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文献詳細

雑誌文献

公衆衛生83巻12号

2019年12月発行

文献概要

特集 栄養と健康—糖質制限食を中心に

ゆるやかな糖質制限(ロカボ)の有効性と安全性

著者: 山田悟1

所属機関: 1北里大学北里研究所病院糖尿病センター

ページ範囲:P.870 - P.878

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はじめに
わが国の食事療法の問題点
 わが国において,メタボリックシンドロームやその時間的推移を示すメタボリックドミノが公衆衛生学上の問題となってから久しい.これまで,わが国の肥満や糖尿病の食事療法として採用されてきたのは,唯一無二でエネルギー制限食であり,概して標準体重に身体活動係数を乗して1日のエネルギー量を処方する方法が採用されてきた1).日本糖尿病学会には専門医向けのガイドラインである「糖尿病診療ガイドライン」2)3)と一般医家向けの「糖尿病治療ガイド」1)が存在するが,いずれの記述も同様である(表1)1)2).栄養素比率についても概して炭水化物50〜60%,蛋白質15〜20%,脂質20〜30%程度で推奨されてきた(表1)1)2)
 しかし,わが国で行われた「J-DOIT3」という2型糖尿病患者を対象にした,厳格多面的治療介入と標準多面的治療介入を比較した試験において,標準体重に27を乗する厳格治療群にせよ,標準体重に25〜35を乗する標準治療群にせよ,3年後の時点ではBMI(body mass index)は(有意ではなかろうが)増加していたことが示された(24.8→25.1 vs. 24.9→25.0)4).エネルギー制限食指導の意義は臨床研究の場で否定されたのである.

参考文献

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掲載誌情報

出版社:株式会社医学書院

電子版ISSN:1882-1170

印刷版ISSN:0368-5187

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