設計適合「高血壓前期或第一期、糖尿病前期患者」的「降血壓、降血糖」飲食及其效果評估

Designing and testing efficacy of blood pressure and glucose lowering diets for Taiwanese patients with pre-/1st staged hypertension and/or pre-diabetes

蔡健慧(Chien-Hui Tsai)

指導教授 ： 潘文涵

國立臺灣大學/生命科學院/生化科技學系/碩士(2011年)

https://doi.org/10.6342/NTU.2011.02217

摘要

研究背景與目的：
　　高血壓與糖尿病是重要的公共衛生議題。過去有許多研究顯示飲食療法能除去對高血壓或糖尿病藥物的依賴，減少醫療花費，並且除了改善目標疾病，還有其他附加價值，像是預防其他慢性疾病之發生及改善生活品質，因此，從改變生活飲食型態的層面來改善國人血壓及血糖狀況為當務之急。過去在美國臨床試驗顯示得舒飲食可有效幫助高血壓患者降低血壓。得舒飲食是一種富含鉀、鎂、鈣、纖維與較少飽和脂肪酸、較少膽固醇的飲食，以西式菜餚所設計的飲食。本研究想證實以華人飲食設計的得舒飲食是否同樣有降血壓的效果，並進一步評估維持得舒飲食鉀、鎂、鈣、纖維含量與飽和脂肪酸的比例，但減少得舒飲食醣類比例的減醣得舒飲食是否對於降低血壓、血糖和血脂有更好的效果。

材料與方法：
本研究為一個隨機交叉的飲食性介入試驗。共有36位年齡為20~65歲，符合收縮壓130~159mmHg或舒張壓85~99mmHg或血糖100~125mg/dl其中一項條件，且簽署同意書願意參加試驗的受試者。本研究將受試者隨機分配成二組，分別隨機先後給予得舒飲食和減醣得舒飲食。減醣得舒飲食與得舒飲食的不同在於減少得舒飲食的醣類比例，其減少的部份以使用豆製品和芥花油的方式，由蛋白質、單元不飽和脂肪酸各一部份取代。試驗方式為給予受試者食用4個星期的第一種飲食後，緊接著4個星期的沖淡期，再進行4星期的第二種飲食，試驗前後共計12個星期。在受試者食用試驗飲食前與試驗期間，研究人院定期測量受試者的血壓、血糖和血脂值，並且定期收集受試者的尿液以檢測尿液中的電解質。

研究結果：
得舒飲食的組別其與基線相比之收縮壓、舒張壓和血糖值分別下降7.91mmHg、4.64mmHg和3.53mg/dl (P<0.05)。減醣得舒飲食的組別其與基線相比之收縮壓、舒張壓和血糖值分別下降5.13mmHg、2.63mmHg和3.69mg/dl (P<0.05)。兩種飲食的血壓及血糖下降效果沒有顯著差異，但對於血壓偏高的受試者，得舒飲食收縮壓下降的效果較減糖得舒飲食好，且有顯著差異(P=0.04)。在血脂方面，兩種飲食對總膽固醇和LDL-C都有顯著的下降效果。減醣得舒飲食對於禁食胰島素濃度、三酸甘油酯有顯著下降效果，對於HDL-C/TC比例有顯著上升的效果。

結論：
台灣化得舒飲食和得舒減醣飲食都能有效降低血壓，在血壓偏高的族群中，血壓下降的程度較血壓正常者大，並且台灣化得舒飲食對收縮壓下降較減醣得舒飲食有更好的效果。減醣得舒飲能同時改善血壓、血糖和三酸甘油酯。

關鍵字

得舒飲食 ； 減醣得舒飲食 ； 血壓 ； 血糖

並列摘要

Background & objective:
Hypertension and diabetes are important public health problems in Taiwan and in the world. Many studies have shown that dietary therapy can ease high blood pressure or diabetes drug dependence and reduce medical costs. In addition, dietary therapy can prevent other chronic diseases and improve total wellbeing. Therefore, it is imperative to promote dietary and lifestyle therapy for newly diagnosed patients. Clinical trials have shown that the US. DASH diet can effectively help lower blood pressure in patients with hypertension. The DASH diet is rich in potassium, magnesium, calcium, fiber and low in saturated fatty acids, low cholesterol content. This study is firstly to confirm whether a Chinese-style DASH diet has not only a similar blood pressure lowering effect, but also effects on blood glucose and lipids. Secondly, assessment was made to see whether a reduced carbohydrate DASH diet can lower blood pressure, blood glucose and blood lipids. This diet has similar levels of potassium, magnesium, calcium, fiber and percentage of saturated fatty acids, but reduced proportion of carbohydrate.

Method:
This study adopted a randomized crossover dietary intervention trial. Thirty six participants were in the trial. They were aged 20 to 65, with systolic blood pressure 130 ~ 159mmHg or diastolic blood pressure 85 ~ 99mmHg or fasting blood glucose 100 ~ 125mg/dl. Participants were randomly assigned to two groups, each was given either DASH diet or reduced carbohydrate DASH diet in different stage. Soybean products and canola oil were used to increase the proportion of protein and monounsaturated fatty acid and thus reduce the carbohydrate in reduced carbohydrate DASH. Participants consumed the first diet for 4 weeks, followed by four weeks of washout period, then the second diet for 4 weeks. Total experiment lasted 12 weeks. Before and during the experiment, participants were regularly measured for blood pressure, blood glucose and lipid values. Urine was regularly collected to monitor urinary electrolytes.

Result:
In DASH diet group, systolic blood pressure, diastolic blood pressure and blood glucose levels decreased 7.91mmHg, 4.64mmHg and 3.53mg/dl, respectively (P <0.05). Where as in the reduced carbohydrate DASH diet group, they decreased 5.13mmHg, 2.63mmHg and 3.69mg/dl respectively (P <0.05). However, there were no significant differences between two kinds of diets in blood pressure and blood glucose lowering effect. Only in those with pre-hypertension and hypertension, the DASH diet (-8.85mmHg) group decreased mean systolic blood pressure more so than the reduced carbohydrate DASH diet (-5.06mmHg) group (P = 0.04). And for lipids, both diets significantly decreased total cholesterol and LDL-C. Reduced carbohydrate DASH diet group significantly decreased fasting insulin, triglycerides and significantly increased HDL-C/TC ratio.

Conclusion:
Chinese-style DASH diet and reduced carbohydrate DASH diet can effectively lower blood pressure. In high blood pressure participants, both diet lower blood pressure effectively, and DASH diet has better effect than reduced carbohydrate DASH diet. In addition to lowering the blood pressure, reduced carbohydrate DASH can also lower insulin and triglycerides, and increase HDL/TC ratio.

並列關鍵字

DASH ； reduced carbohydrate DASH ； blood pressure ； blood glucose

參考文獻

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