DOI:10.1017/S0007114513000548.
[13]U.S.Department of Health and Human Services,U.S.Department of Agriculture.Dietary guidelines for Americans 2015-2020(eighth edition)[EB/OL].(2016-01-07)[2017-06-10].https://health.gov/dietaryguidelines/2015/guidelines/.