膳食纖維補充 對於代謝症候群及第二型糖尿病之影響

Effects of Dietary Fiber Supplementation in Metabolic Syndrome and Type 2 Diabetes

鄭鈞源(Cheang Kuan Un)

指導教授 ： 李信昌

共同指導教授 ： 施純光(Chun-Kuang Shih)

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(2013年)

https://doi.org/10.6831/TMU.2013.00081

摘要

中文摘要
治療代謝症候群 ( metabolic syndrome, MetS ) 首重於如何減少動脈粥狀硬化冠心症 ( atherosclerotic cardiovascular disease, ASCVD ) 及第二型糖尿病 ( type 2 diabetes mellitus, T2DM ) 之發生。而 T2DM 之治療在於預防或延緩併發症。應及早給予患者生活模式介入，以求達到健康促進之目標。根據美國 2012 年治療準則，建議糖尿病患者每攝取一千大卡熱量即需要包含 14 公克之膳食纖維 ( dietary fiber, DF)。臨床研究證明，DF 可減少胃腸道葡萄糖及脂肪之吸收、改善脂肪之代謝、提高 T2DM 及 MetS 病患對於胰島素之敏感度、並且有益生質之作用。但臨床上補充膳食纖維之介入性研究不多，而且一般民眾難以攝取足夠的膳食纖維 ( 男性 > 38 g/d、女性 > 25 g/d )。本研究分為 DF 補充劑及 DF 熟麵兩部份進行臨床介入實驗。第一部份為針對血糖控制不良的 T2DM 患者 ( 男性 18 人、女性 12 人、年齡 40-85 歲、糖化血色素 ≧ 8% ) 給予每天 3 包，每包含 5 公克之 DF 補充劑沖泡服用。對照組為同時招募條件相當之男性 6 人、女性 5 人，研究為期三個月。測量項目包括受試者補充前後之體重、身體質量指數 ( body mass index, BMI )、腰圍、血壓、脈博、糖化血色素 ( glycemic hemoglobin, HbA1c )，並檢驗血清中肝功能、腎功能、總膽固醇、三酸甘油酯、低密度及高密度脂蛋白膽固醇、高敏感度 C 反應蛋白 ( high sensitivity C-reactive protein, hs-CRP ) 以及脂溶性維生素 A、E 、β-carotene 等生化指標之變化。第二部份為針對 MetS 患者，提供受試者 ( 年齡 20-65 歲、男性 15 人、女性17 人 ) 富含蒟蒻纖維 ( Konjac glucomannan, KGM ) 之熟麵，並評估其是否有改善 MetS 患者之保健功效。其方式為提供受試者每包含有 2 公克蒟蒻之熟麵做為主食，分別於午、晚餐各食用一包，對照組則給予不含蒟蒻之熟麵，研究為期四週，並分別於試驗前後測量病患之腰圍、血壓、血糖、血脂肪、HbA1c 與胰島素、計算 HOMA-IR 以及 β-cell 之 capacity、並檢驗血清中肝功能、腎功能、尿酸、總膽固醇、三酸甘油酯、低密度及高密度脂蛋白膽固醇、hs-CRP 血清濃度之變化。實驗第一部份結果顯示，每天補充 15 公克之 DF 沖泡劑三個月後，能顯著減少腰圍 ( 93.60 ± 8.01 vs. 90.07 ± 8.14 in cm, p = 0.001 )、增加血清中 β-carotene 之濃度 ( 0.54 ± 0.52 vs. 0.92 ± 0.87 in μmol/L, p = 0.019 )、但亦同時增加血清中 hs-CRP 之濃度 ( 0.21 ± 0.34 vs. 0.55 ± 0.74 in mg/L, p = 0.013 )。第二部份結果顯示 KGM 介入組腰圍 ( 90.4 ± 5.0 vs. 87.9 ± 5.7 in cm, p < 0.001 )、體重 ( 73.4 ± 9.8 vs. 72.3 ± 9.5 in kg, p = 0.001 )、BMI ( 27.8 ± 2.9 vs. 27.4 ± 3.0 in kg/m2, p = 0.002 ) 以及腰臀比 ( 0.91 ± 0.03 vs. 0.89 ± 0.04, p = 0.039 ) 明顯下降，而在對照組腰圍 ( 94.3 ± 6.2 vs. 92.4 ± 6.3 in cm, p = 0.006 ) 以及體重 ( 75.3 ± 10.2 vs. 74.5 ± 9.6 in kg, p = 0.015) 亦明顯下降，BMI 以及腰臀比則無顯著差異。兩組之 hs-CRP 均明顯下降 ( 試驗組0.92 ± 1.34 vs. 0.22 ± 0.26, p < 0.001、對照組0.78 ± 0.54 vs 0.29 ± 0.27, p =0.006 )。

關鍵字

關鍵字: 代謝症候群、第二型糖尿病、膳食纖維、健康促進、蒟蒻纖維

並列摘要

英文摘要
Abstract
The main goal for management of MetS is how to prevent the atherosclerotic cardiovascular disease ( ASCVD ) and delay the onset of type 2 diabetes mellitus ( T2DM ), and management for T2DM is how to prevent or delay the onset of complications. According to the diabetic care guidelines in 2012, dietary fiber ( DF ) is recommended for T2DM in dosage of 14 g/1000 kcal/day, and early life-style intervention is suggested for MetS, to achieve the goal of health promotion. Clinical evidences have been proved that consumption of DF is effective in decreased lipid and glucose uptake, improved fat metabolism, improved the insulin sensitivity in T2DM and MetS, diminished hepatic gluconeogensis and functioned as prebiotics. DF has the positive effects to T2DM and MetS, but this is relative lack in clinical trials for DF supplementation, and people are so hard to consume the enough dosage of DF daily ( > 25 g/d for women and > 38 g/d for men ). There were 2 parts in this clinical trial. In part one a 5 g/pack of DF powder was supplied 3 times per day to the T2DM ( 18 in male, 12 in female, age 40-85, with HbA1c ≧ 8%) for 3 months in period ( also recruited 6 in male and 5 in female with the same criteria without the DF supplementation as the control group), any changing in body weight, BMI, waist, blood pressure, pulse rate, glycemic hemoglobin ( HbA1c in % ), liver and renal function, total cholesterol, triglyceride, low and high density lipoprotein cholesterol, high sensitivity C-reactive protein ( hs-CRP ), and the serum level of fat-soluble vitamins A,E and β-carotene were measured and compared. In the part two, the participants in testing arm received glucomannan ( a water soluble DF, the main component of konjac mannan)-containing noodle ( 2 g/200 g ), twice daily as being the main carbohydrate intake, in the control arm participants received the noodle in 200 g without glucomannan twice per day as same schedule in a 4 weeks period. Any changing in body weight, BMI, waist, blood pressure, pulse rate, HbA1c, serum insulin, HOMA-IR, β-cell capacity in %, liver and renal function, uric acid, total cholesterol, triglyceride, low and high density lipoprotein cholesterol, hs-CRP were all measured and compared before and after test. The results in part one showed there were significant decreased in waist circumference ( 93.60 ± 8.01 vs. 90.07 ± 8.14 in cm, p = 0.001 ), increased in serum β-carotene concentration ( 0.54 ± 0.52 vs. 0.92 ± 0.87 in μmol/L, p = 0.019 ), but also increased in serum hs-CRP level ( 0.21 ± 0.34 vs. 0.55 ± 0.74 in mg/L, p = 0.013 ). The results in second part showed that after 4-week intervention with KGM-noodle, there were decreased in waist ( 90.4 ± 5.0 vs. 87.9 ± 5.7 in cm, p < 0.001 ), body weight ( 73.4 ± 9.8 vs. 72.3 ± 9.5 in kg, p = 0.001 ), BMI ( 27.8 ± 2.9 vs. 27.4 ± 3.0 in kg/m2, p = 0.002 ) and waist-hip ratio ( 0.91 ± 0.03 vs. 0.89 ± 0.04, p = 0.039 ) significant. In the control group without KGM intervention, decreased in waist ( 94.3 ± 6.2 vs. 92.4 ± 6.3 in cm, p = 0.006 ), body weight ( 75.3 ± 10.2 vs. 74.5 ± 9.6 in kg, p = 0.015) were also significant, but not showed in change of BMI and waist-hip ratio. In both arms, decreased in hs-CRP were also significant ( 0.92 ± 1.34 vs. 0.22 ± 0.26, p < 0.001in testing arm, 0.78 ± 0.54 vs 0.29 ± 0.27, p =0.006 in control ).

並列關鍵字

Keywords: metabolic syndrome, type 2 diabetes mellitus, dietary fiber, konjac mannan

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