Acute metabolic responses to a high-carbohydrate meal in outpatients with type 2 diabetes treated with a low-carbohydrate diet: a crossover meal tolerance studyReportar como inadecuado




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Nutrition and Metabolism

, 6:52

First Online: 29 December 2009Received: 14 August 2009Accepted: 29 December 2009

Abstract

BackgroundA low-carbohydrate diet LCD achieves good glycemic control in type 2 diabetes T2DM compared with a high-carbohydrate diet. With respect to energy metabolism, acute metabolic responses to high-carbohydrate meals HCMs have not been determined in LCD patients with T2DM.

Subjects and methodsWe enrolled 31 subjects with T2DM mean age: 62 yrs, mean hemoglobin A1c level: 6.9%, of whom 13 were on a strict LCD 26% carbohydrate diet, and 18 a moderate one 44% carbohydrate diet. Two isocaloric meals were administered to all subjects in a randomized crossover design. The carbohydrate:protein:fat ratios of HCMs and low-carbohydrate meals LCMs were 59:20:21 and 7:20:73, respectively. Serum β-hydroxybutyrate, acetoacetate, free fatty acids FFAs, triglyceride and insulin, and plasma glucose concentrations were measured for 120 minutes after the intake of each meal.

ResultsHCMs rapidly decreased postprandial β-hydroxybutyrate, acetoacetate and FFA concentrations within 2 hours in all patients in combination with rapid increases in serum insulin and plasma glucose, while LCMs increased or did not change β-hydroxybutyrate, acetoacetate and FFAs P < 0.001 for all. HCMs did not change postprandial triglyceride concentrations over 2 hours, while LCMs gradually increased them P < 0.001.

HCMs sharply and rapidly decreased postprandial β-hydroxybutyrate and acetoacetate concentrations in strict LCD subjects over 2 hours, but only slightly decreased them in moderate LCD subjects P < 0.001, difference between strict and moderate LCD subjects. The parameter Δketone bodies level at 120 minutes - level at baseline was significantly correlated with the insulinogenic index Spearman-s r = 0.503 for β-hydroxybutyrate and 0.509 for acetoacetate, but not with total insulin secretory capacity. Moreover, HCMs slightly decreased postprandial triglyceride levels in strict LCD subjects but somewhat increased them in the moderate LCD subjects P = 0.002. The parameter Δtriglyceride was significantly correlated with background dietary %carbohydrate Spearman-s r = 0.484.

ConclusionHCMs rapidly decreased postprandial ketone body concentrations in T2DM patients treated with a LCD. The decreases were more remarkable in strict than in moderate LCD subjects. HCMs slightly decreased postprandial triglyceride levels in strict LCD subjects. The parameter Δketone bodies was significantly correlated with the insulinogenic index, as was Δtriglyceride with background dietary %carbohydrate.

AbbreviationsCARDcarbohydrate-reduced diet

FFAsfree fatty acids

HbA1chemoglobin A1c

HCDhigh-carbohydrate diet

HCMhigh-carbohydrate meal

LCDlow-carbohydrate diet

LCMlow-carbohydrate meal

T2DMtype 2 diabetes mellitus.

Electronic supplementary materialThe online version of this article doi:10.1186-1743-7075-6-52 contains supplementary material, which is available to authorized users.

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Autor: Hajime Haimoto - Tae Sasakabe - Hiroyuki Umegaki - Kenji Wakai

Fuente: https://link.springer.com/







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