EVALUATION OF METABOLIC EFFECTS OF SUBSTITUTION OF COMPLEX CARBOHYDRATES FOR SATURATED FAT IN INDIVIDUALS WITH OBESITY AND NIDDM

被引:47
作者
HOWARD, BV
ABBOTT, WGH
SWINBURN, BA
机构
[1] Medlantic Research Foundation, Washington, DC
[2] Medlantic Research Foundation, Washington, DC 20010, 108 Irving Street, NW
关键词
D O I
10.2337/diacare.14.9.786
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Dietary recommendations for diabetic patients now generally include the reduction of total and saturated fat and an increase in complex carbohydrates. We conducted two series of studies on individuals with obesity and/or non-insulin-dependent diabetes mellitus (NIDDM) to assess the effects of this dietary recommendation on both lipoproteins and their metabolism as well as on insulin secretion and action and energy expenditure. Both series compared a diet high in saturated fat with a diet high in complex carbohydrates and fiber. Calories and proportion of protein were constant. In the first set of studies, we sought to examine the effect of replacement of saturated fat with complex carbohydrate in a regimen with conventional foods that would closely approximate foods expected to be used and recommended to diabetic patients. In the second regimen, we examined a more extreme difference between carbohydrate content and fat content using a dietary change that would approximate the contrasts between traditional diets of Native Americans or other cultures and a modern westernized diet. The effects on lipoproteins included consistent decreases in total and low-density lipoprotein (LDL) cholesterol (av 10%), minimum to no change in high-density lipoprotein cholesterol, and insignificant changes in total or very-low-density lipoprotein (VLDL) triglycerides or 24-h triglyceride profiles. Changes in total and LDL cholesterol required 3-4 wk to reach equilibrium. Metabolic studies used to elucidate the reasons for the decrease in LDL cholesterol confirmed no stimulation of VLDL triglyceride or apolipoprotein B (apoB) production on the high-carbohydrate diet. The decrease in LDL appeared to be due to decreases in mechanisms that convert VLDL to LDL and increased activity of LDL apoB clearance. There were no changes in fasting and 2- or 24-h glucose profiles or in fasting and 2-h insulin concentrations in individuals consuming a diet of 30% fat and 55% carbohydrate. However, in the study with traditional foods, where dietary carbohydrate was 70% and fat only 15%, there was an improvement in glucose tolerance. It was accompanied by an improvement in glucose-mediated glucose disposal and insulin secretion. Finally, with a whole-body calorimeter, we found no difference between the high-fat and high-carbohydrate diets in terms of 24-h energy expenditure. In individuals having a wide range of obesity and glucose tolerance, substitution of complex carbohydrates for saturated fat has beneficial effects of lowering LDL cholesterol and possibly improving glucose tolerance and insulin secretion but without having any adverse effects on lipoprotein metabolism or energy expenditure.
引用
收藏
页码:786 / 795
页数:10
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共 40 条
  • [1] ENERGY-EXPENDITURE IN HUMANS - EFFECTS OF DIETARY-FAT AND CARBOHYDRATE
    ABBOTT, WGH
    HOWARD, BV
    RUOTOLO, G
    RAVUSSIN, E
    [J]. AMERICAN JOURNAL OF PHYSIOLOGY, 1990, 258 (02): : E347 - E351
  • [2] EFFECT OF A HIGH-CARBOHYDRATE, LOW-SATURATED-FAT DIET ON APOLIPOPROTEIN-B AND TRIGLYCERIDE-METABOLISM IN PIMA-INDIANS
    ABBOTT, WGH
    SWINBURN, B
    RUOTOLO, G
    HARA, H
    PATTI, L
    HARPER, I
    GRUNDY, SM
    HOWARD, BV
    [J]. JOURNAL OF CLINICAL INVESTIGATION, 1990, 86 (02) : 642 - 650
  • [3] EFFECTS OF REPLACING SATURATED FAT WITH COMPLEX CARBOHYDRATE IN DIETS OF SUBJECTS WITH NIDDM
    ABBOTT, WGH
    BOYCE, VL
    GRUNDY, SM
    HOWARD, BV
    [J]. DIABETES CARE, 1989, 12 (02) : 102 - 107
  • [4] HIGH-CARBOHYDRATE, HIGH-FIBER DIETS FOR INSULIN-TREATED MEN WITH DIABETES-MELLITUS
    ANDERSON, JW
    WARD, K
    [J]. AMERICAN JOURNAL OF CLINICAL NUTRITION, 1979, 32 (11) : 2312 - 2321
  • [5] HYPOLIPIDEMIC EFFECTS OF HIGH-CARBOHYDRATE, HIGH-FIBER DIETS
    ANDERSON, JW
    CHEN, WJL
    SIELING, B
    [J]. METABOLISM-CLINICAL AND EXPERIMENTAL, 1980, 29 (06): : 551 - 558
  • [6] EFFECTS OF DIET ON CELLULAR INSULIN BINDING AND INSULIN SENSITIVITY IN YOUNG HEALTHY SUBJECTS
    BECKNIELSEN, H
    PEDERSEN, O
    SORENSEN, NS
    [J]. DIABETOLOGIA, 1978, 15 (04) : 289 - 296
  • [7] DEVELOPMENT OF AN INTEGRATED MODEL FOR ANALYSIS OF THE KINETICS OF APOLIPOPROTEIN-B IN PLASMA VERY LOW-DENSITY LIPOPROTEINS, INTERMEDIATE DENSITY LIPOPROTEINS, AND LOW-DENSITY LIPOPROTEINS
    BELTZ, WF
    KESANIEMI, YA
    HOWARD, BV
    GRUNDY, SM
    [J]. JOURNAL OF CLINICAL INVESTIGATION, 1985, 76 (02) : 575 - 585
  • [8] EQUIVALENCE OF THE INSULIN SENSITIVITY INDEX IN MAN DERIVED BY THE MINIMAL MODEL METHOD AND THE EUGLYCEMIC GLUCOSE CLAMP
    BERGMAN, RN
    PRAGER, R
    VOLUND, A
    OLEFSKY, JM
    [J]. JOURNAL OF CLINICAL INVESTIGATION, 1987, 79 (03) : 790 - 800
  • [9] REDUCTION OF SERUM TRIGLYCERIDE LEVELS BY POLYUNSATURATED FAT - STUDIES ON MODE OF ACTION AND ON VERY LOW-DENSITY LIPOPROTEIN COMPOSITION
    CHAIT, A
    ONITIRI, A
    NICOLL, A
    RABAYA, E
    DAVIES, J
    LEWIS, B
    [J]. ATHEROSCLEROSIS, 1974, 20 (02) : 347 - 364
  • [10] INSULIN RESISTANCE AND BETA-CELL DYSFUNCTION IN AGING - THE IMPORTANCE OF DIETARY CARBOHYDRATE
    CHEN, M
    BERGMAN, RN
    PORTE, D
    [J]. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1988, 67 (05) : 951 - 957