美國(guó)糖尿病學(xué)會(huì)2007 營(yíng)養(yǎng)治療指南12

Theguidelinesofmedicalnutritiontherapy(MNT)2007—TheAmericanDiabetesAssociation(ADA)四川省人民醫(yī)院內(nèi)科楊毅

ClinicalContext

Appropriatenutritionisoneofthecornerstonesofmanagementforbothtype1andtype2diabetesPreviousresearchhasfoundthatMNTcanreduceglycatedhemoglobinlevelsbyapproximately1%amongpatientswithtype1diabetesandby1%to2%amongpatientswithtype2diabetes.

ClinicalContextoverweightandobesityarecloselyassociatedwithdevelopmentofdiabetes,thepositionstatementhighlightsthisareaofMNTClinicalContextTheADAlastpublishedrecommendationsregardingMNTin2002.slightlymodifiedin2004.TheupdaterecommendationsinDecember28,2007withanemphasisonrecentresearchfindings.

specificrecommendations(1)IndividualswithprediabetesordiabetesshouldreceiveindividualizedMNT,preferablyadministeredbyaregistereddietitianknowledgeableaboutthecomponentsofdiabetesMNT(B)specificrecommendations(1)Nutritioncounselingshouldbetailoredtothepersonalneedsoftheindividualandhisorherwillingnessandabilitytomakechanges(E).

specificrecommendations(2)Modestweightlossinoverweightandobeseinsulin-resistantindividualshasbeenshowntoimproveinsulinresistance(A).

Intheshort-term(upto1year),eitherlow-carbohydrateorlow-fat,energy-restricteddietsmaybeeffectiveforweightloss(A).

specificrecommendations(2)Physicalactivityandbehaviormodificationaidinweightlossandaremosthelpfulinmaintainingweightloss.(B)Whencombinedwithlifestylemodification,weightlossmedicationsmayhelpachievea5%to10%weightloss.(B)specificrecommendations(2)abodymassindexof35kg/m2ormore,bariatricsurgerycanmarkedlyimproveglycemia.(B)specificrecommendations(3)Akeystrategyforachievingglycemiccontrolistomonitorcarbohydratebycounting,exchanges,orexperienced-basedestimation.(A)Intakeoflow-glycemicindexfoodsthatarerichinfiberandothervitalnutrientsshouldbeencouraged.(E)食物交換份表等值谷薯類交換表

食品重量(g)食品重量(g)大米、小米、糯米25綠豆、紅豆、干豌豆25高粱米、玉米碴25干粉條、干蓮子25面粉、玉米面25油條、油餅、蘇達(dá)餅25混合面25燒餅、烙餅、饅頭35燕麥片、莜麥面25咸面包、窩窩頭35各種掛面、龍須面25生面條、魔芋生面條35馬鈴薯100鮮玉米200等值蔬菜類交換表

食品重量（克）食品重量（克）大白菜、圓白菜、菠菜500白蘿卜、青椒、茭白、冬筍400韭菜、茴香500倭瓜、南瓜、花菜350芹菜、苤藍(lán)、萵筍、油菜苔500鮮豇豆、扁豆、洋蔥、蒜苗250西葫蘆、西紅柿、冬瓜、苦瓜500胡蘿卜200黃瓜、茄子、絲瓜500山藥、孛薺、藕150芥藍(lán)菜、飄菜500茨菇、百合、芋頭100蕹菜、筧菜500毛豆、鮮豌豆70綠豆芽、鮮蘑菇500等值水果類交換表

食品重量（g）食品重量（g）柿、香蕉、鮮荔枝150李子、杏200梨、桃、蘋果（帶皮）200葡萄（帶皮）200桔子、橙子、柚子200草莓300獼猴桃（帶皮）200西瓜500等值奶制類交換表

食品重量（g）食品重量（g）奶粉20牛奶160脫脂奶粉25羊奶160奶酪25無糖酸奶130glycemicindex1、definition2、class：low-glycemicindex≤55middle-glycemicindex56-69high-glycemicindex≥703、glycemicloadlow-glycemicindex谷類:全蛋面、蕎麥面、粉絲、黑米、黑米粥、通心粉、藕粉蔬菜:魔芋、粟米、大白菜、黃瓜、芹菜、茄子、青椒、海帶、雞蛋、金針蘑、香菇、菠菜、蕃茄、豆芽、蘆筍、花椰菜、洋蔥、生菜豆類:黃豆、四季豆、豆腐、豆角、綠豆、扁豆水果:蘋果、水梨、橙、桃、提子、沙田柚、雪梨、車?yán)遄印㈣肿?、草莓、櫻桃、金桔、葡?/p>

奶類:牛奶、紅茶、脫脂奶、無糖豆?jié){糖類:果糖、山梨醇、木糖醇

middle-glycemicindex谷類:紅米飯、西米、麥片蔬菜:番薯、番茄、薯片肉類：魚肉、雞肉、豬肉、蟹、蝦水果：木瓜、香蕉、菠蘿、芒果、哈密瓜奶類：奶油、鮮奶精糖類：蔗糖、紅酒、啤酒、可樂、咖啡high-glycemicindex谷類:白飯、糯米飯、炒飯、拉面、爆米花、饅頭、油條、燕麥片、白面包蔬菜：南瓜肉類：肥腸、貢丸水果：西瓜、荔枝、龍眼、棗糖類：葡萄糖、麥芽糖、汽水、蜂蜜specificrecommendations(3)Sucrose-containingfoodsshouldbe