Efeitos da alimentação com baixo teor de carboidrato nos padrões bioquímicos e antropométricos de pacientes com sobrepeso/obesidade e pré-diabetes/diabetes melittus tipo 2

Abstract

Society’s industrial revolution came together with plenty of world’s public health problems such as a sharp increase in overweight (SP), Obesity (OB), pre-diabetes (pDM), and Type 2 Diabetes (DM2). The World Health Organization has demonstrated great concern in dealing with the advance of diseases associated with the metabolic syndrome, such as hypertension, cardiovascular disease and kidney disease. Nutritional advice has been given more and more visibility in the guidelines, regarding the adjuvant treatment of such diseases. Aiming to evaluate a nutritional therapy based on carbohydrate restriction (<130g daily), we recruited two patient groups, both with BMI ≥25 kg/m2 with or without pDM/DM2. The groups were called: “group SP/OB + pDM/DM2” and “group SP/OB”. These groups were assessed for their biochemical, anthropometric parameters and associated cardiovascular risks at pretreatment (time 0), 1st reassessment (≥ 6 months) and 2nd reassessment (7 to 12 months) of follow-up time (values in parentheses). Results for the SP/OB + pDM/DM2 group are as follows: fasted blood glucose (GJ) (-10.9 and -10.8 mg/dL), HbA1c (-0.7 and -0.7%), fasted insulin (-5.4 and 5.3 μU/dL), HOMA-IR (-1.4 and -1.3), HDL (+2.3 and +2.3 mg/dL), Triglycerides (TG) (-21.7 and -21.6 mg/dL), GGT (-8.7 and -8.4 mg/dL) TGP (-9.8 and -13.3 mg/dL), BMI (-2.3 and -3.8 kg/m2), body weight (-6.2 and -7.1 kg) and waist circumference (CA) (-4.5 and -5.7 cm). Insulin use was reduced and 6 cases of pDM remission and 2 possible cases of partial DM2 remission were achieved. The SP/OB group showed improvements in Hb1Ac (-0.7% and 0.7%), insulin (-5.4 and 5.3 μU/dL), HOMA-IR (-0.5 and -0.4), TG (-21.7 and 21.6 mg/dL), GGT (-8.8 and 8.4 mg/dL), TGP (-9.8 and 13.1 mg/dL), BMI (0.7 and -3.9 kg/m2), body weight (-5.6 and 13.3 kg), waist circumference (-3.4 and 8.7 cm). In both groups the Medication effect score wasn´t increased and there were no reports of kidney damage. Both also showed improvement in liver enzyme levels in patients with pre-existing non-alcoholic fatty liver disease, after the low carbohydrate diet (DBC) introduction. Our results are in accordance with previous studies and urge a review of the evidence in order to adopt the low carbohydrate approach for glycemic control, weight loss and improvement of cardiovascular risk factors and comorbidities associated with pDM/DM2 and SP/OB.