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

Factors affecting the glycemic index of fruits and its application in fruits choice of type 2 DM patients

吳品青(Pin-Ching Wu)

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(2010年)

https://doi.org/10.6831/TMU.2010.00221

摘要

糖尿病患者應該要有良好的血糖控制以延緩併發症的發生。飲食中的碳水化合物在血糖調控上扮演一個很重要的角色，而水果是富含碳水化合物的食物，但對於糖尿病患者在水果的選擇上仍未有定論。故本研究目的為，分析水果昇糖指數 (Glycemic index；GI) 及其相關因子，同時運用於第 2 型糖尿病患者做為選擇水果之依據。實驗第一部份招募年齡介於 19-25 歲的健康受試者，給予 18 種台灣常見水果進行測試。每次實驗在抽取空腹血液後，給予等量碳水化合物 (25 g) 之葡萄糖液或水果，並於 15 分鐘內吃完，接著抽取 30, 45, 60, 90, 120 分鐘的血液進行 PII (peak incremental indices) 及 GI 值的計算。同時分析水果中醣含量、糖度 (brix)、膳食纖維等影響因子及探討其與 GI 之相關性為何。實驗第二部份先進行問卷調查，以了解第 2 型糖尿病患者對於水果選擇的認知情形。並根據實驗第一部分及問卷結果選出 6 種水果，給予第 2 型糖尿病患者食用，利用餐後血糖計算 PII 及 GI 值，並與健康受試者之結果進行比對，及探討與問卷結果之差異。實驗第一部分結果發現，水果的 GI 值介於 14.9-106.1，最高的前 5 項水果為:葡萄、西瓜、文旦、龍眼、芒果，而聖女番茄最低；糖度介於 4.8-21.0，最高的前 5 項水果為:葡萄、香蕉、黃金奇異果、荔枝、綠奇異果，而聖女番茄最低；膳食纖維含量介於 1.6-7.8 (克/25公克總碳水化合物)，最高的前 5 項水果為:芭樂、聖女番茄、綠奇異果、柳丁、西瓜，而龍眼含量最低；a-glucosidase inhibitory activity 介於 11.8-82.3 (%)，最高的前 5 項水果為：綠奇異果、黃金奇異果、文旦、龍眼、香蕉，而芒果含量最低。在相關性分析結果顯示，GI 值與總醣量、糖度具有顯著正相關 (p <0.05)，而與膳食纖維含量具有顯著負相關 (p <0.05)。實驗第二部份結果發現， 159 份之第 2 型糖尿病患者問卷中，53.5% 患者認為部份水果不可食用，其中 96% 患者認為水果甜度會影響血糖，因此較甜的水果不適合食用。認為最適合食用的水果前 5 項為芭樂、奇異果、蕃茄、蘋果及火龍果；最不適合食用的水果前 5 項為荔枝、龍眼、釋迦、香蕉及芒果。第 2 型糖尿病患者與健康受試者在 PII 及 GI 值沒有差異，而健康受試者之水果 GI 值排序，與第 2 型糖尿病患者認知的可吃與不可吃之水果排序結果則不一致。故本研究結果顯示，第 2 型糖尿病患者可藉由健康受試者水果的 GI 值及相關因子做為選擇之依據，而在固定碳水化合物量的情況下，則以較低 GI 值、糖度及較高膳食纖維量者做為選擇之標準。

關鍵字

水果 ； 昇糖指數 ； 糖含量 ； 糖度 ； 膳食纖維 ； 第 2 型糖尿病

並列摘要

Purposes: The objectives of this study were (1) to analyze the GI value on different kinds of fruit and its affecting factors (2) to provide a guideline of fruits selection for Type 2 DM patients. Methods: In part 1, twenty healthy adults (19-25 y) were recruited and carried out the glycemic index (GI) measurement on 18 kinds of Taiwan common fruit. After an overnight fasting, subjects consumed the test fruit (25 g iso-carbohydrate) and then blood samples were taken at baseline, 30, 45, 60, 90, 120 min to calculate the PII and GI value. The relationship between the GI value and the affecting factors, such as sugar content, brix level and fiber amount were assessed. In Part-2, a questionnaire was given to type 2 DM patients to reveal their cognition on fruit choice. Six fruits from part 1 result were selected for the GI test of DM patients and the value was compared to healthy group. Result: In part 1, top 5 fruits with the highest GI value were: grapes, watermelon, pomelo, longan and mango, the lowest was tomato; brix level were: grapes, banana, golden kiwifruit, litchi and green kiwifruit the lowest was tomato; fiber content were: guava, tomato, green kiwifruit, sweet orange and watermelon, the lowest was longan; a-glucosidase Inhibitory activity were: green kiwifruit, golden kiwifruit, pomelo, logan and banana, the lowest was mango. There was a positive correlation between GI value with sugar content and brix level (r = 0.60 and r = 0.45, respectively; p <0.05), while was inversely related to fiber content (r = -0.41; p <0.05). In part 2, 53.5% of DM patients considered some fruits were non-edible and 96% of whom thought the major affecting factor of blood sugar is the sweetness of fruit. The top 5 edible fruits were guava, kiwifruit, tomato, apple and dragon-fruit; non-edible fruits were litchi, longan, sugarapple, banana and mango. Compared to healthy subjects, DM patients have similar PII and postprandial glycemic response of fruits; however, there was inconsistent with the sweetness. Conclusion: According to our study, the GI value of fruit in healthy subjects and its relative factors (brix level and fiber content) can provide a useful indicator for the selection of fruit of type 2 DM patients.

並列關鍵字

Fruit ； Glycemic index ； Sugar content ； Brix level ； Fiber amount ； Type 2 diabetes mellitus

參考文獻

Poppitt SD, van Drunen JD, McGill AT, Mulvey TB, Leahy FE (2007) Supplementation of a high-carbohydrate breakfast with barley beta-glucan improves postprandial glycaemic response for meals but not beverages. Asia Pac J Clin Nutr 16: 16-24.

Abdulrhman M, El-Hefnawy M, Hussein R, El-Goud AA (2009) The glycemic and peak incremental indices of honey, sucrose and glucose in patients with type 1 diabetes mellitus: effects on C-peptide level-a pilot study. Acta Diabetol 26 [Epub ahead of print].

American Diabetes Association (2008) Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 31: S61-78.

Atkinson FS, Foster-Powell K, Brand-Miller JC (2008) International tables of glycemic index and glycemic load values: 2008. Diabetes Care 31: 2281-3.

Belzer LM, Smulian JC, Lu SE, Tepper BJ (2009) Changes in sweet taste across pregnancy in mild gestational diabetes mellitus: relationship to endocrine factors. Chem Senses 34: 595-605.