背景:蛋白质影响急性餐后葡萄糖和胰岛素反应,但剂量的影响,蛋白质类型和健康状况未知。
目的:确定在碳水化合物中添加蛋白质对餐后反应的急性作用,并确定作用调节剂。
方法:我们搜索了MEDLINE,截至2023年7月30日,EMBASE和Cochrane数据库用于急性,在无糖尿病或2型(T2DM)或1型(T1DM)糖尿病的成年人中,比较含有碳水化合物的试验餐与不添加蛋白质引起的急性餐后反应的交叉试验。使用随机效应模型的通用逆方差分别汇集组数据,并以[95%CIs]的均值比率表示。评估偏倚风险和证据确定性(GRADE)。
结果:在154个动物试验比较中,乳制品和植物蛋白(无糖尿病,n=22,67,32;T2DM,n=14,16,3),与无糖尿病患者相比,T2DM患者的每克蛋白质/克碳水化合物(g/g)降低的葡萄糖曲线下面积(AUC)较少(-10%vs-50%,P<0.05),但胰岛素-AUC增加相似(+76vs+56%,分别)。在没有糖尿病的受试者中,每g/g乳制品和植物蛋白可使葡萄糖AUC降低52%和55%,并使胰岛素AUC增加64%和45%(均P<0.05)。动物蛋白可显著降低31%的葡萄糖AUC和37%的胰岛素AUC(合并效应),但没有明显的剂量反应。在T2DM中,动物蛋白使葡萄糖AUC降低了13%,胰岛素AUC增加了105%,没有明显的剂量反应。乳制品蛋白将葡萄糖AUC降低了18%(无剂量反应),但每克/克使胰岛素-AUC增加34%(P<0.05)。在T1DM中,蛋白质增加了40%的葡萄糖-AUC(P<0.05,n=5)。数据来源(报告与计算)和研究方法质量显着改变了一些结果,并导致研究之间的高异质性。
结论:在没有糖尿病的人群中,将乳品或植物蛋白添加到含碳水化合物的膳食中引起葡萄糖-AUC的生理学显著降低并增加胰岛素-AUC。动物蛋白可能会略微降低葡萄糖-AUC,并可能增加胰岛素-AUC。在T2DM中,蛋白质可能没有如此大和一致的影响。需要进一步的研究来确定蛋白质的影响是否因健康状况和蛋白质来源而异。
背景:PROSPEROCRD42022322090。
背景:通用磨坊。
BACKGROUND: Protein influences acute postprandial glucose and insulin responses, but the effects of dose, protein type, and health status are unknown.
OBJECTIVE: We aimed to determine the acute effect of adding protein to carbohydrate on postprandial responses and identify effect modifiers.
METHODS: We searched MEDLINE, EMBASE, and Cochrane databases through 30 July, 2023 for acute, crossover trials comparing acute postprandial responses elicited by carbohydrate-containing test meals with and without added protein in adults without diabetes or with type 2 (T2DM) or type 1 (T1DM) diabetes mellitus. Group data were pooled separately using generic inverse variance with random-effects models and expressed as the ratio of means with 95% confidence interval. Risk of bias and certainty of evidence (Grading of Recommendations Assessment, Development, and Evaluation) were assessed.
RESULTS: In 154 trial comparisons of animal, dairy, and plant proteins (without diabetes, n = 22, 67, 32, respectively; T2DM, n = 14, 16, 3, respectively), each gram protein per gram available carbohydrate (g/g) reduced the glucose area under the curve (AUC) less in adults with T2DM than in those without diabetes (-10% compared with -50%, P < 0.05) but increased the insulin AUC similarly (+76% compared with +56%). In subjects without diabetes, each g/g of dairy and plant protein reduced glucose AUC by 52% and 55%, respectively, and increased the insulin AUC by 64% and 45%, respectively (all P < 0.05). Animal proteins significantly reduced the glucose AUC by 31% and increased the insulin AUC by 37% (pooled effects) but without a significant dose-response. In adults with T2DM, animal protein reduced the glucose AUC by 13% and increased the insulin AUC by 105%, with no significant dose-response. Dairy protein reduced the glucose AUC by 18% (no dose-response), but each g/g increased the insulin AUC by 34% (P < 0.05). In adults with T1DM, protein increased the glucose AUC by 40% (P < 0.05, n = 5). Data source (reported AUC compared with calculated AUC) and study methodology quality significantly modified some outcomes and contributed to high between-study heterogeneity.
CONCLUSIONS: In people without diabetes, adding dairy or plant protein to a carbohydrate-containing meal elicits physiologically significant reductions in glucose AUC and increases insulin AUC. Animal protein may slightly reduce the glucose AUC and may increase the insulin AUC. In people with T2DM, protein may not have such large and consistent effects. Further research is needed to determine if the effects of protein differ by health status and protein source. This study was registered at PROSPERO as CRD42022322090.