不同糖代谢状态人群静息能量消耗变化及影响因素分析
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摘要
目的比较不同糖代谢状态人群静息能量消耗(resting energy expenditure,REE)变化特点及影响因素。方法以2016年10月～2017年10月解放军总医院健康管理研究院接受健康体检的533例为研究对象,平均年龄(49.8±8.1)岁,男性384例,女性149例。进行一般体格检查,测定身高、体重、腰围、臀围、体脂肪量和体脂肪率,检测血生化指标空腹血糖、餐后2 h血糖、糖化血红蛋白、血脂和血清尿酸水平,采用代谢仪测量静息能量消耗,对比正常血糖组、糖尿病前期组和糖尿病组的REE变化特点。结果糖尿病组静息能量消耗值(1 615.1±125.6)kJ/d高于正常血糖组(1 523.4±142.6)k J/d和糖尿病前期组(1 534±157.5)kJ/d,差异有统计学意义(P <0.05)。随着年龄的增加,静息能量消耗值减低,相同年龄段糖尿病组静息能量消耗值升高显著,男性静息能量消耗明显高于女性,肥胖者静息能量消耗明显升高,差异有统计学意义(P <0.001)。多元线性回归分析,影响正常血糖组静息能量消耗的因素有年龄、体重、收缩压、总胆固醇、空腹血糖;影响糖尿病前期组静息能量消耗的因素有年龄、体重;影响糖尿病组静息能量消耗的因素有年龄、体重和臀围。结论不同糖代谢状态人群REE有差异,血糖升高增加能量消耗,正常血糖人群饮食运动管理需结合体重、血压、血脂和血糖进行早期综合管理,糖尿病前期和糖尿病患者需要更重视体重管理。
Objective To investigate the resting energy expenditure(REE) feature and its influence factors among population of different glucose tolerance status. Methods A total of 533 adults(384 males and 149 females) at the age of(49.8 ± 8.1)years were enrolled in this study. They had health examination in health management institute of PLA General Hospital between October2016 and October 2017. Their body height,body weight,waist circumference(WC),hip circumference(HC),fat mass(FM),fat ratio(FR),biochemical indications level were measured. Their resting energy expenditure(REE) was assayed by indirect calorimetry(MedGem). Distribution characteristics of REE between hypertension group and control group were analyzed. Results There were153 adults in normal glucose tolerance group(101 males and 52 females) at the age of(47.9 ± 7.9)years. There were 120 adults(72 males and 48 females) at the age of(50.7 ± 7.6) years in prediabetes group. There were 260 adults(211 males and 49 females) at the age of(52.4 ± 8.0) years in diabetes group. Patients with diabetes had higher level of REE compared with normal glucose tolerance group(1615.1 ± 125.6 vs. 1523.4 ± 142.6 k J/d,P < 0.05),and prediabetes group(1615.1 ± 125.6 vs. 1534 ± 157.5 k J/d,P <0.05). The older adults had lower level of REE. The male adults had higher level of REE compared with female(P < 0.001). The obesity adults had higher level of REE(P < 0.001). Multivariate linear regression analysis showed that age,body weight,SBP,TC,FPG were influence factors of REE of normal glucose tolerance group,and age,body weight for prediabetes group,and age,body weight,hip circumference for diabetes group. Conclusion The level of REE is changed between different glucose tolerance status.The level of REE increases with the blood glucose. The management of diet and exercise for normal glucose tolerance group should be combined with the weight,blood pressure,blood lipid and blood glucose management. Diabetes and prediabetes patients need to pay more attention to weight management.
Objective To investigate the resting energy expenditure(REE) feature and its influence factors among population of different glucose tolerance status. Methods A total of 533 adults(384 males and 149 females) at the age of(49.8 ± 8.1)years were enrolled in this study. They had health examination in health management institute of PLA General Hospital between October2016 and October 2017. Their body height,body weight,waist circumference(WC),hip circumference(HC),fat mass(FM),fat ratio(FR),biochemical indications level were measured. Their resting energy expenditure(REE) was assayed by indirect calorimetry(MedGem). Distribution characteristics of REE between hypertension group and control group were analyzed. Results There were153 adults in normal glucose tolerance group(101 males and 52 females) at the age of(47.9 ± 7.9)years. There were 120 adults(72 males and 48 females) at the age of(50.7 ± 7.6) years in prediabetes group. There were 260 adults(211 males and 49 females) at the age of(52.4 ± 8.0) years in diabetes group. Patients with diabetes had higher level of REE compared with normal glucose tolerance group(1615.1 ± 125.6 vs. 1523.4 ± 142.6 k J/d,P < 0.05),and prediabetes group(1615.1 ± 125.6 vs. 1534 ± 157.5 k J/d,P <0.05). The older adults had lower level of REE. The male adults had higher level of REE compared with female(P < 0.001). The obesity adults had higher level of REE(P < 0.001). Multivariate linear regression analysis showed that age,body weight,SBP,TC,FPG were influence factors of REE of normal glucose tolerance group,and age,body weight for prediabetes group,and age,body weight,hip circumference for diabetes group. Conclusion The level of REE is changed between different glucose tolerance status.The level of REE increases with the blood glucose. The management of diet and exercise for normal glucose tolerance group should be combined with the weight,blood pressure,blood lipid and blood glucose management. Diabetes and prediabetes patients need to pay more attention to weight management.
引文
[1]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,1(10):6.
[2]姚峰.综合健康管理模式对老年2型糖尿病患者的干预效果研究[J].中华保健医学杂志,2017,19(1):64-65.
[3]Yang W,Lu J,Weng J,et al.Prevalence of diabetes among men and women in China[J].N Engl J Med,2010,362(12):1090-1101.
[4]Johannsen DL,Welk GJ,Sharp RL,et al.Differences in daily energy expenditure in lean and obese women:the role of posture allocation[J].Obesity(Silver Spring),2008,16(1):34-39.
[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[S].北京:人民卫生出版社,2006,23-39.
[6]St-Onge MP,Rubiano F,Jones A,et al.A new hand-held indirect calorimeter to measure postprandial energy expenditure[J].Obes Res,2004,12(4):704-709.
[7]徐冬连,李群,曾珊,等.老年糖尿病患者膳食营养状况对脂质代谢的影响[J].江苏医药,2010,36(16):1936-1937.
[8]Buscemi S,Donatelli M,Grosso G,et al.Resting energy expenditure in type 2 diabetic patients and the effect of insulin bolus[J].Diabetes Res Clin Practice,2014,106(3):605-610.
[9]严翊,谢敏豪.能量平衡与体重管理[J].北京体育大学学报,2014,37(8):48-53.
[10]周书明,尹秋生,姚依群,等.综合干预对老年糖耐量正常者进展为糖代谢异常的影响[J].中华保健医学杂志,2009,11(5):336-338.
[11]Villegas R,Shu XO,Yang G,et al.Energy balance and type 2diabetes:a report from the Shanghai women,health study[J].Nutr Metab Cardiovasc Dis,2011,19(3):190-197.
[12]Weyer C,Bogardus C,Pratley RE.Metabolic factors contributing to increased resting metabolic rate and decreased insulininduced thermogenesis during the development of type 2diabetes[J].Diabetes,1999,48(6):1607-1614.
[13]Martin K,Rust PF,Wallace P,et al.Estimation of resting energy expenditure considering effects of race and diabetes status[J].Diabetes Care,2004,27(6):1405-1407.
[14]Gougeon R,Lamarehe M,Yale JF,et al.The predietion of resting energy expenditure in type 2 diabetes mellitus is improved by factoring for glycemia[J].Int J Obes Relat Metab Disord,2002,26(12):1547-1552.
[15]Lupinsky L,Singer P,Theilla M,et al.Comparison between two metabolic monitors in the measurement of resting energy expenditure and oxygen consumption in diabetic and nondiabetic ambulatory and hospitalized patients[J].Nutrition,2015,31(1):176-179.
[16]韩明明,齐玉梅,孙学丽,等.2型糖尿病患者的静息能量消耗及底物氧化利用研究[J].天津医科大学学报,2011,17(2):255-258.
[17]Ikeda K,Fujimoto S,Goto M,et al.Impact of endogenous and exogenous insulin on basal energy expenditure in patients with type 2 diabetes under standard treatment[J].Am J Clin Nutr,2011,94(6):1513-1518.
[18]Tan TM,Field BCT,Mc Cullough KA,et al.Coadministration of glucagon-like peptide-1 during glucagon infusion in humans results in increased energy expenditure and amelioration of hyperglycemia[J].Diabetes,2013,62(3):1131-1138.
[19]Ikeda K,Fujimoto S,Goto M,et al.A new equation to estimate basal energy expenditure of patients with diabetes[J].Clin Nutr,2013,32(5):777-782.
[20]Nakajima Y,Sato K,Sudo M,et al.Practical dietary calorie management,body weight control and energy expenditure of diabetie Patients in short-term hospitalization[J].J Atheroscler Thromb,2013,17(6):558-567.
[21]Hoehstenbaeh-Waelen A,Veldhorst MA,Nieuwenhuizen Aq et al.Comparison of 2 diets with either 25%or 10%of energy as casein on energy expenditure,substrate balance,and appetite profile[J].Am J Clin Nutr,2012,89(3):831-838.
[22]田慧.重视糖尿病教育、提高患者自我管理水平的重要性[J].中华保健医学杂志,2015,17(5):353-355.
[23]潘群,李小莉,刘春荣,等.糖调节受损人群知信行社区综合干预效果研究[J].中国全科医学,2016,19(19):2319-2323.
[24]梁洪芳.有氧运动对肥胖症患者体重、血脂水平的影响[J].中国医学文摘-内科学分册,2017,12(3):406-407.
[25]常凤.中年2型糖尿病患者有氧运动结合原地深蹲抗阻训练方案及其干预效果研究[J].中国全科医学,2018,21(24):2980-2986.
[2]姚峰.综合健康管理模式对老年2型糖尿病患者的干预效果研究[J].中华保健医学杂志,2017,19(1):64-65.
[3]Yang W,Lu J,Weng J,et al.Prevalence of diabetes among men and women in China[J].N Engl J Med,2010,362(12):1090-1101.
[4]Johannsen DL,Welk GJ,Sharp RL,et al.Differences in daily energy expenditure in lean and obese women:the role of posture allocation[J].Obesity(Silver Spring),2008,16(1):34-39.
[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[S].北京:人民卫生出版社,2006,23-39.
[6]St-Onge MP,Rubiano F,Jones A,et al.A new hand-held indirect calorimeter to measure postprandial energy expenditure[J].Obes Res,2004,12(4):704-709.
[7]徐冬连,李群,曾珊,等.老年糖尿病患者膳食营养状况对脂质代谢的影响[J].江苏医药,2010,36(16):1936-1937.
[8]Buscemi S,Donatelli M,Grosso G,et al.Resting energy expenditure in type 2 diabetic patients and the effect of insulin bolus[J].Diabetes Res Clin Practice,2014,106(3):605-610.
[9]严翊,谢敏豪.能量平衡与体重管理[J].北京体育大学学报,2014,37(8):48-53.
[10]周书明,尹秋生,姚依群,等.综合干预对老年糖耐量正常者进展为糖代谢异常的影响[J].中华保健医学杂志,2009,11(5):336-338.
[11]Villegas R,Shu XO,Yang G,et al.Energy balance and type 2diabetes:a report from the Shanghai women,health study[J].Nutr Metab Cardiovasc Dis,2011,19(3):190-197.
[12]Weyer C,Bogardus C,Pratley RE.Metabolic factors contributing to increased resting metabolic rate and decreased insulininduced thermogenesis during the development of type 2diabetes[J].Diabetes,1999,48(6):1607-1614.
[13]Martin K,Rust PF,Wallace P,et al.Estimation of resting energy expenditure considering effects of race and diabetes status[J].Diabetes Care,2004,27(6):1405-1407.
[14]Gougeon R,Lamarehe M,Yale JF,et al.The predietion of resting energy expenditure in type 2 diabetes mellitus is improved by factoring for glycemia[J].Int J Obes Relat Metab Disord,2002,26(12):1547-1552.
[15]Lupinsky L,Singer P,Theilla M,et al.Comparison between two metabolic monitors in the measurement of resting energy expenditure and oxygen consumption in diabetic and nondiabetic ambulatory and hospitalized patients[J].Nutrition,2015,31(1):176-179.
[16]韩明明,齐玉梅,孙学丽,等.2型糖尿病患者的静息能量消耗及底物氧化利用研究[J].天津医科大学学报,2011,17(2):255-258.
[17]Ikeda K,Fujimoto S,Goto M,et al.Impact of endogenous and exogenous insulin on basal energy expenditure in patients with type 2 diabetes under standard treatment[J].Am J Clin Nutr,2011,94(6):1513-1518.
[18]Tan TM,Field BCT,Mc Cullough KA,et al.Coadministration of glucagon-like peptide-1 during glucagon infusion in humans results in increased energy expenditure and amelioration of hyperglycemia[J].Diabetes,2013,62(3):1131-1138.
[19]Ikeda K,Fujimoto S,Goto M,et al.A new equation to estimate basal energy expenditure of patients with diabetes[J].Clin Nutr,2013,32(5):777-782.
[20]Nakajima Y,Sato K,Sudo M,et al.Practical dietary calorie management,body weight control and energy expenditure of diabetie Patients in short-term hospitalization[J].J Atheroscler Thromb,2013,17(6):558-567.
[21]Hoehstenbaeh-Waelen A,Veldhorst MA,Nieuwenhuizen Aq et al.Comparison of 2 diets with either 25%or 10%of energy as casein on energy expenditure,substrate balance,and appetite profile[J].Am J Clin Nutr,2012,89(3):831-838.
[22]田慧.重视糖尿病教育、提高患者自我管理水平的重要性[J].中华保健医学杂志,2015,17(5):353-355.
[23]潘群,李小莉,刘春荣,等.糖调节受损人群知信行社区综合干预效果研究[J].中国全科医学,2016,19(19):2319-2323.
[24]梁洪芳.有氧运动对肥胖症患者体重、血脂水平的影响[J].中国医学文摘-内科学分册,2017,12(3):406-407.
[25]常凤.中年2型糖尿病患者有氧运动结合原地深蹲抗阻训练方案及其干预效果研究[J].中国全科医学,2018,21(24):2980-2986.