含高水溶性膳食纖維及大豆蛋白之管灌配方對糖尿病患者營養狀況之改善效益

The improvement on nutritional status of diabetic patients by tube feeding formula containing water souble-fiber and soy protein

張文馨(Wen-Hsin Jhang)

指導教授 ： 王進崑

中山醫學大學/健康管理學院/營養學研究所/碩士(2015年)

https://doi.org/10.6834/CSMU.2015.00069

摘要

糖尿病是造成許多併發症和死亡的主要原因，在糖尿病治療當中飲食的控制與藥物和運動同樣重要。過去研究發現水溶性膳食纖維的攝取可以延緩或降低碳水化合物的吸收。而大豆蛋白為高生物價蛋白質，因此有高消化率及完整的必需胺基酸可被人體吸收，且可以改善周邊胰島素敏感性，降低胰島素濃度，達到控制血糖的效果。
本研究主要是探討藉由管灌餵食含高水溶性膳食纖維及大豆蛋白之管灌配方對糖尿病患者之營養狀況及血糖改善效果。本研究共納入30位受試者，其中男性13名，女性17名，平均年齡為74歲。研究介入期為12週，在營養配方介入前、後(第0週、第12週)，評估體位、營養狀況、飲食攝取情況、血液生化值及臨床症狀。介入營養配方12週後，受試者的膳食纖維攝取由9.81±5.55 g/day顯著增加至32.05±4.13 g/day。蛋白質攝取由60.60±11.96 g/day增加至82.07±10.86 g/day。受試者體位包括體重、身體質量指數(BMI)、腰臀圍(WHR)、皮下脂肪厚度(TSF)、上臂肌環圍(MAC)均無顯著的影響。在生化分析方面，管灌餵食12週營養配方後，血清白蛋白、前白蛋白沒有顯著變化。尿素氮(BUN)、尿酸、鐵、鈣有顯著增加(p<0.05)。在血脂方面，LDL-C有顯著下降。HOMA-IR、血漿胰島素也有顯著降低，但餐前血糖和糖化血色素則沒有差異。在臨床症狀方面，對便祕的情況稍有改善。綜合上述結果，餵食含高水溶性膳食纖維及大豆蛋白營養配方，可以降低血中LDL-C濃度，改善胰島素敏感性，且可維持正常營養狀況。

關鍵字

水溶性膳食纖維 ； 大豆蛋白 ； 糖化血色素 ； HOMA-IR

並列摘要

Diabetes causes a lot of complications and death.Diet control,medication and exercise are equally important treatments for diabetic patients. Some studies show that intake of water soluble-fiber can delay or reduce the carbohydrate absorption . Soy protein has high biological value of protein, it is highly digestible and containly essential amino acids ,this could improve peripheral insulin sensitivity, reduce insulin levels and control blood sugar . The objective of this study was to understand the effect of tube feeding formula containing highly water soluble-fiber and soy protein on the improvement of nutritional status and blood sugar status of diabetic patients. The study included 30 subjects, 13 males and 17 females, average age was 74 years olds. The experimental period was 12 weeks. Anthropometric factors, dietary condition,biochemical analyses,physiological symptoms were measured before and after 12 weeks of intervention . Dietary record showed that the dietary fiber intake was greatly increased from 9.81±5.55 g to 32.05±4.13 g / day and protein intake from 60.60±11.96 g / day to 82.07±10.86 g / day.Results showed no significant difference on body weight,BMI,WHR,TSF and MAC. The levels of serum albumin, prealbumin were not changed. BUN, uric acid, iron, calcium were significantly increased (p <0.05).LDL-C was significantly decreased.HOMA-IR, plasma insulin were significantly decreased .Fasting plasma glucose and glycosylated hemoglobin were not changed.
Constipation was improved after the intervention. In conclusion,the intervention of high water soluble fiber and soy protein formula could decrease LDL-C concentrations,insulin resistance and maintain normal nutritional status.

並列關鍵字

water souble-fiber ； soy protein ； glycohemoglobin ； HOMA-IR

參考文獻

劉松臻、王朝弘、簡銘男(2010)。長效型胰島素類似物在第2型糖尿病人的應用。內科學誌21：109-116。

鄭美美、江銘彥、劉聰勳、黃志強、鄭高珍、吳佳純（2013）。慢性腎臟病貧血的治療新進展。內科學誌24：118-122。

顏啟華(2014)。糖尿病與肌少症。社團法人中華民國糖尿病衛教學會

莊淑如、嚴永裕、王進崑(2012)。營養介入對居家照護之糖尿病病人

張惠萍(2009)。醫院自製天然養生灌食配方的營養成分探討。台北醫學大學保健營養學系碩士論文。