精“英”克糖 | 饮食与胃旁路术对糖尿病代谢功能的影响

编者按：近些年，随着技术的提升和人们观念的改变，减重手术日益受到人们的关注。华盛顿大学医学院Mihoko Yoshino博士进行了一项研究，旨在评估饮食与胃旁路术对糖尿病代谢功能的影响。2020年8月，该研究的结果发表在NEJM上。NEJM的Michael Brewer博士对该文献进行了播讲。

文章作者

Mihoko Yoshino博士华盛顿大学医学院

中英文字幕

Taylor swift

饮食与胃旁路术对糖尿病代谢功能的影响，作者为华盛顿大学医学院Mihoko Yoshino博士。

Effects of Diet versus Gastric Bypass on Metabolic Function in Diabetes by Mihoko Yoshino from Washington university school of medicine, Saint Louis.

本研究评估了Roux-en-Y胃旁路术，是否对肥胖和2型糖尿病患者调节血糖控制的主要生理因素具有独立于减肥的治疗作用。在患者通过胃旁路术或单纯饮食干预达到匹配的减重幅度（约18%）之前和之后，研究人员评估了患者的混合膳食摄入后的代谢反应、24小时血糖，游离脂肪酸和胰岛素谱、多器官胰岛素敏感性和β细胞功能。

This study evaluated whether Roux-en-Y gastric bypass has therapeutic effects independent of weight loss on the major physiologic factors that regulate glycemic control in people with obesity and type 2 diabetes. The investigators assessed the metabolic response to mixed meal ingestion, 24-hour glucose，free fatty acid and insulin profiles, multiorgan insulin sensitivity and beta-cell function before and after matched approximately 18% weight loss induced by gastric bypass surgery or therapy alone.

数据显示，通过饮食疗法或胃旁路手术大幅减重的患者，其身体状况均有较大改善，体脂量、内脏脂肪体积、肝内甘油三酯含量、24小时血糖、游离脂肪酸、胰岛素状况、β细胞功能、肝脏、骨骼肌和脂肪组织的胰岛素敏感性等方面的改善，在两组之间没有显著差异。这些结果强调了减肥对代谢功能的有效治疗作用，并表明胃分流手术的代谢益处可能仅仅是减重的结果。

The data show that after a marked weight loss induced by either diet therapy or gastric bypass, there were considerable improvements in body composition, body fat mass, intraabdominal adipose tissue volume and intrahepatic triglyceride content, 24-hour plasma glucose, free fatty acid and insulin profiles, beta-cell function and insulin sensitivity in the liver, skeletal muscle and adipose tissue with no significant differences between the groups in any of these variables. These results underscore the potent therapeutic effects of weight loss on metabolic function and show that the metabolic benefits of gastric bypass surgery are probably the result of weight loss alone.

波士顿塔夫茨大学医学院的Clifford Rosen和新英格兰医学杂志的副主编Julie Ingelfinger就此文章共同撰写了一篇评论。文章数据显示，胃分流手术的代谢益处主要是由于整体肥胖减少导致的体重减轻。但该研究有几项局限性值得注意。首先，该试验并非随机。其次，试验中每组的人数都很少。此外，在接受手术的患者和选择低热量饮食的患者之间可能存在一些混杂因素。还有，所有的手术均为Roux-en-Y术式，因此将此研究中葡萄糖耐量改善的结果，外推至目前最常见的垂直袖状胃切除术时，必须谨慎进行。尽管如此，这项研究证实了肥胖的致病本质，即肥胖驱动胰岛素抵抗，并最终导致2型糖尿病。此外，其为临床医生和患者传递了一个直接而重要的信息，即无论用什么方法，只要减少脂肪组织，就可能改善2型糖尿病患者的血糖控制。

In an editorial, Clifford Rosen from Tufts University school of medicine, Boston, and Julie Ingelfinger, deputy editor for the journal write the taken together. The data suggest that the metabolic benefits of gastric bypass surgery were principally a result of weight loss owing to reduced overall adiposity. Several study limitations are important to note. The trial was not randomized, and there were small numbers in each group. In addition, there was probably some confounding due to differences between patients who underwent surgery and those who chose a low- calorie diet. Furthermore, all operations were Roux-en-Y procedures, so extrapolating those findings to the improved glucose tolerance associated with vertical sleeve gastrectomy, currently the most frequent procedure, must be done with caution. Nevertheless, this study confirms that pathogenic nature of obesity in driving insulin resistance and ultimately type 2 diabetes. Furthermore, it delivers a straightforward and important message for both clinicians and patients reducing adipose tissue volume by whatever means, will likely improve blood glucose control in persons with type 2 diabetes.

相关单词学习

Word Study

Roux-en-Y gastric bypass Roux-en-Y

胃旁路术

[注：1966年，美国Mason和Ito医生开展了第一例胃旁路手术治疗肥胖症；1977年Griffen医生将其改良定型为Roux-en-Y胃旁路手术]

glycemic /ɡlɪ'semɪk/ control

血糖控制

free fatty acid

游离脂肪酸

insulin profiles

胰岛素谱

intraabdominal adipose tissue volume

内脏脂肪体积

intrahepatic triglyceride content

肝内甘油三酯含量

deputy editor

副主编

adiposity /ˌædəˈpɑːsəti/

肥胖

vertical sleeve gastrectomy /ɡæsˈtrektəmi/

垂直袖状胃切除术