Effects of ketogenic diet on vitamin D and glycolipid metabolism in overweight or obese patients with polycystic ovary syndrome
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摘要:目的 探讨生酮饮食对超重/肥胖多囊卵巢综合征(PCOS)患者血清维生素D及糖脂代谢的影响。方法 选取2021年6—12月在首都医科大学附属北京世纪坛医院妇科门诊就诊的超重/肥胖PCOS患者51例, 给予生酮饮食干预4周。比较患者干预前后体质量、维生素D以及糖脂代谢指标的变化。结果 生酮饮食干预4周后，患者维生素D水平从(16.37±5.67) ng/mL升高至(21.72±6.64) ng/mL, 维生素D水平不足或缺乏比率由82.35%降至45.10%, 差异有统计学意义(P < 0.01); 体成分分析显示，体质量[(81.11±11.23) kg与(75.32±10.58) kg]、体质量指数[(29.87±3.79) kg/m2与(27.75±3.68) kg/m2]、体脂率[(40.77±4.70)%与(37.88±5.14)%]、内脏脂肪面积[(163.25±38.76) cm2与(142.56±39.53) cm2]、腰臀比[(0.96±0.05)与(0.94±0.06)]均下降, 差异有统计学意义(P < 0.01); 糖脂代谢指标显示，空腹胰岛素[(18.59±8.86) μIU/mL与(11.43±4.90)μIU/mL]、空腹血糖[(5.57±1.90) mmol/L与(4.90±0.78) mmol/L]、胰岛素抵抗指数[(4.62±2.55)与(2.52±1.20)]、糖化血红蛋白[(5.70±1.06)%与(5.24±0.63)%]、甘油三酯[(1.68±0.86) mmol/L与(1.07±0.33) mmol/L]、高密度脂蛋白[(1.22±0.25) mmol/L与(1.07±0.21) mmol/L]均下降，差异有统计学意义(P < 0.01), 总胆固醇[(4.98±1.09) mmol/L与(4.80±0.91) mmol/L]、低密度脂蛋白[(3.42±1.02) mmol/L与(3.27±0.91) mmol/L]下降，但差异无统计学意义(P>0.05)。干预前，患者维生素D水平与腰臀比呈显著负相关(r=-0.289, P=0.039); 干预后，患者维生素D水平与腰臀比、内脏脂肪面积、空腹胰岛素、胰岛素抵抗指数均呈显著负相关(r=-0.361、-0.279、-0.329、-0.309, P < 0.05)。结论 生酮饮食可以在有效减重的同时提高患者维生素D水平，改善糖脂代谢，维生素D与糖代谢之间有相互协同作用。Abstract:Objective To explore the effects of ketogenic diet on serum vitamin D and glycolipid metabolism in overweight or obese patients with polycystic ovary syndrome (PCOS).Methods A total of 51 overweight or obese patients with PCOS from June to December 2021 in the gynecological clinic of Beijing Shijitan Hospital Affiliated to Capital Medical University were selected and conducted with ketogenic diet intervention for 4 weeks. Changes of body weight, vitamin D and glycolipid metabolism indexes before and after the intervention were compared in all the patients.Results After 4 weeks of ketogenic diet intervention, the level of vitamin D significantly increased from (16.37±5.67) ng/mL to (21.72±6.64) ng/mL, and the proportion of insufficient or deficient vitamin D significantly decreased from 82.35% to 45.10% in all the patients (P < 0.01); body composition analysis showed that the body mass [(81.11±11.23) kg versus (75.32±10.58) kg], body mass index[(29.87± 3.79) kg/m2 versus (27.75±3.68) kg/m2], body fat rate [(40.77±4.70)% versus (37.88±5.14)%], visceral fat area [(163.25±38.76) cm2 versus (142.56±39.53) cm2] and waist hip ratio [(0.96±0.05) versus (0.94±0.06)] decreased significantly (P < 0.01); the indexes of glycolipid metabolism showed that fasting blood glucose [(18.59±8.86) μIU/mL versus (11.43±4.90) μIU/mL], fasting insulin [(5.57±1.90) mmol/L versus (4.90±0.78) mmol/L], insulin resistance index [(4.62±2.55) versus (2.52±1.20)], glycosylated hemoglobin [(5.70±1.06)% versus (5.24±0.63)%], triglyceride [(1.68±0.86) mmol/L versus (1.07±0.33) mmol/L], high density lipoprotein [(1.22±0.25) mmol/L versus (1.07±0.21) mmol/L] decreased significantly in all the patients (P < 0.01), while the total cholesterol [(4.98±1.09) mmol/L versus (4.80±0.91) mmol/L] and low density lipoprotein [(3.42±1.02) mmol/L versus (3.27±0.91) mmol/L] showed no significant decrease (P>0.05). Before intervention, there was a significant negative correlation between vitamin D level and waist-hip ratio (r=-0.289, P=0.039); after the intervention, the level of vitamin D was significantly negatively correlated with waist-hip ratio, visceral fat area, fasting insulin and insulin resistance index in all the patients(r=-0.361, -0.279, -0.329 and -0.309, P < 0.05).Conclusion Ketogenic diet can effectively reduce weight and improve vitamin D level and glycolipid metabolism at the same time, and there is a synergistic effect between vitamin D and glucose metabolism.
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Keywords:
- ketogenic diet /
- vitamin D /
- glycolipid metabolism /
- polycystic ovary syndrome /
- obesity /
- insulin resistance index
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表 1 生酮饮食干预前后患者维生素D水平比较(n=51)(x±s)[n(%)]
指标 基线 干预4周后 维生素D/(ng/mL) 16.37±5.67 21.72±6.64** 维生素D营养状况 正常 9(17.65) 28(54.90)** 不足 33(64.70) 22(43.14)** 缺乏 9(17.65) 1(1.96)** 与基线比较, **P < 0.01。 
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表 2 生酮饮食前后患者体成分各项指标变化(n=51)(x±s)
体成分指标 基线 干预4周后 体质量/kg 81.11±11.23 75.32±10.58** BMI/(kg/m2) 29.87±3.79 27.75±3.68** 体脂率/% 40.77±4.70 37.88±5.14** 内脏脂肪面积/cm2 163.25±38.76 142.56±39.53** 腰臀比 0.96±0.05 0.94±0.06** BMI: 体质量指数。与基线比较, **P < 0.01。
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表 3 生酮饮食干预前后患者糖脂代谢指标变化(n=51)(x±s)
糖脂代谢指标 基线 干预4周后 空腹胰岛素/(μIU/mL) 18.59±8.86 11.43±4.90** 空腹血糖/(mmol/L) 5.57±1.90 4.90±0.78** 胰岛素抵抗指数 4.62±2.55 2.52±1.20** 糖化血红蛋白/% 5.70±1.06 5.24±0.63** 总胆固醇/(mmol/L) 4.98±1.09 4.80±0.91 甘油三酯/(mmol/L) 1.68±0.86 1.07±0.33** 高密度脂蛋白/(mmol/L) 1.22±0.25 1.07±0.21** 低密度脂蛋白/(mmol/L) 3.42±1.02 3.27±0.91 与基线比较, **P < 0.01。
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表 4 生酮饮食干预前后维生素D与体成分及糖脂代谢相关性分析结果
指标 干预前 干预后 r P r P 体质量 -0.075 0.603 -0.208 0.143 体质量指数 0.039 0.788 -0.154 0.280 体脂率 -0.132 0.358 -0.183 0.198 内脏脂肪面积 -0.169 0.235 -0.279 0.047 腰臀比 -0.289 0.039 -0.361 0.009 空腹胰岛素 -0.065 0.651 -0.329 0.018 空腹血糖 0.057 0.689 0.000 0.999 胰岛素抵抗指数 -0.037 0.798 -0.309 0.027 糖化血红蛋白 0.125 0.382 0.105 0.462 总胆固醇 -0.070 0.623 0.036 0.802 甘油三酯 0.036 0.801 -0.025 0.860 高密度脂蛋白 -0.079 0.582 0.078 0.586 低密度脂蛋白 -0.034 0.814 0.045 0.756
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