第2型糖尿病肥胖和體重過重病人的飲食治療－低醣vs.低脂

Nutrition Therapy for Overweight and Obese Patients with Type 2 Diabetes Low Fat vs. Low Carbohydrate

蕭雅純(Ya-chun Hsiao) ； 許碧惠(Pi-Hui Shue)

《內科學誌》 31卷6期 (2020/12) Pp. 390-397

https://doi.org/10.6314/JIMT.202012_31(6).02

摘要

糖尿病罹病人口眾多且逐年增加，是全球重視的公共衛生議題，而糖尿病罹病率上升與肥胖人口的增加息息相關，85％以上第2型糖尿病人合併有肥胖。多吃少動的外在因素是導致肥胖的元兇，因此飲食控制與運動是減重控糖的不二法門。飲食治療對糖尿病人血糖與體重控制的療效，有許多實證支持，糖化血色素下降程度不亞於目前糖尿病藥物的療效，不僅能使糖尿病人減重、降壓，還可以預防糖尿病的發生。低醣飲食和低脂飲食都有減重、降低血糖和改善血脂的療效，然而長時間以高油脂取代碳水化合物飲食，若低醣飲食油脂來自紅肉或奶製品，或低脂飲食取代油脂的精緻醣類攝取過多，反而增加肥胖、心血管疾病或癌症的風險。巨量營養素沒有所謂黃金比例，地中海、得舒飲食或蔬食飲食均強調注意食物品質，避免加工食物、糖和精緻穀類，減少飽和反式脂肪攝取，對健康更有助益。

關鍵字

第2型糖尿病（Type 2 diabetes） ； 肥胖（Obesity） ； 飲食治療（Nutrition therapy） ； 巨量營養素比例（Macronutrient composition） ； 食物品質（Food quality）

並列摘要

The increasing prevalence and total population of diabetes is a global public health problem. The twin epidemics of obesity and type 2 diabetes (T2DM) present in the world. Almost 85% of T2DM is obese, which could be resulted from the lifestyle change. So diet modification remains essential to successful weight loss and blood sugar control. Strong evidence supports that nutrition therapy had multi-effects on weight loss blood sugar reduction and prevention of diabetes. Reported hemoglobin A1c (A1C) reductions from Nutrition therapy can be similar to or greater than what would be expected with treatment using currently available medication for T2DM. Both low carbohydrate diet and Low fat diet decrease body weight, reduce A1c and lower blood pressure for patients with T2DM. However the food quality is more important than macronutrient composition. Mediterranean diet, DASH and plant-based food all emphasize food quality. Less red meat, whole milk products processed food or refined sugars will decrease the risk of obesity, cardiovascular disease or cancer.