美国糖尿病学会2007 营养治疗指南12

Theguidelinesofmedicalnutritiontherapy(MNT)2007—TheAmericanDiabetesAssociation(ADA)四川省人民医院内科杨毅

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)食物交换份表等值谷薯类交换表

食品重量(g)食品重量(g)大米、小米、糯米25绿豆、红豆、干豌豆25高粱米、玉米碴25干粉条、干莲子25面粉、玉米面25油条、油饼、苏达饼25混合面25烧饼、烙饼、馒头35燕麦片、莜麦面25咸面包、窝窝头35各种挂面、龙须面25生面条、魔芋生面条35马铃薯100鲜玉米200等值蔬菜类交换表

食品重量（克）食品重量（克）大白菜、圆白菜、菠菜500白萝卜、青椒、茭白、冬笋400韭菜、茴香500倭瓜、南瓜、花菜350芹菜、苤蓝、莴笋、油菜苔500鲜豇豆、扁豆、洋葱、蒜苗250西葫芦、西红柿、冬瓜、苦瓜500胡萝卜200黄瓜、茄子、丝瓜500山药、孛荠、藕150芥蓝菜、飘菜500茨菇、百合、芋头100蕹菜、笕菜500毛豆、鲜豌豆70绿豆芽、鲜蘑菇500等值水果类交换表

食品重量（g）食品重量（g）柿、香蕉、鲜荔枝150李子、杏200梨、桃、苹果（带皮）200葡萄（带皮）200桔子、橙子、柚子200草莓300猕猴桃（带皮）200西瓜500等值奶制类交换表

食品重量（g）食品重量（g）奶粉20牛奶160脱脂奶粉25羊奶160奶酪25无糖酸奶130glycemicindex1、definition2、class：low-glycemicindex≤55middle-glycemicindex56-69high-glycemicindex≥703、glycemicloadlow-glycemicindex谷类:全蛋面、荞麦面、粉丝、黑米、黑米粥、通心粉、藕粉蔬菜:魔芋、粟米、大白菜、黄瓜、芹菜、茄子、青椒、海带、鸡蛋、金针蘑、香菇、菠菜、蕃茄、豆芽、芦笋、花椰菜、洋葱、生菜豆类:黃豆、四季豆、豆腐、豆角、綠豆、扁豆水果:苹果、水梨、橙、桃、提子、沙田柚、雪梨、車厘子、柚子、草莓、樱桃、金桔、葡萄

奶类:牛奶、红茶、脱脂奶、无糖豆漿糖类:果糖、山梨醇、木糖醇

middle-glycemicindex谷类:红米饭、西米、麦片蔬菜:番薯、番茄、薯片肉类：鱼肉、鸡肉、猪肉、蟹、虾水果：木瓜、香蕉、菠萝、芒果、哈密瓜奶类：奶油、鲜奶精糖类：蔗糖、红酒、啤酒、可乐、咖啡high-glycemicindex谷类:白饭、糯米饭、炒饭、拉面、爆米花、馒头、油条、燕麦片、白面包蔬菜：南瓜肉类：肥肠、贡丸水果：西瓜、荔枝、龙眼、枣糖类：葡萄糖、麦芽糖、汽水、蜂蜜specificrecommendations(3)Sucrose-containingfoodsshouldbe