Asociación entre nutrientes y hemoglobina glicosilada en diabéticos tipo 2

Samuel Durán Agüero, Eloina Fernández Godoy, Elena Carrasco Piña

Resumen


Introducción: la hiperglicemia es la característica principal de la diabetes (DM). La restricción de CHO en la dieta presenta el mayor efecto en la disminución de los niveles de glucosa en sangre tanto en DM 1 y 2.

Objetivo: asociar la ingesta de macro y micronutrientes con el control metabólico de pacientes con diabetes tipo 2.

Material y métodos: se entrevistó a 714 pacientes diabéticos tipo 2 de ambos sexos, entre 27 y 90 años, en centros de salud familiar de Santiago de Chile. Se les aplicó una encuesta alimentaria y una evaluación antropométrica. Se realizó prueba de regresión logística, se estimó además el valor del Odds Ratio (OR) y su correspondiente intervalo de confianza (IC).

Resultados: el IMC promedio fue de 30,8 ± 5,7 kg/m2, el 29,8% de los sujetos tenía una HbA1c compensada. Se puede observar que solo la ingesta elevada de carbohidratos (percentil 75) se asoció con un incremento en el riesgo de tener HbA1c elevada OR = 2,7 (IC 95% 1,5-4,8; p < 0,001).

Conclusiones: la ingesta elevada de carbohidratos de rápida absorción, altos en sacarosa y bajos en fibra se asocia como factor de riesgo en el incremento de HbA1c. La ingesta total de energía y el patrón de alimentación saludable se debe priorizar sobre la distribución de macronutrientes. Es importante la asesoría de un experto en nutrición especializado en diabetes quien, en colaboración con el equipo médico, debe determinar el tratamiento para cumplir con los objetivos individuales del paciente.


Palabras clave


Diabetes tipo 2;Hiperglicemia;Hemoglobina;glicosilada;Nutrientes;Carbohidratos

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Referencias


[WHO] World Health Organization. Diabetes facts 2008.

[CDC] Centers for Disease Control and Prevention. Diabetes data and trends 2008. Available at: http://apps.nccd.cdc.gov/DDTSTRS/default.aspx.

Franz MJ, Powers MA, Leontos C, Holzmeister LA, Kulkarni K, Monk A, et al. The evidence for medical nutrition therapy for type 1 and type 2 diabetes in adults. J Am Diet Assoc 2010;110(12):1852-89.

Durán-Agüero S, Carrasco-Pina E, Araya-Perez M. Food and diabetes. Nutr Hosp 2012;27(4):1031-6.

Sheard NF, Clark NG, Brand-Miller JC, Franz MJ, Pi-Sunyer FX, Mayer-Davis E, et al. Dietary carbohydrate (amount and type) in the prevention and management of diabetes: a statement by the American Diabetes Association. Diabetes Care 2004;27(9):2266-71.

Alhazmi A, Stojanovski E, McEvoy M, Garg ML. Macronutrient intakes and development of type 2 diabetes: a systematic review and meta-analysis of cohort studies. J Am Coll Nutr 2012;31(4):243-58.

Ericson U, Hellstrand S, Brunkwall L, Schulz CA, Sonestedt E, Wallstrom P, et al. Food sources of fat may clarify the inconsistent role of dietary fat intake for incidence of type 2 diabetes. Am J Clin Nutr 2015;101(5):1065-80.

Oba S, Nanri A, Kurotani K, Goto A, Kato M, Mizoue T, et al. Dietary glycemic index, glycemic load and incidence of type 2 diabetes in Japanese men and women: the Japan Public Health Center-based Prospective Study. Nutr J 2013;12(1):165.

Pastors JG, Warshaw H, Daly A, Franz M, Kulkarni K. The evidence for the effectiveness of medical nutrition therapy in diabetes management. Diabetes Care 2002;25(3):608-13.

Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 2013;36(11):3821-42.

Accurso A, Bernstein RK, Dahlqvist A, Draznin B, Feinman RD, Fine EJ, et al. Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal. Nutr Metab (Lond) 2008;5:9.

Westman EC, Yancy WS, Jr., Mavropoulos JC, Marquart M, McDuffie JR. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr Metab (Lond) 2008;5:36.

Gannon MC, Nuttall FQ. Control of blood glucose in type 2 diabetes without weight loss by modification of diet composition. Nutr Metab (Lond) 2006;3:16.

Turner RC, Millns H, Neil HA, Stratton IM, Manley SE, Matthews DR, et al. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23). BMJ 1998;316(7134):823-8.

Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000;321(7258):405-12.

Shi L, Ye X, Lu M, Wu EQ, Sharma H, Thomason D, et al. Clinical and economic benefits associated with the achievement of both HbA1c and LDL cholesterol goals in veterans with type 2 diabetes. Diabetes Care 2013;36(10):3297-304.

Organization. WH. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. Geneva: World Health Organization; 2000.

Hussain TA, Mathew TC, Dashti AA, Asfar S, Al-Zaid N, Dashti HM. Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes. Nutrition 2012;28(10):1016-21.

Gannon MC, Hoover H, Nuttall FQ. Further decrease in glycated hemoglobin following ingestion of a LoBAG30 diet for 10 weeks compared to 5 weeks in people with untreated type 2 diabetes. Nutr Metab (Lond) 2010;7:64.

Nuttall FQ, Schweim K, Hoover H, Gannon MC. Effect of the LoBAG30 diet on blood glucose control in people with type 2 diabetes. Br J Nutr 2008;99(3):511-9.

Feinman RD, Pogozelski WK, Astrup A, Bernstein RK, Fine EJ, Westman EC, et al. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition 2015;31(1):1-13.

Encuesta Nacional de Consumo Alimentario. Available at: http://web.minsal.cl/sites/default/files/ENCA-INFORME_FINAL.pdf

Schwingshackl L, Strasser B, Hoffmann G. Effects of monounsaturated fatty acids on glycaemic control in patients with abnormal glucose metabolism: a systematic review and meta-analysis. Ann Nutr Metab 2011;58(4):290-6.

Schwingshackl L, Strasser B. High-MUFA diets reduce fasting glucose in patients with type 2 diabetes. Ann Nutr Metab 2012;60(1):33-4.

Mari-Sanchis A, Beunza JJ, Bes-Rastrollo M, Toledo E, Basterra Gortariz FJ, Serrano-Martinez M, et al. Olive oil consumption and incidence of diabetes mellitus, in the Spanish sun cohort. Nutr Hosp.2011;26(1):137-43.

Jenkins DJ, Kendall CW, Banach MS, Srichaikul K, Vidgen E, Mitchell S, et al. Nuts as a replacement for carbohydrates in the diabetic diet. Diabetes Care 2011;34(8):1706-11.

Wien M, Oda K, Sabate J. A randomized controlled trial to evaluate the effect of incorporating peanuts into an American Diabetes Association meal plan on the nutrient profile of the total diet and cardiometabolic parameters of adults with type 2 diabetes. Nutr J 2014;13:10.

Hartweg J, Perera R, Montori V, Dinneen S, Neil HA, Farmer A. Omega-3 polyunsaturated fatty acids (PUFA) for type 2 diabetes mellitus. The Cochrane database of systematic reviews; 2008(1):CD003205.

Harding AH, Day NE, Khaw KT, Bingham SA, Luben RN, Welsh A, et al. Habitual fish consumption and glycated haemoglobin: the EPIC-Norfolk study. Eur J Clin Nutr 2004;58(2):277-84.

Harding AH, Sargeant LA, Welch A, Oakes S, Luben RN, Bingham S, et al. Fat consumption and HbA(1c) levels: the EPIC-Norfolk study. Diabetes Care 2001;24(11):1911-6.

Balk SN, Schoenaker DA, Mishra GD, Toeller M, Chaturvedi N, Fuller JH, et al. Association of diet and lifestyle with glycated haemoglobin in type 1 diabetes participants in the EURODIAB prospective complications study. Eur J Clin Nutr 2015. DOI: 10.1038/ejcn.2015.110

Fujii H, Iwase M, Ohkuma T, Ogata-Kaizu S, Ide H, Kikuchi Y, et al. Impact of dietary fiber intake on glycemic control, cardiovascular risk factors and chronic kidney disease in Japanese patients with type 2 diabetes mellitus: the Fukuoka Diabetes Registry. Nutr J 2013;12:159.

Silva FM, Kramer CK, de Almeida JC, Steemburgo T, Gross JL, Azevedo MJ. Fiber intake and glycemic control in patients with type 2 diabetes mellitus: a systematic review with meta-analysis of randomized controlled trials. Nutr Rev 2013;71(12):790-801.

Papakonstantinou E, Triantafillidou D, Panagiotakos DB, Iraklianou S, Berdanier CD, Zampelas A. A high protein low fat meal does not influence glucose and insulin responses in obese individuals with or without type 2 diabetes. J Hum Nutr Diet 2010;23(2):183-9.

Papakonstantinou E, Triantafillidou D, Panagiotakos DB, Koutsovasilis A, Saliaris M, Manolis A, et al. A high-protein low-fat diet is more effective in improving blood pressure and triglycerides in calorie-restricted obese individuals with newly diagnosed type 2 diabetes. Eur J Clin Nutr 2010;64(6):595-602.

Terrio L. Self-sufficient diabetes management: maintaining Independence in older adults.On the Cutting Edge 2009;2009(30):10-4.




DOI: http://dx.doi.org/10.20960/nh.18

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