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《新英格兰》——低碳水化合物饮食、地中海饮食和低脂肪饮食减肥的对比研究

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Weight Loss with a Low-Carbohydrate, Mediterranean,

or Low-Fat Diet

Iris Shai, R.D., Ph.D., Dan Schwarzfuchs, M.D., Yaakov Henkin, M.D., Danit R. Shahar, R.D., Ph.D., Shula Witkow, R.D., M.P .H., Ilana Greenberg, R.D., M.P .H., Rachel Golan, R.D., M.P.H., Drora Fraser, Ph.D.,

Arkady Bolotin, Ph.D., Hilel Vardi, M.Sc., Osnat Tangi-Rozental, B.A., Rachel Zuk-Ramot, R.N.,

Benjamin Sarusi, M.Sc., Dov Brickner, M.D., Ziva Schwartz, M.D., Einat Sheiner, M.D., Rachel Marko, M.Sc.,

Esther Katorza, M.Sc., Joachim Thiery, M.D., Georg Martin Fiedler, M.D., Matthias Blüher, M.D.,

Michael Stumvoll, M.D., and Meir J. Stampfer, M.D., Dr.P.H.,

for the Dietary Intervention Randomized Controlled Trial (DIRECT) Group

ABSTR ACT

From the S. Daniel Abraham Center for Health and Nutrition, Ben-Gurion Uni-versity of the Negev, Beer-Sheva (I.S., D.R.S., S.W., I.G., R.G., D.F., A.B., H.V., O.T.-R.); the Nuclear Research Center Negev, Dimona (D.S., R.Z.-R., B.S., D.B., Z.S., E.S., R.M., E.K.); and the Depart-ment of Cardiology, Soroka University Medical Center, Beer-Sheva (Y.H.) — all in Israel; the Institute of Laboratory Med-icine, University Hospital Leipzig (J.T., G.M.F.); and the Department of Medi-cine, University of Leipzig (M.B., M.S.) — both in Leipzig, Germany; and Chan-ning Laboratory, Department of Medi-cine, Brigham and Women’s Hospital and Harvard Medical School, and the De-partments of Epidemiology and Nutri-tion, Harvard School of Public Health — all in Boston (M.J.S.). Address reprint requests to Dr. Shai at the S. Daniel Abra-ham International Center for Health and Nutrition, Department of Epidemiology and Health Systems Evaluation, Ben- Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel, or at irish@bgu.ac.il.

This article (10.1056/NEJMoa0708681) was updated on December 30, 2009, at https://www.wendangku.net/doc/2c17731159.html,.

N Engl J Med 2008;359:229-41.

Background

Trials comparing the effectiveness and safety of weight-loss diets are frequently limited by short follow-up times and high dropout rates.

Methods

In this 2-year trial, we randomly assigned 322 moderately obese subjects (mean age, 52 years; mean body-mass index [the weight in kilograms divided by the square of the height in meters], 31; male sex, 86%) to one of three diets: low-fat, restricted-calorie; Mediterranean, restricted-calorie; or low-carbohydrate, non–restricted-calorie.

Results

The rate of adherence to a study diet was 95.4% at 1 year and 84.6% at 2 years. The Mediterranean-diet group consumed the largest amounts of dietary fiber and had the highest ratio of monounsaturated to saturated fat (P<0.05 for all comparisons among treatment groups). The low-carbohydrate group consumed the smallest amount of car-bohydrates and the largest amounts of fat, protein, and cholesterol and had the highest percentage of participants with detectable urinary ketones (P<0.05 for all comparisons among treatment groups). The mean weight loss was 2.9 kg for the low-fat group, 4.4 kg for the Mediterranean-diet group, and 4.7 kg for the low-carbohydrate group (P<0.001 for the interaction between diet group and time); among the 272 participants who com-pleted the intervention, the mean weight losses were 3.3 kg, 4.6 kg, and 5.5 kg, respec-tively. The relative reduction in the ratio of total cholesterol to high-density lipoprotein cholesterol was 20% in the low-carbohydrate group and 12% in the low-fat group (P = 0.01). Among the 36 subjects with diabetes, changes in fasting plasma glucose and insulin levels were more favorable among those assigned to the Mediterranean diet than among those assigned to the low-fat diet (P<0.001 for the interaction among diabetes and Mediterranean diet and time with respect to fasting glucose levels).

Conclusions

Mediterranean and low-carbohydrate diets may be effective alternatives to low-fat diets. The more favorable effects on lipids (with the low-carbohydrate diet) and on glycemic control (with the Mediterranean diet) suggest that personal preferences and metabolic considerations might inform individualized tailoring of dietary in-terventions. (https://www.wendangku.net/doc/2c17731159.html, number, NCT00160108.)

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he dramatic increase in obesity worldwide remains challenging and un-derscores the urgent need to test the ef-fectiveness and safety of several widely used weight-loss diets.1-3 Low-carbohydrate, high-pro-tein, high-fat diets (referred to as low-carbohy-drate diets) have been compared with low-fat, energy-restricted diets.4-9 A meta-analysis of five trials with 447 participants 10 and a recent 1-year trial involving 311 obese women 4 suggested that a low-carbohydrate diet is a feasible alternative to a low-fat diet for producing weight loss and may have favorable metabolic effects. However, longer-term studies are lacking.4,10 A Mediterranean diet with a moderate amount of fat and a high pro-portion of monounsaturated fat provides cardio-vascular benefits.11 A recent review citing several trials 12 included a few that suggested that the Med-iterranean diet was beneficial for weight loss.13,14 However, this positive effect has not been con-clusively demonstrated.15

Common limitations of dietary trials include high attrition rates (15 to 50% within a year), small size, short duration, lack of assessment of adherence, and unequal intensity of inter-vention.10,12,15-17 We conducted the 2-year Di-etary Intervention Randomized Controlled Trial (DIRECT) to compare the effectiveness and safe-ty of three nutritional protocols: a low-fat, restrict-ed-calorie diet; a Mediterranean, restricted-calorie diet; and a low-carbohydrate, non–restricted-calorie diet.

Methods

Eligibility and Study Design

We conducted the trial between July 2005 and June 2007 in Dimona, Israel, in a workplace at a research center with an on-site medical clinic. Recruitment began in December 2004. The crite-ria for eligibility were an age of 40 to 65 years and a body-mass index (BMI, the weight in kilo-grams divided by the square of the height in meters) of at least 27, or the presence of type 2 diabetes (according to the American Diabetes As-sociation criteria 18) or coronary heart disease, regardless of age and BMI. Persons were exclud-ed if they were pregnant or lactating, had a serum creatinine level of 2 mg per deciliter (177 μmol per liter) or more, had liver dysfunction (an in-crease by a factor of at least 2 above the upper limit of normal in alanine aminotransferase and aspartate aminotransferase levels), had gastro-intestinal problems that would prevent them from following any of the test diets, had active cancer, or were participating in another diet trial.

The participants were randomly assigned with-in strata of sex, age (below or above the median), BMI (below or above the median), history of coro-nary heart disease (yes or no), history of type 2 diabetes (yes or no), and current use of statins (none, <1 year, or ≥1 year) with the use of Monte Carlo simulations. The participants received no financial compensation or gifts. The study was approved and monitored by the human subjects committee of Soroka Medical Center and Ben-Gurion University. Each participant provided writ-ten informed consent.

The members of each of the three diet groups were assigned to subgroups of 17 to 19 partici-pants, with six subgroups for each group. Each diet group was assigned a registered dietitian who led all six subgroups of that group. The dietitians met with their groups in weeks 1, 3, 5, and 7 and thereafter at 6-week intervals, for a total of 18 sessions of 90 minutes each. We adapted the Israeli version (developed by the Maccabi Health Maintenance Organization) of the diabetes-prevention program 19 and developed additional themes for each diet group (see Supplementary Appendix 1, available with the full text of this article at https://www.wendangku.net/doc/2c17731159.html,). In order to maintain equal intensity of treatment, the workshop for-mat and the quality of the materials were similar among the three diet groups, except for instruc-tions and materials specific to each diet strategy. Six times during the 2-year intervention, another dietitian conducted 10-to-15-minute motivation-al telephone calls with participants who were having difficulty adhering to the diets and gave a summary of each call to the group dietitian. In addition, a group of spouses received education to strengthen their support of the participants (data not shown).

Low-Fat Diet

The low-fat, restricted-calorie diet was based on American Heart Association 20 guidelines. We aimed at an energy intake of 1500 kcal per day for women and 1800 kcal per day for men, with 30% of calories from fat, 10% of calories from saturated fat, and an intake of 300 mg of choles-terol per day. The participants were counseled to consume low-fat grains, vegetables, fruits, and legumes and to limit their consumption of addi-tional fats, sweets, and high-fat snacks.

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Mediterranean Diet

The moderate-fat, restricted-calorie, Mediterranean diet was rich in vegetables and low in red meat, with poultry and fish replacing beef and lamb. We restricted energy intake to 1500 kcal per day for women and 1800 kcal per day for men, with a goal of no more than 35% of calories from fat; the main sources of added fat were 30 to 45 g of olive oil and a handful of nuts (five to seven nuts, <20 g) per day. The diet is based on the recom-mendations of Willett and Skerrett.21

Low-Carbohydrate Diet

The low-carbohydrate, non–restricted-calorie diet aimed to provide 20 g of carbohydrates per day for the 2-month induction phase and immediately after religious holidays, with a gradual increase to a maximum of 120 g per day to maintain the weight loss. The intakes of total calories, protein, and fat were not limited. However, the participants were counseled to choose vegetarian sources of fat and protein and to avoid trans fat. The diet was based on the Atkins diet (see Supplementary Appendix 2).22

Nutritional and Color Labeling of Food in the Cafeteria

Lunch is typically the main meal in Israel. The self-service cafeteria in the workplace provided a varied menu and was the exclusive source of lunch for the participants. A dietitian worked closely with the kitchen staff to adjust specific food items to specific diet groups. Each food item was provided with a label showing the num-ber of calories and the number of grams of car-bohydrates, fat, and saturated fat, according to an analysis based on the Israeli nutritional data-base. Each food item was also labeled with a full circle (indicating “feel free to consume”) or a half circle (indicating “consume in moderation”). The labels were color-coded according to diet group and were updated daily (see Supplementa-ry Appendix 2).23

Electronic Questionnaires at Baseline and Follow-up

Adherence to the diets was evaluated by a validat-ed food-frequency questionnaire 24 that included 127 food items and three portion-size pictures for 17 items.25 A subgroup of participants completed two repeated 24-hour dietary recalls to verify ab-solute intake (data not shown). We used a vali-dated questionnaire to assess physical activity.26

At baseline and at 6, 12, and 24 months of fol-low-up, the questionnaires were self-adminis-tered electronically through the workplace intra-net. The 15% of participants who requested aid in completing the questionnaires were assisted by the study nurse. The electronic questionnaire helped to ensure completeness of the data by prompting the participant when a question was not answered, and it permitted rapid automated reporting by the group dietitians.

Outcomes

The participants were weighed without shoes to the nearest 0.1 kg every month. With the use of a wall-mounted stadiometer, height was measured to the nearest millimeter at baseline for determi-nation of BMI. Waist circumference was measured halfway between the last rib and the iliac crest. Blood pressure was measured every 3 months with the use of an automated system (Datascop Acutor 4) after 5 minutes of rest.

Blood samples were obtained by venipuncture at 8 a.m. after a 12-hour fast at baseline and at 6, 12, and 24 months and were stored at –80°C until an assay for lipids, inflammatory biomark-ers, and insulin could be performed. Levels of fasting plasma glucose, glycated hemoglobin, and liver enzymes were measured in fresh samples. The level of glycated hemoglobin was determined with the use of Cobas Integra reagents and equip-ment. Serum levels of total cholesterol, high-density-lipoprotein (HDL) cholesterol, low-density-lipoprotein (LDL) cholesterol, and triglycerides were determined enzymatically with a Wako R-30 automatic analyzer, with coefficients of varia-tion of 1.3% for cholesterol and 2.1% for triglyc-erides. Plasma insulin levels were measured with the use of an enzyme immunometric assay (Immulite automated analyzer, Diagnostic Prod-ucts), with a coefficient of variation of 2.5%. Plasma levels of high-molecular-weight adiponec-tin were measured by an enzyme-linked immu-nosorbent assay (ELISA) (AdipoGen or Axxora), with a coefficient of variation of 4.8%. Plasma leptin levels were assessed by ELISA (Mediagnost), with a coefficient of variation of 2.4%. Plasma levels of high-sensitivity C-reactive protein were measured by ELISA (DiaMed), with a coefficient of variation of 1.9%. The clinic and laboratory staff members were unaware of the treatment assignments, and the study coordinators were unaware of all outcome data until the end of the intervention.

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Statistical Analysis

For weight loss, the prespecified primary aim was the change in weight from baseline to 24 months. We used the Israeli food database 23 in the analy-sis of the results of the dietary questionnaires. We analyzed the dietary-composition data and bio-markers with the use of raw unadjusted means, without imputation of missing data. We compared the dietary-intake values between groups at each time point with the use of an analysis of variance in which all pairwise comparisons among the three diet groups were performed with the use of Tukey’s Studentized range test. We transformed physical-activity scores into metabolic equivalents per week 27 according to the amount of time spent in various forms of exercise per week, with each activity weighted in terms of its level of intensity. For intention-to-treat analyses, we included all 322 participants and used the most recent values for weight and blood pressure. To evaluate the re-peated measurements over time, we used gener-alized estimating equations for panel data analy-sis, also known as cross-sectional time-series analysis, with the use of the Stata software XTGEE command; this allowed us to account for the non-independence of repeated measurements of the same bioindicator in the same participant over time. We used age, sex, time point, and diet group as explanatory variables in our models. To study changes over time and the effects of sex or the presence or absence of diabetes, we added appro-priate interaction terms. We assessed the within-person changes from baseline in each diet group with the use of pairwise comparisons. We calcu-lated the homeostasis model assessment of insu-lin resistance (HOMA-IR) according to the follow-ing equation 28: insulin (U/ml) × fasting glucose (mmol/liter) ÷ 22.5. For a mean (±SD) difference between groups of at least 2±10 kg of weight loss, with 100 participants per group and a type I error of 5%, the power to detect significant dif-ferences in weight loss is greater than 90%. We used SPSS software, version 15, and Stata soft-ware, version 9, for the statistical analysis.

R esults

Characteristics of the Participants

The baseline characteristics of the participants are shown in Table 1. The mean age was 52 years and the mean BMI was 31. Most participants (86%) were men. The overall rate of adherence

(Fig. 1) was 95.4% at 12 months and 84.6% at 24 months; the 24-month adherence rates were 90.4% in the low-fat group, 85.3% in the Mediterranean-diet group, and 78.0% in the low-carbohydrate group (P = 0.04 for the comparison among diet groups). During the study, there was little change in usage of medications, and there were no sig-nificant differences among groups in the amount of change; four participants initiated and three stopped cholesterol-lowering therapy. Twenty par-ticipants initiated blood-pressure treatment, five initiated medications for glycemic control, and one reduced the dosage of medications for glyce-mic control.

Dietary Intake, Energy Expenditure, and Urinary Ketones

At baseline, there were no significant differences in the composition of the diets consumed by par-ticipants assigned to the low-fat, Mediterranean, and low-carbohydrate diets. Daily energy intake, as assessed by the food-frequency questionnaire, decreased significantly at 6, 12, and 24 months in all diet groups as compared with baseline (P<0.001); there were no significant differences among the groups in the amount of decrease (Table 2). The low-carbohydrate group had a low-er intake of carbohydrates (P<0.001) and higher intakes of protein (P<0.001), total fat (P<0.001), saturated fat (P<0.001), and total cholesterol (P = 0.04) than the other groups. The Mediterra-nean-diet group had a higher ratio of mono-unsaturated to saturated fat than the other groups (P<0.001) and a higher intake of dietary fiber than the low-carbohydrate group (P = 0.002). The low-fat group had a lower intake of saturated fat than the low-carbohydrate group (P = 0.02). The amount of physical activity increased significant-ly from baseline in all groups, with no signifi-cant difference among groups in the amount of increase. The proportion of participants with de-tectable urinary ketones at 24 months was higher in the low-carbohydrate group (8.3%) than in the low-fat group (4.8%) or the Mediterranean-diet group (2.8%) (P = 0.04).

Weight Loss

A phase of maximum weight loss occurred from 1 to 6 months and a maintenance phase from 7 to 24 months. All groups lost weight, but the reduc-tions were greater in the low-carbohydrate and the Mediterranean-diet groups (P<0.001 for the inter-

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action between diet group and time) than in the low-fat group (Fig. 2). The overall weight changes among the 322 participants at 24 months were ?2.9±4.2 kg for the low-fat group, ?4.4±6.0 kg for the Mediterranean-diet group, and ?4.7±6.5 kg for the low-carbohydrate group. Among the 277 male participants, the mean 24-month weight changes were ?3.4 kg (95% confidence interval [CI], ?4.3 to ?2.5) for the low-fat group, ?4.0 kg

(95% CI, ?5.1 to ?3.0) for the Mediterranean-diet

* Plus–minus values are means ±SD. To convert values for cholesterol to millimoles per liter, multiply by 0.02586. To convert values for tri-glycerides to millimoles per liter, multiply by 0.01129. To convert values for glucose to millimoles per liter, multiply by 0.05551. To convert values for bilirubin to micromoles per liter, multiply by 17.1. BMI denotes body-mass index, HDL high-density lipoprotein, HOMA-IR ho-meostasis model assessment of insulin resistance, and LDL low-density lipoprotein.? Data were available from 297 participants.? Data were available from 302 participants.

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group, and ?4.9 kg (95% CI, ?6.2 to ?3.6) for the low-carbohydrate group. Among the 45 women, the mean 24-month weight changes were ?0.1 kg (95% CI, ?2.2 to 1.9) for the low-fat group, ?6.2 kg (95% CI, ?10.2 to ?1.9) for the Mediterranean-diet group, and ?2.4 kg (95% CI, ?6.9 to 2.2) for the low-carbohydrate group (P<0.001 for the in-teraction between diet group and sex). The mean weight changes among the 272 participants who completed 24 months of intervention were ?3.3±4.1 kg in the low-fat group, ?4.6±6.0 kg in the Mediterranean-diet group, and ?5.5±7.0 kg in the low-carbohydrate group (P = 0.03 for the com-parison between the low-fat and the low-carbo-hydrate groups at 24 months). The mean (±SD) changes in BMI were ?1.0±1.4 in the low-fat group, ?1.5±2.2 in the Mediterranean-diet group, and ?1.5±2.1 in the low-carbohydrate group (P = 0.05 for the comparison among groups).

All groups had significant decreases in waist circumference and blood pressure, but the dif-ferences among the groups were not significant. The waist circumference decreased by a mean of 2.8±4.3 cm in the low-fat group, 3.5±5.1 cm in the Mediterranean-diet group, and 3.8±5.2 cm in the low-carbohydrate group (P = 0.33 for the com-parison among groups). Systolic blood pressure fell by 4.3±11.8 mm Hg in the low-fat group, 5.5±14.3 mm Hg in the Mediterranean-diet group, and 3.9±12.8 mm Hg in the low-carbohydrate group (P = 0.64 for the comparison among groups). The corresponding decreases in diastolic pres-sure were 0.9±8.1, 2.2±9.5, and 0.8±8.7 mm Hg (P = 0.43 for the comparison among groups).

Lipid Profiles

Changes in lipid profiles during the weight-loss and maintenance phases are shown in Figure 3. HDL cholesterol (Fig. 3A) increased during the weight-loss and maintenance phases in all groups, with the greatest increase in the low-carbohydrate group (8.4 mg per deciliter [0.22 mmol per liter], P<0.01 for the interaction between diet group and time), as compared with the low-fat group (6.3 mg per deciliter [0.16 mmol per liter]). Tri-glyceride levels (Fig. 3B) decreased significantly in the low-carbohydrate group (23.7 mg per decili-ter [0.27 mmol per liter], P = 0.03 for the interac-tion between diet group and time), as compared with the low-fat group (2.7 mg per deciliter [0.03 mmol per liter]). LDL cholesterol levels (Fig. 3C) did not change significantly within groups, and there were no significant differences between the groups in the amount of change. Overall, the ratio of total cholesterol to HDL cholesterol (Fig. 3D) decreased during both the weight-loss and the maintenance phases. The low-carbohydrate group had the greatest improvement, with a rela-tive decrease of 20% (P = 0.01 for the interaction between diet group and time), as compared with a decrease of 12% in the low-fat group.

High-Sensitivity C-Reactive Protein, High-Molecular-Weight Adiponectin, and Leptin

The level of high-sensitivity C-reactive protein de-creased significantly (P<0.05) only in the Medi-terranean-diet group (21%) and the low-carbohy-drate group (29%), during both the weight-loss and the maintenance phases, with no significant differences among the groups in the amount of decrease (Fig. 4A). During both the weight-loss and the maintenance phases, the level of high-molecular-weight adiponectin (Fig. 4B) increased significantly (P<0.05) in all diet groups, with no significant differences among the groups in the amount of increase. Circulating leptin, which reflects body-fat mass, decreased significantly (P<0.05) in all diet groups, with no significant differences among the groups in the amount of decrease; the decrease in leptin paralleled the de-crease in body weight during the two phases (Fig. 4C). The interaction between the effects of low-carbohydrate diet and sex on the reduction of leptin (P = 0.04), as compared with the low-fat diet, reflects the greater effect of the low-carbo-hydrate diet among men.

Fasting Plasma Glucose, HOMA-IR,

and Glycated Hemoglobin

Among the 36 participants with diabetes (Fig. 4D), only those in the Mediterranean-diet group had a decrease in fasting plasma glucose levels (32.8 mg per deciliter); this change was significantly differ-ent from the increase in plasma glucose levels among participants with diabetes in the low-fat group (P<0.001 for the interaction between diet group and time). There was no significant change in plasma glucose level among the participants without diabetes (P<0.001 for the interaction among diabetes and Mediterranean diet and time). In contrast, insulin levels (Fig. 4E) decreased sig-nificantly in participants with diabetes and in those without diabetes in all diet groups, with no significant differences among groups in the

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amount of decrease. Among the participants with diabetes, the decrease in HOMA-IR at 24 months (Fig. 4F) was significantly greater in those assigned to the Mediterranean diet than in those assigned to the low-fat diet (2.3 and 0.3, respectively; P = 0.02; P = 0.04 for the interaction among diabe-tes and Mediterranean diet and time). Among the participants with diabetes, the proportion of gly-cated hemoglobin at 24 months decreased by 0.4±1.3% in the low-fat group, 0.5±1.1% in the Mediterranean-diet group, and 0.9±0.8% in the

low-carbohydrate group. The changes were signifi-

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* Plus–minus values are means ±SD.

? P values for differences among the three diet groups were calculated by analysis of variance, except for urinary ketone values, for which the chi-square test was used. When the difference among the groups was significant (P<0.05), all pairwise comparisons between groups were tested for significance with the use of Tukey’s Studentized range test. The Mediterranean-diet group consumed the largest amounts of di-etary fiber and had the highest ratio of monounsaturated to saturated fat (P<0.05 for all comparisons among treatment groups). The low-carbohydrate group consumed the smallest amount of carbohydrates and the largest amounts of fat, protein, and cholesterol; the percent-age of participants with detectable urinary ketones was also highest in this group (P<0.05 for all comparisons among treatment groups). The amount of decrease in intake of calories was similar among the diet groups.

? The value for the low-carbohydrate group is significantly different from the value for the low-fat group or the Mediterranean-diet group (P<0.05).

§ The value for the low-carbohydrate group is significantly different from the value for the low-fat group (P<0.05).

? The value for the Mediterranean-diet group is significantly different from the value for the low-fat group or the low-carbohydrate group (P<0.05).

‖ The value for the low-carbohydrate group is significantly different from the value for the Mediterranean-diet group (P<0.05).

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cant (P<0.05) only in the low-carbohydrate group (P = 0.45 for the comparison among groups).

Liver-Function Tests

Changes in bilirubin, alkaline phosphatase, and alanine aminotransferase levels were similar among the diet groups. Alanine aminotransferase levels were significantly reduced from baseline to 24 months in the Mediterranean-diet and the low-carbohydrate groups (reductions of 3.4±11.0 and 2.6±8.6 units per liter, respectively; P<0.05 for the comparison with baseline in both groups).

Discussion

In this 2-year dietary-intervention study, we found that the Mediterranean and low-carbohydrate di-ets are effective alternatives to the low-fat diet for weight loss and appear to be just as safe as the low-fat diet. In addition to producing weight loss in this moderately obese group of participants, the low-carbohydrate and Mediterranean diets had some beneficial metabolic effects, a result sug-gesting that these dietary strategies might be con-sidered in clinical practice and that diets might be individualized according to personal preferences and metabolic needs. The similar caloric deficit achieved in all diet groups suggests that a low-car-bohydrate, non–restricted-calorie diet may be opti-mal for those who will not follow a restricted-cal-orie dietary regimen. The increasing improvement in levels of some biomarkers over time up to the 24-month point, despite the achievement of maxi-mum weight loss by 6 months, suggests that a diet with a healthful composition has benefits be-yond weight reduction.

The present study has several limitations. We enrolled few women; however, we observed a sig-nificant interaction between the effects of diet group and sex on weight loss (women tended to lose more weight on the Mediterranean diet), and this difference between men and women was also reflected in the changes in leptin levels. This pos-sible sex-specific difference should be explored in further studies. The data from the few partici-pants with diabetes are of interest, but we recog-nize that measurement of HOMA-IR is not an op-timal method to assess insulin resistance among persons with diabetes. We relied on self-reported dietary intake, but we validated the dietary assess-ment in two different dietary-assessment tools and used electronic questionnaires to minimize the amount of missing data. Finally, one might argue that the unique nature of the workplace in this study, which permitted a closely monitored di-etary intervention for a period of 2 years, makes it difficult to generalize the results to other free-living populations. However, we believe that simi-lar strategies to maintain adherence could be ap-plied elsewhere.

The strengths of the study include the one-phase design, in which all participants started simultaneously; the relatively long duration of the study; the large study-group size; and the high rate of adherence. The monthly measurements of weight permitted a better understanding of the weight-loss trajectory than was the case in previ-ous studies.

We observed two phases of weight change: initial weight loss and weight maintenance. The maximum weight reduction was achieved during the first 6 months; this period was followed by the maintenance phase of partial rebound and a plateau. Among all diet groups, weight loss was greater for those who completed the 24-month study than for those who did not. Even moderate weight loss has health benefits, and our find-ings suggest benefits of behavioral approaches that yield weight losses similar to those obtained with pharmacotherapy.29

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We distinguished between changes in levels of biomarkers (leptin, adiponectin, and high-sensi-tivity C-reactive protein) that are apparently related to loss of adipose tissue and changes in biomark-ers (triglycerides, HDL cholesterol, glucose, and insulin) that apparently reflect, in part, the effects of specific diet composition. The changes we ob-served in levels of adiponectin and leptin,30 which were consistent in all groups, reflect loss of weight. Consumption of monounsaturated fats is thought to improve insulin sensitivity,14,31,32 an effect that may explain the favorable effect of the Mediter-ranean diet on glucose and insulin levels. The results imply that dietary composition modifies metabolic biomarkers in addition to leading to weight loss. Our results suggest that health care professionals might consider more than one di-etary approach, according to individual preferences and metabolic needs, as long as the effort is sus-tained.

This trial also suggests a model that might be applied more broadly in the workplace. As Okie recently suggested,33 using the employer as a health coach could be a cost-effective way to improve health. The model of intervention with the use of dietary group sessions, spousal sup-

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port, food labels, and monthly weighing in the

workplace within the framework of a health pro-motion campaign might yield weight reduction and long-term health benefits.

Supported by the Nuclear Research Center Negev (NRCN), the Dr. Robert C. and Veronica Atkins Research Foundation, and the S. Daniel Abraham International Center for Health and Nutri-tion, Ben-Gurion University, Israel.

No potential conflict of interest relevant to this article was reported.We thank the 322 participants in the Dietary Intervention Randomized Controlled Trial (DIRECT) for their consistent co-operation, as well as the consultants and health care providers (Yitzhak Gurevitz, Hassia Krakauer, Meir Yoseffi, Meyer Aviv, Ilanit Asulin, Zvi Zur, Sapir Medikar, Haim Strasler, Avraham Shlonsky, Dr. Abby Bloch, and Dr. Ayala Canfi), the workplace

cafeteria managers (Naftali Tal, Yitzchak Chen, Yair Tubul, and the Norcate Company), the adviser researchers (Drs. Ofra Paz-Tal, Assaf Rudich, Amir Tirosh, Ilana Harman-Bohem, and

Ronit Andvelt), and the members of the DIRECT steering com-mittee (Prof. Shimon Weitzman, Prof. Uri Goldbourt, and Prof.

Eran Leitersdorf) for their invaluable contributions.References

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低碳水化合物膳食与肥胖

* 低碳水化合物膳食与肥胖 low carbohydrate diet and obesity 肥胖症的患病率和发病率无论在发达国家还是发展中国家都正以惊人的速度激增，并呈低龄化趋势，已成为当今全球性公共卫生问题，即仅次于吸烟的第2个可以预防的致死危险因素。肥胖、高血压、高血脂和高血糖并称为"死亡四重奏"。肥胖有可能成为21世纪的头号杀手，因此，WHO向全世界宣布："肥胖症将成为全球首要健康问题"。 2002年我国营养与健康状况调查发现，成人超重率22.8%，肥胖率7.1%，估计人数分别达到2亿和6000万；大城市成人超重率与肥胖率分别高达30.0%和12.3%，儿童肥胖率已达8.1%，与1992年全国营养调查资料相比，成人超重率上升39%，肥胖率上升97%。同时，我国作为发展中国家，肥胖发病率具有特殊性： 1)膳食模式从植物性食物为主转变为高脂、高糖食物，加之体力活动强度下降，而致超重肥胖患病率上升；其特点是超重率增长较快而肥胖症发病率尚较低； 2)肥胖症和营养不良同时存在，因营养不良而出生体重低的婴儿成年后更易发展成超重和肥胖。 1肥胖的原因肥胖症是能量摄入超过能量消耗导致体内脂肪积聚过多，达到危害健康程度的一种多因素引起的慢性代谢性疾病。这种潜在的疾病表现为不良的正能量平衡和体重增长。当机体的能量平衡处于自动稳定状态时，所对应该阈值的体重(体重调节点)受到多种可引起脂肪平衡变化因素的影响。肥胖原因相当复杂，涉及到遗传和环境诸多因素： (1)遗传因素：肥胖者常有家族史，有明显的家族聚集性。这一方面是因为家庭成员间存在某些相同的遗传基因：另一方面与他们处在相同的文化背景下，生活习惯、膳食模式和行为方式等易于相互影响。 (2)环境因素：主要是进食过多，特别是油煎、油炸和糖类食物；不良饮食习惯，加上膳食结构不合理；另外运动不足可使能量消耗降低，易发生肥胖，而肥胖者通常又不喜欢运动，两者互为因果。肥胖还与我们生活的社会环境密切相关。由于社会和经济的快速发展，使我们能更方便地接触到高脂肪、高能量食品，像麦当劳和肯德基食品。同时，交通的便利，如家用小汽车的增加、出租车的利用、高层建筑的增加以及可供人们安全步行及玩耍的场地减少等，都使人们运动与锻炼的机会大为减少。 2膳食管理方式及理论根据要把肥胖患者的体重降至正常并不现实，但人们意识到，任何体重下降都对健康有益，这已被列入《对亚太地区肥胖及其治疗的重新定义》肥胖治疗目标之一。肥胖治疗方法主要有饮食疗法、运动疗法、行为疗法、药物疗法以及手术疗法，前3种为肥胖治疗的基本方法。对于轻度和中度肥胖，一般都能取得一定的治疗效果，对于中度肥胖和恶性肥胖常需借助药物治疗和手术治疗。但无论如何，饮食治疗都是肥胖患者的首选方案和长久坚持的根本。因此，本文主要对目前流行的减肥饮食方案进行总结。

吃什么食物减肥最快还有营养

吃什么食物减肥最快.，还要有营养这个希望能帮到你： ⒈鸡蛋黄瓜吃一个礼拜可以瘦５-7公斤鸡蛋吃水煮蛋黄瓜生吃 ⒉苹果三日减肥法最好是夏苹果或者选用酸甜的不宜过甜三天只吃苹果可瘦⒊-⒌公斤 ⒊苹果加牛奶法吃两天第一天只吃苹果第二天喝牛奶[脱脂] 两天可瘦一公斤 ⒋蜂蜜三日法三天只喝蜂蜜不喝水可瘦⒊-⒋公斤 ⒌红豆法红豆煮成粥喝吃一个礼拜可减⒌-⒎公斤 ⒍黑米减肥与红豆法一样制作十天为一个周期可瘦⒋-⒍公斤 ⒎水煮芹菜把芹菜用水煮好后拌醋调均食用一周可减⒍-⒑斤只吃芹菜 ⒏海带减肥法拌醋食用可治疗便秘一周减⒌--⒏斤 ⒐过午不食法过了中午12点就不再进食一天一斤 ⒑葡萄减肥法一个星期只吃葡萄可瘦⒏-⒑斤 11十二日减肥法⒈-⒊天只吃水果和蔬菜[热量低于一千卡] ⒋-⒍天只和酸奶或脱脂奶] 最后⒍天两个混合起来吃分量不限⒈⒉天可减体重的12% 12黑咖啡减肥法一个礼拜中只喝黑咖啡可减⒎--⒑斤13在一个礼拜中选一天不进食一个月就可减⒋--⒍斤 13.此外，经典减肥胶囊，我感觉就不错，最起码没有副作用.效果也是非常好的。网上就可以看到，你可以试一下。成功就在眼前，努力前进吧！想快速减肥，一定要吃药吗？不，介绍30种快速减肥的饮食减肥法给大家，助你成功减掉肉肉。每次减肥两天。第三/四天恢复正常饮食，然后再开始两天。第一天：苹果两斤（五六个左右，最多不能超过七个）。注意：全天只能吃苹果，不能喝水，不能喝酸奶，不能吃任何东东！只吃苹果。吃的时候将苹果洗净，然后慢慢地一小口一小口吃。第二天：酸奶或脱脂牛奶1000ML（小于四斤）分成六七等份，每次喝一份。全天只喝牛奶。不能吃其它任何东东。特别连水都不能喝。渴了就只能喝牛奶。（也可牛奶、酸奶同时喝，

35种低碳水化合物食物清单

35种低碳水化合物食物清单作者晃悠的老xx 關注 2015.01.27 09:45字數3746閱讀1799評論6喜歡112讚賞2 碳水化合物一直是一个让人又爱又恨的东西，一方面你需要碳水化合物来给你提供身体所必须的燃料，另一方面它可以轻易的把你的6块腹肌变成一块肥肉。如果身体出现低能量，内脏和肌肉增长乏力这些迹象，就表明你最近你和高碳水化合物接触的过于亲密了，毫无疑问，如果你经常在超市目的不清的购物，往往都会被淀粉和精制碳水化合物引诱，然后让你远离天然食物，使你碳水化合物消费泛滥，导致身体缺乏蛋白质。要赢得这场战争的关键因素就是要让你的身体充满了低碳水化合物和蛋白质食物，同时还要富含重要的矿物质和维生素和未经加工的复杂碳水化合物，我们曾经列出过一份蛋白质食物的清单，那么今天就来看看低碳水化合物的清单，希望能为你的生活带来更多更好的营养建议。低碳水化合物蔬菜 1、西葫芦，碳水化合物含量：7克（中等大小）西葫芦是一个很好的蔬菜，非常适合低碳水化合物饮食，如果你拥有高超的厨艺，能够把它变成意大利面的替代品是最好的，注意，是替代高碳水化合物的意大利面条。做土豆饼添加它也可以减少面粉的用量。营养价值：虽然西葫芦不被人们认为是所谓的超级食品，但它含有一系列的基本营养素： xx B6、锰、钾、xx C2、菜花，碳水化合物含量：

每100xx5xx 菜花在营养界一直被誉为瘦淀粉，一旦蒸熟后，其特性完全可以代替土豆泥成为低碳水化合物的首选，甚至能加入到奶油汤和比萨饼里，做面食时也可以代替部分面粉，同时可以替代大米或其他主食。营养价值：作为十字花科芸薹属家族的一员与花椰菜和甘蓝为身体提供大量的抗氧化剂。 3、甜菜，碳水化合物含量：每100xx9xx 营养丰富，绿叶蔬菜应该作为低碳水化合物的首选添加到您的购物车中，甜菜也不例外。你可以蒸它或搭配肉丝炒制，味道非常不错，颜色也很好看。营养价值：提供大量的维生素K，在营养学杂志的一项研究发现，能够降低患癌症和心脏病的风险。 4、蘑菇，碳水化合物含量：每100xx3xx 从白色到小褐菇到更多异国情调的香菇，都是低碳水化合物的代表，但这些食用菌富含鲜美的味道。大而多肉的种类可以用作代替汉堡中的面包，或者洒进你最喜爱的比萨饼里面。营养的好处: 含有大量促进免疫的化合物。 5、芹菜，碳水化合物含量：1xx/根

表9 常见食物碳水化合物含量表

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21天减肥法—深度减肥什么是21天减肥法：21天减肥法，就是在21天内，通过控制饮食的份量和种类，控制进食时间等，不用依靠药物或运动而达到减肥的效果。21天共分三个阶段，分别是前3天断食阶段，中8天蔬果餐，后10天6成饱饮食。但这种减肥方法会有副作用，会一定程度上影响健康，应慎重采用，如果众人一起减肥效果会更好，不推荐使用任何的药物。 21天减肥法减重数 21天减肥法效果明显，如果不严格控制，效果因人因质会不同。控制效果好：20-30斤控制效果中：15-20斤控制效果差：10-15斤 21天减肥法饮食第一阶段——排毒阶段在体质正常情况下，一天饮水不少于2500毫升（切记：完全断食，只饮水）第二阶段——消脂阶段早、中、晚各一小盘放少许盐的水煮菜(豆腐、土豆淀粉质的除外，吃8成饱，多喝水)，上午和下午各一个中小个水果（切记：禁食主食，脂肪和甜食类）。第三阶段——巩固阶段正常饮食，但要半饱，也就是吃点就行，还要杜绝零食，晚餐最好是在下午5~6点之间，以后就不再吃任何食物。)能维持体重，如有回升可2个月后再次进行此法（切记：睡觉前5小时不进任何食物）。 21天减肥法好处 21天减肥法这个计划包括了营养均衡的膳食，规律的运动，同时强调了日常生活的行为改变。通过21天饮食运动的调整，形成一个健康的生活习惯，你收获的不仅是体重方面的变化，更是让你一辈子受益的健康的生活方式。 21天减肥法坏处采用了21天减肥法后，身体地比较虚弱，毕竟少了那么多斤，如此体质本来就是很虚，那会容易生病，最最重要的是，如果在两个月内秒不注意，就会反弹，而且反弹到原来的斤数，或是比原来的斤数更多，如果没有毅力和决心请慎用。

减肥正确的饮食方法一日三餐简易减肥食谱

减肥正确的饮食方法一日三餐简易减肥食谱减肥是女性们离不开的话题，采用节食的方法已是不可取的极端方法，那么有哪些饮食方法既能让人吃得饱也不发胖的呢?今天，为你带来了减肥正确的饮食方法。 1、烧烤后吃根香蕉烧烤类食品会产生较多的苯并芘等致癌物。军事医学科学院食品与营养系博士芮莉莉表示，最新研究发现，香蕉能在一定程度上抑制苯并芘的致癌作用，保护胃肠。 2、喝杯芹菜汁吃得太油腻，喝杯芹菜汁。芮莉莉介绍说，如果一餐中吃的油腻食物较多，喝杯糖分低、纤维素含量高的芹菜汁大有裨益。芹菜中的纤维素可以带走部分脂肪。 3、饭前服用一包膳食纤维膳食纤维能使人产生强烈的饱腹感，减少能量物质的摄取，同时增加胃肠的蠕动消化液的分泌，最终促进脂肪的溶解。

4、吃火锅后喝点酸奶火锅汤温度高，配料咸辣，对胃肠的刺激大。吃火锅后喝点酸奶，可以有效保护胃肠道黏膜。此外，酸奶中含有乳酸菌，可抑制腐败菌的生长。 5、饭后喝大麦茶或橘皮水消化不良，饭后喝大麦茶或橘皮水。大麦中的尿囊素和橘皮中的挥发油，可增加胃液分泌，促进胃肠蠕动，对食物的消化和吸收很有好处。 6、吃方便面后吃水果进食方便面后吃一点水果，如苹果、草莓、橙子、猕猴桃等，可以有效补偿维生素与矿物质的不足。此外，提倡煮食方便面。煮后的面条更柔软，有利于肠道吸收水分，帮助消化 7、吃蟹后，喝生姜红糖水蟹肉属寒性，脾胃虚寒的人吃后可能引发胃痛、腹泻、呕吐等。中华中医药学会医学博士庄乾竹博士表示，吃蟹后喝一杯性温的生姜

红糖水，能祛寒暖胃、促进消化、缓解胃部不适。但糖尿病患者不宜食用。高热量、密度的食物经过油烹调的食物，会提高60%～100%的热量，像炸、爆、煎、炒、油酥等食物。口味重的食物又酸、又甜、又辣、又咸的食物，通常都是高脂肪+高糖的混合体，会诱使你胃口大开，在不知不觉中多吃了。例如大碗的炸酱面、诱人的咕口老肉、宫爆鸡丁。过分精致的加工食品或速食加入大量奶油、糖、香料的蛋糕及西式点心;加了火腿、奶油、面粉、马铃薯、玉米的西式浓汤;汉堡、鸡块、奶昔、薯条及可乐，这类食品的热量相当高! 令人上瘾的食物

食物中的碳水化合物含量表

食物中的碳水化合物含量表主食：白糖99 红糖 93 藕粉 87 干粉条 84 团粉 82 蜂蜜 80 麦乳精 73 巧克力 66 蛋糕 65 牛乳粉 55 茶叶 52 大米76糯米 76 高粱米 75 青稞 72 小麦粉 72 玉米 72 面条 56 馒头 48 烙饼油条 47 米饭 25 燕麦66 荞麦 66 薏米 64 大麦 63 赤小豆 61 绿豆 59 豌豆 57 蚕豆 48 扁豆 40 黑豆 27 黄豆 25 腐竹15 牛奶 5 豆腐 2.8 豆浆 1.5 面筋 1.3 豆腐脑 0.5 水果：葡萄干79 干枣 73 干龙眼 65 干荔枝 56 熟栗子 45 乌梅 42 鲜枣 23 山楂 22 花生仁 22 甘蔗 21 香蕉 20 西瓜子20炒石榴 17 柿子 11 哈密瓜 9 芒果15 鲜龙眼 15 桑椹 14 苹果 13 橄榄 12 柚子 12 无花果 12 橙子 12 桔子 12 猕猴桃 11 桃11 鲜葡萄 11 葵花子 10炒核桃 10 椰子 10 李子 9 柠檬 9 菠萝 9 梨 9 樱桃 9 木瓜 8 草莓6 杨梅 6 枇杷 6 甜瓜 6 杏 5 西瓜 4

蔬菜：银耳78 平菇 70 木耳 66 黄花菜 60干冬菇 60 香菇 59 海带 56 紫菜 49 猴头菇 45 黑木耳 34 地瓜30 百合 29 海藻 29 慈菇 26 大蒜 24 山芋 22 荸荠 21 藕 20 蚕豆芽 20 土豆 17 莲子 16干山药14 黄花菜 12鲜芋头 12 蒜苗 10 姜 9 胡萝卜 8 洋葱 8 黄豆芽 7 香菜 7 水萝卜 7 毛豆 7 大葱6 马兰 6 冬笋 6 甜菜 6 四季豆 6 白萝卜 6 丝瓜 5 茭白 5 辣椒 5青尖芥菜 5 菜豆 5 空心菜 5 苋菜 5 春菜 4 刀豆 4 菜花 4 小葱 4 柿子椒 4青绿豆芽 4 圆白菜 3 芥蓝 3 韭菜 3 韭黄3 生菜 3 莴笋叶 3 龙须菜 3芦笋苤蓝 3 卷心菜 3 菠菜 3 茄子 3 苦瓜 3 雪里红 3 黄瓜 3 冬瓜2 芹菜 2 番茄 2 蘑菇 2 油菜 2 大白菜 2 小白菜 2 莴笋 2 南瓜 1 松蘑 0.4

《新英格兰》——低碳水化合物饮食、地中海饮食和低脂肪饮食减肥的对比研究

n engl j med 359;3 https://www.wendangku.net/doc/2c17731159.html, july 17, 2008 229 Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet Iris Shai, R.D., Ph.D., Dan Schwarzfuchs, M.D., Yaakov Henkin, M.D., Danit R. Shahar, R.D., Ph.D., Shula Witkow, R.D., M.P .H., Ilana Greenberg, R.D., M.P .H., Rachel Golan, R.D., M.P.H., Drora Fraser, Ph.D., Arkady Bolotin, Ph.D., Hilel Vardi, M.Sc., Osnat Tangi-Rozental, B.A., Rachel Zuk-Ramot, R.N., Benjamin Sarusi, M.Sc., Dov Brickner, M.D., Ziva Schwartz, M.D., Einat Sheiner, M.D., Rachel Marko, M.Sc., Esther Katorza, M.Sc., Joachim Thiery, M.D., Georg Martin Fiedler, M.D., Matthias Blüher, M.D., Michael Stumvoll, M.D., and Meir J. Stampfer, M.D., Dr.P.H., for the Dietary Intervention Randomized Controlled Trial (DIRECT) Group ABSTR ACT From the S. Daniel Abraham Center for Health and Nutrition, Ben-Gurion Uni-versity of the Negev, Beer-Sheva (I.S., D.R.S., S.W., I.G., R.G., D.F., A.B., H.V., O.T.-R.); the Nuclear Research Center Negev, Dimona (D.S., R.Z.-R., B.S., D.B., Z.S., E.S., R.M., E.K.); and the Depart-ment of Cardiology, Soroka University Medical Center, Beer-Sheva (Y.H.) — all in Israel; the Institute of Laboratory Med-icine, University Hospital Leipzig (J.T., G.M.F.); and the Department of Medi-cine, University of Leipzig (M.B., M.S.) — both in Leipzig, Germany; and Chan-ning Laboratory, Department of Medi-cine, Brigham and Women’s Hospital and Harvard Medical School, and the De-partments of Epidemiology and Nutri-tion, Harvard School of Public Health — all in Boston (M.J.S.). Address reprint requests to Dr. Shai at the S. Daniel Abra-ham International Center for Health and Nutrition, Department of Epidemiology and Health Systems Evaluation, Ben- Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel, or at irish@bgu.ac.il. This article (10.1056/NEJMoa0708681) was updated on December 30, 2009, at https://www.wendangku.net/doc/2c17731159.html,. N Engl J Med 2008;359:229-41. Copyright ? 2008 Massachusetts Medical Society. Background Trials comparing the effectiveness and safety of weight-loss diets are frequently limited by short follow-up times and high dropout rates. Methods In this 2-year trial, we randomly assigned 322 moderately obese subjects (mean age, 52 years; mean body-mass index [the weight in kilograms divided by the square of the height in meters], 31; male sex, 86%) to one of three diets: low-fat, restricted-calorie; Mediterranean, restricted-calorie; or low-carbohydrate, non–restricted-calorie. Results The rate of adherence to a study diet was 95.4% at 1 year and 84.6% at 2 years. The Mediterranean-diet group consumed the largest amounts of dietary fiber and had the highest ratio of monounsaturated to saturated fat (P<0.05 for all comparisons among treatment groups). The low-carbohydrate group consumed the smallest amount of car-bohydrates and the largest amounts of fat, protein, and cholesterol and had the highest percentage of participants with detectable urinary ketones (P<0.05 for all comparisons among treatment groups). The mean weight loss was 2.9 kg for the low-fat group, 4.4 kg for the Mediterranean-diet group, and 4.7 kg for the low-carbohydrate group (P<0.001 for the interaction between diet group and time); among the 272 participants who com-pleted the intervention, the mean weight losses were 3.3 kg, 4.6 kg, and 5.5 kg, respec-tively. The relative reduction in the ratio of total cholesterol to high-density lipoprotein cholesterol was 20% in the low-carbohydrate group and 12% in the low-fat group (P = 0.01). Among the 36 subjects with diabetes, changes in fasting plasma glucose and insulin levels were more favorable among those assigned to the Mediterranean diet than among those assigned to the low-fat diet (P<0.001 for the interaction among diabetes and Mediterranean diet and time with respect to fasting glucose levels). Conclusions Mediterranean and low-carbohydrate diets may be effective alternatives to low-fat diets. The more favorable effects on lipids (with the low-carbohydrate diet) and on glycemic control (with the Mediterranean diet) suggest that personal preferences and metabolic considerations might inform individualized tailoring of dietary in-terventions. (https://www.wendangku.net/doc/2c17731159.html, number, NCT00160108.) The New England Journal of Medicine Downloaded from https://www.wendangku.net/doc/2c17731159.html, on January 24, 2011. For personal use only. No other uses without permission. Copyright ? 2008 Massachusetts Medical Society. All rights reserved.

减肥正确的饮食方法

减肥正确的饮食方法减肥是女性们离不开的话题，采用节食的方法已是不可取的极端方法，那么有哪些饮食方法既能让人吃得饱也不发胖的呢?今天，为你带来了减肥正确的饮食方法。 1、烧烤后吃根香蕉烧烤类食品会产生较多的苯并芘等致癌物。军事医学科学院食品与营养系博士芮莉莉表示，最新研究发现，香蕉能在一定程度上抑制苯并芘的致癌作用，保护胃肠。 2、喝杯芹菜汁吃得太油腻，喝杯芹菜汁。芮莉莉介绍说，如果一餐中吃的油腻食物较多，喝杯糖分低、纤维素含量高的芹菜汁大有裨益。芹菜中的纤维素可以带走部分脂肪。 3、饭前服用一包膳食纤维膳食纤维能使人产生强烈的饱腹感，减少能量物质的摄取，同时增加胃肠的蠕动消化液的分泌，最终促进脂肪的溶解。 4、吃火锅后喝点酸奶火锅汤温度高，配料咸辣，对胃肠的刺激大。吃火锅后喝点酸奶，可以有效保护胃肠道黏膜。此外，酸奶中含有乳酸菌，可抑制腐败菌的生长。 5、饭后喝大麦茶或橘皮水

消化不良，饭后喝大麦茶或橘皮水。大麦中的尿囊素和橘皮中的挥发油，可增加胃液分泌，促进胃肠蠕动，对食物的消化和吸收很有好处。 6、吃方便面后吃水果进食方便面后吃一点水果，如苹果、草莓、橙子、猕猴桃等，可以有效补偿维生素与矿物质的不足。此外，提倡煮食方便面。煮后的面条更柔软，有利于肠道吸收水分，帮助消化 7、吃蟹后，喝生姜红糖水蟹肉属寒性，脾胃虚寒的人吃后可能引发胃痛、腹泻、呕吐等。中华中医药学会医学博士庄乾竹博士表示，吃蟹后喝一杯性温的生姜红糖水，能祛寒暖胃、促进消化、缓解胃部不适。但糖尿病患者不宜食用。让人长胖的10种食物高热量、密度的食物经过油烹调的食物，会提高60%～100%的热量，像炸、爆、煎、炒、油酥等食物。口味重的食物又酸、又甜、又辣、又咸的食物，通常都是高脂肪+高糖的混合体，会诱使你胃口大开，在不知不觉中多吃了。例如大碗的炸酱面、诱人的咕口老肉、宫爆鸡丁。过分精致的加工食品或速食加入大量奶油、糖、香料的蛋糕及西式点心;加了火腿、奶油、面粉、马铃薯、玉米的西式浓汤;汉堡、鸡块、奶昔、薯条及可乐，

“低碳水化合物-高营养密度”膳食模式_一种有效的减重膳食模式

“低碳水化合物-高营养密度”膳食模式：一种有效的减重膳食模式邓宇虹,曾婷,黎玉玲,叶小芳,廖玉梅广州医科大学附属第二医院目的评估一种减重膳食模式“低碳水化合物-高营养密度”在1-6个月的减重效果。方法入组了145名超重/肥胖患者，第一个月内将碳水化合物摄入限制在50克/天，此后逐渐增加碳水化合物比例，在第三个月时碳水化合物摄入达110克，同时3个月内的能量摄入为：在患者静息能量消耗结合其活动度推荐量的基础上，减少500kcal/天，在第1、2月还提供“代餐食品”代替高碳水化合物的主食；从第三个月起，不再限制热量和碳水化合物摄入，给予“高营养密度食物宝塔”教育，继续随访至6个月。以上措施均由营养师制作食谱指导患者实施，在6个月内保证了6次的面诊和10次的远程沟通(包括短信、电话、微信、邮件的形式)。另外鼓励患者增加运动。结果（1）失访率：第1个月为5% (8/145)，第3个月为25%(37/145)，第6个月为 32%(47/145)。（2）体重下降情况：第1个月平均体重下降3.77±1.76kg，第2个月平均体重下降6.67±3.5kg，第3个月平均体重下降7.85±4.12kg；减重在5-10%的患者在第1、3、6个月时分别为38.2%，43.5%，40.5%；减重>10%的患者在第3、6个月时分别为37.0%、44.6%。部分患者合并的代谢综合征有减轻。结论低碳水化合物-高营养密度”膳食模式是一种有效、可持续的减重膳食模式，值得推广，也需要更长时间的研究。膳食血糖负荷与糖尿病前期转归的相关性研究何凤怡,陈超刚,林刁珠,林秀红,袁智敏,严励中山大学孙逸仙纪念医院目的探讨不同膳食血糖负荷（GL）对糖尿病前期4年转归的影响，为糖尿病前期人群选择正确的膳食GL提供参考依据。方法研究对象来源于2011年参与我院社区2型糖尿病流行病学调查研究的队列人群，随机选取40-79岁且确诊为糖尿病前期的广州社区常住居民为研究对象，每2年对其进行随访，基线及随访调查内容包括人口特征学、膳食、体格检查和口服葡萄糖耐量试验。膳食调查采用连续3天24小时膳食回顾法，膳食GL采用2011年、2013年和2015年三次膳食调查的平均值，并经膳食能量校正。根据膳食GL三分位将研究对象分为低GL组（GL<84.4/1000kcal）、中GL组（GL 84.4- 98.5/1000kcal）和高GL组（GL≥98.6/1000kcal）。结果2011年纳入研究对象566人，其中502人（男172人，女330人）完成随访，随访率89%。三组基线空腹血糖（FPG）和糖耐量2小时血糖（2hPG）差异无统计学意义（P>0.05）。与基线值相比，低GL组随访FPG（5.55mmol/L vs 5.43mmol/L，P=0.03）和2hPG（8.82mmol/L vs 8.36mmol/L，P<0.01）明显降低，中、高GL组基线和随访FPG、2hPG差异均未见统计学意义（P>0.05）。4年随访转归为糖尿病者111人（22.1%），转归为正常糖耐量者185人（36.8%）。其中低、中、高GL组转归为糖尿病者分别28人（16.8%）、38人（22.6%）和45人（26.9%），转归为糖代谢正常者分别73人（43.7%）、54人（32.1%）和58人（34.7%）。Logistics回归分析显示，与低GL组相比，中、高GL组转归为糖尿病的风险均增加，校正后OR（95%CI）分别为1.45（0.84-2.52）和1.86（1.07-3.25）。结论膳食GL与糖尿病前期转归相关，在糖尿病前期阶段，高膳食GL增加转归为糖尿病的风险。 237

什么食物减肥又饱腹感,科学家发现低碳水或许更容易减肥

什么食物减肥又饱腹感，科学家发现低碳水或许更容易减肥说到饮食，很多人总是希望又能吃饱又能减肥，不管是什么食物都是有热量的，吃多长胖是必然。所以我们能做的，就是尽可能低的热量、充足的营养，增加蛋白质和脂肪的摄入，可是有的人明明吃很多了，还是感觉不到饱，会一直吃一直吃，直到吃到自己肚子里实在撑不下去了，才会考虑放弃不吃了，归根结底就是大脑饱腹感反馈机制太慢。必要的时候可以通过“HICIBI”智能生物减脂酶技术阻断淀粉类，减少热量摄入，控制餐后血糖，减低脂肪囤积。 2012年我国碳水化合物的建议量：每餐45-60克，但往往摄取超过75克，在西方国家75％营养师会推荐肥胖者使用“HICIBI”热量阻断剂，帮助控制碳水化合物的摄取，减少热量吸收-降低升糖指数 -减少淀粉-糖-脂肪的转化，其中的白芸豆提取物是唯一临床验证安~全性和功效性的食品，至今全球已有二十多篇超过 600位受试者的临床研究、期刊文献和引文支持：研究证明白芸豆提取物有~效减少 66% 淀粉吸收，获得美国FDA蕞高安~全认证和权~威宣称. 增加能~量消耗的方法

影响能~量消耗的因素很多。例如，运动后体重减轻和能~量消耗的补偿性减少也是体重减轻和容易反~弹的原因之一。除了运动，你怎么能增加能~量消耗？路德维希博士提出了碳水化合物 - 胰岛素模型。碳水化合物 - 胰岛素模型表明，高碳饮食可增加胰岛素分泌，促~进脂肪堆积，增加饥饿感并减少能~量消耗。换句话说，低碳饮食更有利于减~肥。然而，近期的一项分析显示低碳水化合物和低脂肪饮食之间的能~量消耗没有显着差异。在这方面，Ludwig博士认为纳入分析的研究时间太短，大多不到两周，而且身体需要两到三周的时间来适应低碳，高脂肪的饮食。低碳水化合物饮食导致胰岛素水平降低，这将导致肾脏从身体排出过多的水分，并且还会失去许多其~他矿物质。根据研究，“HICIBI”可以提供多种矿物质和微量元素，包括钙，镁，钾和铜，铁，所以它不仅更健康，而且还增加能~量消耗，更有利于减~肥。

35种低碳水化合物食物清单

35种低碳水化合物食物清单作者晃悠的老刘忙 2015.01.27 09:45 字數3746 閱讀179799評論6喜歡112讚賞2 碳水化合物一直是一个让人又爱又恨的东西，一方面你需要碳水化合物来给你提供身体所必须的燃料，另一方面它可以轻易的把你的6块腹肌变成一块肥肉。如果身体出现低能量，内脏和肌肉增长乏力这些迹象，就表明你最近你和高碳水化合物接触的过于亲密了，毫无疑问，如果你经常在超市目的不清的购物，往往都会被淀粉和精制碳水化合物引诱，然后让你远离天然食物，使你碳水化合物消费泛滥，导致身体缺乏蛋白质。要赢得这场战争的关键因素就是要让你的身体充满了低碳水化合物和蛋白质食物，同时还要富含重要的矿物质和维生素和未经加工的复杂碳水化合物，我们曾经列出过一份蛋白质食物的清单，那么今天就来看看低碳水化合物的清单，希望能为你的生活带来更多更好的营养建议。低碳水化合物蔬菜 1、西葫芦，碳水化合物含量：7克（中等大小）西葫芦是一个很好的蔬菜，非常适合低碳水化合物饮食，如果你拥有高超的厨艺，能够把它变成意大利面的替代品是最好的，注意，是替代高碳水化合物的意大利面条。做土豆饼添加它也可以减少面粉的用量。营养价值：虽然西葫芦不被人们认为是所谓的超级食品，但它含有一系列的基本营养素：维生素B6、锰、钾、维生素C 2、菜花，碳水化合物含量：每100克含5克

菜花在营养界一直被誉为瘦淀粉，一旦蒸熟后，其特性完全可以代替土豆泥成为低碳水化合物的首选，甚至能加入到奶油汤和比萨饼里，做面食时也可以代替部分面粉，同时可以替代大米或其他主食。营养价值：作为十字花科芸薹属家族的一员与花椰菜和甘蓝为身体提供大量的抗氧化剂。 3、甜菜，碳水化合物含量：每100克含9克营养丰富，绿叶蔬菜应该作为低碳水化合物的首选添加到您的购物车中，甜菜也不例外。你可以蒸它或搭配肉丝炒制，味道非常不错，颜色也很好看。营养价值：提供大量的维生素K，在营养学杂志的一项研究发现，能够降低患癌症和心脏病的风险。 4、蘑菇，碳水化合物含量：每100克含3克从白色到小褐菇到更多异国情调的香菇，都是低碳水化合物的代表，但这些食用菌富含鲜美的味道。大而多肉的种类可以用作代替汉堡中的面包，或者洒进你最喜爱的比萨饼里面。营养的好处: 含有大量促进免疫的化合物。 5、芹菜，碳水化合物含量：1克/根芹菜由大约95%的水构成，所以毫无疑问它是一个低碳水化合物食物，可以添加到沙拉里食用，或者只是涂一些黄油，其营养成分也秒杀加工过的碳水化合物零食。所以，你为何不像《急救男神》里的帅哥医生一样每天来一根呢？营养价值：获得额外剂量的维生素K，从而增强骨骼强度。6、樱桃番茄，碳水化合物含量：每100克含4克