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低升糖指數飲食有助改善非酒精性脂肪肝病情 - PowerPoint PPT Presentation

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香港中文大學醫學院. 營養研究中心. 內科及藥物治療學系. Centre for Nutritional Studies. Department of Medicine of Therapeutics. Faculty of Medicine, The Chinese University of Hong Kong. 低升糖指數飲食有助改善非酒精性脂肪肝病情. Low-glycemic Dietary Intervention Program Improves the Nonalcoholic Fatty Liver Effectively.

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Centre for Nutritional Studies

Department of Medicine of Therapeutics

Faculty of Medicine, The Chinese University of Hong Kong


Low-glycemic Dietary Intervention Program

Improves the Nonalcoholic Fatty Liver Effectively

prevalence of fatty liver among asia
脂肪肝在亞洲的普遍程度Prevalence of Fatty Liver among Asia

Hong Kong China Taiwan Japan Korea Malaysia

non alcoholic fatty liver disease simplified fatty liver
非酒精性脂肪肝(Non-alcoholic Fatty Liver Disease)(簡稱脂肪肝 Simplified: Fatty Liver)

Matteoni, et al. Gastroenterology 1999






Fatty liver



脂肪性肝炎= 脂肪累積 + 細胞汽球化退化 ± 馬洛透明或肝纖維化

Fatty Liver = Fat cells accumulation + Ballooning degeneration + Mallory's hyaline or Fibrosis


代謝症候群 Metabolic Syndrome

“胰島素抗阻症候群” Insulin Resistance


Central Obesity


High Blood Pressure

脂肪肝 Fatty Liver


High Blood Sugar




High Triglyceride

65 nafld patients also have nash non alcoholic steatophepatitis
六成半脂肪肝患者同時患有非酒精性脂肪性肝炎65% NAFLD patients also have NASH (Non-alcoholic Steatophepatitis)

80 名曾進行肝活檢患者証實患有脂肪肝

80 patients were diagnosed with fatty liver after liver biopsy

Mild fatty liver Non-alcoholic Steatophepatitis

Wong VWS, et al., Clinical Gastroenterol Hepatol 2006

脂肪肝治療 Treatment
  • 未有針對性的藥物治療。No specific treatment
  • “三低一高”的飲食原則: “3 low 1 high”Healthy Eating Principle
    • 減少脂肪、鹽份及糖類的攝取,多吃高纖維的食物。Reduce fat, salt and sugar intake. Increase fibre intake
  • 多運動,維持標準體重。Increase exercise, maintain healthy body weight
  • 同時患有糖尿病的病人,須加強血糖控制。Well control blood sugar level for diabetic patients
aim of study
研究目的Aim of Study
  • 測試低升糖指數飲食配合生活模式輔導對患有非酒精性脂肪肝病人的影響

To test the efficacy of a low-glycemic index dietary intervention programme in NAFLD patients

study design
研究構思 Study Design

低升糖指數飲食配合生活模式輔導 (干預組)(100人)

Low-glycemic index dietary intervention

+ LMP (n=100)



Review lab results and rule out other liver diseases


Fatty liver on ultrasound


Simple lifestyle advice (control) (n=100)

篩查 隨機選擇(0月) 12月

Screening Randomization (Month 0) Month 12

content of low gi diet and intensive lifestyle modification programme
低升糖指數飲食配合生活模式輔導Content of Low GI Diet and Intensive Lifestyle Modification Programme
  • 病人經過隨機抽選,只有干預組病人能參與

Only subjects randomized in the intervention group will receive the low glycemic diet and intensive lifestyle modification programme (LMP)

what is gi
什麼是升糖指數 What is GI?
  • 升糖指數是用來量度進食食物後的 2 小時內,血糖水平上升幅度與參考食物(麵包或葡萄糖)比較的一個指標。

Glycemic Index is a standardized system of ranking foods based on their effect on blood glucose levels over 2 - 3 hours compared to a reference food (bread or glucose)

effects of high gi foods on fatty liver
進食高升糖指數食物Effects of High GI Foods on Fatty Liver


High GI foods


Boost insulin secretion


Triggers fat synthesis in liver


Fatty Liver

the aim of lmp

  • Archives of Internal Medicine. 162(21):2428-35,2002 Nov 25,
  • Obesity Reviews. 7(S2):86, 2006 Sep,
  • Journal of Evaluation in Clinical Practice. 13(6):853-9, 2007 Dec,
  • Int. J. Environ. Res Public Health 6(10), 2608-22, 2009 Oct,
  • Int. J. Environ. Res. Public Health 2010, 7
健康生活模式輔導The aim of LMP
  • 鼓勵長久生活習慣上的改變,從而減低熱量的吸收,增加熱量的消耗

The purpose of the program is to develop lifestyle behaviours that encourage increasing caloric expenditure while decreasing caloric intake, with an emphasis on long term lifestyle and behaviour change

  • 包括4個月的體重控制和8個月的體重維持期

4 months intensive follow-ups for weight loss and then 8 months monthly follow up for weight maintenance

  • LMP是香港中文大學營養研究中心結合過去的研究成果,再經臨床驗證的一項有效及健康的體重控制療程†。透過個人化的生活模式修正輔導,令參加者達到理想的體重。重獲健康的身心,更可增加他們對營養和健康的認識。

LMP is a healthy weight loss program established by the Centre for Nutritional Studies and its efficacy has been clinically proved†. It aims to help people to lose and stay a healthy weight as well as enhance their dietary, nutritional and health knowledge through an individualized tailor made lifestyle counseling.

change in weight
體重變化Change in Weight
  • 18人屬體重肥胖 18 patients were obese
  • 所有人士的體重、 脂肪比例、 腰圍都有顯著下降
  • All showed significantly drop in body weight, %fat, waist circum.
  • 平均體重下降 Average weight loss:  5.64kg(7.75%)

脂肪及腰圍變化Changes in Body Fat and Waist Circumference

  • 平均脂肪比例下降Average %fat loss: 3.53%
  • 平均腰圍下降Average waist circumference loss: 5.6 厘米(cm)
changes in cholesterol and triglyceride
血脂及膽固醇變化Changes in Cholesterol and Triglyceride
  • 8人患高膽固醇,6人改善 (5.58  5.18 mmol/L)
  • 6 out of 8 patients with cholesterol improved
  • 5人患高血脂,4人改善 (3.58  1.78 mmol/L)
  • 4 out of 5 patients with triglyceride improved
change in blood pressure
血壓變化Change in Blood Pressure
  • 14人患高血壓,12人改善 (149/86  134/82)
  • 12 out of 14 patients with blood pressure improved
changes in lifestyle
生活習慣改變Changesin Lifestyle
  • 活躍生活模式,如急步行、踏步、踏單車,最少每日30分鐘,飯後站立
  • Be physically active e.g. brisk walking, marching, cycling at least 30 min/ day. Avoid sitting after meal.
  • 減少出外進食Less dinning out
  • 減少進食高升糖指數食物,如糖水、甜品、蛋糕、糖果
  • Less high GI food e.g. white rice, dessert, cake, candies.
1 case 1
個案1 Case 1
  • 李女士 68 歲 Ms Lee Age 68
  • 家庭主婦 Housewife
  • 體重Body weight:68kg,體重指標 BMI: 28.7, 脂肪比例Body fat: 37.6%
  • 飲食份量偏多,出外飲食多選擇炒,含高鹽份食物

Large amount of food intake, choose fried food and high sodium food when dining out

  • 曾嘗試減肥,缺乏恆心

Try weight loss before but unsuccessful due to lack of motivation

  • 退休後開始每星期三次踏單車機,每次30分鐘

After retirement, she takes cycling 3 times/ week, 30 min each time

1 4 8 after 1 year lmp 4 month weight loss and 8 month maintenance
經過1年的生活模式輔導(4個月體重控制和8個月體重維持期)After 1 year LMP (4 month weight loss and 8 month maintenance)
  • 體重Body weight: 58.9kg (↓13.4% ),體重指標BMI: 24.6 脂肪比例Body fat: 25.9%
  • 多選用蒸、煮的烹調方式,出外時會選擇湯粉麵類
  • Chooses steam, boil as cooking method. Considers soup noodles when dining out
  • 用脫脂奶粉代替三合一即沖咖啡
  • Considers skim milk to replace instant coffee
  • 維持每星期三次運動;每次一小時,每餐飯後步行30分鐘
  • Maintains exercise 3 times/ week, each time for 1 hour; walks for 30 min after meal
2 case 2
個案2 Case 2
  • 吳先生,年齡: 41 Mr Ng, Age:41
  • 病歷 :脂肪肝,高血脂,低密度膽固醇偏高,哮喘 Medical History: Fatty Liver, high TG, borderline high LDL, asthma
  • 輔導前Before LMP: 體重Weight 86.7 kg (190.7 lbs), BMI:30.0, 脂肪比例Body fat 28.1%, 腰圍104cm(40.9 inches),血壓BP 143/88
  • 輔導後 After LMP (6.5 months):體重Weight 69.6 kg (153.1 lbs), BMI:24.1, 脂肪比例Body fat 18.3%, 腰圍 85cm(33.5 inches),血壓BP 111/77, 無脂肪肝No more fatty liver,血脂,低密度膽固醇降低至正常水平 TG and LDL were lowered to normal level
  • 非此研究的參與者, 脂肪肝是能透過低升糖指數和密集性飲食指導逆轉的Not included in the study but a very good example to show that fatty liver can be reversed through low glycemic foods with LMP:
結論 Conclusion
  • 營養師的密集性飲食指導有效改善代謝症候群的風險因素。

Through lifestyle modification programme, patients show a drop in the metabolic syndrome risk

  • 此飲食指導長遠有可能逆轉脂肪肝及其併發症。

May help to reverse fatty liver and its complications

  • 做法:
  • 焗爐預熱至175度
  • 麥糠用脫脂奶浸15分鐘
  • 麵粉、全麥麵粉、梳打粉、泡打粉、鹽過篩混合
  • 雞蛋略為打勻, 加入蘋果蓉和代糖, 拌入(2)
  • 把粉類分三次加入(4)中拌勻
  • 拌入黑加倫子乾
  • 倒入蛋糕模內約焗20分鐘即成
  • 材料(約15杯份量):

麥糠 1½ 杯


蘋果蓉(無添加糖)½ 杯

雞蛋 1 隻

代糖 ½ 杯

麵粉 ½ 杯

全麥麵粉½ 杯

梳打粉 1茶匙

泡打粉 1茶匙

鹽 ½茶匙

黑加倫子乾 ⅓ 杯


量度進食食物後的 2 小時內,血糖水平上升幅度的一個指標


麥糠 7

全麥麵粉 36

麵粉 53