Animal and <scp>plant‐based</scp> proteins have different postprandial effects on energy expenditure, glycemia, insulinemia, and lipemia: A review of controlled clinical trials

✅ 全文

动物性和植物性蛋白质对餐后能量消耗、血糖、胰岛素血症和血脂血症的影响不同:一项对照临床试验综述

作者 Zahra Dehnavi; Hanieh Barghchi; Ali Jafarzadeh Esfehani; Mehdi Barati; Zahra Khorasanchi; Farima Farsi; Andisheh Norouzian Ostad; Golnaz Ranjbar; Reza Rezvani; Mitra Rezaie; Mohammad Safarian 期刊 Food Science & Nutrition 发表日期 2023 ISSN 2048-7177 DOI 10.1002/fsn3.3417 类型 原创研究 (Original Research)

📄 中文摘要 Chinese Abstract

中文
膳食蛋白质影响产热、饱腹感和胰岛素敏感性等代谢反应。动物蛋白(AP)与植物蛋白(PP)在氨基酸组成、生物利用度和消化率方面存在差异,可能导致对能量消耗(EE)、血糖、胰岛素血症和血脂产生不同的餐后效应。本综述旨在比较对照临床试验中关于AP与PP急性代谢影响的研究发现。

📋 英文结构化总结 English Structured Summary

全文整理

EN

Background:

Dietary proteins influence metabolic responses such as thermogenesis, satiety, and insulin sensitivity. Animal-based proteins (AP) and plant-based proteins (PP) differ in amino acid composition, bioavailability, and digestibility, potentially leading to distinct postprandial effects on energy expenditure (EE), glycemia, insulinemia, and lipemia. This review aimed to compare findings from controlled clinical trials on the acute metabolic impacts of AP versus PP.

Methods:

N/A – Review article. The study synthesized evidence from controlled clinical trials that compared postprandial effects of animal-based and plant-based proteins on energy expenditure, glycemia, insulinemia, and lipemia. Data sources included peer-reviewed studies identified through literature searches, with outcomes extracted and summarized qualitatively.

Results:

Evidence suggests that APs may increase postprandial energy expenditure, diet-induced thermogenesis (DIT), and substrate oxidation (SO) more than PPs, possibly due to higher leucine content and superior amino acid profile. Most studies indicate that APs reduce or delay postprandial glycemia and lipemia while increasing insulinemia compared to PPs, attributed to faster digestion, greater insulinotropic amino acid content (e.g., BCAAs), and effects on incretins like GIP and GLP-1. However, results across trials are inconsistent, particularly for EE and lipid metabolism.

Data Summary:

In a crossover trial by Mikkelsen et al. (2000), pork protein increased EE by 1.9% more than soy protein (p = .05). Acheson et al. (2011) found whey protein isolate (WPI) induced significantly higher EE than soy protein isolate (SPI; p < 0.0001). For glycemia, Silva Ton et al. (2014) reported lower postprandial glucose after whey versus soy at 15, 30, and 45 min (p ≤ 0.007). Mortensen et al. (2009) showed whey protein reduced triglyceride iAUC by 25–30% compared to casein, cod, and gluten proteins (p = .008–.004).

Conclusions:

Animal-based proteins appear to exert more favorable postprandial metabolic effects than plant-based proteins, including enhanced energy expenditure, reduced glycemia and lipemia, and greater insulin response. These differences are likely driven by variations in amino acid composition, digestion kinetics, and hormonal regulation. However, findings remain inconclusive, necessitating further well-designed acute and long-term studies to clarify mechanisms and clinical relevance.

Practical Significance:

Understanding differential postprandial effects of protein sources can inform dietary strategies for weight management, type 2 diabetes prevention, and cardiovascular risk reduction, supporting personalized nutrition recommendations based on protein quality.

📋 中文结构化总结 Chinese Structured Summary

中文

背景:

膳食蛋白质影响产热、饱腹感和胰岛素敏感性等代谢反应。动物蛋白(AP)与植物蛋白(PP)在氨基酸组成、生物利用度和消化率方面存在差异,可能导致对能量消耗(EE)、血糖、胰岛素血症和血脂产生不同的餐后效应。本综述旨在比较对照临床试验中关于AP与PP急性代谢影响的研究发现。

方法:

不适用——综述文章。本研究综合了比较动物蛋白与植物蛋白对能量消耗、血糖、胰岛素血症和血脂餐后效应的对照临床试验证据。数据来源包括通过文献检索确定的同行评审研究,结果以定性方式提取和总结。

结果:

证据表明,AP可能比PP更能增加餐后能量消耗、饮食诱导产热(DIT)和底物氧化(SO),这可能是由于较高的亮氨酸含量和更优越的氨基酸谱。大多数研究表明,与PP相比,AP降低或延迟餐后血糖和血脂,同时增加胰岛素血症,归因于更快的消化速度、更高的促胰岛素氨基酸含量(如支链氨基酸)以及对GIP和GLP-1等肠促胰素的影响。然而,各试验结果不一致,特别是对于能量消耗和脂质代谢。

数据总结:

在Mikkelsen等人(2000年)的交叉试验中,猪肉蛋白比大豆蛋白使能量消耗增加1.9%(p = .05)。Acheson等人(2011年)发现乳清蛋白分离物(WPI)比大豆蛋白分离物(SPI)诱导显著更高的能量消耗(p < 0.0001)。关于血糖,Silva Ton等人(2014年)报告在15、30和45分钟时,乳清蛋白后的餐后葡萄糖低于大豆蛋白(p ≤ 0.007)。Mortensen等人(2009年)显示,与酪蛋白、鳕鱼蛋白和麸质蛋白相比,乳清蛋白使甘油三酯iAUC降低25-30%(p = .008-.004)。

结论:

动物蛋白似乎比植物蛋白产生更有利的餐后代谢效应,包括增强能量消耗、降低血糖和血脂以及更大的胰岛素反应。这些差异可能由氨基酸组成、消化动力学和激素调节的差异驱动。然而,研究结果仍不确定,需要进一步设计良好的急性和长期研究来阐明机制和临床相关性。

实际意义:

了解蛋白质来源的不同餐后效应可以为体重管理、2型糖尿病预防和心血管风险降低的饮食策略提供信息,支持基于蛋白质质量的个性化营养建议。

📖 英文全文 English Full Text

EN

pmc Food Sci Nutr Food Sci Nutr 2357 fsn FSN3 Food Science & Nutrition 2048-7177 Wiley PMC10420774 PMC10420774.1 10420774 10420774 37576026 10.1002/fsn3.3417 FSN33417 FSN3-2022-12-1695.R1 1 Review Reviews Animal and plant‐based proteins have different postprandial effects on energy expenditure, glycemia, insulinemia, and lipemia: A review of controlled clinical trials Dehnavi et al. Dehnavi Zahra https://orcid.org/0000-0003-4926-4229

1

2 Barghchi Hanieh https://orcid.org/0000-0002-3503-5540

1

2 Esfehani Ali Jafarzadeh https://orcid.org/0000-0002-4185-2694

3 Barati Mehdi https://orcid.org/0000-0002-5715-1948

4 Khorasanchi Zahra https://orcid.org/0000-0001-9579-9465

1

2 Farsi Farima https://orcid.org/0000-0003-3715-4858

2

5 Ostad Andisheh Norouzian https://orcid.org/0000-0002-2343-8086

1 Ranjbar Golnaz https://orcid.org/0000-0003-0672-6323

1 Rezvani Reza https://orcid.org/0000-0003-3585-9854

1 Gorgani Mitra Rezaie https://orcid.org/0000-0002-1965-4886

1 Safarian Mohammad https://orcid.org/0000-0002-0583-0412

3 safarianm@mums.ac.ir

1

Department of Nutrition, School of Medicine Mashhad University of Medical Sciences

Mashhad Iran

2

Student Research Committee, Faculty of Medicine Mashhad University of Medical Sciences

Mashhad Iran

3

Metabolic Syndrome Research Centre Mashhad University of Medical Sciences

Mashhad Iran

4

Department of Pathobiology and Laboratory Sciences

North Khorasan University of Medical Sciences Bojnurd

Iran

5

School of Medicine Mashhad University of Medical Sciences (MUMS)

Mashhad Iran

* Correspondence

Mohammad Safarian, Metabolic Syndrome Research Centre, Mashhad University of Medical Sciences; Department of Nutrition, Faculty of Medicine, Ferdowsi University of Mashhad Campus, Azadi Square, Mashhad, PO Box: 9177948564, Iran.

Email: safarianm@mums.ac.ir

22 5 2023 8 2023 11 8 443014 10.1002/fsn3.v11.8 4398 4408

21 4 2023 07 12 2022 27 4 2023 22 05 2023 12 08 2023 22 09 2024 © 2023 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC. https://creativecommons.org/licenses/by/4.0/ This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Abstract Dietary proteins have been shown to stimulate thermogenesis, increase satiety, and improve insulin sensitivity in the short and long term. Animal‐based proteins (AP) and plant‐based proteins (PP) have different amino acid profiles, bioavailability, and digestibility, so it seems to have various short‐ and long‐term effects on metabolic responses. This review aimed to compare the findings of controlled clinical trials on postprandial effects of dietary Aps versus PPs on energy expenditure (EE), lipemia, glycemia, and insulinemia. Data are inconclusive regarding the postprandial effects of APs and PPs. However, there is some evidence indicating that APs increase postprandial EE, DIT, and SO more than PPs. With lipemia and glycemia, most studies showed that APs reduce or delay postprandial glycemia and lipemia and increase insulinemia more than PPs. The difference in amino acid composition, digestion and absorption rate, and gastric emptying rate between APs and PPs explains this difference. Animal protein and plant protein may exert different postprandial effects that may be helpful in designing weight control programs, prevention, and treatment of chronic diseases. animal proteins carbohydrate metabolism energy metabolism lipid metabolism plant proteins postprandial period pmc-status-qastatus 0 pmc-status-live yes pmc-status-embargo no pmc-status-released yes pmc-prop-open-access yes pmc-prop-olf no pmc-prop-manuscript no pmc-prop-legally-suppressed no pmc-prop-has-pdf yes pmc-prop-has-supplement no pmc-prop-pdf-only no pmc-prop-suppress-copyright no pmc-prop-is-real-version no pmc-prop-is-scanned-article no pmc-prop-preprint no pmc-prop-in-epmc yes pmc-license-ref CC BY source-schema-version-number 2.0 cover-date August 2023 details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.2 mode:remove_FC converted:11.08.2023

Dehnavi , Z.

, Barghchi , H.

, Esfehani , A. J.

, Barati , M.

, Khorasanchi , Z.

, Farsi , F.

, Ostad , A. N.

, Ranjbar , G.

, Rezvani , R.

, Gorgani , M. R.

, & Safarian , M. ( 2023 ). Animal and plant‐based proteins have different postprandial effects on energy expenditure, glycemia, insulinemia, and lipemia: A review of controlled clinical trials . Food Science & Nutrition , 11 , 4398 – 4408 . 10.1002/fsn3.3417

PMC10420774 37576026 1 INTRODUCTION Dietary proteins have been shown to exhibit beneficial effects on metabolic responses in the short and long term (Baba et al.,  1999 ; Clifton et al.,  2008 ), including increased thermogenesis, decreased energy intake, and improved insulin sensitivity (Gannon et al.,  2003 ; Halton & Hu,  2004 ). However, regardless of the amount of dietary protein, not all protein sources seem to have the same metabolic effects because of differences in profile characteristics. Animal‐based proteins (AP) and plant‐based proteins (PP) are different in terms of amino acid profile, bioavailability, and digestibility (Sá et al.,  2020 ). Plant‐based proteins are low in some essential amino acids, such as lysine, leucine, and methionine (van Vliet et al.,  2015 ; WHO,  2007 ). Therefore, PPs may have lower quality compared with APs. PPs also have lower digestibility (75%–80%) than APs (90%–95%). Additionally, plant proteins have lower enzyme accessibility due to their seed coats and rigid cell walls (Annor et al.,  2017 ; Habiba,  2002 ). The postprandial effects of APs and PPs on different metabolism markers have been previously studied (Acheson et al.,  2011 ; Crowder et al.,  2016 ; Veldhorst et al.,  2009 ). It has been shown that APs induce more energy expenditure compared with PPs, which may be due to the higher thermogenic effect of some essential amino acids in APs compared with the amino acid content of PPs (Mikkelsen et al.,  2000 ). The various effects of APs and PPs on postprandial lipid and carbohydrate metabolism are possibly due to their different insulinotropic effects (Nilsson et al.,  2004 ). Insulin release is differently affected by various amino acids. For instance, branched‐chain amino acids (BCAAs), including valine, leucine, and isoleucine, are known as insulinogenic amino acids and can induce insulin release in the short and long term (von Post‐Skagegård et al.,  2006 ). APs and PPs differently affect the serum levels of incretins, including Glucose‐dependent insulinotropic polypeptide (GIP) and Glucagon‐like Polypeptide‐1 (GLP‐1), which affect insulin release and some enzymes involved in lipid metabolism, including lipoprotein lipase (LPL) and hormone‐sensitive lipase (Oliveira et al.,  2011 ). This review investigated the existing literature from controlled clinical trials to compare the postprandial effects of dietary protein sources (AP and PP) on expended energy (EE), lipemia, glycemia, and insulinemia. Furthermore, we aimed to clarify the possible potential mechanisms underlying the postprandial effects of different protein sources. 1.1 Postprandial energy expenditure Total energy expenditure (TEE) is comprised of basal metabolic rate (BMR; 60%–80%), diet‐induced thermogenesis (DIT; 10%), and expended energy during physical activity (15%–30%) (Wang et al.,  2001 ). The thermogenic effect of protein is the difference between the metabolizable energy value and gross energy value (Westerterp‐Plantenga et al.,  2012 ). Protein has a higher thermogenic effect compared with other macronutrients. The possible biological mechanism for the high thermogenic effect of proteins is the lack of storage capacity for proteins in the body to cope with high‐protein intakes, which lead to protein metabolization and thus increase thermogenesis (Gurr et al.,  1980 ; Rothwell & Stock,  1987 ). The high thermogenic effect of protein may be attributed to (a) high Adenosine triphosphate (ATP) costs of peptide bonds (Garlick et al.,  1991 ; Giordano & Castellino,  1997 ; Golden et al.,  1977 ; Rennie et al.,  1982 ), (b) the high‐energy cost of the pathways that involve protein metabolism, including gluconeogenesis and urea production (Stryer,  1995 ), and (c) increased proton‐pump activity in liver cell membrane following high‐protein meal ingestion (Forslund et al.,  1999 ). The protein synthetic response largely depends on the availability of essential amino acids, especially; leucine (Atherton et al.,  2010 ; Volpi et al.,  2003 ). After ingestion of APs, protein synthesis increases more than PPs, which is due to the increase in plasma essential AAs (e.g., leucine; Gorissen et al.,  2016 , 2017 ; Robinson et al.,  2013 ; Yang et al.,  2012 ). Since APs and PPs have different amino acid compositions and different effects on protein synthesis, they may affect EE, DIT, and substrate oxidation (SO) differently in the postprandial period. The findings of previous studies regarding the postprandial effects of APs and PPs on different markers of energy metabolism have been controversial (Table  1 ). TABLE 1 Controlled clinical trials on the acute effects of protein source (AP vs. PP) on EE. Reference Study population Study design Test meals Outcomes EE BMR SO DIT

Per B Mikkelsen et al. (2000) (Denmark; Mikkelsen et al.,  2000 )

22 young, overweight‐to moderately obese Randomized, single‐blind, crossover, 3‐treatment trial design

Diets:

Low‐fat, high pork‐meat protein diet (pork diet) Low‐fat, high‐soy‐protein diet (soy diet) Low‐fat, high‐carbohydrate diet (CHO diet)

Pork diet > soy diet (1.9%; p  = .05) Pork diet > CHO diet (3.9%; p  < .0001)

Soy diet > CHO diet (1.9%; p  < .05)

Pork diet > CHO diet (4.5%) Pork and soy diets (not significantly different)

‐ Pork diet > CHO diet (5.5%) Soy diet > CHO diet (1.9%)

Pork and soy diets (not significantly different)

Kevin J Acheson et al. (2011) (Switzerland; Acheson et al.,  2011 )

23 lean, healthy subjects Randomized, double‐blind, crossover, 5‐treatment trial design

High‐protein test meals:

WPI Micellar CP SPI Carbohydrate test meal

WPI > micellar CP ( p  = .003) WPI > SPI ( p  < 0.0001)

Micellar CP and SPI (not significantly different; p  = .80)

All of the pro test meals > CHO meal ( p  < .0001)

‐ Fat oxidation:

WPI > SPI ( p  = .098) WPI > CHO ( p  < .0001)

Protein oxidation: not significantly different between the 3 test meals

WPI > Micellar CP ( p  = .002) WPI > SPI ( p  = .001)

All of the protein test meals > CHO meal ( p  < .0001)

Sze‐Yen Tan et al. (2010) (Australia; Tan et al.,  2010 )

12 healthy participants Randomized, crossover, 3‐treatment trial design

Diets:

Meat (lean beef and ham) Dairy (low‐fat milk, cheese, and yoghurt) Soy (as a plant alternative option)

Meat > soy (1.1%, but not significant) ‐ CHO oxidation:

Not significantly different between the 3 test meals.

Fat oxidation:

Not significantly different among the 3 test meals.

Pro oxidation:

Meat (34.9 ± 11.1) < soy (39.5 ± 10.7) ( p  = .012)

‐ Aubree L Hawley et al. (2020) (USA) (Hawley et al.,  2020 )

15 young men 18–29 year and 15 old men 60–85 year of age Randomized, single‐blind, crossover, 2‐treatment trial design

Beverages:

Animal‐based protein test beverage (Chocolate WPI) Plant‐based protein test beverage (Chocolate pea protein isolate (PPI))

Not significantly different between WPI and PPI ‐ Fat oxidation: Not significantly different between WPI and PPI Not significantly different between WPI and PPI

Caroline E. Melson et al. (2019) (North Carolina, United States) (Melson et al.,  2019 )

17 healthy adults Randomized, double‐blind, crossover, 3‐treatment trial design

Breakfast smoothies:

Plant‐based protein smoothie (whey concentrate and isolate) Animal‐based protein smoothie (soy isolate) Carbohydrate (CHO)

‐ ‐ RER:

Whey < CHO ( p  = .007) Soy < CHO ( p  = .015)

WP and SP (not significantly different; p  = .364)

Whey > CHO ( p  < .001) Soy > CHO ( p  < .001)

Whey and Soy (not significantly different; p  = .308)

Rita de Cassia Gonçalves Alfenas et al. (2010) (Brazil) (Alfenas et al.,  2010 )

24 subjects, aged 23.5 ± 3.95 years Randomized, crossover, four 7‐day experimental sessions design

Shakes:

CP SP WP No test proteins (control session)

‐ ‐ RQ:

Whey < Control (on days 1 and 7) ( p  ≤ .030) WP < SP (on days 1 and 7) ( p  ≤ .027)

SP > control (on days 1 and 7) ( p  ≤ .035) SP > WP (on day 7) ( p  = .024)

Abbreviations: <, Less than; >, More than; BMR, Basal Metabolic Rate; CHO, Carbohydrate; CP, Casein Protein; DIT, Diet‐Induced Thermogenesis; EE, Energy Expenditure; RER, Respiratory Exchange Ratio; RQ, Respiratory Quotient; SO, Substrate Oxidation; SP, Soy Protein; WP, Whey Protein; WPI, Whey Protein Isolate. Some studies showed that APs increased postprandial EE and SO compared with PPs (Acheson et al.,  2011 ; Mikkelsen et al.,  2000 ; Tan et al.,  2010 ). The higher EE and DIT due to AP ingestion may be due to the higher thermogenic response produced by a high biological value protein, consisting of a well‐balanced amino acid mixture, than a lower biological value protein (soy; Nielsen et al.,  1994 ; Pitkänen et al.,  1994 ). Moreover, leucine, which is found in larger amounts in animal proteins, has the most thermogenic effect (Tsujinaka et al.,  1996 ). APs also have lower protein oxidation than PPs, suggesting that APs, like meat, can produce a protein‐sparing effect and might maintain lean body mass (Tan et al.,  2010 ). On the other hand, some studies showed no significant difference in postprandial effects on EE, carbohydrate, and fat oxidation neither between APs and PPs nor between different AP proteins (Hawley et al.,  2020 ; Melson et al.,  2019 ). In summary, although some studies declare that APs increase EE and SO more than PPs, the findings of controlled clinical trials are inconclusive, and there is a need for further studies to evaluate the effects of protein sources on postprandial EE and SO. 1.2 Postprandial glycemia and insulinemia The quality and quantity of dietary protein could affect glycemic response. Dietary proteins induce insulin secretion and influence glycemic response, both in the long and short term (Bowen et al.,  2007 ; Layman et al.,  2003 ; von Post‐Skagegård et al.,  2006 ). Therefore, high‐protein meals with low or moderate carbohydrate content increase insulin secretion due to the synergistic effect of high‐protein and low‐carbohydrate intake on insulin sensitivity and glucose uptake (Frid et al.,  2005 ; Gannon et al.,  2003 ). Animal‐based proteins and PPs seem to affect insulin secretion and glucose uptake differently in the postprandial period (Frid et al.,  2005 ). Some AAs, including BCAAs (valine, leucine, isoleucine), are known as insulinogenic amino acids and can increase insulin secretion in the short and long term (Schmid et al.,  1992 ; von Post‐Skagegård et al.,  2006 ). On the other hand, the digestion and absorption rate of AP and PP is different, which alters the serum levels of the gastric inhibitory polypeptide as an insulinotropic peptide (Jakubowicz & Froy,  2013 ). The faster the digestion of proteins, the faster the release of bioactive amino acids in the bloodstream and the higher stimulation of incretins secretion (Oliveira et al.,  2011 ). Incretins, including Glucose‐dependent insulinotropic polypeptide (GIP) and Glucagon‐like Polypeptide‐1 (GLP‐1) stimulate insulin release and inhibit glucagon hormone secretion (Calbet & MacLean,  2002 ; Chacra,  2006 ; Johnston & Buller,  2005 ). The absorption and digestion rate of whey protein is faster than PPs. Whey protein contains higher concentrations of valine, leucine, isoleucine, and lysine, which have insulinotropic effects than PP. Therefore, whey protein can induce insulin secretion and improve insulin sensitivity and reduce glycemic response to a greater extent compared with PPs (Akhavan et al.,  2010 ; Pal & Ellis,  2010 ; van Loon et al.,  2000 ). In addition to digestion and absorption rate, the different gastric emptying rates may explain the differences in the glycemic response of AP and PPs (Lang et al.,  1999 ). The concept of fast and slow proteins was first introduced by Boirie et al. ( 1997 ) (Boirie et al.,  1997 ); hence, slow proteins reduce and delay glycemic responses due to gastric emptying (Figure  1 ). FIGURE 1 Schematic representation of postprandial glycemia, insulinemia, and lipemia modulated by dietary protein source. Table  2 summarizes controlled clinical trials, which evaluated the effects of different protein sources (AP vs. PP) on postprandial glycemia and insulinemia. TABLE 2 Controlled clinical trials on the acute effects of protein source (AP vs. PP) on glycemia and insulinemia. Reference Study population Study design Test meals Outcomes Glycemia Insulinemia

Ann Bjørnshave et al. (2019) (Denmark) (Bjørnshave et al.,  2019 )

28 subjects above 18 years with the Metabolic syndrome Randomized, crossover design

Fat‐rich meal Pre‐meals (15 min before the fat‐rich meal) with three different protein types:

Whey (−15 and −30 min) Casein (−15 min) Gluten (−15 min)

The glucose responses fluctuated between 5.1 and 6.3 mmoL/L at 0–120 min after 4 meals.

No effect of protein quality ( p  = .93)

Ins after all 4 pre‐meals ↑ Ins after 15 min:

WP (−15 min) > gluten Casein > gluten ( p  = .0062)

Max Ins:

WP (−15 min), WP (−30 min) and casein: after 15 min

Gluten: after 30 min

Anestis Dougkas et al. (2018) (Sweden) (Dougkas & Östman,  2018 )

28 healthy adult men Randomized SB, crossover design

Rice puddings:

Animal‐based protein (milk proteins) (AP) A blend of plant proteins (oat, pea and potato) (VP) Mixture of the two (50:50) (MP) Carbohydrate‐rich meal (CHO)

Glucose concentrations:

CHO > Protein‐rich meals AP < VP No differences between MP and VP or AP meals

Significant difference between all groups ( p  = .001)

Insulin concentrations:

AP > VP (but did not reach statistical significance)

Not significantly different between all groups ( p  = .06)

Christina M. Crowder et al. (2016) (USA) (Crowder et al.,  2016 )

12 Normal weight and 8 overweight women Randomized, crossover design

Commercially breakfast sandwiches:

Plant‐based protein (PP) Animal‐based protein (AP)

Postprandial blood glucose (at 30 min):

PP (126.8 ± 4.4 mg/dL) > AP (112.1 ± 3.9 mg/dL) ( p  < .05)

Percent change in blood glucose response (from the postprandial peak at 30 min to 120 min):

AP (−26.9 ± 4.3%) < PP (−46.5 ± 4.9%) ( p  < .01)

‐ Winder Tadeu Silva Ton et al. (2014) (Brazil) ( Silva Ton et al.,  2014 )

10 subjects with normal body weight and fasting glucose Randomized, crossover design

Protein shakes:

WP SP Egg white Control drink (spring water + calories‐free blackberry powder juice) Glucose solution (anhydrous glucose)

Postprandial Glycemia:

After 15 min: WP < SP and egg white ( p  = .007)

After 30 min: WP < SP and egg white ( p  = 0.001)

After 45 min: WP < egg white ( p  ≤ 0.02) After 60 min: Not significantly different between 3 protein drinks ( p  > .05)

‐ Jens Holmer‐Jensena et al. (2013) (Denmark) (Holmer‐Jensen et al.,  2013 )

11 obese non‐diabetic subjects Randomized, crossover design

Soups with 45 gr protein of:

Cod protein (Cod‐meal) The spray dried WPI (Whey‐meal) Gluten (Glu‐meal) CP (Cas‐meal)

Glucose net iAUC (0 to 120 min):

A statistically significant main effect of treatment group ( p  = .0022)

The glucose increment after Whey‐meal < other meals

Insulin net iAUC (0 to 120 min):

A statistically significant main effect of treatment group ( p  = .0001)

The initial insulin response:

Whey‐meal > Cod‐meal (67%) Whey‐meal > Glu‐meal (88%)

Whey‐meal > Cas‐meal (47%)

Kevin J Acheson et al. (2011) (Switzerland) (Acheson et al.,  2011 )

23 lean, healthy subjects Randomized, DB, crossover design

High‐protein test meals:

WPI Micellar casein SPI CHO test meal

↓ peak glycemia:

Both after animal and plant‐based proteins Glycemia IAUC at 120 min and end test: protein meals < CHO meal ( p  < .0001)

Not significantly different between 3 protein meals ( p  > .05)

Glycemic index after protein meals:

WP = 33 ± 3% CP = 36 ± 3% SP = 32 ± 4% ( p  < .01)

Insulinemia IAUC at 120 min:

WP > glucose ( p  = .02) WP > SP (51%; p  = .03)

WP > CP (43%; p  = .07) Insulinemia IAUC end test:

WP > Glucose ( p  < .01) WP > SP ( p  = .08)

Lene S Mortensen et al. (2009) (Denmark) (Mortensen et al.,  2009 )

12 diabetic subjects Randomized, crossover design Soups with 45 gr protein of:

Casein protein (CP) Whey protein (WP) Cod protein (Cod‐P) Gluten protein (GP)

The glucose iAUC:

WP < other meals (at both 360 min ( p  = .015) and 480 min ( p  = .015))

The insulin responses:

No significant differences between the 4 test meals

Mikael Nilsson et al. (2004) (Denmark) (Nilsson et al.,  2004 )

12 healthy subjects Randomized, crossover design

Reconstituted milk Cheese Whey Cod Wheat gluten (low (GL) & high (GH)) Anequi CHO load of white‐wheat bread (reference meal)

Glucose AUC (0–90 min):

Milk (−57%) & whey (−62%) < reference meal No significant differences between the reference and the GL, GH, cod, and cheese meals.

BG response at 30 min:

Milk and whey > cod ( p  < .05) GH & GL > whey ( p  < .05)

Insulin AUC (0–90 min):

Whey > all other meals ( p  < .05) Milk & cheese > GL‐meal ( p  < .05)

V Lang et al. (1999) (France) (Lang et al.,  1999 )

9 healthy normal‐weight men Randomized, crossover design High‐calorie (3.6 MJ) and low‐calorie (1.8 MJ) Test lunches with 23% energy as protein:

CA GE Soy

PG:

Significantly fluctuated across the postprandial period after all meals ( p  < .001)

Time × protein source interaction for glucose ( p  < .005) was observed

No protein source effect was found for plasma glucose and glucose AUCs

Time × protein source interaction for insulin ( p  < .001) was observed

Insulin AUCs (following 3.6 MJ lunches):

GE‐high < Soy protein‐high ( p  < .05) Insulin AUCs (following 1.8 MJ lunches):

GE‐low < CA‐low ( p  < .05) Abbreviations: <, Less than; >, More than; ↑, Increase; ↓, Decrease; BG, Blood Glucose; CHO, Carbohydrate; CP, Casein Protein; DB, Double‐blinded; GE, Gelatin; iAUC, Incremental Area Under The Curve; PG, Plasma Glucose; SB, Single‐blinded; SPI, Soy protein isolate; WPI, Whey protein isolate. The findings of most previous studies were in favor of the postprandial glucose‐lowering effects of APs compared with PPs (Bjørnshave et al.,  2019 ; Crowder et al.,  2016 ; Dougkas & Östman,  2018 ; Holmer‐Jensen et al.,  2013 ; Silva Ton et al.,  2014 ). Silva Ton et al. ( 2014 ) compared the postprandial effects of three types of proteins, including whey, egg white, and soy proteins, on glycemia among 10 healthy normoglycemic subjects. They concluded that whey protein resulted in a lower glycemic response than soy and egg white proteins at 15, 30, and 45 min after the meal. Furthermore, postprandial glycemia was more stable after whey protein consumption. The absorption and digestion rate of whey protein is faster than PP. Whey protein contains higher concentrations of valine, leucine, isoleucine, and lysine, which have insulinotropic effects than PP. Therefore, whey protein can induce insulin secretion and improve insulin sensitivity, contributing to a lower glycemic response than PP (Akhavan et al.,  2010 ; Pal & Ellis,  2010 ; van Loon et al.,  2000 ). Hence, whey protein exerts a more significant effect on glycemic response. Dougkas and Östman ( 2018 ) compared the postprandial effects of breakfast meals containing PP (a blend of oat, pea, and potato), AP (milk), and a 50:50 mixture. The results showed that plasma glucose was higher after consuming the PP compared with the AP, possibly due to the higher insulin levels after ingestion of the AP meal. However, this difference was not statistically significant. In another randomized, crossover study by Crowder et al. ( 2016 ), the effects of AP versus PP on postprandial metabolic response, including postprandial glycemia, were compared (Crowder et al.,  2016 ). The authors showed that postprandial glucose was higher after PP meal ingestion than after AP meals. Moreover, the percent change in glucose response from the postprandial peak was lower following the AP meal ingestion than a PP meal. In summary, APs, especially whey protein, result in lower glycemic and higher insulin responses than PPs, including soy or peas. The amino acid composition, digestion and absorption rate, and gastric emptying rate between different protein sources may explain these differences. 1.3 Postprandial lipemia Postprandial lipemia is associated with meal composition, and it is demonstrated that the amount and type of food macronutrients can affect the duration and increment of postprandial lipemia (Bozzetto et al.,  2020 ; Draper et al.,  2019 ; Dubois et al.,  1998 ; Jeppesen et al.,  1995 ; Miyoshi et al.,  2014 ; Thomsen et al.,  1999 ). Protein quantity and quality may also affect postprandial lipemia. It has been proven that consuming a high‐protein diet enriched with AP leads to lower postprandial chylomicronemia than a low‐protein diet (25% and 14%, respectively; Mamo et al.,  2005 ). APs and PPs have different effects on postprandial lipemia. The mechanism of the different effects of APs and PPs on postprandial lipemia is not clearly understood. However, some hypotheses have been proposed for these findings. One mechanism might be related to the formation and clearance of chylomicron (Mortensen et al.,  2009 ). Another mechanism might be the different effects of protein sources on lipoprotein lipase (LPL) release (Acheson et al.,  2011 ; Eckel,  1989 ). Lipoprotein lipase is the essential enzyme in regulating the metabolism of lipids and lipoproteins; it plays a vital role in the hydrolysis of the TG content of these lipoproteins (Eckel,  1989 ; Kersten,  2014 ). Another reason might be the difference in the insulinogenic amino acid content of different protein sources that results in different insulin stimulation (Acheson et al.,  2011 ; Nilsson et al.,  2004 ). Insulin is an essential stimulant for LPL and hormone‐sensitive lipase, affecting TG levels and postprandial lipemia (Draper et al.,  2019 ; Holmer‐Jensen et al.,  2013 ). Another mechanism might be the different effects of protein sources on incretins (GIP and GLP‐1) release that results in different gastric emptying and insulinogenic effects (Bjørnshave et al.,  2019 ). The other possible mechanism for this observation is the difference in protein precipitation rate, which affects gastrointestinal transit (Stanstrup et al.,  2014 ; Figure  1 ). Table  3 summarizes the findings of controlled clinical trials on the effects of APs and PPs on postprandial lipemia. TABLE 3 Controlled clinical trials on the acute effects of protein source (AP vs. PP) on lipemia. Reference Study population Study design Test meals Outcomes TG FFA

Ann Bjørnshave et al. (2019) (Denmark) (Bjørnshave et al.,  2019 )

28 subjects >18 years with the MS Randomized, crossover design

Fat‐rich meal Pre‐meals (15 min before the fat‐rich meal) with 3 different protein types:

WP (−15 and −30 min) CP (−15 min) Gluten (−15 min)

The postprandial TG Response:

No effect of the type of protein pre‐meal ( p  = .95) and its timing ( p  = .87)

Postprandial NEFA suppressions:

Similar after all 4 groups; Reached a minimum at 60 min and returned to fasting levels at 360 min.

No effect of type of protein pre‐meal ( p  = .79) or timing ( p  = .22)

Jan Stanstrup et al. (2014) (Denmark) (Stanstrup et al.,  2014 )

11 Obese, non‐diabetic subjects Randomized, SB, crossover design

Soups with 45 gr protein of:

WPI Calcium caseinate Gluten Cod protein

‐ MCFA, including α Hydroxydecanoic, lauric and myristic acid levels after:

WI meal < other meals (at one or more time points after 2 h)

The WI meal ⇒ ↓ levels of a number of FA The GLU meal ⇒ ↑ levels of a number of unidentified hydroxy and dicarboxylic FA

Jens Holmer‐Jensena et al. (2013) (Denmark) (Holmer‐Jensen et al.,  2013 )

11 obese non‐diabetic subjects Randomized, crossover design

Soups with 45 gr protein of:

Cod protein (Cod‐meal) The spray dried WPI (Whey‐meal) Gluten (Glu‐meal) CP (Cas‐meal)

Plasma TG:

Significant ( p  = .048) main effect of treatment group for net iAUC (0–360 min)

Cod‐meal > Whey‐meal (61%) Glu‐meal > Whey‐meal (66%)

Supernatant TG:

Significant ( p  = .03) main effect of treatment group for net iAUC (0–360 min)

Cod‐meal > Whey‐meal (73%) Glu‐meal > Whey‐meal (61%)

Significant ( p  = .0092) main effect of treatment group for NEFA net iAUC (0–360 min)

Suppression of NEFA:

Whey‐meal and Cas‐meal > Cod‐meal and Glu‐meal ( p  < .05)

Kevin J Acheson et al. (2011) (Switzerland) (Acheson et al.,  2011 )

23 lean, healthy subjects Randomized, DB, crossover, 5‐treatment trial design

High‐protein test meals:

WPI Micellar CP SPI CHO test meal

Peak concentrations of TG at 240 min:

Soy: 1.09 ± 0.12 mmol/L ( p  = .003) Whey: 1.05 ± 0.12 mmol/L ( p  = .017) Casein: 0.99 ± 0.10 mmol/L ( p  = .003) ( p ‐value not reported)

Time of TG response to test meal:

−45 min after the high‐CHO meal ‐Took longer to respond to the protein‐containing test meals

↓ FFA ( p , .0001) after each test meal, and continued for a further 120–180 min.

↑ FFA at 240 min, in all tests FFA concentrations by the end of the test:

Whey > CHO > Casein > Soy ( p ‐value not reported)

Lene S Mortensen et al. (2009) (Denmark) (Mortensen et al.,  2009 )

12 diabetic subjects Randomized, crossover design Soups with 45 gr protein of:

CP 2.WP Cod‐P GP

TG concentrations of the chylomicron‐poor fraction:

Not significantly different between the meals.

The iAUC of TG in plasma (at 360 min):

WP < 3 other meals ( p  = .008) The iAUC of TG in the chylomicron‐rich Fraction (at 360 min):

WP < 3 other meals ( p  = .004) WP ⇒ delayed rise in p‐TG and in the chylomicron‐rich fraction, with a peak appearing 3 h later than with the 3 other meals

FFA concentrations (at 240 min):

WP < other 3 meals ( p  < .05) Total AUC for FFA responses (at 360 min):

WP < other 3 meals ( p  < .001) Total AUC for FFA responses (at 480 min):

WP < Cod‐P ( p  = .011) Not differ from the response to the GP and CP

Abbreviations: <, Less than; >, More than; ↑, Increase; ↓, Decrease; CHO, Carbohydrate; DB, Double‐blinded; FFA, Free Fatty Acid; GP, Gluten Protein; iAUC, Incremental Area Under The Curve; MCFA, Medium Chain Fatty Acid; MS, Metabolic Syndrome; NEFA, Non‐Esterified Fatty Acid; SB, Single‐blinded; SPI, Soy protein isolate; TG, Triglyceride; WPI, Whey protein isolate. Previous studies have reported that APs could ameliorate postprandial lipemia by reducing TG levels or free fatty acids (FFAs) compared with PPs (Holmer‐Jensen et al.,  2013 ; Mortensen et al.,  2009 ). Some studies also showed that whey protein was associated with lower postprandial serum lipids and reduced TG content of chylomicron‐rich supernatant (Acheson et al.,  2011 ; Holmer‐Jensen et al.,  2013 ; Mortensen et al.,  2009 ). In contrast, Bjørnshave et al. ( 2019 ) reported no significant relationship between the type of ingested protein and postprandial lipemia (Bjørnshave et al.,  2019 ). The possible mechanisms for the greater effect on postprandial lipemia observed after whey protein ingestion might be as follow; whey protein induces insulin release, increases the activity of LPL, and leads to a lower postprandial lipemia compared with other proteins. On the other hand, increased insulin levels after consuming whey protein inhibits hormone‐sensitive lipase and suppresses FFA release from adipose tissue. Furthermore, some studies have mentioned that whey protein delays gastric emptying compared with casein (Acheson et al.,  2011 ; Hall et al.,  2003 ). Delayed gastric emptying may result in delayed and even slower postprandial peak levels of TG. However, the results of some previous studies regarding the difference in gastric transition were in contrast to the findings of the mentioned studies (Calbet & Holst,  2004 ; Mortensen et al.,  2009 ). A possible reason for this controversy might be the difference in protein precipitation rates. For instance, different precipitation rates of casein compared with whey protein may result in different liquid and solid phases, where the former has a faster transit. Another possible explanation is the various effects of protein sources on GLP‐1 that may reduce stomach emptying. However, some studies showed no difference in GLP‐1 responses after the intake of AP (whey, casein, or cod) or PP (gluten) in subjects with diabetes (Mortensen et al.,  2009 ) or metabolic syndrome (Bjørnshave et al.,  2019 ). In summary, few studies have compared the differences in the effects of AP and PP on postprandial lipemia and indicated that APs, in particular whey protein, result in a lower and delayed postprandial plasma TG elevation in comparison to other protein sources. Nevertheless, the distinct effects and mechanisms of action of APs and PPs on postprandial lipemia have not yet been documented. Thus, there is a need for further studies to evaluate the effects of different protein sources on postprandial lipemia. 2 CONCLUSION Based on the findings of this review of control clinical trials, APs and PPs may have different effects on postprandial metabolism and physiology, including EE, glycemia and lipemia. Data are inconclusive concerning the postprandial effects of APs and PPs. However, there is some evidence indicating that APs increase postprandial EE, DIT, and SO more than PPs, which may be due to the higher thermogenic response produced by a high biological value protein consisting of a well‐balanced amino acid mixture. APs also found to reduce or delay postprandial glycemia and lipemia and increase insulinemia more than PPs. Knowing the differences in postprandial effects of APs and PPs may provide an opportunity for weight control programs and prevention and management of chronic diseases. However, further well‐designed acute phase and long‐term studies are needed to evaluate the exact metabolic differences between APs and PPs and to identify the underlying mechanisms for these effects. AUTHOR CONTRIBUTIONS

Zahra Dehnavi: Conceptualization (equal); writing – original draft (equal). Hanieh Barghchi: Writing – original draft (equal). Ali Jafarzadeh Esfehani: Data curation (equal). Mehdi Barati: Visualization (equal). Zahra khorasanchi: Writing – review and editing (equal). Farima Farsi: Data curation (equal); writing – review and editing (equal). Andisheh Norouzian Ostad: Writing – review and editing (equal). Golnaz Ranjbar: Writing – review and editing (equal). Reza Rezvani: Conceptualization (equal); supervision (equal). Mitra Rezaie Gorgani: Conceptualization (equal); supervision (equal). Mohammad Safarian: Conceptualization (equal); supervision (equal). CONFLICT OF INTEREST STATEMENT The authors also declare that they have no conflict of interest. ETHICAL APPROVAL No ethical approval was required, as this is a review article with no original research data. INFORMED CONSENT There were no study participants in this review article, and informed consent was not required. ACKNOWLEDGMENTS The authors would like to thank Mashhad University of Medical Sciences. DATA AVAILABILITY STATEMENT The data that support the findings of this study are available on request from the corresponding author. REFERENCES

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# 动物源与植物源蛋白质对餐后能量消耗、血糖、胰岛素和血脂的不同影响:一项对照临床试验综述

## 摘要

膳食蛋白质已被证明可在短期和长期内刺激产热、增加饱腹感并改善胰岛素敏感性。动物源蛋白质(AP)和植物源蛋白质(PP)在氨基酸谱、生物利用度和消化率方面存在差异,因此似乎对代谢反应具有不同的短期和长期影响。本综述旨在比较对照临床试验中关于膳食AP与PP对餐后能量消耗(EE)、血脂、血糖和胰岛素影响的研究结果。关于AP和PP餐后影响的数据尚无定论。然而,一些证据表明,AP比PP更能增加餐后EE、DIT和SO。在血脂和血糖方面,大多数研究表明,AP比PP更能降低或延迟餐后血糖和血脂,并增加胰岛素水平。AP与PP之间氨基酸组成、消化吸收速率和胃排空速率的差异解释了这一差异。动物蛋白和植物蛋白可能发挥不同的餐后效应,这可能有助于设计体重控制方案以及慢性疾病的预防和治疗。

## 1 引言

膳食蛋白质已被证明在短期和长期内对代谢反应表现出有益效应(Baba等,1999;Clifton等,2008),包括增加产热、减少能量摄入和改善胰岛素敏感性(Gannon等,2003;Halton & Hu,2004)。然而,无论膳食蛋白质摄入量如何,并非所有蛋白质来源似乎都具有相同的代谢效应,因为它们的特征谱存在差异。动物源蛋白质(AP)和植物源蛋白质(PP)在氨基酸谱、生物利用度和消化率方面存在差异(Sá等,2020)。植物源蛋白质在某些必需氨基酸(如赖氨酸、亮氨酸和蛋氨酸)含量较低(van Vliet等,2015;WHO,2007)。因此,PP的质量可能低于AP。PP的消化率(75%–80%)也低于AP(90%–95%)。此外,由于种皮和坚硬的细胞壁,植物蛋白的酶可及性较低(Annor等,2017;Habiba,2002)。

AP和PP对不同代谢标志物的餐后影响此前已有研究(Acheson等,2011;Crowder等,2016;Veldhorst等,2009)。研究表明,与PP相比,AP诱导更多的能量消耗,这可能是由于AP中某些必需氨基酸的产热效应高于PP中的氨基酸含量(Mikkelsen等,2000)。AP和PP对餐后脂质和碳水化合物代谢的不同影响可能是由于其不同的促胰岛素效应(Nilsson等,2004)。不同氨基酸对胰岛素释放的影响不同。例如,支链氨基酸(BCAAs),包括缬氨酸、亮氨酸和异亮氨酸,被称为生胰岛素氨基酸,可在短期和长期内诱导胰岛素释放(von Post-Skagegård等,2006)。AP和PP对肠促胰素(包括葡萄糖依赖性促胰岛素多肽(GIP)和胰高血糖素样肽-1(GLP-1))血清水平的影响不同,从而影响胰岛素释放和参与脂质代谢的某些酶,包括脂蛋白脂肪酶(LPL)和激素敏感性脂肪酶(Oliveira等,2011)。

本综述调查了来自对照临床试验的现有文献,以比较膳食蛋白质来源(AP和PP)对能量消耗(EE)、血脂、血糖和胰岛素的餐后影响。此外,我们旨在阐明不同蛋白质来源餐后影响的潜在机制。

### 1.1 餐后能量消耗

总能量消耗(TEE)由基础代谢率(BMR;60%–80%)、饮食诱导产热(DIT;10%)和体力活动期间的能量消耗(15%–30%)组成(Wang等,2001)。蛋白质的产热效应是可代谢能量值与总能量值之间的差异(Westerterp-Plantenga等,2012)。与其他宏量营养素相比,蛋白质具有更高的产热效应。蛋白质高产热效应可能的生物学机制是体内缺乏蛋白质储存能力以应对高蛋白摄入,从而导致蛋白质代谢并因此增加产热(Gurr等,1980;Rothwell & Stock,1987)。蛋白质的高产热效应可归因于:(a)肽键的高三磷酸腺苷(ATP)成本(Garlick等,1991;Giordano & Castellino,1997;Golden等,1977;Rennie等,1982),(b)涉及蛋白质代谢途径的高能量成本,包括糖异生和尿素生成(Stryer,1995),以及(c)高蛋白餐摄入后肝细胞膜质子泵活性增加(Forslund等,1999)。

蛋白质合成反应在很大程度上取决于必需氨基酸的可用性,尤其是亮氨酸(Atherton等,2010;Volpi等,2003)。摄入AP后,蛋白质合成增加超过PP,这是由于血浆必需氨基酸(如亮氨酸)增加所致(Gorissen等,2016,2017;Robinson等,2013;Yang等,2012)。由于AP和PP具有不同的氨基酸组成和对蛋白质合成的不同影响,它们可能在餐后期间对EE、DIT和底物氧化(SO)产生不同影响。

关于AP和PP对不同能量代谢标志物餐后影响的研究结果此前存在争议(表1)。

**表1 蛋白质来源(AP与PP)对EE急性影响的对照临床试验**

一些研究表明,与PP相比,AP增加了餐后EE和SO(Acheson等,2011;Mikkelsen等,2000;Tan等,2010)。AP摄入导致的较高EE和DIT可能是由于高生物价值蛋白质(由均衡的氨基酸混合物组成)比低生物价值蛋白质(大豆)产生更高的产热反应(Nielsen等,1994;Pitkänen等,1994)。此外,在动物蛋白中含量较高的亮氨酸具有最大的产热效应(Tsujinaka等,1996)。AP的蛋白质氧化也低于PP,表明AP(如肉类)可以产生蛋白质节约效应,并可能维持瘦体重(Tan等,2010)。另一方面,一些研究表明,AP与PP之间以及不同AP蛋白之间对EE、碳水化合物和脂肪氧化的餐后影响无显著差异(Hawley等,2020;Melson等,2019)。

总之,尽管一些研究声称AP比PP更能增加EE和SO,但对照临床试验的结果尚无定论,需要进一步研究来评估蛋白质来源对餐后EE和SO的影响。

### 1.2 餐后血糖和胰岛素

膳食蛋白质的质量和数量可能影响血糖反应。膳食蛋白质诱导胰岛素分泌并影响血糖反应,无论是在长期还是短期(Bowen等,2007;Layman等,2003;von Post-Skagegård等,2006)。因此,低碳水化合物或中等碳水化合物含量的高蛋白餐由于高蛋白和低碳水化合物摄入对胰岛素敏感性和葡萄糖摄取的协同效应而增加胰岛素分泌(Frid等,2005;Gannon等,2003)。

动物源蛋白质和PP似乎在餐后期间对胰岛素分泌和葡萄糖摄取产生不同影响(Frid等,2005)。一些氨基酸,包括BCAAs(缬氨酸、亮氨酸、异亮氨酸),被称为生胰岛素氨基酸,可在短期和长期内增加胰岛素分泌(Schmid等,1992;von Post-Skagegård等,2006)。另一方面,AP和PP的消化吸收速率不同,这改变了作为促胰岛素肽的胃抑制多肽的血清水平(Jakubowicz & Froy,2013)。蛋白质消化越快,生物活性氨基酸在血液中释放越快,对肠促胰素分泌的刺激越高(Oliveira等,2011)。肠促胰素,包括GIP和GLP-1,刺激胰岛素释放并抑制胰高血糖素激素分泌(Calbet & MacLean,2002;Chacra,2006;Johnston & Buller,2005)。

乳清蛋白的吸收和消化速率快于PP。乳清蛋白含有比PP更高浓度的缬氨酸、亮氨酸、异亮氨酸和赖氨酸,这些氨基酸具有促胰岛素效应。因此,与PP相比,乳清蛋白可以更大程度地诱导胰岛素分泌、改善胰岛素敏感性并降低血糖反应(Akhavan等,2010;Pal & Ellis,2010;van Loon等,2000)。除了消化吸收速率外,不同的胃排空速率也可以解释AP和PP血糖反应的差异(Lang等,1999)。快蛋白和慢蛋白的概念最早由Boirie等(1997)提出;因此,慢蛋白由于胃排空而降低和延迟血糖反应(图1)。

**图1 膳食蛋白质来源调节的餐后血糖、胰岛素和血脂的示意图**

表2总结了评估不同蛋白质来源(AP与PP)对餐后血糖和胰岛素影响的对照临床试验。

**表2 蛋白质来源(AP与PP)对血糖和胰岛素急性影响的对照临床试验**

大多数先前研究结果支持AP与PP相比的餐后降血糖效应(Bjørnshave等,2019;Crowder等,2016;Dougkas & Östman,2018;Holmer-Jensen等,2013;Silva Ton等,2014)。Silva Ton等(2014)比较了三种蛋白质(乳清蛋白、蛋清蛋白和大豆蛋白)对10名健康血糖正常受试者血糖的餐后影响。他们得出结论,餐后15、30和45分钟时,乳清蛋白的血糖反应低于大豆和蛋清蛋白。此外,乳清蛋白摄入后餐后血糖更稳定。乳清蛋白的吸收和消化速率快于PP。乳清蛋白含有比PP更高浓度的缬氨酸、亮氨酸、异亮氨酸和赖氨酸,这些氨基酸具有促胰岛素效应。因此,乳清蛋白可以诱导胰岛素分泌并改善胰岛素敏感性,从而比PP产生更低的血糖反应(Akhavan等,2010;Pal & Ellis,2010;van Loon等,2000)。因此,乳清蛋白对血糖反应发挥更显著的影响。

Dougkas和Östman(2018)比较了含有PP(燕麦、豌豆和土豆混合物)、AP(牛奶)和50:50混合物的早餐餐的餐后影响。结果显示,摄入PP后的血浆葡萄糖高于AP,可能是由于AP餐摄入后胰岛素水平较高。然而,这一差异无统计学意义。在Crowder等(2016)的另一项随机交叉研究中,比较了AP与PP对餐后代谢反应(包括餐后血糖)的影响。作者表明,PP餐摄入后的餐后血糖高于AP餐。此外,从餐后峰值开始的葡萄糖反应百分比变化在AP餐摄入后低于PP餐。

总之,AP(尤其是乳清蛋白)比PP(包括大豆或豌豆)产生更低的血糖和更高的胰岛素反应。不同蛋白质来源之间的氨基酸组成、消化吸收速率和胃排空速率可以解释这些差异。

### 1.3 餐后血脂

餐后血脂与餐食组成有关,研究表明食物宏量营养素的数量和类型可以影响餐后血脂的持续时间和增量(Bozzetto等,2020;Draper等,2019;Dubois等,1998;Jeppesen等,1995;Miyoshi等,2014;Thomsen等,1999)。蛋白质的数量和质量也可能影响餐后血脂。已证明,与低蛋白饮食相比,食用富含AP的高蛋白饮食导致餐后乳糜微粒血症更低(分别为25%和14%;Mamo等,2005)。

AP和PP对餐后血脂具有不同的影响。AP和PP对餐后血脂不同影响的机制尚不完全清楚。然而,已有一些假设被提出来解释这些发现。一种机制可能与乳糜微粒的形成和清除有关(Mortensen等,2009)。另一种机制可能是不同蛋白质来源对脂蛋白脂肪酶(LPL)释放的不同影响(Acheson等,2011;Eckel,1989)。脂蛋白脂肪酶是调节脂质和脂蛋白代谢的关键酶;它在这些脂蛋白甘油三酯(TG)内容物的水解中发挥重要作用(Eckel,1989;Kersten,2014)。另一个原因可能是不同蛋白质来源中生胰岛素氨基酸含量的差异导致不同的胰岛素刺激(Acheson等,2011;Nilsson等,2004)。胰岛素是LPL和激素敏感性脂肪酶的重要刺激物,影响TG水平和餐后血脂(Draper等,2019;Holmer-Jensen等,2013)。另一种机制可能是不同蛋白质来源对肠促胰素(GIP和GLP-1)释放的不同影响,导致不同的胃排空和生胰岛素效应(Bjørnshave等,2019)。这一观察的其他可能机制是蛋白质沉淀速率的差异,这影响胃肠道转运(Stanstrup等,2014;图1)。

表3总结了AP和PP对餐后血脂影响的对照临床试验结果。

**表3 蛋白质来源(AP与PP)对血脂急性影响的对照临床试验**

先前研究表明,与PP相比,AP可以通过降低TG水平或游离脂肪酸(FFA)来改善餐后血脂(Holmer-Jensen等,2013;Mortensen等,2009)。一些研究还表明,乳清蛋白与较低的餐后血清脂质和乳糜微粒富集上清液中TG含量降低有关(Acheson等,2011;Holmer-Jensen等,2013;Mortensen等,2009)。相反,Bjørnshave等(2019)报告摄入蛋白质类型与餐后血脂之间无显著关系。

乳清蛋白摄入后对餐后血脂更大影响的可能机制如下:乳清蛋白诱导胰岛素释放,增加LPL活性,并导致比其他蛋白质更低的餐后血脂。另一方面,摄入乳清蛋白后胰岛素水平增加抑制激素敏感性脂肪酶并抑制脂肪组织中FFA的释放。此外,一些研究提到,与酪蛋白相比,乳清蛋白延迟胃排空(Acheson等,2011;Hall等,2003)。胃排空延迟可能导致TG餐后峰值水平延迟甚至更慢。然而,一些先前研究关于胃肠道转运差异的结果与上述研究结果相反(Calbet & Holst,2004;Mortensen等,2009)。这一争议的可能原因是蛋白质沉淀速率的差异。例如,酪蛋白与乳清蛋白的不同沉淀速率可能导致不同的液相和固相,其中前者具有更快的转运。另一个可能的解释是不同蛋白质来源对GLP-1的各种影响,这可能减少胃排空。然而,一些研究表明,在糖尿病受试者(Mortensen等,2009)或代谢综合征受试者(Bjørnshave等,2019)中,摄入AP(乳清、酪蛋白或鳕鱼)或PP(谷蛋白)后GLP-1反应无差异。

总之,很少有研究比较AP和PP对餐后血脂影响的差异,并表明AP(特别是乳清蛋白)与其他蛋白质来源相比,导致更低和更延迟的餐后血浆TG升高。然而,AP和PP对餐后血脂的不同影响和作用机制尚未被记录。因此,需要进一步研究来评估不同蛋白质来源对餐后血脂的影响。

## 2 结论

基于本对照临床试验综述的发现,AP和PP可能对餐后代谢和生理(包括EE、血糖和血脂)产生不同影响。关于AP和PP餐后影响的数据尚无定论。然而,一些证据表明,AP比PP更能增加餐后EE、DIT和SO,这可能是由于高生物价值蛋白质(由均衡的氨基酸混合物组成)产生更高的产热反应。还发现AP比PP更能降低或延迟餐后血糖和血脂,并增加胰岛素。了解AP和PP餐后效应的差异可能为体重控制方案以及慢性疾病的预防和管理提供机会。然而,需要进一步设计良好的急性期和长期研究来评估AP和PP之间的确切代谢差异,并确定这些效应的潜在机制。