PDF(Pubmed)
Abstract：
Consensus has not been reached on what constitutes an optimal diet in individuals with prediabetes and type 2 diabetes mellitus (T2DM), especially between low-carbohydrate options.
We compared 2 low-carbohydrate diets with 3 key similarities (incorporating nonstarchy vegetables and avoiding added sugars and refined grains) and 3 key differences (incorporating compared with avoiding legumes, fruits, and whole, intact grains) for their effects on glucose control and cardiometabolic risk factors in individuals with prediabetes and T2DM.
Keto-Med was a randomized, crossover, interventional trial. Forty participants aged ≥18 years with prediabetes or T2DM followed the well-formulated ketogenic diet (WFKD) and the Mediterranean-plus diet (Med-Plus) for 12 weeks each, in random order. The diets shared the 3 key similarities noted above. The Med-Plus incorporated legumes, fruits, and whole, intact grains, while the WFKD avoided them. The primary outcome was the percentage change in glycated hemoglobin (HbA1c) after 12 weeks on each diet. Secondary and exploratory outcomes included percentage changes in body weight, fasting insulin, glucose, and blood lipids; average glucose from continuous glucose monitor (CGM), and nutrient intake.
The primary analysis was of 33 participants with complete data. The HbA1c values did not differ between diets at 12 weeks. Triglycerides decreased more for the WFKD [percentage changes, -16% (SEM, 4%) compared with -5% (SEM, 6%) for the Med-Plus; P = 0.02] and LDL cholesterol was higher for the WFKD [percentage changes, +10% (SEM, 4%) compared with -5% (SEM, 5%) for the Med-Plus; P = 0.01]. Weight decreased 8% (SEM, 1%) compared with 7% (SEM, 1%) and HDL cholesterol increased 11% (SEM, 2%) compared with 7% (SEM, 3%) for the WFKD compared with the Med-Plus, respectively; however, there was a significant interaction of diet × order for both. Participants had lower intakes of fiber and 3 nutrients on the WFKD compared with the Med-Plus. Twelve-week follow-up data suggest the Med-Plus is more sustainable.
HbA1c values were not different between diet phases after 12 weeks, but improved from baseline on both diets, likely due to several shared dietary aspects. The WFKD led to a greater decrease in triglycerides, but also had potential untoward risks from elevated LDL cholesterol and lower nutrient intakes from avoiding legumes, fruits, and whole, intact grains, as well as being less sustainable. This trial was registered at clinicaltrials.gov as NCT03810378.
We compared 2 low-carbohydrate diets with 3 key similarities (incorporating nonstarchy vegetables and avoiding added sugars and refined grains) and 3 key differences (incorporating compared with avoiding legumes, fruits, and whole, intact grains) for their effects on glucose control and cardiometabolic risk factors in individuals with prediabetes and T2DM.
Keto-Med was a randomized, crossover, interventional trial. Forty participants aged ≥18 years with prediabetes or T2DM followed the well-formulated ketogenic diet (WFKD) and the Mediterranean-plus diet (Med-Plus) for 12 weeks each, in random order. The diets shared the 3 key similarities noted above. The Med-Plus incorporated legumes, fruits, and whole, intact grains, while the WFKD avoided them. The primary outcome was the percentage change in glycated hemoglobin (HbA1c) after 12 weeks on each diet. Secondary and exploratory outcomes included percentage changes in body weight, fasting insulin, glucose, and blood lipids; average glucose from continuous glucose monitor (CGM), and nutrient intake.
The primary analysis was of 33 participants with complete data. The HbA1c values did not differ between diets at 12 weeks. Triglycerides decreased more for the WFKD [percentage changes, -16% (SEM, 4%) compared with -5% (SEM, 6%) for the Med-Plus; P = 0.02] and LDL cholesterol was higher for the WFKD [percentage changes, +10% (SEM, 4%) compared with -5% (SEM, 5%) for the Med-Plus; P = 0.01]. Weight decreased 8% (SEM, 1%) compared with 7% (SEM, 1%) and HDL cholesterol increased 11% (SEM, 2%) compared with 7% (SEM, 3%) for the WFKD compared with the Med-Plus, respectively; however, there was a significant interaction of diet × order for both. Participants had lower intakes of fiber and 3 nutrients on the WFKD compared with the Med-Plus. Twelve-week follow-up data suggest the Med-Plus is more sustainable.
HbA1c values were not different between diet phases after 12 weeks, but improved from baseline on both diets, likely due to several shared dietary aspects. The WFKD led to a greater decrease in triglycerides, but also had potential untoward risks from elevated LDL cholesterol and lower nutrient intakes from avoiding legumes, fruits, and whole, intact grains, as well as being less sustainable. This trial was registered at clinicaltrials.gov as NCT03810378.
摘要：
关于糖尿病前期和2型糖尿病（T2DM）患者的最佳饮食尚未达成共识。尤其是在低碳水化合物选项之间。
我们比较了2种低碳水化合物饮食与3个关键相似性（加入非淀粉蔬菜，避免添加糖和精制谷物）和3个关键差异（与避免豆类相比，水果,和整体,完整的谷物）对糖尿病前期和T2DM患者的血糖控制和心脏代谢危险因素的影响。
Keto-Med是随机的，交叉，介入试验。40名年龄≥18岁的糖尿病前期或T2DM患者遵循配方良好的生酮饮食（WFKD）和地中海加饮食（Med-Plus），每组12周，以随机顺序。饮食共享上述3个关键相似性。Med-Plus融合了豆类，水果,和整体,完整的谷物,而WFKD避开了他们。主要结果是每种饮食12周后糖化血红蛋白（HbA1c）的百分比变化。次要和探索性结果包括体重变化百分比，空腹胰岛素，葡萄糖，和血脂；来自连续葡萄糖监测仪（CGM）的平均葡萄糖，和营养摄入。
主要分析了33名具有完整数据的参与者。12周时不同饮食的HbA1c值没有差异。WFKD的甘油三酯下降更多[百分比变化，-16%(SEM，4%)与-5%(SEM，6%)；P=0.02]和LDL胆固醇较高的WFKD[百分比变化，+10%(SEM，4%)与-5%(SEM，5％）为Med-Plus；P=0.01]。体重减轻8%(SEM，1%)与7%(SEM，1％）和HDL胆固醇增加11％（SEM，2%)与7%(SEM，3%)的WFKD与Med-Plus相比，分别；然而，两者的饮食×顺序有显著的交互作用。与Med-Plus相比，WFKD参与者的纤维和3种营养素摄入量较低。12周的随访数据表明，Med-Plus更具可持续性。
12周后不同饮食阶段的HbA1c值没有差异，但是两种饮食都从基线有所改善，可能是由于几个共同的饮食方面。WFKD导致甘油三酯的更大下降，但也有潜在的不良风险，因为低密度脂蛋白胆固醇升高和减少营养摄入量，避免豆类，水果,和整体,完整的谷物,以及不那么可持续。该试验在clinicaltrials.gov注册为NCT03810378。
我们比较了2种低碳水化合物饮食与3个关键相似性（加入非淀粉蔬菜，避免添加糖和精制谷物）和3个关键差异（与避免豆类相比，水果,和整体,完整的谷物）对糖尿病前期和T2DM患者的血糖控制和心脏代谢危险因素的影响。
Keto-Med是随机的，交叉，介入试验。40名年龄≥18岁的糖尿病前期或T2DM患者遵循配方良好的生酮饮食（WFKD）和地中海加饮食（Med-Plus），每组12周，以随机顺序。饮食共享上述3个关键相似性。Med-Plus融合了豆类，水果,和整体,完整的谷物,而WFKD避开了他们。主要结果是每种饮食12周后糖化血红蛋白（HbA1c）的百分比变化。次要和探索性结果包括体重变化百分比，空腹胰岛素，葡萄糖，和血脂；来自连续葡萄糖监测仪（CGM）的平均葡萄糖，和营养摄入。
主要分析了33名具有完整数据的参与者。12周时不同饮食的HbA1c值没有差异。WFKD的甘油三酯下降更多[百分比变化，-16%(SEM，4%)与-5%(SEM，6%)；P=0.02]和LDL胆固醇较高的WFKD[百分比变化，+10%(SEM，4%)与-5%(SEM，5％）为Med-Plus；P=0.01]。体重减轻8%(SEM，1%)与7%(SEM，1％）和HDL胆固醇增加11％（SEM，2%)与7%(SEM，3%)的WFKD与Med-Plus相比，分别；然而，两者的饮食×顺序有显著的交互作用。与Med-Plus相比，WFKD参与者的纤维和3种营养素摄入量较低。12周的随访数据表明，Med-Plus更具可持续性。
12周后不同饮食阶段的HbA1c值没有差异，但是两种饮食都从基线有所改善，可能是由于几个共同的饮食方面。WFKD导致甘油三酯的更大下降，但也有潜在的不良风险，因为低密度脂蛋白胆固醇升高和减少营养摄入量，避免豆类，水果,和整体,完整的谷物,以及不那么可持续。该试验在clinicaltrials.gov注册为NCT03810378。
