探討第 2 型糖尿病病人甜味味覺及其相關之因子

Investigation of the Sweet Taste and Related Factors in Type 2 Diabetes

黃盈真(Ying-Chen Huang)

指導教授 ： 劉[珍芳

臺北醫學大學/公共衛生暨營養學院/保健營養學研究所/碩士(2012年)

https://doi.org/10.6831/TMU.2012.00040

摘要

糖尿病患者應該有良好的飲食習慣以控制血糖，但是味覺敏銳度為影響食物喜愛與選擇的重要因子。且過去本實驗室的研究中發現，糖尿病患者對水果甜味的認知似乎有異於健康者。因此，若能了解糖尿病患者甜味感受度及甜味敏銳度較差的原因，則對於第2 型糖尿病病人的血糖控制將有正面的幫助。故本研究的主要目的為，比較健康受試者與第 2 型糖尿病病人的甜味味覺敏銳度 (甜味識別閾值、果汁甜味感受度)，並探討類昇糖素胜肽 (Glucagon-like peptide-1, GLP-1)、胰島素 (Insulin)、瘦體素 (Leptin) 等荷爾蒙是否為影響第 2 型糖尿病病人甜味味覺的可能因子。本研究招募 30~65 歲之 10 位第 2 型糖尿病病人及 16 位健康受試者，條件分別為 HbA1c 介於 7~9 % 及小於或等於 6 %。實驗分成兩大部分，第一部分為感官品評，分別利用甜味識別閾值測試 (recognition threshold test of sweetness) 及果汁甜味感受度測試 (sensory test of juice sweetness)，來評估受試者的甜味味覺。第二部分為給予受試者含有25 克碳水化合物的果汁或葡萄糖溶液，觀察受試者飲用前後相關荷爾蒙之變化。結果顯示，糖尿病組的甜味識別閾值皆高於健康組，若以人數分佈來分析，則發現糖尿病組有顯著較差的葡萄糖敏銳度 (p < 0.05)，且味覺受損程度會受到HbA1c, 空腹血糖值、糖尿病疾病史的影響。在以Visual Analogue Scale (VAS) 量表測量果汁甜味感受度方面，兩組的芒果汁甜味感受度相近，而黃金奇異果汁的甜味感受度，健康組為3.0 ± 0.5，糖尿病組為 2.1 ± 0.4，雖然未達統計差異，但健康組有較高的甜味感受度，顯示其有較高的甜味敏銳度。另外，荷爾蒙變化部份，糖尿病組飲用葡萄糖、黃金奇異果汁、芒果汁後的GLP-1, Insulin單位時間分泌量皆小於健康組，且第 2 型糖尿病組空腹及餐後Leptin 濃度皆高於健康受試者。綜合本研究結果後發現，血糖控制不穩定的第 2 型糖尿病組有較遲鈍的甜味味覺，尤其是有顯著較差的葡萄糖敏銳度，且糖尿病患 GLP-1, Insulin, Leptin 等荷爾蒙之分泌機制有別於健康者，故可能因此影響到糖尿病病人的甜味味覺。

關鍵字

第 2 型糖尿病 ； 水果 ； 甜味味覺 ； 類昇糖素胜肽胰島素 ； 瘦體素

並列摘要

Purpose: This study was to investigate the sweet sensitivity (recognition threshold of sweetness, sensory of juice sweetness ) in type 2 diabetes. We also elucidated the effect of hormone (Glucagon-like peptide-1, Insulin, Leptin) on sweet taste. Method: The study was conducted on 26 subjects (16 healthy subjects and 10 type 2 diabetes) aged 30~65 years The included criteria were HbA1c ≦ 6 % for healthy subjects and 7~9 % for type 2 diabetes. Recognition thresholds of sweetness (glucose, sucrose and fructose) and sensory of juice sweetness (golden kiwifruit, mango) were examined. After an overnight fasting, subjects consumed the juices (golden kiwifruit, mango), glucose solution containing 25 g carbohydrate and then the blood samples of subjects were taken at baseline, 15, 30, 60, 90, 120 min to measure the concentration of GLP-1, Insulin and Leptin. Results: Compared with healthy subjects, the recognition thresholds of sweetness (glucose, sucrose and fructose) were higher in type 2 diabetes . A significant difference was found in sensitivity of glucose (p < 0.05). Furthermore, HbA1c, fasting blood glucose and diabetic duration influenced the recognition thresholds of sweetness. The postprandial secretion of GLP-1 and insulin were decreased in type 2 diabetes. Fasting and postprandial leptin level were greater in the type 2 diabetes than those in the healthy subjects. Conclusion: Type 2 diabetes have a blunted taste of sweetness, especially for glucose. There is different secretion or regulation mechanisms of GLP-1, Insulin and Leptin between healthy subjects and type 2 diabetes. If plasma blood glucose can be controlled well, then there is less impairment on the sweet taste.

並列關鍵字

Type 2 diabetes ； Fruit ； Sweet taste ； Glucagon -like peptide-1 ； Inslin ； Leptin

參考文獻

台灣地區食品營養成份資料庫。1998。行政院衛生署，台北市。

張毓芬、區少梅。2000。初次診斷患非胰島素依賴型糖尿病老年人味覺敏銳度變化之探討。台灣營養學會雜誌 25: 115-123 。

吳品青。2010。探討影響水果昇糖指數之因子並運用於第2型糖尿病患者對水果的選擇。臺北醫學大學保健營養學系碩士論文。

Ahne G, Erras A, Hummel T, Kobal G. (2000) Assessment of gustatory function by means of tasting tablets. Laryngoscope 110:1396-1401.

N Barzilai, J Wang, D Massilon, P Vuguin, M Hawkins, L Rossetti. (1997) Leptin selectively decreases visceral adiposity and enhances insulin action. J Clin Invest 100: 3105–3110.