大豆对男性2型糖尿病和亚临床性腺功能减退的影响:一项随机对照研究

T. Sathyapalan, A. Rigby, S. Bhasin, N. Thatcher, E. Kilpatrick, S. Atkin
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引用次数: 41

摘要

背景:豆制品中发现的异黄酮具有与雌激素相似的化学结构,这引起了人们对男性不良雌激素效应的担忧,特别是对那些因性腺功能减退而睾酮水平较低的2型糖尿病(T2DM)患者。目的:主要观察指标为总睾酮水平的变化。次要结果是血糖和心血管危险指标的变化。设计:这是一项随机双盲平行研究。环境:本研究发生在英国的二级医疗机构。参与者:纳入200名总睾酮水平≥12 nmol/L的2型糖尿病男性。干预措施:每天15克大豆蛋白含66毫克异黄酮(SPI)或15克大豆蛋白不含异黄酮(SP)作为零食棒,持续3个月。结果:SPI和SP对总睾酮和绝对游离睾酮水平均无影响,促甲状腺激素(TSH)升高,游离甲状腺素(fT4)降低;P < 0.01)。血糖控制得到改善,糖化血红蛋白(A1c)显著降低(- 4.19 [7.29]mmol/mol, P < 0.01), SPI后评估胰岛素抵抗的稳态模型显著降低。心血管风险随着甘油三酯、c反应蛋白和舒张压(DBP)的降低而改善;P < 0.05)。在补充SPI 3个月后,10年冠心病风险提高了6%。添加SPI和SP均可改善内皮功能(P < 0.01),且SPI组反应性充血指数升高(P < 0.05)。结论:在3个月的时间里,与单独使用SPI相比,睾酮水平没有变化,血糖和心血管危险指标有显著改善。TSH也大幅增加,fT4也大幅减少。
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Effect of Soy in Men With Type 2 Diabetes Mellitus and Subclinical Hypogonadism: A Randomized Controlled Study
Context: Isoflavones found in soy products have a chemical structure similar to estrogen, leading to concerns of an adverse estrogenic effect in men, particularly in those with type 2 diabetes mellitus (T2DM) who have low testosterone levels due to hypogonadism. Objective: The primary outcome was change in total testosterone levels. The secondary outcomes were the changes in glycemia and cardiovascular risk markers. Design: This was a randomized double-blind parallel study. Setting: This study occurred in a secondary care setting in United Kingdom. Participants: Two hundred men with T2DM and a total testosterone level ⩽12 nmol/L were included. Intervention: Fifteen grams of soy protein with 66 mg of isoflavones (SPI) or 15 g soy protein alone without isoflavones (SP) daily as snack bars for 3 months were administered. Results: There was no change in either total testosterone or in absolute free testosterone levels with either SPI or SP. There was an increase in thyrotropin (TSH) and reduction in free thyroxine (fT4; P < 0.01) after SPI supplementation. Glycemic control improved with a significant reduction in hemoglobin A1c (−4.19 [7.29] mmol/mol, P < 0.01) and homeostasis model of assessment - insulin resistance after SPI. Cardiovascular risk improved with a reduction in triglycerides, C-reactive protein, and diastolic blood pressure (DBP; P < 0.05) with SPI vs SP supplementation. There was a 6% improvement in 10-year coronary heart disease risk after 3 months of SPI supplementation. Endothelial function improved with both SPI and SP supplementation (P < 0.01), with an increased reactive hyperemia index that was greater for the SPI group (P < 0.05). Conclusions: Testosterone levels were unchanged and there was a substantial improvement in glycaemia and cardiovascular risk markers with SPI compared with SP alone over 3 months. There was also a substantial increase in TSH and a reduction in fT4.
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