坚持替代健康饮食指数是糖尿病前期逆转的有效方法吗？纵向随访。

IF 2.6 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-06-04 DOI:10.1016/j.clnesp.2025.05.046

Zahra Bahadoran , Parvin Mirmiran , Fereidoun Azizi

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引用次数: 0

摘要

目的：我们研究了坚持健康饮食对不同表型的糖尿病前期（Pre-DM）患者恢复正常葡萄糖调节（NGR）的可能性的潜在影响，糖尿病前期（Pre-DM）是一种影响葡萄糖代谢的异质性代谢紊乱，即孤立的空腹血糖受损(i-IFG；空腹血糖100-125 mg/dL，葡萄糖耐量正常)，分离糖耐量受损(i-IGT；负荷后2小时葡萄糖140-199 mg/dL（正常空腹血糖）和IFG-IGT联合（满足两个标准）。方法：在基线时使用替代健康饮食指数（AHEI）评估1456名糖尿病前期患者对健康饮食的依从性，参与者的中位随访时间为5.8年。采用Cox比例风险模型计算糖尿病前期恢复至NGR的风险比（hr）和95%置信区间（ci），这些风险比适用于AHEI的坚持类别（即AHEI的低依从性和高依从性）以及每增加10个AHEI。使用log-rank检验比较低依从性和高依从性AHEI患者预dm逆转的估计时间。结果：参与者平均年龄为47.2±12.8岁，男性占52.5%。糖尿病前期的总体逆转率为46.8%，其中i-IGT、i-IFG和IFG-IGT的逆转率分别为53.6、55.1和15.7%。调整糖尿病风险评分后，高依从性AHEI增加了回归到NGR的概率，HR=1.31, 95% CI=1.13-1.51。考虑到糖尿病前期表型，与分离表型的受试者相比，联合IFG-IGT的受试者从高依从性AHEI中获得了更大的益处，HR=2.33, 95% CI=1.27-4.30。此外，从IFG-IGT回归到NGR的平均估计时间(6.2 y（5.1-6.2）比8.4 y (8.0-8.8), Plog-rank=0.051，具有轻微的显著性趋势。结论：糖尿病前期个体坚持健康饮食可有效增加NGR逆转的可能性，且IFG-IGT联合治疗的效果强于单独表型组。

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Is adherence to the alternate healthy eating index an effective approach for prediabetes reversion? A longitudinal follow-up

Aim

We investigated the potential effect of adherence to a healthy diet on the probability of reversion to normal glucose regulation (NGR) among different phenotypes of prediabetes (Pre-DM), a heterogeneous metabolic disorder affecting glucose metabolism, i.e., isolated impaired fasting glucose (i-IFG; fasting glucose 100–125 mg/dL with normal glucose tolerance), isolated impaired glucose tolerance (i-IGT; 2-h post-load glucose 140–199 mg/dL with normal fasting glucose) and combined IFG-IGT (meeting both criteria).

Methods

Adherence of 1456 individuals with Pre-DM to a healthy diet was assessed using the Alternate Healthy Eating Index (AHEI) at baseline, and the participants were followed for a median of 5.8 years. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95 % confidence intervals (CIs) for Pre-DM reversion to NGR across the categories of adhering to AHEI (i.e., low and high-adherence of AHEI) and per each 10-increment of AHEI. The estimated time to Pre-DM reversion was compared among low- and high-adherence to AHEI using a log-rank test.

Results

The mean age of the participants was 47.2 ± 12.8, and 52.5 % were men. Overall rate of Pre-DM reversion was 46.8 %, with rates of 53.6, 55.1, and 15.7 % in i-IGT, i-IFG, and IFG-IGT, respectively. After adjustment of diabetes risk score, high-adherence to AHEI increased the probability of a reversion to NGR, HR = 1.31, 95 % CI = 1.13–1.51. Considering Pre-DM phenotypes, subjects with combined IFG-IGT showed a greater benefit from high adherence to AHEI compared to those with isolated phenotypes, HR = 2.33 and 95 % CI = 1.27–4.30. Furthermore, the mean of estimated time to reversion to NGR from IFG-IGT showed a marginally significant trend toward being shorter, 6.2 y (5.1–6.2) vs. 8.4 y (8.0–8.8) and P_log-rank = 0.051.

Conclusion

Adherence of individuals with Pre-DM to healthy diet effectively increased the probability of reversion to NGR, and the observed effect was stronger in subjects with combined IFG-IGT than the isolated phenotypes.

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.