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1、 推荐意见 推荐 级别 证据 1 对于所有患有糖尿病或有罹患糖尿病风险的超重个体， 应建议减轻体重 A RCT研究、 指南推荐 2 在超重和肥胖的胰岛素抵抗的个体中，适当地减轻体重 可以改善胰岛素抵抗 A RCT研究、 Meta-分析 3 低碳水化合物或低脂肪的限制能量的饮食在短期内（1年 内）可有效减轻体重 BRCT 4就减重效果而言，限制能量摄入较营养素比例更关键B RCT、 Meta-分析 5 低碳水化合物饮食患者，应当监测血糖、血脂、肾功能 、蛋白质摄入情况（对于伴有肾病的个体），必要时调 整降糖措施 D专家意见 6 个体化的饮食计划应该包括食物选择的优化，符合中国 居民膳食推荐摄入量
2、，以获得各种营养素合理摄入 D专家意见 7 不推荐2型糖尿病患者长期接受极低能量（总能量12）时，游离果糖不会对血清甘油三酯产生不利影响 Fructose RecommendationEvidence rating People with diabetes should limit or avoid intake of SSBs (from any caloric sweetener including high fructose corn syrup and sucrose) to reduce risk for weight gain and worsening of cardiometa
3、bolic risk profile. B 强调糖尿病患者应限制或避免摄入含糖饮料（即含有能量型甜味剂， 包括高果葡糖浆和蔗糖），以降低体重增加的风险和心血管代谢的负 担 NNSs and hypocaloric sweeteners RecommendationEvidence rating Use of NNSs has the potential to reduce overall calorie and carbohydrate intake if substituted for caloric sweeteners without compensation by intake of
4、additional calories from other food sources. B 在不从其他食物中摄取额外能量的情况下，使用非能量型甜味剂 来替代能量型甜味剂，则有助于减少总能量和碳水化合物的摄人。 对于肾功能正常的糖尿病患者，基于目前的研究证据，有利于血糖控 制或降低心血管风险的理想蛋白质摄人量尚无定论，因此需结合个体 情况制定蛋白质摄入目标。 RecommendationEvidence rating For people with diabetes and no evidence of diabetic kidney disease, evidence is inconclu
5、sive to recommend an ideal amount of protein intake for optimizing glycemic control or improving one or more CVD risk measures; therefore, goals should be individualized. C 蛋白质 对于糖尿病肾病患者（包括微量和大量蛋白尿），均不建议将蛋白质 的摄入量减少至正常水平以下（0.8 g/kgd），因为目前证据未能证明 单纯低蛋白饮食可改善血糖、降低心血管疾病风险及改善肾小球滤过 率（GFR） RecommendationEvid
6、ence rating For people with diabetes and diabetic kidney disease (either micro- or macroalbuminuria), reducing the amount of dietary protein below usual intake is not recommended because it does not alter glycemic measures, cardiovascular risk measures, or the course of GFR decline. A 蛋白质 2型糖尿病患者摄入优
7、质蛋白质可能有助提高胰岛素应答，却不升高血 糖水平。因此，蛋白含量高的碳水化合物不能用于治疗或预防低血糖 RecommendationEvidence rating In individuals with type 2 diabetes, ingested protein appears to increase insulin response without increasing plasma glucose concentrations. Therefore, carbohydrate sources high in protein should not be used to treat
8、or prevent hypoglycemia. B 蛋白质 糖尿病患者适合的每日总脂肪推荐摄人比例仍无定论。美国医学研究所（IOM） 提出正常成年人膳食脂肪摄人在20-35时，冠心病及肥胖的发病风险最 低。然而，这一建议并非针对糖尿病患者，由于目前研究证据有限，仍需结合 个体情况制定摄人目标。 从已有的研究来看，脂肪的质要比量重要。 RecommendationEvidence rating Evidence is inconclusive for an ideal amount of total fat intake for people with diabetes; therefore,
9、 goals should be individualized. Fat quality appears to be far more important than quantity C，B Total fat 高单不饱和脂肪酸（MUFA）饮食，一种地中海饮食模式，可改善血糖控制并 降低心血管疾病风险。MUFA饮食可作为低脂肪，高碳水化合物饮食模式的一 种有效的替代方法 RecommendationEvidence rating In people with type 2 diabetes, a Mediterranean-style, MUFA- rich eating pattern ma
10、y benefit glycemic control and CVD risk factors and can therefore be recommended as an effective alternative to a lower-fat, higher-carbohydrate eating pattern. B MUFAs/PUFAs 对于糖尿病患者，尚无明确证据支持-3 （EPA与DHA）补充剂对预防 或者治疗心血管事件有益。 RecommendationEvidence rating Evidence does not support recommending omega-3
11、(EPA and DHA) supplements for people with diabetes for the prevention or treatment of cardiovascular events. A Omega-3 fatty acids 与针对普通人群的建议一致，推荐糖尿病患者多摄入含有长链-3脂肪酸 （含脂肪多的鱼中EPA及DHA）和-3亚麻酸（ALA）的食物。观察性研究显 示它们对脂蛋白和预防心脏病有益 RecommendationEvidence rating As recommended for the general public, an increase i
12、n foods containing long-chain omega-3 fatty acids (EPA and DHA) (from fatty fish) and omega-3 linolenic acid (ALA) is recommended for individuals with diabetes because of their beneficial effects on lipoproteins, prevention of heart disease, and associations with positive health outcomes in observat
13、ional studies. A Omega-3 fatty acids 同普通人群一样，推荐糖尿病患者每周至少吃两次（两份）鱼（尤其 是含脂肪多的鱼，如三文鱼等）。 RecommendationEvidence rating The recommendation for the general public to eat fish (particularly fatty fish) at least two times (two servings) per week is also appropriate for people with diabetes. B Omega-3 fatty a
14、cids 少数随机对照研究显示每日摄入1.63.0g膳食来源的植物甾烷醇或植 物固醇对糖尿病和血脂异常患者降低总胆固醇和低密度脂蛋白可能有 益 RecommendationEvidence rating Individuals with diabetes and dyslipidemia may be able to modestly reduce total and LDL cholesterol by consuming 1.6 3 g/day of plant stanols or sterols typically found in enriched foods. C Plant st
15、anols and sterols 脂肪成分中的饱和脂肪酸，膳食胆固醇和反式脂肪酸与普通人群预防 心血管疾病的推荐相同。 RecommendationEvidence rating The amount of dietary saturated fat, cholesterol, and trans fat recommended for people with diabetes is the same as that recommended for the general population. C Saturated fat, dietary cholesterol, and trans
16、fat 于维生素或矿物质补充剂，无明确证据表明对不存在缺乏的糖尿病患 者有益。 出于长期安全性因素考虑，不推荐常规补充抗氧化剂，如维生素E、维 生素C及胡萝卜素。 RecommendationEvidence rating There is no clear evidence of benefit from vitamin or mineral supplementation in people with diabetes who do not have underlying deficiencies. Routine supplementation with antioxidants, su
17、ch as vitamins E and C and carotene, is not advised because of lack of evidence of efficacy and concern related to long-term safety. C A Micronutrients and herbal supplements 无足够证据支持糖尿病患者应常规性服用微量营养素，如铬、镁及维 生素D，以改善血糖控制 关于中草药制剂，尚无明确证据支持肉桂及其他植物类补充剂对糖尿 病患者有益 RecommendationEvidence rating There is insuff
18、icient evidence to support the routine use of micronutrients such as chromium, magnesium, and vitamin D to improve glycemic control in people with diabetes. There is insufficient evidence to support the use of cinnamon or other herbs/supplements for the treatment of diabetes. C C Micronutrients and
19、herbal supplements 仍推荐个体化的饮食计划包括将食物进行优化组合，满足所有微量营 养素推荐摄入标准 RecommendationEvidence rating It is recommended that individualized meal planning include optimization of food choices to meet recommended dietary allowance/dietary reference intake for all micronutrients. E Micronutrients and herbal supplem
20、ents 若糖尿病患者选择饮酒，他们应建议适量（成年女性每天只喝一杯酒或 更少，和成年男子每天两杯酒或更少的） 饮酒会增加延迟糖尿病低血糖风险，特别是如果注射胰岛素或服用胰岛素 促泌剂。教育和宣传有关延迟低血糖的识别和管理是必要的 RecommendationEvidence rating If adults with diabetes choose to drink alcohol, they should be advised to do so in moderation (one drink per day or less for adult women and two drinks p
21、er day or less for adult men). E Alcohol consumption may place people with diabetes at increased risk for delayed hypoglycemia, especially if taking insulin or insulin secretagogues. Education and awareness regarding the recognition and management of delayed hypoglycemia is warranted C Alcohol 建议糖尿病
22、患者减少钠摄取，一般小于2.3克/天。 对糖尿病合并高血压的患者，是否进一步减少钠摄入量应个体化。 RecommendationEvidence rating The recommendation for the general population to reduce sodium to less than 2,300 mg/day is also appropriate for people with diabetes. For individuals with both diabetes and hypertension, further reduction in sodium inta
23、ke should be individualized. B B Sodium 美国糖尿病协会（ADA）发布最新营养指南 提出糖尿病患者的日常膳食计划不应仅注重个别 营养素或某单一食物 而应注意搭配与个体化饮食模式 美国糖尿病协会（ADA）发布最新营养指南 重点关注整体饮食模式及患者的喜好，而 非特定的膳食处方 指南文件中提到的都是“饮食计划(eating plans)”或“饮食模式(eating patterns)” ，而非饮食(diet) 美国糖尿病协会（ADA）发布最新营养指南 新指南回顾了地中海饮食、素食、低脂肪饮食、低 碳水化合物饮食、预防高血压膳食疗法（DASH） 等几种常见饮食计
24、划的循证证据，但并未特别推荐 其中一种 新指南建议，应根据患者的个人喜好（包括习俗、 文化、宗教、健康理念和目标、经济状况）及其要 达到的代谢目标来选择适合自己的饮食计划 重要的是，医生在确诊患者患有糖尿病后应尽快将 其转诊至营养科进行营养治疗 美国糖尿病协会（ADA）发布最新营养指南 在碳水化合物方面，新指南推荐可选用营养价值高 、富含纤维的食物，并呼吁不要饮用含糖饮料 新指南推荐，应根据患者个人目前的饮食模式、偏 好及目标据顶其营养素的分配比例 新指南推荐用含不饱和脂肪酸的食物替代饱和脂肪 酸含量较高的食物，并推荐个体化的钠盐摄入推荐 值，建议糖尿病患者不要应用特定的维生素或矿物 质补充剂、-3脂肪酸及中草药 Click to edit Master title style 58 谢 谢！