胰岛素非依赖型糖尿病并发高脂血症膳食控制效果分析

胰岛素非依赖型糖尿病(NIDDM)并发高脂血症时,体内血糖、血脂代谢紊乱,易导致器官的器质性并发症.治疗的主要目的是力争良好的代谢控制,其中膳食控制是最基本的方法.本文观察28例NIDDM并发高脂血症患者住院期间膳食控制效果,报告如下:1 对象与方法1.1 对象选择临床用降脂药物效果不佳患者28例,其中男性25例,女性3例,年龄38～71岁.病程5～31年.发病年龄33～70岁,50～65岁20例(71.4%)     

妊娠期高脂血症对母婴妊娠结局的影响

目的 探讨妊娠期高脂血症对母婴妊娠结局的影响.方法 选择120例妊娠期高脂血症者作为观察组,按照1:1比例选择120例正常的孕妇作为对照组,比较母体的并发症、分娩并发症及围产儿结局.结果 妊娠期高脂血症母体合并妊娠期高血压、妊娠期糖尿病(Gestational diabetes mellitus GDM)的例数多于对照组;引产率、会阴侧切率高于对照组;巨大儿及新生儿体重增长多于对照组;差异均有统计学意义(P＜0.05).结论 合并妊娠期高脂血症增加母体并发症、分娩并发症和巨大儿率,对新生儿结局影响不大.     

糖尿病患者血中载脂蛋白含量和SOD水平与其并发症的关系

目的为了解糖尿病血管病变与载脂蛋白(APO)含量及超氧化物歧化酶(SOD)活性、过氧化脂质(LPO)的关系.方法对48例非胰岛素依赖性糖尿病(NIDDM)患者和60例同龄的对照组进行检测分析.结果NIDDM患者的ApoA-I、T-SOD CuZn-SOD、Mn-SOD均明显降低,APOB、LPO均显著增高,P均＜0.01;NIDDM并发症的发生率与APOB水平、LPO含量呈正相关,r分别为0.8851、0.8805,P＜0.01,与APOA-I水平、T-SOD、CuZn-SOD活性呈负相关,r分别为-0.613、-0.8392、-0.5374、P＜0.01.结论提示NIDDM时机体存在脂质过氧化作用增强可能是引起并发症的重要原因之一.     

糖尿病患者血中载脂蛋白含量和SOD水平与其并发症的关系

目的 为了解糖尿病血管病变与载脂蛋白(APO)含量及超氧化物歧化酶(SOD)活性、过氧化脂质(LPO)的关系。方法 对48例非胰岛素依赖性糖尿病(NIDDM)患者和60例同龄的对照组进行检测分析。结果 NIDDM患者的ApoA-I、T-SOD CuZn-SOD、M_n-SOD均明显降低,APOB、LPO均显著增高,P均<0.01;NIDDM并发症的发生率与APOB水平、LPO含量呈正相关,r分别为0.8851、0.8805,P<0.01,与APOA-I水平、T—SOD、CuZn-SOD活性呈负相关,r分别为—0.613、-0.8392、-0.5374、P<0.01。结论 提示NIDDM时机体存在脂质过氧化作用增强可能是引起并发症的重要原因之一。     

金钱草对高脂血症模型大鼠脂代谢及相关炎性因子的影响

目的探讨金钱草对高脂血症模型大鼠脂代谢及相关炎性因子的影响。方法48只大鼠适应性喂养1 w后,随机抽取8只为正常对照组,普通饲料喂养;其余40只大鼠用高脂饲料继续喂养4 w建立高脂血症模型。高脂血症模型大鼠随机分为:模型组,血脂康组(0.15 g/kg血脂康胶囊)及金钱草低、中、高剂量组(6、12、24 g/kg的金钱草水煮液),每组8只。各治疗给予相应剂量的药物灌胃,1次/d,连续4 w,末次给药后,腹主动脉采血,测定血脂指标和白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平。结果总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白在各组间比较差异均有统计学意义(均P<0.05)。模型组总胆固醇、甘油三酯、低密度脂蛋白明显高于正常对照组,高密度脂蛋白明显低于正常对照组;血脂康组以及金钱草组12 g/kg组、24 g/kg组的总胆固醇、甘油三酯、低密度脂蛋白明显高于模型组,高密度脂蛋白明显低于模型组,差异均有统计学意义(均P<0.05)。IL-6、TNF-α水平在各组间比较差异均有统计学意义(均P<0.01)。模型组IL-6、TNF-α水平均明显高于正常对照组;血脂康组以及金钱草12 g/kg组、24g/kg组的IL-6、TNF-α水平均明显低于模型组,差异均有统计学意义(均P<0.05)。结论金钱草能够有效改善高脂血症模型大鼠的脂代谢和IL-6、TNF-α水平,有利于动脉粥样硬化斑块的稳定。     

高脂血症的食疗

高脂血症的食疗□／是明启血浆中的脂类总称血脂。当血浆脂质总量或其中部分超过正常高限时，称高脂血症。高脂血症是导致动脉粥样硬化性心脑血管疾病的主要病理基础。因此，防治高脂血症具有重要的医疗和保健意义。近年来，世界各地均有调查指出，血脂与血清胆固醇的浓度...     

非胰岛素依赖型糖尿病体内氧化代谢改变及与高血压的关系

目的 :评价氧化损伤及抗氧化酶活性对非胰岛素依赖型糖尿病即Ⅱ型糖尿病 (NIDDM )及其伴发高血压 (HT)的影响。方法 :采用鲁米诺依赖的中性粒细胞化学发光法 ,对 136例NIDDM患者 (其中 70例不伴有HT ,6 6例伴有HT)及 30例年龄匹配的健康对照者 ,检测其外周血中性粒细胞产生氧自由基 (OFR)的水平。采用化学定量法 ,测定其血浆脂质过氧化终末产物———丙二醛 (MDA)的浓度及抗氧化酶———超氧化物歧化酶 (SOD)、谷胱甘肽过氧化物酶 (GSHPx)的活性。结果 :NIDDM伴发HT组 ,其PMN -CL峰值、积分和吞噬指数均明显高于NIDDM不伴HT组及健康对照组 ;血浆MDA浓度较后两组也明显升高 (P均 <0 .0 1) ;NIDDM组及NIDDM伴发HT组的血浆SOD和GSHPx活性较正常对照组均明显降低 (P均 <0 .0 1) ;但与NIDDM组相比 ,NIDDM伴发HT组的血浆SOD和GSHPx活性其差异无显著性 (P均 >0 .0 5 ) ;PMN -CL峰值与MDA呈明显正相关 (r=0 .7486 ,Y =15 9.8X 132 .2 ,P <0 .0 1,n =6 6 ) ,与SOD活性呈明显负相关 (r =- 0 .6 471,Y =5 .6X 112 7.4,P <0 .0 5 ,n =6 6 )。结论 :NIDDM患者体内已存在着氧化损伤 ,而在NIDDM伴发HT时氧化损伤进一步加重 ,提示氧化损伤对NIDDM患者HT的发生发展可能有着病因学意义     

城市居民非胰岛素依赖型糖尿病危害因素的病例对照研究

目的 了解城市居民NIDDM的危险因素，制定针对高危人群及全人群的干预措施。方法 对126例NIDDM患进行1：1配对病例对照研究，采用条件Logistic回归模型分析。结果 糖尿病家族史（OR＝3．713）、高脂血症（OR＝3．292）、体重指数（OR＝3．055）、高血压、饮食习惯（喜荤食、喜甜食）等是NIDDM的主要危险因素。结论 遗传在NIDDM发病中起重要作用，肥胖，高血压、高血脂症在NIDDM的病因中为最受重视的环境危险因素。应对城市居民NIDDM高危人群及全人群提倡合理膳食，采用适度活动，控制体重和血压、加强对社区一般人群糖尿病知识的宣传，提高居民的自我保健意识。     

对甜食与糖耐量下降相关性的探讨

本文对我校45岁以上教职工365人进行了糖耐量试验问Grt）普查，发现NIDDM（非胰岛素依赖型糖尿病）的发病率为4．4％，IGT（糖耐量下降）的患病率为268％。我们又对其进行了饮食习惯的调查，发现偏爱甜食的人占被调查人的71％，其中约有11．2％的人不喜爱甜食。将正常饮食外加食甜食的量大致分为4等：（以白糖计算，含水果等高糖食物）（m）约平均150g／天，（忖）约100g／天，（＋）约SOg／天，（－）基本不食或不食甜食。结果：（th）型万人，患NIDDM为8人，IGT为38人3（H）型176人，患NIDDM为6人，IGT为76人；（＋）型73人，…     

放免法检测NIDDM患者4种尿微量蛋白的意义

肾功能异常是非胰岛素依赖型糖尿病(NIDDM)主要并发症之一,为早期发现NIDDM肾病和判断肾功损害程度,笔者对34例NIDDM病人疑有早期肾功损害者的尿进行β2-M、α1—M、ALb、IgG检测,现将检测结果分析如下。     

Effect of source of dietary fats on serum glucose, insulin, and gastric inhibitory polypeptide responses to mixed test meals in subjects with non-insulin dependent diabetes mellitus

We recently demonstrated that normal subjects given mixed test meals of varying fatty acid composition showed significantly greater serum insulin responses to meals enriched with polyunsaturated fat as compared to those in which the fat content was derived from saturated fatty acids. To determine if a similar phenomenon occurs in subjects with non-insulin dependent diabetes mellitus (NIDDM), serum glucose, insulin, C-peptide, and gastric inhibitory polypeptide (GIP) responses to three mixed test meals of varying fatty acid composition were assessed in twelve subjects with NIDDM. Baseline means (+/- SEM) fasting serum glucose concentration was 205 +/- 15 mg/dl and mean glycosylated hemoglobin was 8.5 +/- 0.5%. Fatty acids in the test meals were either saturated fats, or polyunsaturated fats derived from vegetables or fish. Each test meal provided 40% of the subjects' calculated daily caloric requirement and contained approximately 45% carbohydrate, 40% fat, and 15% protein. No appreciable differences in serum glucose, insulin, and C-peptide responses occurred during the three mixed test meals. Although GIP values were higher in the saturated fat and the vegetable meals when compared to the fish meal, the differences did not reach statistical significance. The inability of NIDDM subjects to evoke a greater insulin response to polyunsaturated fatty acids than to saturated fatty acids suggests another pathogenetic factor contributing to their glucose intolerance.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of source of dietary fats on serum glucose,insulin, and gastric inhibitory polypeptide responses to mixed test meals in subjects with non-insulin dependent diabetes mellitus.

We recently demonstrated that normal subjects given mixed test meals of varying fatty acid composition showed significantly greater serum insulin responses to meals enriched with polyunsaturated fat as compared to those in which the fat content was derived from saturated fatty acids. To determine if a similar phenomenon occurs in subjects with non-insulin dependent diabetes mellitus (NIDDM), serum glucose, insulin, C-peptide, and gastric inhibitory polypeptide (GIP) responses to three mixed test meals of varying fatty acid composition were assessed in twelve subjects with NIDDM. Baseline means (+/? SEM) fasting serum glucose concentration was 205 +/? 15 mg/dl and mean glycosylated hemoglobin was 8.5 +/? 0.5%. Fatty acids in the test meals were either saturated fats, or polyunsaturated fats derived from vegetables or fish. Each test meal provided 40% of the subjects' calculated daily caloric requirement and contained approximately 45% carbohydrate, 40% fat, and 15% protein. No appreciable differences in serum glucose, insulin, and C-peptide responses occurred during the three mixed test meals. Although GIP values were higher in the saturated fat and the vegetable meals when compared to the fish meal, the differences did not reach statistical significance. The inability of NIDDM subjects to evoke a greater insulin response to polyunsaturated fatty acids than to saturated fatty acids suggests another pathogenetic factor contributing to their glucose intolerance.(ABSTRACT TRUNCATED AT 250 WORDS)     

Nutritive content of college meals. II. Lipids.

Two samples, each consisting of two breakfasts, two lunches, and two dinners as offered to college students, were collected for seven consecutive days from each of fifty colleges. Two samples of the composited meals from each college were analyzed for fat and fatty acids. The fat content of the meals averaged 125.58 gm., with a range of 96.96 to 163.74 gm. This provided an average of 42.33 per cent of total calories, (range, 36.68 to 47.67 per cent). No college served meals with as little as 35 per cent of calories derived from fat. The meals contained an average of 46.3 gm. saturated fatty acids; 48.98 gm. mono-unsaturated fatty acids, of which 48.19 gm. were oleic acid; and 18.25 gm. polyunsaturated fatty acids, of which 17.22 gm. were linoleic acid. Four fatty acids--palmitic (C-16); stearic (C-18); oleic (C-18:1); and linoleic (C-18:2)--contributed approximately 92 per cent of the total fatty acids. The average ratio of polyunsaturated fatty acids to saturated fatty acids was 0.39 (range, 0.22 to 0.69). Six colleges served meals with a P:S ratio of 0.30 or below; five colleges had a P:S ratio of 0.50 or above.     

Water volume and consumption time: influence on the glycemic and insulinemic responses in non-insulin-dependent diabetic subjects

The present study was carried out to see if either the volume of water or the duration of ingestion time influence the postprandial blood glucose and insulin responses in non-insulin-dependent diabetic (NIDDM) subjects. Small test meals containing 40 g carbohydrate as rye bread (100 g) with butter (10 g) and tomatoes (75 g) were given to 10 NIDDM subjects. The meals were taken in random order with either 90 or 600 mL tap water. The meal with 90 mL tap water was ingested over 10 and 30 min. The glycemic responses to isocaloric meals of large and small volumes were similar (338 +/- 56 vs 384 +/- 67 mmol/L.240 min) as were the insulinemic responses (29,424 +/- 6512 min vs 27,140 +/- 6548 mumol/L.240 min). An extension of eating time from 10 to 30 min did not alter the glycemic (384 +/- 67 vs 370 +/- 54 mmol/L.240 min) or the insulinemic response (27,140 +/- 6548 vs 35,670 +/- 10,245 mumol/L.240 min) in the NIDDM patients.     

某社区158例中老年2型糖尿病患者营养状况调查

[目的]通过开展某社区中老年2型糖尿病患者营养现况调查,为在糖尿病患者中开展营养干预研究提供科学依据。[方法]从某社区中选取已确诊的非住院2型糖尿病患者158例为调查对象,采用24h膳食回顾法记录调查对象3d膳食情况,录入＂营养之星专家系统＂进行膳食分析,并对其进行体检和血糖、血脂、肝肾功能等生化指标检测,以分析其营养状况。[结果]糖尿病患者脂肪和胆固醇摄入偏高,膳食纤维摄入较少,均存在各种营养素如钙、锌、硒等和多种维生素摄入不足。体检结果显示血尿素氮、三酰甘油、游离脂肪酸、糖化血红蛋白、尿微量蛋白、空腹血糖、餐后2h血糖均值超标。血糖控制率仅为15.2%。[结论]2型糖尿病患者膳食结构不合理,血糖控制不佳,需加强对糖尿病患者合理膳食的指导。     

Rational Use of Protein Supplements in the Elderly—Relevance of Gastrointestinal Mechanisms

Protein supplements are increasingly used by older people to maintain nutrition and prevent or treat loss of muscle function. Daily protein requirements in older people are in the range of 1.2 gm/kg/day or higher. Many older adults do not consume this much protein and are likely to benefit from higher consumption. Protein supplements are probably best taken twice daily, if possible soon after exercise, in doses that achieve protein intakes of 30 gm or more per episode. It is probably not important to give these supplements between meals, as we have shown no suppressive effects of 30 gm whey drinks, and little if any suppression of 70 gm given to older subjects at varying time intervals from meals. Many gastrointestinal mechanisms controlling food intake change with age, but their contributions to changes in responses to protein are not yet well understood. There may be benefits in giving the supplement with rather than between meals, to achieve protein intakes above the effective anabolic threshold with lower supplement doses, and have favourable effects on food-induced blood glucose increases in older people with, or at risk of developing, type 2 diabetes mellitus; combined protein and glucose drinks lower blood glucose compared with glucose alone in older people.     

The glycemic index: similarity of values derived in insulin-dependent and non-insulin-dependent diabetic patients

To see whether relative differences in the glycemic responses to different foods were similar in insulin-dependent (IDDM) and non-insulin-dependent diabetic patients (NIDDM) we determined the glycemic index (GI) of a total of 20 foods and mixed test meals in groups of IDDM and NIDDM volunteers. The mean GI values ranged from 32 in NIDDM and 41 in IDDM (pearled barley) to 105 in NIDDM and 111 in IDDM (bread with cheese and tomato). The correlation between the mean GI values in IDDM and NIDDM was highly significant (r = 0.927, p less than 0.001). The mean GI values for 15 of the 20 test meals was greater in IDDM than in NIDDM (mean of GI for all 20 foods, 76 in IDDM compared with 68 in NIDDM, p less than 0.005). However, the difference in GI between IDDM and NIDDM was t statistically significant for 19 of the 20 individual test meals. Greater within-individual variability of glycemic responses in IDDM probably accounts for the slightly greater mean GI value seen in IDDM compared with NIDDM. The addition of 32 g cheddar cheese to four foods which were also fed without cheese had no significant effect on the GI in NIDDM (mean GI of 68 without cheese compared with 72 for the meals with cheese), but had a small effect in IDDM where the mean GI was increased from 72 to 87 (p less than 0.05). However, despite small increases in glycemic response to foods with added cheese, the relative differences between foods were unaffected by the addition of cheese in both IDDM and NIDDM. It is concluded that mean GI values for foods are very similar in IDDM and NIDDM patients.     

The glycemic index: similarity of values derived in insulin-dependent and non-insulin-dependent diabetic patients.

To see whether relative differences in the glycemic responses to different foods were similar in insulin-dependent (IDDM) and non-insulin-dependent diabetic patients (NIDDM) we determined the glycemic index (GI) of a total of 20 foods and mixed test meals in groups of IDDM and NIDDM volunteers. The mean GI values ranged from 32 in NIDDM and 41 in IDDM (pearled barley) to 105 in NIDDM and 111 in IDDM (bread with cheese and tomato). The correlation between the mean GI values in IDDM and NIDDM was highly significant (r = 0.927, p less than 0.001). The mean GI values for 15 of the 20 test meals was greater in IDDM than in NIDDM (mean of GI for all 20 foods, 76 in IDDM compared with 68 in NIDDM, p less than 0.005). However, the difference in GI between IDDM and NIDDM was t statistically significant for 19 of the 20 individual test meals. Greater within-individual variability of glycemic responses in IDDM probably accounts for the slightly greater mean GI value seen in IDDM compared with NIDDM. The addition of 32 g cheddar cheese to four foods which were also fed without cheese had no significant effect on the GI in NIDDM (mean GI of 68 without cheese compared with 72 for the meals with cheese), but had a small effect in IDDM where the mean GI was increased from 72 to 87 (p less than 0.05). However, despite small increases in glycemic response to foods with added cheese, the relative differences between foods were unaffected by the addition of cheese in both IDDM and NIDDM. It is concluded that mean GI values for foods are very similar in IDDM and NIDDM patients.     

Glycemic and insulinemic responses after ingestion of ethnic foods by NIDDM and healthy subjects.

In an attempt to apply the concept of glycemic index (GI) and insulinemic index (II) to local eating habits, we examined the plasma glucose and insulin responses in subjects with non-insulin-dependent diabetes mellitus (NIDDM) and healthy subjects to five mixed meals of different ethnic origins. All meals contained 50 g carbohydrate and were compared with a 50-g glucose load. The GI was highest for the Polish dish and lowest for the Syrian dish (66 +/- 5.5 vs 24 +/- 5.1). However, the II was the highest for the standard meal and lowest again for the Syrian dish (174 +/- 27 vs 66 +/- 25). A high correlation was found between the area under the glucose curve and the predicted GI in both NIDDM and healthy subjects. The GI concept is valid and potentially useful in diet planning and legume foods should be incorporated as a carbohydrate source when diets are being planned for NIDDM subjects or individuals with impaired glucose tolerance.     

二甲双胍与阿卡波糖治疗Ⅱ型糖尿病疗效比较

目的　比较二甲双胍和阿卡波糖治疗Ⅱ型糖尿病的疗效。方法　选择 6 0例Ⅱ型糖尿病患者 ,分为二甲双胍组 30例 (男 16例 ,女 14例 )口服二甲双胍 0 2 5g～ 0 5g,tid。阿卡波糖组 30例 (男 18例 ,女12例 ) ,口服阿卡波糖 5 0mg～ 10 0mg ,tid ,均口服 6周。结果　二甲双胍和阿卡波糖均能明显降低空腹和餐后血糖 ,二甲双胍的有效率分别为 87%和 73%。阿卡波糖的有效率分别为 83%和 97%。降低餐后血糖的作用 ,阿卡波糖优于二甲双胍 (P <0 0 1) ,而降低胆固醇的作用 ,阿卡波糖不如二甲双胍 (P <0 0 1)。二甲双胍的不良反应为恶心和腹泻 ,发生率为 13% ;阿卡波糖不良反应为腹胀和排气增多 ,发生率为 17%。结论　二甲双胍和阿卡波糖均能明显降低空腹和餐后血糖 ,且治疗Ⅱ型糖尿病都安全有效 ,降低餐后血糖 ,阿卡波糖优于二甲双胍。