糖尿病核心更新 2026年2月

我们又迎来了一个出色的月份，本月的文章以《柳叶刀》上关于司美格鲁肽与心血管结局的研究开篇，该研究根据基线脂肪量和脂肪量变化进行了分析，这是SELECT试验的预设分析。

We have another great month, this month of articles starting with an article from The Lancet on semaglutide and cardiovascular outcomes looked at by baseline adiposity and changes in adiposity, and this is a prespecified analysis of the SELECT trial.

接下来，我们将查看《糖尿病护理》上的一项试验，探讨口服司美格鲁肽对2型糖尿病患者肾脏结局的影响。

Then we're gonna look at a trial from Diabetes Care on the impact of oral semaglutide on kidney outcomes in people with type two diabetes.

这项研究来自SOLE随机试验。

This is from the SOLE randomized trial.

此外，来自《糖尿病护理》的SODAS试验，研究了用饮用水替代人工甜味饮料对2型糖尿病患者血糖和体重指标的影响。

Then also from Diabetes Care, the SODAS trial, which is the effect of substituting water for artificially sweetened beverages on glycemic and weight measures in people with type two diabetes.

最后，一篇发表在《美国临床营养学杂志》上的文章，内容是——如果你或你的朋友还没试过，我不知道你们平时都在哪儿混——关于低碳水化合物饮食和宏量营养素替代对成年人心血管健康和身体成分的影响，这是对随机试验的荟萃分析，希望能解答我们常在患者咨询和日常对话中遇到的一些问题。

And finally, an article from the American Journal of Clinical Nutrition on something that, boy, if you or a friend hasn't tried, I don't know where you're hanging out, the effect of carbohydrate restricted diets and macronutrient replacements on cardiovascular health and body composition in adults, a meta analysis of randomized trials, hopefully addressing some questions that we have for patients and come up in casual conversations.

约翰，你来从第一项研究开始讲吗？

John, do you want to start with the first trial?

我们的第一篇文章来自《柳叶刀》

So our first article was from The

《柳叶刀》研究了司美格鲁肽对心血管结局的影响，依据基线脂肪量和脂肪量变化的测量结果，这是SELECT试验的预设分析。

Lancet and it looked at semaglutide and cardiovascular outcomes by baseline and changes in adiposity measurements, a pre specified analysis of the SELECT trial.

在这项研究中，患者的年龄至少为45岁，BMI至少为27。

So in this study, the patients were at least 45 years of age and had a BMI of at least twenty seven.

他们从41个国家的804个研究中心招募了患者，并将他们随机分配为每周接受一次司美格鲁肽2.4毫克或安慰剂，比例为1:1。

They enrolled patients from 41 countries at eight zero four sites, and they were randomized to one to one to weekly semaglutide two point four milligrams or placebo.

主要终点是首次发生主要不良心血管事件（MACE）的时间，包括心血管死亡、非致死性心肌梗死和非致死性中风的复合终点。

The primary outcome was time to first MACE, so that was the composite of cardiovascular death, non fatal MI, non fatal stroke.

脂肪量指标包括体重和腰围。

Adiposity measures included weight and waist circumference.

在本分析中，评估了20周后发生的MACE事件与患者前20周脂肪量变化之间的关系；另一项独立分析则评估了整个试验期间所有MACE事件与患者104周（两年）内脂肪量变化之间的关系。

In this analysis, of MACE occurring after twenty weeks was assessed between patients by adiposity changes in the first twenty weeks and the separate analysis, all in trial MACE were assessed between patients by adiposity changes over one hundred and four weeks or two years.

他们发现，在SELECT试验中纳入的超过17,000名患者中，司美格鲁肽显著降低了MACE的发生率，优于安慰剂。

So, what they found was semaglutide significantly reduced MACE incidents compared with placebo among over 17,000 patients enrolled in the SELECT trial.

在所有基线体重和腰围类别中，都观察到了一致的益处。

They found consistent benefits across all baseline weight and waist circumference categories.

在司美格鲁肽组的线性趋势分析中显示，较低的基线体重和腰围与较低的MACE发生率相关。

In the semaglutide group analysis for linear trends showed lower baseline body weight and waist circumference were associated with a lower incidence of MACE.

因此，每减少五公斤体重，风险降低4%，风险比为0.96；每减少五厘米腰围，风险比同样为0.96。

So a four percent reduction in risk per five kilogram lower body weight with a hazard ratio of 0.96 and a per five centimeter smaller waist circumference also with a hazard ratio of 0.96.

在安慰剂组中，较低的基线腰围与风险降低0.96相关，但体重则无显著关联，其风险比接近1，为0.99。

In the placebo group, lower baseline waist circumference, was associated with a lower risk of 0.96, but not body weight, which was really around one at 0.99.

较低的MACE风险与减重之间存在悖论，反而与较高的MACE风险相关。

Lower MACE risk and weight loss was paradoxically associated with increased MACE risk.

在接受司美格鲁肽治疗的患者中，20周时的减重与后续MACE风险之间无显著线性关联，但20周时腰围减少越多，MACE风险越低；而104周时腰围的减少则与整个试验期间MACE风险降低相关。

And those receiving semaglutide, there was no linear trend linking weight loss at twenty weeks to subsequent MACE risk, but greater waist circumference reduction at twenty weeks was associated with lower MACE risk and waist circumference reduction by one hundred and four weeks was associated with lower in trial risk of MACE.

估计观察到的MACE获益中有33%是通过腰围减少介导的，风险比为0.86。

An estimated thirty three percent of the observed benefit on MACE was mediated through waist circumference with a hazard ratio of zero point eight six.

尼尔？

Neil?

约翰，这简直太令人着迷了。

John, this is absolutely fascinating.

你知道吗，几年前SELECT试验刚公布时，那是一项极具里程碑意义的研究，显示在超重和肥胖且已确诊动脉粥样硬化性疾病的患者中，使用司美格鲁肽治疗可使MACE风险降低20%，这一结果持续了大约三年。

And you know, you remember a few years ago when the SELECT trial came out, that was and remains an incredibly pivotal trial showing a twenty percent decrease in MACE in people with overweight and obesity who also had established atherosclerotic disease and were treated with semaglutide, and that was over about three years.

当时的一个假设或问题是，这完全与减重有关。

Now the presumption at the time or the question at the time was that entirely related to weight loss.

现在显然有一部分确实如此，而这正是这项研究显示的结果。

Now clearly, some of it is, and that's what this trial shows.

但另一点发现是，还有其他因素在起作用。

But the other thing that turns out is that there's something else going on.

这并不仅仅关乎减重。

It's not just all about weight loss.

这项研究显示，约30%的心脏事件减少可归因于减重，主要是腰围的缩小，这反映了内脏脂肪，而内脏脂肪与心脏事件关系最为密切。

This trial showed that about thirty percent of the decrease in cardiac outcomes could be attributable to weight loss primarily to a decrease in, waist circumference, which reflects visceral fat, which is most closely tied to, cardiac outcomes.

但最近一项发表的研究也提示存在另一种多效性作用，该研究于五月在欧洲肥胖大会上公布，显示MACE的发生率在显著减重之前就已经开始下降，这表明司美格鲁肽必然具有其他重要的有益作用。

But the other study that came out recently that also suggests there's another pleiotropic effect going on was presented at the European Congress of Obesity in May that showed that MACE began to be lowered temporally before there was significant weight loss so that we see that semaglutide must be having other very important beneficial effects.

我们知道它能降低LDL，降低甘油三酯，降低血压，但这些效应，以及可能的其他多效性作用，才是除了减重之外真正导致心脏事件和MACE风险下降的原因。

We know it lowers LDL, we know it lowers triglycerides, we know it lowers blood pressure, but those effects and maybe additional pleiotropic effects are what actually, in addition to the weight that is lost, lead to the decrease in cardiac outcomes and the outcomes in MACE.

从临床角度看，我认为作为全科医生和内分泌科医生，我们有必要关注那些有中风或心肌梗死病史的患者，因为我经常看到许多患者在接受专科医生治疗时，并未被处方GLP-1受体激动剂——特别是司美格鲁肽——以降低未来MACE的风险，这为我们为已确诊ASCVD且超重或肥胖的患者提供干预机会提供了可能。

I'll say clinically, this is an area where I think we really, as primary care clinicians, endocrinologists, we need to be thinking about in our patients who have either stroke or MI, because I see a lot of people that are seeing our subspecialty colleagues that are not put on a GLP-one specifically semaglutide with the goal of decreasing future MACE and it gives us an opportunity to do so in people who have established ASCVD and also overweight or obesity.

我们的下一项研究来自《糖尿病护理》，题为《口服索马鲁肽对2型糖尿病患者肾脏结局的影响：SOUL随机试验的结果》。

Our next trial is from Diabetes Care titled The Impact of Oral Semaglutide on Kidney Outcomes in People with Type two Diabetes Results from the SOUL randomized trial.

这项亚组分析的目的是探讨口服索马鲁肽对2型糖尿病合并动脉粥样硬化性心血管疾病和/或肾脏疾病患者肾脏结局的影响。

The goal of this sub analysis was to examine the effects of oral semaglutide on kidney outcomes in people with Type two diabetes and atherosclerotic cardiovascular disease and or kidney disease.

SOUL试验是一项双盲随机对照试验，比较了口服索马鲁肽与安慰剂在2型糖尿病、ASCVD和/或CKD患者中的效果，结果显示主要不良心血管事件风险降低了14%。

The SELL trial was a double blind randomized controlled trial that compared oral semaglutide with placebo in people with type two diabetes, ASCVD, and or CKD, and it showed a fourteen percent reduction in the risk of major adverse cardiac events.

这一结果发布时引起了我们的高度关注，意义重大。

That was a big deal that we all were very attentive to when it came out.

预先指定的肾脏结局包括一个五项复合终点，即eGFR下降≥50%、持续性eGFR低于15、开始透析或因肾脏或心血管原因死亡，以及一个排除心血管死亡的四项复合终点。

Prespecified kidney outcomes that they then looked at included a five point composite, which was a greater than or equal to 50% decrease in EGFR, persistent EGFR that led to less than fifteen initiation of dialysis or death from kidney or cardiovascular causes and a four point composite that excluded cardiovascular death.

他们还分析了超过9600名参与者的估算肾小球滤过率（eGFR）下降情况。

They also looked at estimated GFR decline among over 9,600 participants.

入组时的平均eGFR为74，随访时间为47.5个月。

The mean entry eGFR was 74 and follow-up was forty seven and a half months.

口服索马鲁肽组和安慰剂组分别有8.4%和9%的参与者发生了五项复合终点事件。

The five point outcome occurred in eight point four percent and nine percent of participants taking oral semaglutide versus placebo respectively.

这没有显著差异。

That was not a significant difference.

四点结局在口服索马鲁肽组和安慰剂组中分别为2.3%和2.7%。

The four point outcome occurred in two point three versus two point seven percent.

同样，差异不显著。

Again, a not significant difference.

口服索马鲁肽组的平均每年eGFR下降幅度小于安慰剂组，p值小于0.0001。

The mean annual eGFR decline was less with oral semaglutide than with placebo with a p value of less than 0.0001.

这些效果在所有亚组中均相似。

And those effects were similar across all subgroups.

约翰？

John?

尼尔，我觉得这个结果挺有意思。

Neil, this one I think was interesting.

我认为，如果你要展望未来二十年基层诊所的诊疗重点，我们会花大量时间和精力来预防肾病的进展。

I think if you're going to look at what is going to play out in primary care offices over the next twenty years, we're gonna spend a lot of our time and energy really trying to prevent the progression of kidney disease.

而且未来关于心肾代谢综合征的讨论会越来越多，对吧？

And there's gonna be a lot more talk about cardio renal metabolic syndrome, right?

随着人们的肾脏功能恶化，他们的心血管疾病也会加重。

That as people's kidneys get worse, their cardiovascular disease gets worse.

这项研究实际上并没有关注微量白蛋白。

So, and this study really didn't look at microalbumin.

因此，你可以想象一个拥有良好糖尿病初级护理的大规模医疗系统，那里会有微量白蛋白和肾小球滤过率的检测数据，还有一批接受口服司美格鲁肽的患者，你可以对此进行研究。

So you could really imagine a large healthcare system with just good primary care of patients with diabetes, you're gonna have microalbumin and you're gonna have GFRs and you're gonna have a decent sized cohort of people who are on oral semaglutide, and you could look at this.

所以，我确实认为这值得单独开展一项研究，以明确这是否是我们用来减缓疾病进展的手段之一。

So, certainly I think this deserves its own study to really say, is this one of the bullets we're gonna have in our gun to decrease the progression?

注射用司美格鲁肽已有这一适应症，但我觉得这个结果挺有意思的。

The injectable semaglutide has that indication, but I think this is kind of interesting.

但我目前不会选择这种药物来宣称它能保护肾脏。

And I would not reach for this medicine right now to say this is gonna protect your kidneys.

根据这项MACE试验，我们现在有证据表明它能保护心脏，而从某种意义上说，这也能保护肾脏，反之亦然。

I think we have evidence now with this MACE trial that's gonna protect people's heart, which in certain ways does protect their kidneys and kind of vice versa.

所以我们已经走了一半，但我不会说这种药适合那些患有微宏观腹痛、我试图阻止其肾功能恶化的患者。

So, we're partway there, but I wouldn't say this would be the medicine for that patient who has micro macroabdomenorrhea that I'm trying to keep their kidney function getting worse.

我们的下一篇文章来自《糖尿病护理》，研究了用饮用水替代人工甜味饮料对2型糖尿病患者血糖和体重指标的影响。

Our next article is from Diabetes Care, and it looked at the effect of substituting water for artificially sweetened beverages on glycemic and weight measures in people with type two diabetes.

这项关于人工甜味饮料的研究，恰如其分地命名为SODAS，是一项随机试验。

The study of drinks with artificial sweeteners, aptly named the SODAS, a randomized trial.

这项SODAS试验在两家学术医疗中心进行，是一项随机双臂平行试验，包含两周的导入期和二十四周的主动干预期。

So this study, the SODAS trial, was conducted at two academic health centers, was a randomized two arm parallel trial with a two week run-in period and a twenty four week active intervention period.

研究对象为2型糖尿病患者，共有181名，糖化血红蛋白在6.5%至8.5%之间，年龄超过35岁，且经常饮用人工甜味饮料。他们被随机分为两组，持续二十四周，每天摄入24盎司：第一组为自行选择的商业人工甜味饮料（对照组），第二组则用无味的气泡水或非气泡瓶装/罐装水替代人工甜味饮料。

Patients who had type two diabetes, and there were one hundred and eighty one in total who had A1Cs between 6.5 and 8.5 who were over 35 years of age, who regularly consumed artificially sweetened beverages, were randomized to receive and consume either twenty four ounces daily for twenty four weeks, or either one, a commercial artificial sweetened beverage of choice, that'd be the control, or two, an unflavored sparkling or still bottled or canned water of choice in place of the artificial sweetened beverages.

研究结果在基线、第十二周和第二十四周进行收集。

The outcome measures were collected at baseline, twelve and twenty four weeks.

其中包括糖化血红蛋白。

They included A1C.

次要指标包括果糖胺、空腹血糖、胰岛素、体重以及连续血糖监测指标。

Secondary measures included fructosamine, fasting glucose, insulin, body weight, and continuous glucose monitoring metrics.

在这群患者中，有179人完整提供了24周的数据。

So of these patients, one hundred and seventy nine provided complete data over two forty one weeks.

从基线到24周，糖化血红蛋白的平均差异为0.29%，具有统计学显著性。

From baseline to twenty four weeks, the mean difference in A1C was 0.29, statistically significant.

水组的数值高于人工甜味剂组。

It was higher than the water arm compared with the artificial sweetener arm.

在次要临床指标上未观察到显著影响。

There were no significant effects on secondary clinical measures.

数据的趋势与主要结果一致。

Data were directionally consistent with the primary results.

尼尔？

Neil?

约翰，我非常喜欢这项研究，从我经常看到你喝的樱桃零度可乐来看，我知道你也一样。

John, I love this study and I know that you do too, judging from that Cherry Coke Zero that I often see you with.

你知道，这项研究真的非常引人入胜。

You know, this was absolutely fascinating.

关于人工甜味饮料，已经进行了大量研究，并引发了诸多争议。

There has been so much research and so much controversy with regard to artificial sweetened beverages.

所有将人工甜味饮料与含糖饮料进行比较的随机试验都显示，前者具有积极效果。

All of the randomized trials that have compared artificially sweetened beverages to sugar sweetened beverages show that it is positive outcomes.

前瞻性研究显示，饮用人工甜味饮料者体重会略有下降，并且其他指标也会改善。

You lose weight a little bit on an artificially sweetened beverage when looked at prospectively, and it improves other parameters.

然而，大型观察性队列研究却得出相反结论，表明饮用人工甜味饮料的人群肥胖和糖尿病发病率更高。

And this is contradicted actually by the large observational cohort studies that have shown that people who drink artificially sweetened beverages have a higher incidence of things like obesity and diabetes.

许多研究者，包括美国心脏协会在此议题上的指南，都认为——正如我所认为的那样——这些观察性研究很可能是由反向因果关系造成的，也就是说，那些体重管理困难的人更倾向于选择人工甜味饮料。

And a number of authors, and in fact, the American Heart Association guidelines on this topic, have felt that, as I do, that most likely those observational trials are the result of reverse causality, meaning that people who struggle with their weight tend to be the ones who pick artificially sweetened beverages.

因此，你可能会在这类人群中观察到肥胖和糖尿病等疾病的发病率更高。

And so therefore you might see a higher incidence of things like obesity and diabetes in that group.

这项研究以一种不同的方式、通过前瞻性随机设计来探讨这一问题：我们是否应该用人工甜味饮料或水来替代其他饮品？

This trial looked at that question in a different way, in a prospective, randomized way, and said, Hey, let's substitute either an artificially sweetened beverage or water, right?

水才是我们所有人都应该饮用的饮品。

Water is what we all should be drinking.

这很理想。

That's ideal.

他们发现，实际上几乎没有差别。

And what they found was there's essentially, I mean, not much difference.

是的，使用人工甜味剂饮料时，糖化血红蛋白略好一些。

Yeah, the A1C looked a little bit better with an artificially sweetened beverage.

不管这是否真实，在这项研究中确实是这样。

Whether or not that's true or not, it was in this study.

但我认为重要的启示是，人工甜味剂饮料并没有什么负面影响，这与其他相关研究结果一致。

But I think the important take home point is that there isn't a downside here of an artificially sweetened beverage, and this is consistent with other trials that have looked at this.

今年早些时候，《营养前沿》发表了一项针对九项随机试验的荟萃分析。

There was a meta analysis of nine randomized trials in frontiers in nutrition this past year.

大约三年前，《糖尿病护理》也发表过一项研究。

There was one in diabetes care about three years ago.

它们都指出，从前瞻性角度来看，将人工甜味剂饮料与含糖饮料相比，低热量或无热量饮料明显更优。

And they say the same thing, that when looked at prospectively, when you compare artificially sweetened beverages to sugar sweetened beverages, you are much better off with the low and no calorie beverages.

当你前瞻性地比较低热量和无热量饮料与水时，它们的效果大致相同。

When you compare prospectively low and no calorie beverages with water, they look about the same.

所以，约翰，我认为你可以安心，我也一样安心？

So, John, I think you can feel comfortable and so can I?

我也选择继续饮用——就我而言，是加了柠檬片的水，但有时也会喝那种人工甜味的可乐，并且确信我们采取的是健康的方式。

I'll opt in here too in continuing to both drink, in my case, water with a squeeze of lemon, but also sometimes that cola with with that's artificially sweetened and feel comfortable that we're we're having a healthy approach.

在我们的最后一篇文章中，我们将探讨发表于《美国临床营养学杂志》的一篇文章，标题为《低碳水化合物饮食及宏量营养素替代对成人心血管健康和身体成分的影响：随机试验的荟萃分析》。

For our last article, we are going to look at an article from the American Journal of Clinical Nutrition titled The Effect of Carbohydrate Restricted Diets and macronutrient replacements on cardiovascular health and body composition in adults, a meta analysis of randomized trials.

这里的背景是，低碳水化合物饮食被广泛推广用于改善心血管健康和身体成分，但不同饮食模式、人群和研究设计中的证据仍然不一致。

Here, the background was that, carbohydrate restricted diets are widely promoted for improving cardiovascular and body composition outcomes, yet the evidence remains mixed across different dietary patterns, populations, and study designs.

因此，作者对174项随机试验进行了荟萃分析，涵盖了来自27个国家的超过11,000人。

So the authors did a meta analysis of a 174 randomized trials that encompassed over 11,000 individuals from 27 countries.

符合条件的研究比较了低碳水化合物饮食。

Eligible studies compared carbohydrate restricted diets.

这里定义的低碳水化合物饮食是指碳水化合物供能比例不超过45%的饮食，与更高碳水化合物含量的饮食进行对比。

Now this was defined as less than or equal to 45% of energy from carbohydrates to higher carbohydrate con containing diets in adults.

他们还考察了不同类型的碳水化合物限制，包括不同程度的生酮饮食、低碳饮食和中等碳水饮食。

They also, looked at different types of carbohydrate restriction, different degrees, ketogenic diets, low carb, moderate carb.

因此，低碳水化合物饮食显著降低了甘油三酯约15%，收缩压降低2点，舒张压降低约1.25点，改善了多种血脂指标和炎症标志物，包括C反应蛋白；同时，高密度脂蛋白增加了约3点，低密度脂蛋白和胆固醇则适度上升了约4点。

So carbohydrate restricted diets significantly reduced triglycerides by about 15, systolic blood pressure by two points, diastolic blood pressure by about, one and a quarter points, various lipid profiles and inflammatory markers, including C reactive protein, though there and there was an increase in high density lipoprotein by about three, low density lipoprotein, and cholesterol though did increase modestly by about four points.

所有测量的身体成分指标在低碳水化合物饮食下均显示出显著下降。

All measured body composition markers showed significant reductions on carbohydrate restricted diets.

中等碳水饮食提供了均衡的益处，而生酮饮食则带来了更大的减重效果，但同时也导致了低密度脂蛋白和总胆固醇的更大上升。

Moderate carb diets offered balanced benefits, whereas ketogenic diets produced greater weight loss, but also greater increase in LDL and total cholesterol.

约翰？

John?

你知道吗，我对这个话题非常兴奋。

You know, I'm very excited by this topic.

所以我们得回到1863年，班廷医生。

So we have to go back to 1863, Banting and Doctor.

哈维。

Harvey.

但并不是那位医生。

But it wasn't that Doctor.

哈维，是另一位医生。

Harvey, it was a different Doctor.

英国的哈维，是一位耳鼻喉科医生。

Harvey in England who was an ENT.

这也不是我们所熟知的胰岛素发现者班廷。

And it wasn't the Banting we think about for insulin.

尽管这位班廷患者是六十后发现胰岛素的弗雷德里克·班廷的远房亲戚。

Although this patient Banting is a distant relative of Frederick Banting who discovers insulin sixty years later.

所以这位班廷先生听力有困难。

So this guy Banting is having trouble with his hearing.

他是一名殡葬师。

He is an undertaker.

他是个体型魁梧的人。

He's a heavy guy.

他去看医生，哈维医生。

He goes to his doctor, Doctor.

哈维告诉他，听力问题是因为太胖了，建议他避免吃土豆、啤酒、糖和黄油，于是他开始执行这个饮食计划。

Harvey, who tells him he's having trouble hearing because he's too fat, and recommends a diet that stays away from potatoes, that stays away from beer, that stays away from sugar and butter, and he goes on this diet.

而且，哈维医生。

And Doctor.

哈维曾经听说过类似这样的饮食方法。

Harvey had heard some whisperings of a diet like this.

他曾在欧洲参加过一个关于糖尿病的会议。

He was somehow at a conference that was talking about diabetes somewhere in Europe.

于是，班廷开始执行这个饮食计划，减掉了大量体重，并撰写了第一本饮食书《论肥胖》，这本书变得相当流行。

So, Banting goes on this diet and loses a lot of weight, and he writes the first diet book called Letters on Corpulence and it becomes kind of a big hit.

‘班廷’这个词一度成为节食的代名词，节食就叫‘班廷’，这种说法迅速流行开来，并持续了大约六十年。

The term 'banting' was synonymous with diet, going on a diet dieting was 'banting' and that really kind of struck this off and that lived for, you know, about sixty years.

到了20世纪20年代，发生了几件不同的事情。

We get into the 1920s and a couple different things happened.

在20世纪20年代，治疗癫痫的人发现低碳水化合物饮食可以减少癫痫发作的复发。

In the 1920s, the people who take care of epilepsy kind of found that low carbohydrate diets decreased the recurrence of seizures.

天啊，这在我职业生涯中从未听说过，但如果你现在去美国癫痫协会，他们会说低碳水化合物饮食可能只对那些对药物治疗无效的儿童癫痫患者有效。

Boy, that's something I've not heard about in my career, but if you were to go to the American Epilepsy Association right now, they would talk about low carbohydrate diets may be effective in children only, who might have seizure disorders that are resistant to medications.

这怎么样？

How about that?

同样在20世纪20年代，1926年有一篇论文发表在《美国医学会杂志》上，作者前往阿拉斯加，观察了因纽特人群体，他们饮食中约90%是鱼类和肉类，发现他们健康状况极佳，这项研究的证据至今未被推翻。

Also in the 1920s, there is a paper in 1926, one hundred years ago in Jama, travels to Alaska and observes the Inuit population who eat mostly fish and meat, about 90% of their diet, and really kind of how well they do, and really the evidence out of that diet, that study has never been refuted.

所以，一百年前发表在《美国医学会杂志》上、关于阿拉斯加因纽特人以及其他北美、冰岛、格陵兰等地区人群的饮食研究，并未显示这些饮食有害。

So, a one hundred year old study on diet in Jama, on the Inuit population in Alaska and other parts in kind of North America, Iceland Greenland kind of area did not show that.

接着，这引出了杜邦公司。

Also then that leads to the DuPont company.

杜邦公司注意到他们的高管们体重增加了。

So the DuPont company had noticed that their executives were getting heavy.

于是他们聘请了一位医生来研究此事，这位医生发现了班廷的某些数据，也看到了其他一些研究结果，于是开始让杜邦公司的高管们采用低碳水化合物饮食，这被称为杜邦试验或杜邦饮食，此后大约过去了四十年。

So they put a doctor on that and he found some of this data from Banting and he saw some of this other data, and he started putting the executives who worked for the DuPont Company on low carbohydrate diets, became known as the DuPont trial, the DuPont diet, and then kind of forty years passes.

然后是一位医生。

And then a Doctor.

阿特金斯，医生。

Atkins, Doctor.

阿特金斯是一位心脏病专家，也是一位生活方式医生，他在六十年代时诊所遇到困难，有点抑郁，像我们大多数人一样，情绪低落时就吃了一些不健康的食物，发现自己体重增加，于是发现了这些内容，并创立了阿特金斯饮食法，该饮食法于1972年出版。

Atkins was a cardiologist, a lifestyle doctor who was having trouble with his practice in the sixties, got a little depressed, did what most of us do when we're a little depressed, we eat some of the wrong stuff, down himself being heavy and really discovered some of this stuff and started the Atkins diet, which was published in 1972.

因此，这种饮食方式的历史非常悠久，早在南北战争结束之前就有人在尝试了。

So, that's this long history that predates the end of the civil war of people trying to do this for diets.

它当然可能取得一些成功。

Certainly it can have some success.

我们肯定见过这种效果，即使自己没有亲身体验过，也肯定在患者身上看到过。

We've certainly seen that if we haven't experienced that personally, we've certainly seen it in patients.

我认为它有很多奠基人。

And I think it has many fathers.

我认为远离某些食物确实有其道理。

And I think there is something to be said about staying away from certain things.

而且，如果你和我经过办公室的咖啡机时，人们拿来当零食的东西大多是碳水化合物。

Also, if you and I walk by the coffee machine in our office, the stuff that people bring in to snack on tends to be a lot of carbohydrates.

没人会把香肠之类的东西放在咖啡机旁边，但这种饮食确实有一定效果。

No one's bringing in baloney to put by the coffee machine and things like that, but certainly it's had some efficacy.

那么，结合这个背景，这项研究中发现了哪些结果呢？

So how about some of the stuff they found in this particular trial with that as a background?

当然，减重与降低甘油三酯水平是相关的，对吧？

Well, certainly weight loss can be associated with lowering triglycerides, right?

如果你深入分析数据，会发现女性的心血管反应更好。

And if you look, if you dig into the data, they showed better kind of cardiovascular responses in women.

如果你看弗雷明汉研究的数据，那些甘油三酯水平下降的人群中，死亡率降低最显著的是那些HDL偏低、甘油三酯在150到300范围内的女性。

Well, if you look at the Framingham trial, the data in the Framingham trial, the people who had lowering triglycerides had the biggest impact on mortality, were women with a low HDL and a triglyceride in that 150 to 300 range.

因此，对于女性而言，甘油三酯是比男性群体更大的风险因素，甚至有些甘油三酯极高的人，如高甘油三酯血症，并不完全与心血管疾病相关，还有其他很多因素。

So, women, triglycerides is a little bit more of a risk factor than it would be in a male population and even some of those people who have very high triglycerides, chole micro anemia, isn't completely associated with cardiovascular disease, lots of other stuff.

所以，降低甘油三酯水平肯定是有帮助的。

So, lowering triglycerides certainly could help.

你看到一点了，就是提高HDL。

You saw a little bit, so raising HDL.

如果你看WHO试验，另一个试验，每提高一个人的HDL一个点，这是一项吉非罗齐试验，但每提高一个点，心血管死亡率大约下降百分之六。

And if you look at the WHO trial, a different trial for every point you raise someone's HDL, and this was a gemfibrozil trial, but for every point you raise someone's HDL, decrease cardiovascular mortality by about six percent.

所以，它提高了HDL，降低了所有炎症标志物。

So, it raised HDL, it lowered all the inflammatory markers.

那这个LDL上升呢？

What about this LDL rising?

我们是不是在解决一个问题的同时又引发了另一个问题？

Are we, you know, fixing one thing and causing another?

如果你看一些鱼油试验，鱼油在足够高的剂量下常被用来降低甘油三酯，它们确实已知会升高LDL，但你知道，并不是所有的LDL都一样。

Well, if you look at some of the trials of fish oils, fish oils often can be used if you use high enough doses to lower triglycerides and they have been known to increase LDL, but you know, not all the LDL are the same.

所以，如果你把那些微小的、致动脉粥样硬化的LDL转化为正常、更蓬松、致动脉粥样硬化性更低的LDL，你的LDL总量可能会增加。

So, if you have little teeny atherogenic LDL that you kind of convert into normal, more fluffy, less atherogenic LDL, you might have an increase in LDL.

所以，我认为这个问题我们可以和人们讨论一下。

So, I think this is something that we can talk about with people.

我认为，从低碳饮食的角度来看世界，最重要的一点是，我们生活中碳水化合物的份量已经发生了巨大变化。

I think one of the things with looking at the world through a lower carbohydrate lens, think is really how portion sizes have changed with regard to carbohydrates in our life.

如果你吃一个快餐汉堡，它看起来并不比1972年时大多少。

If you ate a fast food hamburger, it certainly doesn't seem any bigger than it did in 1972.

但饮料的容量却变得越来越大。

But the size of the soda has gotten bigger and bigger.

麦当劳刚开业时，最小的饮料是10盎司。

McDonald's opened, the smallest soda was 10 ounces.

现在最小的饮料已经是22盎司了。

Now the smallest soda is 22 ounces.

如果你看看薯条、通心粉奶酪或任何其他食物的份量，我们都在大幅增加碳水化合物的摄入。

If you look at the size of fries or the size of mac and cheese or the size of anything, we are so super sizing carbohydrates.

而且，如果你看看美国糖尿病协会的指南，它们并没有建议人们完全不吃碳水化合物，可能人们还是需要摄入一点。

And if you look at kind of ADA guidelines, they don't really say that people should have no carbohydrates, and probably people need to have a little bit.

在这项研究中，那些摄入适量碳水化合物的人在各项指标上表现最好，但也许我们可以像之前提到的那样，避免含糖饮料，或者和家人分一份薯条，只吃几根。

If we looked at in this study, the people who had a modest amount of carbohydrate probably did best in all the different metrics, but, you know, maybe we can avoid that sweetened soda as we heard about earlier, maybe we could split a fry with the family and have a couple of fries.

也许我们可以多在盘子里放些蔬菜。

Maybe we could put a lot more vegetables on our plates.

也许我们可以吃一些瘦肉蛋白。

Maybe we could have some lean pieces of protein.

我认为，当我们审视当前饮食界的情况时，确实有越来越多的声音在提倡每餐都摄入更多瘦蛋白来源。

I think as we look at kind of what is happening in the diet world, there certainly are more voices that are talking about us having more lean sources of protein at every meal.

当然，这也符合我们最近看到的政府新指南，强调确保摄入足够的蛋白质，减少购买超市中间区域的加工食品。

And certainly some of that is in keeping with some of the newer guidelines that we're seeing from the government really talking about making sure we're getting enough protein and not as much stuff in the middle of the grocery store.

所以，这里有一些有趣的内容。

So, think there's some interesting stuff here.

我很感激你给我这篇文章，让我能重新回顾这段历史，以便更好地帮助患者。但我认为，凡事适度是有道理的，我们确实需要蛋白质，尤其是随着你我年龄增长，每餐都摄入一些瘦蛋白来源可能非常有意义。

I love, thank you for giving me this article so I could kind of take that dive back in history, but so it can be helpful to patients, but I think having a little bit of moderation in everything makes some sense, but we do need protein and having some lean sources of protein possibly at every meal, especially as you and I get older might make a whole lot of sense.

如需了解更多信息及我们讨论过的文章链接，请访问 diabetesjournal.org。

For more information and links to the articles that we discussed in this issue, just go to diabetesjournal.org.

下个月再见，继续收听。

Until next month, keep listening

继续学习。

and keep learning.