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背景:研究表明改善肠道菌群微生态或进食低碳饮食能够缓解肥胖及其并发症的发生率,但单独给予菌群治疗肥胖效果并不显著,而单纯低碳饮食安全性也颇有争议.因此,寻求更安全有效的减肥方法成为临床营养等相关学科的研究热点.目的:探讨肠道微生态制剂联合改良低碳饮食靶向调控单纯性肥胖症患者体脂代谢及肠屏障功能的效果.方法:试验纳入2017年8月至2019年5月在南方医科大学深圳医院营养科、健康管理中心门诊就诊的75例成人单纯性肥胖患者,随机分为3组,分别为接受肠道微生态制剂+改良低碳饮食减肥法干预组,接受单纯改良低碳饮食减肥法干预组及均衡饮食对照组,每组25例,同时与25例均衡饮食正常体质量人群进行对照比较.观察各组患者体质量指数、腰臀比、体脂量、血浆血脂指标、脂肪肝发病率及其严重程度变化,同时监测各组营养干预前后D-乳酸、细菌脂多糖、二胺氧化酶等肠屏障功能指标的变化并比较其差异性.结果 与结论:给予不同营养方式干预3个月后,①肠道微生态制剂联合改良低碳饮食的肥胖患者的体质量指数、体脂量、血脂指标、脂肪肝分级和肠屏障功能各项指标的改善更明显(P<0.05或P<0.01),比单纯低碳饮食的临床效果好;②联合肠道微生态制剂的低碳饮食能更显著地降低肥胖症患者血清肠道损伤指标D-乳酸、细菌脂多糖和二胺氧化酶水平(P<0.05或P<0.01);③上述数据证实,肠道微生态制剂联合强化补充维生素矿物质的改良低碳饮食减肥法能够有效降低患者血清肠屏障损伤指标水平,而且相比于单独低碳饮食治疗,这种新的饮食治疗方案可更显著降低此类患者的体脂和血脂水平,减轻脂肪肝的严重程度,改善肠屏障功能.“,”BACKGROUND: Although several studies have shown that improving the microecology of intestinal flora or eating a low-carb diet can reduce the incidence of obesity and its complications, the therapeutic effect of microflora alone on obesity is not significant, and the safety of simple low-carb diet is also quite controversial. Therefore, to find a more safe and effective way to lose weight has become a research hotspot in clinical nutrition and other related disciplines. OBJECTIVE: To investigate the effects of microecological preparation combined with an improved low-carbon diet on fat metabolism and intestinal barrier function in obese patients. METHODS: A total of 75 adult patients with obesity admitted at Department of Nutrition and Health Management Center, Shenzhen Hospital, Southern Medical University, China from August 2017 to May 2019 were included in the trial. The subjects were randomly divided into three groups and received a microecological preparation combined with an improved low-carbon diet (n=25), an improved low-carbon diet (n=25), and a balanced diet (n=25). Another 25 healthy people with a balanced diet was recruited as healthy controls. The changes of body mass index, waist-to-hip ratio, body fat, plasma lipids, incidence of fatty liver and their severity in each group were observed and compared. Meanwhile, the changes of intestinal barrier function indexes such as D-lactic acid, bacterial lipopolysaccharide and diamine oxidase were also monitored and compared before and after nutritional intervention in each group. RESULTS AND CONCLUSION: After 3 months of intervention with different nutritional methods, compared with those with improved low-carbon diet, the improvement of body mass index, body fat mass, blood lipid index, fatty liver grade and intestinal barrier function was more obvious in obese patients with combined diet (P < 0.05 or P < 0.01 ). Low-carb diet or in combination with intestinal microecological preparations could significantly reduce the serum levels of D-lactic acid, bacterial lipopolysaccharide and diamine oxidase in obese patients as compared with other diet schedules (P < 0.05 or P < 0.01). To conclude, these findings indicate that intestinal microecological preparations combined with improved low-carbon diet with vitamins and minerals can effectively reduce the serum and intestinal damage indexes in obese patients. Compared with the low-carbon diet alone, this combined diet schedule can significantly reduce the body fat and blood lipid levels, alleviate the severity of fatty liver, and improve the intestinal barrier function in such patients.