Recent studies show that dietary interventions can induce remission of type 2 diabetes mellitus (T2DM) in individuals with overweight or obesity, but related evidence from China remains limited.

To evaluate the clinical efficacy of a short-term dietary intervention in obese patients with abnormal glucose metabolism and to examine its impact on hepatopancreatic fat content and pancreatic β-cell function.

From March 2020 to August 2022, 60 obese adults with abnormal glucose metabolism attending the Obesity Clinic of the Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, were randomized to a low-calorie balanced diet (LCBD; n=30) or a meal-replacement diet (MRD; n=30) for 3 months. At baseline and post-intervention, group differences in changes in body composition, laboratory indices, and imaging examination were compared.

Groups were comparable at baseline in sex distribution, body composition, laboratory variables, and imaging measures (all P>0.05). After intervention, both groups exhibited significant reductions from baseline in body weight (BW), body mass index (BMI), WC, body fat percentage (BFP), visceral fat area (VFA), subcutaneous fat area (SFA), fasting plasma glucose (FPG), 2-hour plasma glucose during oral glucose tolerance test (OGTT 2 hPG), hemoglobin A_1c (HbA_1c), HOMA-β, HOMA-IR, liver FF, pancreatic FF, and lipid measures (P<0.01). Across both groups, most glycemic indices, lipid parameters, uric acid (UA), alanine aminotransferase (ALT), and insulin resistance indices improved significantly (P<0.05), whereas HDL-C did not change significantly. Compared with the LCBD group, the MRD group achieved greater reductions in absolute and percentage BW, BMI, FPG, and VFA (P<0.05). ΔFPG was positively correlated with reductions in BW, WC, VFA, HOMA-IR, and liver FF (P<0.05). The change in HOMA-IR correlated positively with the change in liver FF (r=0.432, P=0.001).

The 3-month dietary intervention effectively reduced BW, BMI, WC, hepatic fat content, and insulin resistance in obese adults with abnormal glucose metabolism, leading to significant improvements in abnormal glucose metabolism.

近年研究结果表明，通过饮食干预能够促进合并超重和肥胖的2型糖尿病病情的缓解。目前这方面的研究在国内开展尚不充分。

评估短期饮食干预对肥胖合并糖代谢异常患者的临床疗效，探讨其对肝胰腺脂肪含量及胰岛β细胞功能的影响。

2020年3月—2022年8月，收集在上海中医药大学附属普陀医院内分泌科肥胖专病门诊治疗的肥胖合并糖代谢异常受试者的样本（n=60），随机分配至对照组（采用基于传统食物的低热量平衡饮食，n=30）和试验组（采用代餐代替早餐和晚餐，n=30）。两组均进行3个月的饮食干预。干预前后，两组受试者均进行身体成分分析、实验室检查指标和影像学检查检测。比较两组干预前后各指标差异。

干预前对照组和试验组的性别、身体成分指标、实验室检查指标及影像学检查指标比较，差异均无统计学意义（P>0.05）。干预后，对照组和试验组受试者的体质量（BW）、BMI、腰围（WC）、体脂率（BFP）、内脏脂肪面积（VFA）、皮下脂肪面积（SFA）、空腹血糖（FPG）、口服葡萄糖耐量试验2 h血糖（OGTT 2 hPG）、糖化血红蛋白（HbA_1c）、胰岛β细胞功能指数（HOMA-β）、胰岛素抵抗指数（HOMA-IR）、肝脏脂肪分数（FF）、胰腺FF、血脂（BL）均较干预前下降（P<0.01）。两组血糖监测指标、血脂、血尿酸（UA）、丙氨酸氨基转移酶（ALT）及胰岛素抵抗监测指标中除高密度脂蛋白胆固醇（HDL-C）外，其他指标干预前后比较，差异均有统计学意义（P<0.05）。试验组Δ（治疗前后差值）BW、BW下降百分比、ΔBMI、ΔFPG和ΔVFA均较对照组下降明显（P<0.05）。两组治疗前后ΔFPG与ΔBW、ΔWC、ΔVFA、ΔHOMA-IR、Δ肝脏FF均呈正相关（P<0.05）。ΔHOMA-IR与Δ肝脏FF呈正相关（r=0.432，P=0.001）。

3个月的饮食干预有效降低了肥胖合并糖代谢异常受试者的BW、BMI、WC及肝脂肪含量和胰岛素抵抗，显著改善了糖代谢异常。