精“英”克糖|间歇性禁食对2型糖尿病患者的影响(中)

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2020年6月,美国盐城湖山间医学中心的Benjamin Horne教授在JAMA杂志发表了一篇的观点文章,阐述了间歇性禁食对2型糖尿病患者的健康影响和以及其安全性。JAMA杂志的主编Howard Bauchner博士就该话题对Benjamin Horne教授进行了专访。上一期我们聆听了第一部分,本期继续。


Howard Bauchner博士(左一),JAMA杂志主编;

Benjamin Horne教授(右一),美国盐城湖山间医学中心


中英文字幕

Howard Bauchner:那么,需要禁食多长时间才能产生这些效果呢?

Now, how long do you have to fast to have these effects? 


Benjamin Horne:这是一个悬而未决的问题。我认为这与禁食的频率有一定关系。禁食越严格,减重速度越快,同时能更快地减少心脏代谢疾病和慢性疾病的风险因素。目前对其原因还不是很清楚,因为没有较为一致的发现,诸如心脏风险因素降低,或者认知功能的标志物(如脑源性神经营养因子)改变等。所以在(试验的)稳定性设计方面存在一些问题。例如,大多数间歇性禁食的临床试验都是在那些看上去很健康的人中进行的,他们可能超重或肥胖。但一般来说,那些参与研究的受试者,心脏和代谢危险因子水平较为正常。所以这些人群的相关风险因素可能并没有多少可改善的空间,因为在大多数研究中已经有了相当好的结果。

That's an open question right now. And I think it partly relates to the frequency of the fasting. So, the more intense regimens tend to reduce weight much more quickly. And presumably are reducing the risk factors for cardiometabolic disease, chronic diseases, much more quickly. It's not really clear though, because there's not a consistent finding that cardiac risk factors, for example, are reduced, or that the markers of cognitive function, like brain derived neurotrophic factor, are altered. So, there are some issues with steady designs. For example, most clinical trials of intermittent fasting have been conducted in people who are apparently healthy, they may be overweight or obese. But generally, people who have normal cardiac and metabolic risk factor levels are those who have been involved in studies. So, there may not be much room for those risk factors to be improved, because there are already quite good in most of the studies.


Howard Bauchner:你在观点中提到,实际上有一些研究(虽然数量不多),都关注间歇性禁食对2型糖尿病患者的影响。能讲一下从这些研究中得到的数据吗(尽管我知道这些数据是有限的)?
Now you mention in the viewpoint that there are actually a number of studies, although small and limited, that have looked at intermittent fasting in patients with type 2 diabetes. Could you just go over the data that was derived from a number of those studies, albeit I know that they're limited?


Benjamin Horne:间歇性禁食有两个方面,一方面是我们如何使用它,另一方面是我们用它来做什么。一方面是我之前提到的,那些表面上很健康的人往往能够很安全地进行禁食或间歇性禁食。他们患慢性病的风险也不会很高。
There are two sides to the intermittent fasting story, both in terms of how we use it, and also what we're using it for. And the one side touches on, what I was mentioning just previously, that people who are apparently healthy tend to be able to engage in fasting, intermittent fasting quite safely. And they also tend not to have very elevated risk of chronic disease


因此,研究者正在寻找的效果和已经研究过的效果,主要与减肥或减少慢性疾病高风险患者患病的风险因素有关。然而,这样做的风险很高,既可能导致疾病相关后遗症,也有安全隐患。因此,此类针对2型糖尿病患者的间歇性禁食研究,规模相对较小。

And so, the effects that they are looking for and that have been studied are primarily related to weight loss or reduction of risk factors that could lead you to chronic disease for people that have developed chronic disease. However, the risks are higher, both in terms of going on to have sequelae related to their disease, but then also safety issues. And so, these studies looking at people who have diagnosed type 2 diabetes are relatively small. 


目前有大量针对具有糖尿病危险因素的人群的研究。但我们只确定了7项研究,其研究对象是确诊为2型糖尿病的患者。这些研究涉及到很多不同的禁食方案。实际上,所有研究中只有一点具有一致性,即每周2天禁食疗法。这7项研究中有3项观察了每周2天禁食疗法,其余的都有自己的治疗方案,他们发现了一些非常有趣的结果。如你所预料,他们的体重减轻了。对健康人群的研究也主要关注减肥方面,结果发现,体重减少量与持续的能量或热量限制量相似。对2型糖尿病患者的研究,也发现其血糖控制得到改善,同时还发现糖化血红蛋白降低。这与热量限制量是相似的。

There are a plethora of studies looking at people who have risk factors for developing diabetes. But we've only been able to identify 7 studies where the study population, where people who have diagnosed type 2 diabetes. And among those, there are quite a number of different fasting regimes that have been looked at. Only one, actually, those consistent across any of the studies, was a 2-day-perweek fasting regimen, where 3 of those 7 studies looked at that twice weekly fasting regimen. All the others had their own regimen, and they have found some very interesting outcomes. As you might expect, they all found that weight was reduced. And studies among apparently healthy people have primary also addressed weight loss and found that it's very similar amount of weight loss to continuous energy restriction, or caloric restriction. These studies of people with type 2 diabetes also have found that the glycemic control improves. And they have found that includes reduction in hemoglobin A1c. Again, it's been similar amount of reduction to, what we say, with the caloric restriction. 


事实上,这7项研究中规模最大的一项研究,评估了137例受试者,其热量限制量相当于每周禁食两次。结果发现,这些受试者的血糖、生活质量和血压都有改善。此外,对受试者而言还有很多其他潜在的获益,其中一些与情绪和抑郁有关。关于间歇性禁食的报道,很多都显示其有益于代谢健康和糖尿病风险改善。我们研究糖尿病患者是有意义的,因为似乎很多益处都显现在间歇性禁食的糖尿病患者中。

And in fact, in in one study, the largest study of these 7, where they evaluated 137 individuals, they found that it was equivalent reduction to what was found for people engaging in caloric restriction that was twice a week fasting. There also are improvements in glucose and quality of life and blood pressure. And they're variety of other benefits that are potential, some of them related to mood and depression. A lot of the benefits that are reported for intermittent fasting center on metabolic health and diabetes risk, and so it makes sense that we study people with diabetes. Because it seems like probably a lot of the benefits are focused on that population for intermittent fasting




相关单词学习:


open question 

待解决的问题

the more intense regimens tend to reduce weight much more quickly

禁食越严格,减重速度越快

brain derived neurotrophic factor

脑源性神经营养因子

albeit /ˌɔːlˈbiːɪt/

虽然,尽管,固然

sequelae /sɪ'kwili/  

n. 后遗症;结果(sequela的复数sequela /sɪ'kwilə/

plethora  /ˈpleθərə/ 

过剩,过多,过量,多血症

people who have risk factors for developing diabetes 
具有糖尿病危险因素的人群


获取英文文献及音频,后台回复关键词“禁食2”。



Resources:
Horne BD, Grajower MM, Anderson JL. Limited Evidence for the Health Effects and Safety of Intermittent Fasting Among Patients With Type 2 Diabetes.?JAMA.?2020;324(4):341–342. doi:10.1001/jama.2020.3908






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