Resting energy expenditure in subjects with fibro-calculous pancreatic diabetes (胰腺纤维钙化性糖尿病患者的静息时能量消耗)

Background Fibro-calculous pancreatic diabetes is an indigenous disorder present in populations largely in tropical regions. Energy expenditure through indirect calorimetry has not been studied in this disorder and may provide important clues as to the pathogenesis of diabetes in these patients. Methods A total of 51 males in three groups comprising fibrocalculous pancreatic diabetes (FCPD) (group 1; n = 24), type 2 diabetes (group 2; n = 15) and healthy controls (group 3; n = 12) were studied. The body composition was measured using Dual Energy X-ray Absorptiometry (DEXA) and the REE was estimated using indirect calorimetry. The predicted energy expenditure (PEE) was calculated using three different equations. Results Patients in both groups with diabetes had a higher mean waist-hip ratio than the controls (P = 0.002). However patients with type 2 diabetes alone had a significantly higher mean body mass index (P = 0.012), percentage of fat (P = 0.016) and total fat content (P = 0.031). There was no significant difference in REE among the three groups. After adjustment of body mass index (BMI), the REE was significantly higher in patients with FCPD than in those patients with Type 2 diabetes. PEE correlated poorly with indirect calorimetry. Conclusions Energy expenditure in patients with diabetes varies according to the composition and distribution of body fat and is lower in patients with FCPD. Standard predictive equations were not accurate for the assessment of energy expenditure in patients with FCPD. Further research is required to recommend specific nutritional therapy for this group of patients. 摘要 背景 胰腺纤维钙化性糖尿病是一种土著疾病，大多数出现在热带地区人群中。以往并无研究使用间接测热法来测定这些患者的能量消耗，而这可能为研究该种糖尿病的发病机制提供重要的线索。 方法 共有51名男性入组研究，分为3组，包括胰腺纤维钙化性糖尿病组（组1；n=24）、2型糖尿病组（组2；n=15）以及健康对照组（组3；n=12）。使用双能X-线吸收仪来测定体成分，并且使用间接测热法来估静息时能量消耗（resting energy expenditure，REE）。使用三种不同的方程式来计算预测能量消耗。 结果 与对照组相比，两个糖尿病组患者的平均腰臀比都更高（P = 0.002）。然而只有2型糖尿病患者的平均体重指数（P = 0.012）、脂肪比例（P = 0.016）以及总脂肪含量（P = 0.031）显著更高。三组之间的REE没有显著性的差异。校正体重指数后，与2型糖尿病患者相比，胰腺纤维钙化性糖尿病患者的REE显著更高。预测能量消耗与间接测热法的相关性较差。 结论 体脂的组成与分布情况显示糖尿病患者的能量消耗各不相同，胰腺纤维钙化性糖尿病患者的体脂较少。使用标准预测方程式来评估胰腺纤维钙化性糖尿病患者的能量消耗并不精确。需要进行进一步的研究才能够为这组患者推荐特殊的营养治疗方案。