Impact of High-Carbohydrate Diet on Metabolic Parameters in Patients with Type 2 Diabetes

Nutrients - Tập 9 Số 4 - Trang 322
Chan‐Hee Jung1, Kyung Mook Choi2
1Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon Hospital, 170 Jomaru-Ro, Wonmi-Gu, Bucheon-Si, Gyeonggi-Do 420-767, Korea
2Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, 80 Guro-Dong, Guro-Gu, Seoul, 152-050, Korea

Tóm tắt

In patients with type 2 diabetes mellitus (T2DM), whether dietary carbohydrates have beneficial or detrimental effects on cardiometabolic risk factors has drawn attention. Although a high-carbohydrate (HC) diet and a low-carbohydrate (LC) diet have gained popularity for several decades, there is scarce review focusing on the effects of HC diet on glucose, lipids and body weight in patients with T2DM. In this review, we examined recently-published literature on the effects of HC diets on metabolic parameters in T2DM. HC diets are at least as effective as LC diets, leading to significant weight loss and a reduction in plasma glucose, HbA1c and low density lipoprotein-cholesterol (LDL-C) levels. The major concern is that HC diets may raise serum triglyceride levels and reduce high density lipoprotein-cholesterol (HDL-C) levels, increasing the risk of cardiovascular disease. However, these untoward effects were not a persistent consequence and may be ameliorated with the consumption of a low glycemic index (GI)/low glycemic load (GL) and high fiber. Carbohydrate intake should be individualized, and low caloric intake remains a crucial factor to improve insulin sensitivity and reduce body weight; however, an HC diet, rich in fiber and with a low GI/GL, may be recommendable in patients with T2DM.

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Tài liệu tham khảo

Khazrai, 2014, Effect of diet on type 2 diabetes mellitus: A review, Diabetes Metab. Res. Rev., 30, 24, 10.1002/dmrr.2515

Sawyer, 2009, Diet, delusion and diabetes, Diabetologia, 52, 1, 10.1007/s00125-008-1203-9

Stone, 1963, The prolonged effects of a low cholesterol high carbohydrate diet upon the serum lipids in diabetic patients, Diabetes, 12, 127, 10.2337/diab.12.2.127

Hockaday, 1978, Prospective comparison of modified-fat-high-carbohydrate with standard low-carbohydrate dietary advice in the treatment of diabetes: One year follow-up study, Br. J. Nutr., 39, 357, 10.1079/BJN19780045

Becker, 2005, Nordic nutrition recommendations 2004, based on scientific evidence, Scand. J. Nutr., 49, 68, 10.1080/11026480510032025

Margetts, 2003, FAO/WHO launch expert report on diet, nutrition and prevention of chronic diseases, Public Health Nutr., 6, 323, 10.1079/PHN2003481

American Diabetes Association, Bantle, J.P., Wylie-Rosett, J., Albright, A.L., Apovian, C.M., Clark, N.G., Franz, M.J., Hoogwerf, B.J., Lichtenstein, A.H., and Mayer-Davis, E. (2008). Nutrition recommendations and interventions for diabetes: A position statement of the American Diabetes Association. Diabetes Care, 31, S61–S78.

Garg, 1994, Effects of varying carbohydrate content of diet in patients with non-insulin-dependent diabetes mellitus, JAMA, 271, 1421, 10.1001/jama.1994.03510420053034

Garg, 1998, High-monounsaturated-fat diets for patients with diabetes mellitus: A meta-analysis, Am. J. Clin. Nutr., 67, 577S, 10.1093/ajcn/67.3.577S

Feinman, 2015, Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base, Nutrition, 31, 1, 10.1016/j.nut.2014.06.011

Naude, C.E., Schoonees, A., Senekal, M., Young, T., Garner, P., and Volmink, J. (2014). Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk: A systematic review and meta-analysis. PLoS ONE, 9.

Accurso, 2008, Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: Time for a critical appraisal, Nutr. Metab., 5, 9, 10.1186/1743-7075-5-9

Liebman, 2014, When and why carbohydrate restriction can be a viable option, Nutrition, 30, 748, 10.1016/j.nut.2013.11.021

Kodama, 2009, Influence of fat and carbohydrate proportions on the metabolic profile in patients with type 2 diabetes: A meta-analysis, Diabetes Care, 32, 959, 10.2337/dc08-1716

American Diabetes Association (2016). Standards of Medical Care in Diabetes. Diabetes Care, 39, S1–S112.

Canadian Diabetes Assocaition Clinical Practice Guidelines Expert Committee (2013). Clinical Practice Guidelines: Nutrition Therapy. Can. J. Diabetes, 37, S45–S55.

Mann, 2004, Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus, Nutr. Metab. Cardiovasc. Dis., 14, 373, 10.1016/S0939-4753(04)80028-0

Dyson, 2011, Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes, Diabet. Med., 28, 1282, 10.1111/j.1464-5491.2011.03371.x

Tajima, 2015, Evidence-based practice guideline for the treatment for diabetes in Japan 2013, Diabetol. Int., 6, 151, 10.1007/s13340-015-0206-2

Korean Diabetes Association (2016, October 12). 2015 Treatment Guideline for Diabetes (5th Edition). Available online: http://www.diabetes.or.kr/general/index.html.

McDougall, 2014, Effects of 7 days on an ad libitum low-fat vegan diet: The McDougall Program cohort, Nutr. J., 13, 99, 10.1186/1475-2891-13-99

Guldbrand, 2012, In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss, Diabetologia, 55, 2118, 10.1007/s00125-012-2567-4

Brehm, 2009, One-year comparison of a high-monounsaturated fat diet with a high-carbohydrate diet in type 2 diabetes, Diabetes Care, 32, 215, 10.2337/dc08-0687

Meher, 2014, Effect of a mixed meal on plasma lipids, insulin resistance and systemic inflammation in non-obese Indian adults with normal glucose tolerance and treatment naïve type-2 diabetes, Diabetes Res. Clin. Pract., 104, 97, 10.1016/j.diabres.2013.12.047

Davis, 2016, A critical review of low-carbohydrate diets in people with Type 2 diabetes, Diabetic Med., 33, 148, 10.1111/dme.12964

Westman, 2008, The effect of a low-carbohydrate, ketogenic diet versus a lowglycemic index diet on glycemic control in type 2 diabetes mellitus, Nutr. Metab., 5, 36, 10.1186/1743-7075-5-36

Krebs, 2012, The Diabetes Excess Weight Loss (DEWL) Trial: A randomised controlled trial of high-protein versus high-carbohydrate diets over 2 years in type 2 diabetes, Diabetologia, 55, 905, 10.1007/s00125-012-2461-0

Larsen, 2011, The effect of high-protein, low-carbohydrate diets in the treatment of type 2 diabetes: A 12 month randomised controlled trial, Diabetologia, 54, 731, 10.1007/s00125-010-2027-y

Lee, 2008, Nutritional patterns of Korean diabetic patients: An exploratory study, Int. Nurs. Rev., 55, 442, 10.1111/j.1466-7657.2008.00656.x

He, 2016, Dietary and physical activity of adult patients with type 2 diabetes in Zhejiang province of eastern China: Data from a cross-sectional study, J. Diabetes Investig., 7, 529, 10.1111/jdi.12458

Hsu, W.C., Lau, K.H., Matsumoto, M., Moghazy, D., Keenan, H., and King, G.L. (2014). Improvement of insulin sensitivity by isoenergy high carbohydrate traditional Asian diet: A randomized controlled pilot feasibility study. PLoS ONE, 16.

Kamada, 2012, Optimal energy distribution of carbohydrate intake for Japanese elderly patients with type 2 diabetes: The Japanese Elderly Intervention Trial, Geriatr. Gerontol. Int., 12, 41, 10.1111/j.1447-0594.2011.00811.x

Woo, 2010, A comparative study of diet in good and poor glycemic control groups in elderly patients with type 2 diabetes mellitus, Korean Diabetes J., 34, 303, 10.4093/kdj.2010.34.5.303

Tay, 2015, Comparison of low- and high-carbohydrate diets for type 2 diabetes management: A randomized trial, Am. J. Clin. Nutr., 102, 780, 10.3945/ajcn.115.112581

Bozzetto, 2016, Reduction in liver fat by dietary MUFA in type 2 diabetes is helped by enhanced hepatic fat oxidation, Diabetologia, 59, 2697, 10.1007/s00125-016-4110-5

Soare, 2014, The effect of the macrobiotic Ma-Pi 2 diet vs. the recommended diet in the management of type 2 diabetes: The randomized controlled MADIAB trial, Nutr. Metab., 11, 39, 10.1186/1743-7075-11-39

Bozzetto, 2014, A CHO/fibre diet reduces and a MUFA diet increases postprandial lipaemia in type 2 diabetes: No supplementary effects of low-volume physical training, Acta Diabetologica, 51, 385, 10.1007/s00592-013-0522-6

Iqbal, 2010, Effects of a low-intensity intervention that prescribed a low-carbohydrate vs. a low-fat diet in obese, diabetic participants, Obesity, 18, 1733, 10.1038/oby.2009.460

Allerton, D.M., Campbell, M.D., Gonzalez, J.T., Rumbold, P.L.S., West, D.J., and Stevenson, E.J. (2016). Co-Ingestion of Whey Protein with a Carbohydrate-Rich Breakfast Does Not Affect Glycemia, Insulinemia or Subjective Appetite Following a Subsequent Meal in Healthy Males. Nutrients, 8.

Soong, 2015, Effect of co-ingestion of amino acids with rice on glycaemic and insulinaemic response, Br. J. Nutr., 114, 1845, 10.1017/S0007114515003645

Ramos-Lopez, O., Panduro, A., Martinez-Lopez, E., and Roman, S. (2016). Sweet Taste Receptor TAS1R2 Polymorphism (Val191Val) Is Associated with a Higher Carbohydrate Intake and Hypertriglyceridemia among the Population of West Mexico. Nutrients, 8.

Hwang, 2013, Carbohydrate intake interacts with SNP276G>T polymorphism in the adiponectin gene to affect fasting blood glucose, HbA1C, and HDL cholesterol in Korean patients with type 2 diabetes, J. Am. Coll. Nutr., 32, 143, 10.1080/07315724.2013.791795

Qi, 2012, Weight-loss diets modify glucose-dependent insulinotropic polypeptide receptor rs2287019 genotype effects on changes in body weight, fasting glucose, and insulin resistance: The Preventing Overweight Using Novel Dietary Strategies trial, Am. J. Clin. Nutr., 95, 506, 10.3945/ajcn.111.025270

Sonestedt, 2012, Genetic variation in the glucose-dependent insulinotropic polypeptide receptor modifies the association between carbohydrate and fat intake and risk of type 2 diabetes in the Malmo diet and Cancer cohort, J. Clin. Endocrinol. Metab., 97, E810, 10.1210/jc.2011-2444

Riccardi, 2008, Role of glycemic index and glycemic load in the healthy state, in prediabetes, and in diabetes, Am. J. Clin. Nutr., 87, 269S, 10.1093/ajcn/87.1.269S

Liljeberg, 1992, Metabolic responses to starch in bread containing intact kernels versus milled flour, Eur. J. Clin. Nutr., 46, 561

Wheeler, 2008, Carbohydrate issues: Type and amount, J. Am. Diet. Assoc., 108, S34, 10.1016/j.jada.2008.01.024

Garg, 1992, Effect of high carbohydrate intake on hyperglycemia, islet function, and plasma lipoproteins in NIDDM, Diabetes Care, 15, 1572, 10.2337/diacare.15.11.1572

Garg, 1992, Comparison of effects of high and low carbohydrate diets on plasma lipoproteins and insulin sensitivity in patients with mild NIDDM, Diabetes, 41, 1278, 10.2337/diab.41.10.1278

Jenkins, 1981, Glycemic index of foods: A physiological basis for carbohydrate exchange, Am. J. Clin. Nutr., 34, 362, 10.1093/ajcn/34.3.362

Rizkalla, 2004, Improved plasma glucose control, whole-body glucose utilization, and lipid profile on a low–glycemic index diet in type 2 diabetic men, Diabetes Care, 27, 1866, 10.2337/diacare.27.8.1866

Wolever, 2008, The Canadian trial of carbohydrates in diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: No effect on glycated hemoglobin but reduction in C-reactive protein, Am. J. Clin. Nutr., 87, 114, 10.1093/ajcn/87.1.114

Wolever, 2013, Altering source or amount of dietary carbohydrate has acute and chronic effects on postprandial glucose and triglycerides in type 2 diabetes: Canadian trial of Carbohydrates in Diabetes (CCD), Nutr. Metab. Cardiovasc. Dis., 23, 227, 10.1016/j.numecd.2011.12.011

Sacks, 2014, Effects of high vs. low glycemic index of dietary carbohydrate on cardiovascular disease risk factors and insulin sensitivity: The OmniCarb randomized clinical trial, JAMA, 312, 2531, 10.1001/jama.2014.16658

Hayne, 2003, Low-glycemic index diets in the management of diabetes: A meta-analysis of randomized controlled trials, Diabetes Care, 26, 2261, 10.2337/diacare.26.8.2261

Jenkins, 2012, Effect of legumes as part of a low glycemic index diet on glycemic control and cardiovascular risk factors in type 2 diabetes mellitus: A randomized controlled trial, Arch. Intern. Med., 172, 1653, 10.1001/2013.jamainternmed.70

Thomas, 2010, The use of low-glycaemic index diets in diabetes control, Br. J. Nutr., 104, 797, 10.1017/S0007114510001534

Argiana, 2015, The effect of consumption of low-glycemic-index and low-glycemic-load desserts on anthropometric parameters and inflammatory markers in patients with type 2 diabetes mellitus, Eur. J. Nutr., 54, 1173, 10.1007/s00394-014-0795-8

2005, Do glycemic index, glycemic load, and fiber play a role in insulin sensitivity, disposition index, and type 2 diabetes?, Diabetes Care, 28, 2978, 10.2337/diacare.28.12.2978

Holt, 2002, International table of glycemic index and glycemic load values: 2002, Am. J. Clin. Nutr., 76, 5, 10.1093/ajcn/76.1.5

Willett, 2002, Glycemic index, glycemic load, and risk of type 2 diabetes, Am. J. Clin. Nutr., 76, 274S, 10.1093/ajcn/76.1.274S

Goto, 2012, Dietary glycemic index and glycemic load in relation to HbA1c in Japanese obese adults: A cross-sectional analysis of the Saku Control Obesity Program, Nutr. Metab., 9, 79, 10.1186/1743-7075-9-79

Farvid, 2014, Glycemic index, glycemic load and their association with glycemic control among patients with type 2 diabetes, Eur. J. Clin. Nutr., 68, 459, 10.1038/ejcn.2013.288

Venn, 2007, Glycemic index and glycemic load: Measurement issues and their effect on diet–disease relationships, Eur. J. Clin. Nutr., 61, S122, 10.1038/sj.ejcn.1602942

James, 2010, Effects of dietary fiber and its components on metabolic health, Nutrients, 2, 1266, 10.3390/nu2121266

AAAC (2010, November 15). AACC Adopts Oat Bran Definition. Available online: http://www.aaccnet.org/news/pdfs/OatBran.pdf.

(2015, July 26). The British Nutrition Foundation. Available online: http://www.nutrition.org.uk/nutritionscience/nutrients/dietary-fibre.html.

Sizer, F., and Whitney, E. (2008). Nutrition: Concepts and Controversies, Thomson Wadsworth. [11th ed.].

Slavin, 1999, Possible mechanisms for the protectiveness of whole grains, Am. J. Clin. Nutr., 70, 459S, 10.1093/ajcn/70.3.459s

Eleazu, 2016, The concept of low glycemic index and glycemic load foods as panacea for type 2 diabetes mellitus; prospects, challenges and solutions, Afr. Health Sci., 16, 468, 10.4314/ahs.v16i2.15

Jenkins, 1978, Dietary fibres, fibre analogues, and glucose tolerance: Importance of viscosity, Br. Med. J., 1, 1392, 10.1136/bmj.1.6124.1392

Story, 1997, Dietary fiber and bile acid metabolism-an update, Adv. Exp. Med. Biol., 427, 259, 10.1007/978-1-4615-5967-2_27

Weickert, 2008, Metabolic effects of dietary fiber consumption and prevention of diabetes, J. Nutr., 138, 439, 10.1093/jn/138.3.439

Ostman, 2002, Barley bread containing lactic acid improves glucose tolerance at a subsequent meal in healthy men and women, J. Nutr., 132, 1173, 10.1093/jn/132.6.1173

Samra, 2007, Insoluble cereal fiber reduces appetite and short-term food intake and glycemic response to food consumed 75 min later by healthy men, Am. J. Clin. Nutr., 86, 972, 10.1093/ajcn/86.4.972

Craig, 2009, Position of the American Dietetic Association: Vegetarian diets, J. Am. Diet. Assoc., 109, 1266, 10.1016/j.jada.2009.05.027

Kiehm, 1976, Beneficial effects of a high carbohydrate, high fiber diet on hyperglycemic diabetic men, Am. J. Clin. Nutr., 29, 895, 10.1093/ajcn/29.8.895

Fallucca, 2015, Gut microbiota and Ma-Pi 2 macrobiotic diet in the treatment of type 2 diabetes, World J. Diabetes, 6, 403, 10.4239/wjd.v6.i3.403

Post, 2012, Dietary fiber for the treatment of type 2 diabetes mellitus: A meta-analysis, J. Am. Board Fam. Med., 25, 16, 10.3122/jabfm.2012.01.110148

Silva, 2013, Fiber intake and glycemic control in patients with type 2 diabetes mellitus: A systematic review with meta-analysis of randomized controlled trials, Nutr. Rev., 71, 790, 10.1111/nure.12076

Marlett, 2002, Position of the American Dietetic Association: Health implications of dietary fiber, J. Am. Diet. Assoc., 102, 993, 10.1016/S0002-8223(02)90228-2

Trapp, 2010, Usefulness of vegetarian and vegan diets for treating type 2 diabetes, Curr. Diab. Rep., 10, 152, 10.1007/s11892-010-0093-7

Blundell, 1999, High and low carbohydrate and fat intakes: Limits imposed by appetite and palatability and their implications for energy balance, Eur. J. Clin. Nutr., 53, S148, 10.1038/sj.ejcn.1600756

Stubbs, 2001, Carbohydrates, Appetite and Feeding Behavior in Humans, J. Nutr., 131, 2775S, 10.1093/jn/131.10.2775S

Zhao, 1999, 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., 69, 632, 10.1093/ajcn/69.4.632

Astrup, 2000, The role of dietary fat in body fatness: Evidence from a preliminary meta-analysis of ad libitum low-fat dietary intervention studies, Br. J. Nutr., 83, S25, 10.1017/S0007114500000921

Hellerstein, 2002, Carbohydrate-induced hypertriglyceridemia: Modifying factors and implications for cardiovascular risk, Curr. Opin. Lipidol., 13, 33, 10.1097/00041433-200202000-00006

Mensink, 2003, Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: A meta-analysis of 60 controlled trials, Am. J. Clin. Nutr., 77, 1146, 10.1093/ajcn/77.5.1146

Ma, 2006, Association between carbohydrate intake and serum lipids, J. Am. Coll. Nutr., 25, 155, 10.1080/07315724.2006.10719527

Fried, 2003, Sugars, hypertriglyceridemia, and cardiovascular disease, Am. J. Clin. Nutr., 78, 873S, 10.1093/ajcn/78.4.873S

Marckmann, 2000, Ad libitum intake of low-fat diets rich in either starchy foods or sucrose: Effects on blood lipids, factor VII coagulant activity, and fibrinogen, Metabolism, 49, 731, 10.1053/meta.2000.6237

Ginsberg, 1981, Effect of a high carbohydrate diet on apolipoprotein B catabolism in man, Metabolism, 30, 347, 10.1016/0026-0495(81)90114-1

Parks, 1999, Effects of a low-fat, high-carbohydrate diet on VLDL-triglyceride assembly, production, and clearance, J. Clin. Investig., 104, 1087, 10.1172/JCI6572

Farese, 1991, Tissue-specific regulation of lipoprotein lipase activity by insulin/glucose in normal-weight humans, Metabolism, 40, 214, 10.1016/0026-0495(91)90178-Y

Roberts, 2008, Reduced oxidation of dietary fat after a short term high-carbohydrate diet, Am. J. Clin. Nutr., 87, 824, 10.1093/ajcn/87.4.824

Amaral, 1992, Effect of propionate on lipid metabolism in healthy human subjects, FASEB J., 6, A1655

Howard, 2010, Low-fat dietary pattern and lipoprotein risk factors: The Women’s Health Initiative Dietary Modification Trial, Am. J. Clin. Nutr., 91, 860, 10.3945/ajcn.2009.28034

Ludwig, 2014, Increasing adiposity: Consequence or cause of overeating?, JAMA, 311, 2167, 10.1001/jama.2014.4133