資料載入中.....
|
請使用永久網址來引用或連結此文件:
http://libir.tmu.edu.tw/handle/987654321/36263
|
| 題名: | 探討影響水果昇糖指數之因子並運用於第 2 型糖尿病患者對水果的選擇
Factors affecting the glycemic index of fruits and its application in fruits choice of type 2 DM patients |
| 作者: | 吳品青
Wu Pin-Ching |
| 貢獻者: | 保健營養學研究所
劉珍芳 |
| 關鍵詞: | 碩士
指導教授-劉珍芳
委員-詹貴惠
委員-鄭心嫻
水果;昇糖指數;糖含量;糖度;膳食纖維;第 2 型糖尿病
Fruit;Glycemic index;Sugar content;Brix level;Fiber amount;Type 2 diabetes mellitus |
| 日期: | 2010 |
| 上傳時間: | 2010-10-20 10:54:39 (UTC+8) |
| 摘要: | 糖尿病患者應該要有良好的血糖控制以延緩併發症的發生。飲食中的碳水化合物在血糖調控上扮演一個很重要的角色，而水果是富含碳水化合物的食物，但對於糖尿病患者在水果的選擇上仍未有定論。故本研究目的為，分析水果昇糖指數 (Glycemic index；GI) 及其相關因子，同時運用於第 2 型糖尿病患者做為選擇水果之依據。實驗第一部份招募年齡介於 19-25 歲的健康受試者，給予 18 種台灣常見水果進行測試。每次實驗在抽取空腹血液後，給予等量碳水化合物 (25 g) 之葡萄糖液或水果，並於 15 分鐘內吃完，接著抽取 30, 45, 60, 90, 120 分鐘的血液進行 PII (peak incremental indices) 及 GI 值的計算。同時分析水果中醣含量、糖度 (brix)、膳食纖維等影響因子及探討其與 GI 之相關性為何。實驗第二部份先進行問卷調查，以了解第 2 型糖尿病患者對於水果選擇的認知情形。並根據實驗第一部分及問卷結果選出 6 種水果，給予第 2 型糖尿病患者食用，利用餐後血糖計算 PII 及 GI 值，並與健康受試者之結果進行比對，及探討與問卷結果之差異。實驗第一部分結果發現，水果的 GI 值介於 14.9-106.1，最高的前 5 項水果為:葡萄、西瓜、文旦、龍眼、芒果，而聖女番茄最低；糖度介於 4.8-21.0，最高的前 5 項水果為:葡萄、香蕉、黃金奇異果、荔枝、綠奇異果，而聖女番茄最低；膳食纖維含量介於 1.6-7.8 (克/25公克總碳水化合物)，最高的前 5 項水果為:芭樂、聖女番茄、綠奇異果、柳丁、西瓜，而龍眼含量最低；a-glucosidase inhibitory activity 介於 11.8-82.3 (%)，最高的前 5 項水果為：綠奇異果、黃金奇異果、文旦、龍眼、香蕉，而芒果含量最低。在相關性分析結果顯示，GI 值與總醣量、糖度具有顯著正相關 (p <0.05)，而與膳食纖維含量具有顯著負相關 (p <0.05)。實驗第二部份結果發現， 159 份之第 2 型糖尿病患者問卷中，53.5% 患者認為部份水果不可食用，其中 96% 患者認為水果甜度會影響血糖，因此較甜的水果不適合食用。認為最適合食用的水果前 5 項為芭樂、奇異果、蕃茄、蘋果及火龍果；最不適合食用的水果前 5 項為荔枝、龍眼、釋迦、香蕉及芒果。第 2 型糖尿病患者與健康受試者在 PII 及 GI 值沒有差異，而健康受試者之水果 GI 值排序，與第 2 型糖尿病患者認知的可吃與不可吃之水果排序結果則不一致。故本研究結果顯示，第 2 型糖尿病患者可藉由健康受試者水果的 GI 值及相關因子做為選擇之依據，而在固定碳水化合物量的情況下，則以較低 GI 值、糖度及較高膳食纖維量者做為選擇之標準。
Purposes: The objectives of this study were (1) to analyze the GI value on different kinds of fruit and its affecting factors (2) to provide a guideline of fruits selection for Type 2 DM patients. Methods: In part 1, twenty healthy adults (19-25 y) were recruited and carried out the glycemic index (GI) measurement on 18 kinds of Taiwan common fruit. After an overnight fasting, subjects consumed the test fruit (25 g iso-carbohydrate) and then blood samples were taken at baseline, 30, 45, 60, 90, 120 min to calculate the PII and GI value. The relationship between the GI value and the affecting factors, such as sugar content, brix level and fiber amount were assessed. In Part-2, a questionnaire was given to type 2 DM patients to reveal their cognition on fruit choice. Six fruits from part 1 result were selected for the GI test of DM patients and the value was compared to healthy group. Result: In part 1, top 5 fruits with the highest GI value were: grapes, watermelon, pomelo, longan and mango, the lowest was tomato; brix level were: grapes, banana, golden kiwifruit, litchi and green kiwifruit the lowest was tomato; fiber content were: guava, tomato, green kiwifruit, sweet orange and watermelon, the lowest was longan; a-glucosidase Inhibitory activity were: green kiwifruit, golden kiwifruit, pomelo, logan and banana, the lowest was mango. There was a positive correlation between GI value with sugar content and brix level (r = 0.60 and r = 0.45, respectively; p <0.05), while was inversely related to fiber content (r = -0.41; p <0.05). In part 2, 53.5% of DM patients considered some fruits were non-edible and 96% of whom thought the major affecting factor of blood sugar is the sweetness of fruit. The top 5 edible fruits were guava, kiwifruit, tomato, apple and dragon-fruit; non-edible fruits were litchi, longan, sugarapple, banana and mango. Compared to healthy subjects, DM patients have similar PII and postprandial glycemic response of fruits; however, there was inconsistent with the sweetness. Conclusion: According to our study, the GI value of fruit in healthy subjects and its relative factors (brix level and fiber content) can provide a useful indicator for the selection of fruit of type 2 DM patients. |
| 關聯: | 90頁 |
| 描述: | 目錄
中文摘要 I
英文摘要 III
目錄 IV
表目次 VIII
圖目次 IX
第一章 前言 1
第二章 文獻回顧 3
第一節 第 2 型糖尿病的飲食控制與治療 3
第二節 昇糖指數 5
一、 GI 概論及其定義 5
二、 GI 值與糖尿病 7
三、 GI 值與胰島素 7
四、 GI 值與血脂 8
第三節 餐後血糖的重要性 10
第四節 水果的角色 12
一、 單醣及雙醣 12
二、 膳食纖維 13
三、 甜度與糖度 14
第五節 -GLUCOSIDASE INHIBITOR之介紹 15
第三章 動機與目的 16
第四章 實驗設計與研究方法 18
第一節 水果 GI 值測定及其影響因子之分析 20
一、 受試者之召募與條件 20
二、 水果糖度之測定與篩選 22
三、 水果 GI 值之測定 24
四、 相關因子之分析 25
第二節 探討第2型糖尿病患者對選擇水果的認知及水果 GI 值之分析 28
一、 問卷調查 28
二、 水果 GI 的測定 28
第五章 統計分析 31
第六章 實驗結果 32
第一節 實驗第一部份 32
一、 受試者基本資料 32
二、 各種水果的測定時間及基本特性 2
三、 水果 GI 值及其相關因子之關聯性 5
第二節 實驗第二部份 7
一、 第 2 型糖尿病患者問卷調查結果 7
二、 第 2 型糖尿病患者基本資料 10
三、 第 2 型糖尿病患者水果 GI 值之測定 12
第三節 健康受試者與第 2 型糖尿病患者比較 14
一、 餐後血糖反應、水果之 PII 及 GI 值的結果比較 14
二、 第一部份水果 GI 值及第二部份問卷結果比較 17
第七章 討論 18
第一節 水果 GI 值與相關因子之關聯性 18
一、 醣類與 GI 值之相關性 18
二、 膳食纖維與 GI 值之相關性 19
三、 α-glucosidase inhibitory activity 與 GI 值之關聯性 21
四、 不同季節對水果 GI 值的影響 22
五、 香蕉中澱粉的含量對血糖之影響 22
第二節 健康受試者與第 2 型糖尿病患者之比較 24
一、 健康受試者與第 2 型糖尿病患者餐後血糖反應之比較 24
二、 健康受試者與第 2 型糖尿病患者之水果的 PII 及 GI 值比較 25
三、 第 2 型糖尿病患者之水果選擇認知情形與健康受試者之水果 GI 值比較 25
第三節 糖度與甜度 27
第四節 臨床應用 28
第八章 結論 29
第九章 參考資料 30
附錄一 研究計畫執行許可書 38
附錄二 受試者知情同意書 39
附錄三 第 2 型糖尿病患者之問卷調查 44
附錄四 第 2 型糖尿病患者之綜合問卷 47
表目次
表一、健康受試者基本資料 42
表二、各種水果測定的月份 44
表三、水果基本特性 45
表四、第 2 型糖尿病患者基本資料 52
表五、第 2 型糖尿病患者水果 GI 值之測定 54
表六、健康受試者與第 2 型糖尿病患者之水果的 PII 值 57
圖目次
圖 一、各種水果的糖度 32
圖 二、水果 GI 值及其相關因子之關聯性 47
圖 三、第 2 型糖尿病患者認為最可吃之水果排序 49
圖 四、第 2 型糖尿病患者認為最不可吃之水果排序 50
圖 五、第 2 型糖尿病患者與健康受試者之水果的餐後血糖反應曲線 56
食品工業發展研究所與屏東科技大學 (1988) 台灣地區食品營養成份資料庫，pp.94-113，行政院衛生署，台北市。
Abdulrhman M, El-Hefnawy M, Hussein R, El-Goud AA (2009) The glycemic and peak incremental indices of honey, sucrose and glucose in patients with type 1 diabetes mellitus: effects on C-peptide level-a pilot study. Acta Diabetol 26 [Epub ahead of print].
American Diabetes Association (2008) Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 31: S61-78.
Atkinson FS, Foster-Powell K, Brand-Miller JC (2008) International tables of glycemic index and glycemic load values: 2008. Diabetes Care 31: 2281-3.
Belzer LM, Smulian JC, Lu SE, Tepper BJ (2009) Changes in sweet taste across pregnancy in mild gestational diabetes mellitus: relationship to endocrine factors. Chem Senses 34: 595-605.
Brennan CS (2005) Dietary fibre, glycaemic response, and diabetes. Mol Nutr Food Res 49: 560-70.
Chandalia M, Garg A, Lutjohann D, von Bergmann K, Grundy SM, Brinkley LJ (2000) Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. N Engl J Med 342: 1392-8.
Chareoansiri R, Kongkachuichai R (2009) Sugar profiles and soluble and insoluble dietary fiber contents of fruits in Thailand markets. Int J Food Sci Nutr 60: S126-39.
Chong MF, Fielding BA, Frayn KN (2007) Mechanisms for the acute effect of fructose on postprandial lipemia. Am J Clin Nutr 85: 1511-20.
Creutzfeldt W (1999) Effects of the alpha-glucosidase inhibitor acarbose on the development of long-term complications in diabetic animals: pathophysiological and therapeutic implications. Diabetes Metab Res Rev 15: 289-96.
Davidson MH, McDonald A (1988) Fibre: forms and functions. Nutr. Res 18: 617–24.
DeFronzo RA (1988) The Triumvirate: p-cell, muscle, liver: a collusion responsible for NIDDM. Diabetes 37: 667-87.
DeFronzo RA (2004) Pathogenesis of type 2 diabetes mellitus. Med Clin North Am 88: 787-835.
Du H, van der A DL, van Bakel MM, van der Kallen CJ, Blaak EE, van Greevenbroek MM, Jansen EH, Nijpels G, Stehouwer CD, Dekker JM, Feskens EJ (2008) Glycemic index and glycemic load in relation to food and nutrient intake and metabolic risk factors in a Dutch population. Am J Clin Nutr 87: 655-61.
Englyst KN, Liu S, Englyst HN (2007) Nutritional characterization and measurement of dietary carbohydrates. Eur J Clin Nutr 61: S19-39.
Hallfrisch J (1990) Metabolic effects of dietary fructose. FASEB J 4: 2652-60.
Harbis A (2004) Glycemic and insulinemic meal responses modulate postprandial hepatic and intestinal lipoprotein accumulation in obese, insulin-resistant subjects. Am J Clin Nutr 80: 896–902.
Harris PJ, Tasman-Jones C, Ferguson LR (2000) Effects of
two contrasting dietary fibres on starch digestion, short-chain
fatty acid production and transit time in rats. J. Sci. Food Agric 80: 2089–95.
Higgins JA, Brand Miller JC, Denyer GS (1996) Development of insulin resistance in the rat is dependent on the rate of glucose absorption from the diet. J Nutr 126: 596-602.
Hirsch IB, Brownlee M (2005) Should minimal blood glucose variability become the gold standard of glycemic control? J Diabetes Complications 19: 178-81.
Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA (2008) 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 359: 1577-89.
Jenkins DJ, Wolever TM, Taylor RH, Barker H, Fielden H, Baldwin JM, Bowling AC, Newman HC, Jenkins AL, Goff DV (1981) Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr 34: 362-6.
Jenkins DJ, Kendall CW, Augustin LS, Franceschi S, Hamidi M, Marchie A, Jenkins AL, Axelsen M (2002) Glycemic index: overview of implications in health and disease. Am J Clin Nutr 76: S266-73.
Juvonen KR, Purhonen AK, Salmenkallio-Marttila M, Lähteenmäki L, Laaksonen DE, Herzig KH, Uusitupa MI, Poutanen KS, Karhunen LJ (2009 ) Viscosity of oat bran-enriched beverages influences gastrointestinal hormonal responses in healthy humans. J Nutr 139: 461-6.
Karhunen LJ, Juvonen KR, Flander SM, Liukkonen KH, Lähteenmäki L, Siloaho M, Laaksonen DE, Herzig KH, Uusitupa MI, Poutanen KS (2010) A psyllium fiber-enriched meal strongly attenuates postprandial gastrointestinal peptide release in healthy young adults. J Nutr 140: 737-44.
Kim YM, Jeong YK, Wang MH, Lee WY, Rhee HI (2005) Inhibitory effect of pine extract on alpha-glucosidase activity and postprandial hyperglycemia. Nutrition 21: 756-61.
Krishnan S, Rosenberg L, Singer M, Hu FB, Djoussé L, Cupples LA, Palmer JR (2007) Glycemic index, glycemic load, and cereal fiber intake and risk of type 2 diabetes in US black women. Arch Intern Med 167: 2304-9.
Laaksonen DE, Toppinen LK, Juntunen KS, Autio K, Liukkonen KH, Poutanen KS, Niskanen L, Mykkanen HM (2005) Dietary carbohydrate modification enhances insulin secretion in persons with the metabolic syndrome. Am J Clin Nutr 82: 1218-27.
Lebovitz HE (1998) Postprandial hyperglycaemic state: importance and consequences. Diabetes Res Clin Pract 40: S27-8.
Lee BM, Wolever TM (1998) Effect of glucose, sucrose and fructose on plasma glucose and insulin responses in normal humans: comparison with white bread. Eur J Clin Nutr 52: 924-8.
Li X, Staszewski L, Xu H, Durick K, Zoller M, Adler E (2002) Human receptors for sweet and umami taste. Proc Natl Acad Sci USA 99: 4692-6.
Marangoni F, Poli A (2008) The glycemic index of bread and biscuits is markedly reduced by the addition of a proprietary fiber mixture to the ingredients. Nutr Metab Cardiovasc Dis 18: 602-5.
McKeown NM, Meigs JB, Liu S, Wilson PW, Jacques PF (2002) Whole-grain intake is favorably associated with metabolic risk factors for type 2 diabetes and cardiovascular disease in the Framingham Offspring Study. Am J Clin Nutr 76: 390-8.
McKeown NM, Meigs JB, Liu S, Saltzman E, Wilson PW, Jacques PF (2004) Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care 27: 538-46.
Meyer KA, Kushi LH, Jacobs DR Jr, Slavin J, Sellers TA, Folsom AR (2000) Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. Am J Clin Nutr 71: 921-30.
Montori VM (2008) Should patients with type 2 diabetes focus on glycemic control to reduce their cardiovascular risk? Pol Arch Med Wewn 118: 502-7.
Monzillo LU, Hamdy O (2003) Evaluation of insulin sensitivity in clinical practice and in research settings. Nutr Rev 61: 397-412.
Murakami K, Sasaki S, Takahashi Y, Okubo H, Hosoi Y, Horiguchi H, Oguma E, Kayama F (2006) Dietary glycemic index and load in relation to metabolic risk factors in Japanese female farmers with traditional dietary habits. Am J Clin Nutr 83: 1161-9.
Nalysnyk L, Hernandez-Medina M, Krishnarajah G (2010) Glycaemic variability and complications in patients with diabetes mellitus: evidence from a systematic review of the literature. Diabetes Obes Metab 12: 288-98.
Nilsson AC, Ostman EM, Granfeldt Y, Bjorck IM (2008) Effect of cereal test breakfasts differing in glycemic index and content of indigestible carbohydrates on daylong glucose tolerance in healthy subjects. Am J Clin Nutr 87: 645-54.
Parks EJ (2001) Effect of dietary carbohydrate on triglyceride metabolism in humans. J Nutr 131: S2772–4.
Parks EJ, Skokan LE, Timlin MT, Dingfelder CS (2008) dietary sugar stimulate fatty acid synthesis in adults. J Nutr 138: 1039–46.
Poppitt SD, van Drunen JD, McGill AT, Mulvey TB, Leahy FE (2007) Supplementation of a high-carbohydrate breakfast with barley beta-glucan improves postprandial glycaemic response for meals but not beverages. Asia Pac J Clin Nutr 16: 16-24.
Ramli SB, Alkarkhi AF, Yong YS, Easa AM (2009) The use of principle component and cluster analyses to differentiate banana pulp flours based on starch and dietary fiber components. Int J Food Sci Nutr 60: S317-25.
Riby JE, Fujisawa T, Kretchmer N (1993) Fructose absorption. Am J Clin Nutr 58: S748-53.
Rioux LE, Turgeon SL, Beaulieu M (2009) Effect of season on the composition of bioactive polysaccharides from the brown seaweed Saccharina longicruris. Phytochemistry 70: 1069-75.
Samanta A, Burden AC, Jones GR (1985) Plasma glucose responses to glucose, sucrose, and honey in patients with diabetes mellitus: an analysis of glycemic and peak incremental indices. Diabet Med 2:371–3
Schulze MB, Liu S, Rimm EB, Manson JE, Willett WC, Hu FB (2004) Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women. Am J Clin Nutr 80: 348-56.
Scribner KB, Pawlak DB, Ludwig DS (2007) Hepatic steatosis and increased adiposity in mice consuming rapidly vs. slowly absorbed carbohydrate. Obesity 15: 2190-9.
Scribner KB, Pawlak DB, Aubin CM, Majzoub JA, Ludwig DS (2008) Long-term effects of dietary glycemic index on adiposity, energy metabolism,and physical activity in mice. Am J Physiol Endocrinol Metab 295: E1126–31.
Semenkovich CF (2006) Insulin resistance and atherosclerosis. J Clin Invest 116: 1813-22.
Shim YJ, Doo HK, Ahn SY, Kim YS, Seong JK, Park IS, Min BH (2003) Inhibitory effect of aqueous extract from the gall of Rhus chinensis on alpha-glucosidase activity and postprandial blood glucose. J Ethnopharmacol 85: 283-7.
Shim WS, Kim SK, Kim HJ, Kang ES, Ahn CW, Lim SK, Lee HC, Cha BS (2006) Decrement of postprandial insulin secretion determines the progressive nature of type-2 diabetes. Eur J Endocrinol 155: 615-22.
Shimizu H, Uehara Y, Okada S, Mori M (2008) Contribution of fasting and postprandial hyperglycemia to hemoglobin A1c in insulin-treated Japanese diabetic patients. Endocr J 55: 753-6.
Soonthornpun S, Rattarasarn C, Leelawattana R, Setasuban W (1999) Postprandial plasma glucose: a good index of glycemic control in type 2 diabetic patients having near-normal fasting glucose levels. Diabetes Res Clin Pract 46: 23-7.
Teff KL, Elliott SS, Tschop M, Kieffer TJ, Rader D, Heiman M, Townsend RR, Keim NL, D'Alessio D, Havel PJ (2004) Dietary fructose reduces circulating insulin and leptin, attenuates postprandial suppression of ghrelin, and increases triglycerides in women. J Clin Endocrinol Metab 89: 2963-72.
Tokuyama Y, Ishizuka T, Matsui K, Egashira T, Kanatsuka A (2008) Predictors of glycemic control in Japanese subjects with type 2 diabetes mellitus. Metabolism 57: 453-7.
Trinidad TP, Valdez DH, Loyola AS, Mallillin AC, Askali FC, Castillo JC, Masa DB (2003) Glycaemic index of different coconut (Cocos nucifera)-flour products in normal and diabetic subjects. Br J Nutr 90: 551-6.
Ulmius M, Johansson A, Onning G (2009) The influence of dietary fibre source and gender on the postprandial glucose and lipid response in healthy subjects. Eur J Nutr 48: 395-402.
Weickert MO, Pfeiffer AF (2008) Metabolic effects of dietary fiber consumption and prevention of diabetes. J Nutr 138: 439-42.
Weir GC, Laybutt DR, Kaneto H, Bonner-Weir S, Sharma A (2001) Beta-cell adaptation and decompensation during the progression of diabetes. Diabetes 50: S154-9.
Wolever TMS, Chiasson JL, Hunt JA, Palmason C, Ross SA, Ryan EA (1998) Similarity of relative glycaemic but not relative insulinaemic responses in normal IGT, and diabetic subjects. Nutr Res 18: 1667–76.
Wolever TM, Mehling C (2002) High-carbohydrate-low-glycaemic index dietary advice improves glucose disposition index in subjects with impaired glucose tolerance. Br J Nutr 87: 477-87.
Xu J, Eilat-Adar S, Loria CM, Howard BV, Fabsitz RR, Begum M, Zephier EM, Lee ET (2007) Macronutrient intake and glycemic control in a population-based sample of American Indians with diabetes: the Strong Heart Study. Am J Clin Nutr 86: 480-7.
Yusof BN, Talib RA, Kamaruddin NA, Karim NA, Chinna K, Gilbertson H (2009) A low-GI diet is associated with a short-term improvement of glycaemic control in Asian patients with type 2 diabetes. Diabetes Obes Metab 2009 11: 387-96. |
| 資料類型: | thesis |
| 顯示於類別: | [保健營養學系暨研究所] 碩博士論文
|
文件中的檔案:
| 檔案 |
大小 | 格式 | 瀏覽次數 |
|---|
| index.html | 0Kb | HTML | 100 | 檢視/開啟 |
|
在TMUIR中所有的資料項目都受到原著作權保護.
|
