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∂£¡π∫√ ∫∂¡∆ƒ√ ∂ƒ∂À¡∞™, ¶ƒ√§∏æ∏™ & £∂ƒ∞¶∂π∞™ ∆√À
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∂£¡π∫√ ∫∂¡∆ƒ√ ∂ƒ∂À¡∞™, ¶ƒ√§∏æ∏™ & £∂ƒ∞¶∂π∞™ ∆√À
Transféré par
biomedlabsciDroits d'auteur :
Formats disponibles
∂£¡π∫√ ∫∂¡∆ƒ√ ∂ƒ∂À¡∞™,
¶ƒ√§∏æ∏™ & £∂ƒ∞¶∂π∞™
∆√À ™∞∫Ã∞ƒø¢∏ ¢π∞µ∏∆∏ ∫∞π
∆ø¡ ∂¶π¶§√∫ø¡ ∆√À
N.¶.I.¢. (AÚı. 25 N.2071/02, Ù.A/123/92)
Yfi ÙËÓ ÂÔÙ›· ÙÔ˘ KÚ¿ÙÔ˘˜
(YÔ˘ÚÁÂ›Ô YÁ›·˜ & KÔÈÓˆÓÈ΋˜ AÏÏËÏÂÁÁ‡Ë˜)
E.KE.¢I.
¶§OYTAPXOY 3, 106 75 A£HNA
3Ô˜ OPOºO™
TH§.: 210 7295 160, FAX: 210 7295 168
email: hndc@hndc.gr
www. hndc.gr
www.hndc.gr
∂£¡π∫√ ∫∂¡∆ƒ√ ∂ƒ∂À¡∞™, ¶ƒ√§∏æ∏™ & £∂ƒ∞¶∂π∞™
∆√À ™∞∫Ã∞ƒø¢∏ ¢π∞µ∏∆∏ ∫∞π ∆ø¡ ∂¶π¶§√∫ø¡ ∆√À
(¶Úfi‰ÚÔ˜ ¢.™.: ∫·ıËÁËÙ‹˜ ™. ∞. ƒ¿Ù˘)
¢È·ÙÚÔÊÈΤ˜ Ô‰ËÁ›Â˜ Ì ‚¿ÛË ÙȘ ˘¿Ú¯Ô˘Û˜ ÂӉ›ÍÂȘ ÁÈ· ÙË ıÂڷ›·
Î·È ÚfiÏË„Ë ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË
(∞fi ÙËÓ ∂˘Úˆ·˚΋ ∂Ù·ÈÚ›· ÁÈ· ÙË ªÂϤÙË ÙÔ˘ ¢È·‚‹ÙË)
Nutr Metab Cardiovasc Dis (2004) 14:373-394
∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο Î·È ÂÈ̤ÏÂÈ·:
§¤ÎÙÔÚ·˜ ∫. ª·ÎÚ˘Ï¿Î˘ Î·È ∫·ıËÁËÙ‹˜ ¡. §. ∫·ÙÛÈÏ¿ÌÚÔ˜*
3
Evidence-based nutritional approaches to the treatment and prevention
of diabetes mellitus
J.I. Mann (Û˘ÓÙÔÓÈÛÙ‹˜) Dunedin, New Zealand; I. De Leeuw, Antwerp,
Belgium; K. Hermansen, Aarhus, Denmark; B. Karamanos, Athens, Greece;
B. Karlström, Upsalla, Sweden; N. Katsilambros, Athens, Greece; G.
Riccardi, Naples, Italy; A.A Rivallese, Naples, Italy; S. Rizkalla, Paris, France;
G. Slama, Paris, France; M. Toeller, Düsseldorf, Germany; M. Uusitupa,
Kuopio, Finland; B. Vessby, Uppsala, Sweden ÂΠ̤ÚÔ˘˜ Ù˘ ∂ÈÙÚÔ‹˜
ªÂϤÙ˘ Ù˘ ¢È·ÙÚÔÊ‹˜ ÛÙÔ ¢È·‚‹ÙË (Diabetes and Nutrition Study Group
[DNSG]) Ù˘ ∂˘Úˆ·˚΋˜ ∂Ù·ÈÚ›·˜ ÁÈ· ÙË ªÂϤÙË ÙÔ˘ ¢È·‚‹ÙË (European
Association for the Study of Diabetes [EASD])
* ¡.§.∫. ª¤ÏÔ˜ Ù˘ E˘Úˆ·˚΋˜ OÌ¿‰·˜ K·Ù·ÚÙ›Ûˆ˜ ÙˆÓ O‰ËÁÈÒÓ.
ANTI ¶PO§O°OY
HH ÙÚÔÊ‹, ÙÔ ÓÂÚfi Î·È Ô ·¤Ú·˜ Â›Ó·È Ù· ·Ôχو˜ ··Ú·›ÙËÙ· ÛÙÔȯ›· ÁÈ·
ÙËÓ ÂÈ‚›ˆÛË ÙÔ˘ ·ÙfiÌÔ˘. ∫·È ÂÓÒ ÁÈ· ÙÔÓ ·¤Ú· ¯ÚËÛÈÌÔÔÈԇ̠ÌfiÓÔ ÙËÓ
·ıËÙÈ΋ ÂÈÛÓÔ‹, ÁÈ· ÙÔ ÓÂÚfi Î·È Î˘Ú›ˆ˜ ÙËÓ ÙÚÔÊ‹ ÎÈÓËÙÔÔÈÔ‡ÓÙ·È
Ì˯·ÓÈÛÌÔ› ÂÈÏÔÁ‹˜, ‚·ÛÈṲ̂ÓÔÈ Î˘Ú›ˆ˜ ÛÙȘ ·ÈÛı‹ÛÂȘ Ì·˜, ·ÏÏ¿ Î·È ÛÙȘ
ÔÏÈÙÈÛÌÈΤ˜ Ì·˜ ÂȉڿÛÂȘ Î·È Û˘Ó‹ıÂȘ.
∂ȉÈο ÁÈ· ÙËÓ ÙÚÔÊ‹, ·Ó ·Ó·ÙÚ¤ÍÂÈ Î·Ó›˜ ›Ûˆ ÛÙÔ˘˜ ·ÈÒÓ˜, ÌÂÙ¿ ÙËÓ
ÂÍ·ÛÊ¿ÏÈÛË Ù˘ ÔÛfiÙËÙ·˜, Ô ¿ÓıÚˆÔ˜ ‚Ú›ÛÎÂÙ·È Û ̛· ‰È·Ú΋ ÚÔÛ¿-
ıÂÈ· ÁÈ· ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜, ‰›ÓÔÓÙ·˜ ȉȷ›ÙÂÚË ÛËÌ·Û›· ÛÙË Á‡ÛË Î·È
ÛÙËÓ ·fiÏ·˘ÛË.
øÛÙfiÛÔ, Ô ·Ù¤Ú·˜ Ù˘ π·ÙÚÈ΋˜, Ô πÔÎÚ¿Ù˘, ·Ó·ÁÓˆÚ›˙ÂÈ ·fi ÙÔÓ 4Ô
.Ã. ·ÈÒÓ· ÙËÓ ÂÈÛÙ‹ÌË Î·È ÙË ÊÈÏÔÛÔÊ›· Ù˘ ÎÏÈÓÈ΋˜ ‰È·ÙÚÔÊ‹˜, ÙÔÓ›-
˙ÔÓÙ·˜ fiÙÈ Ë ˘Á›· ÌÔÚ› Ó· ÂÍ·ÛÊ·ÏÈÛı› ÌfiÓÔ Ì ÙËÓ Î·Ù¿ÏÏËÏË ‰›·ÈÙ·
Î·È ˘ÁÈÂÈÓ‹. ¶·Ú·ÙËÚ› ÂÚ·ÈÙ¤Úˆ fiÙÈ «ÔÈ ·¯‡Û·ÚÎÔÈ Ù·¯˘ı¿Ó·ÙÔÈ ÂÈÛ›Ó».
4
∏ «Î·Ï‹» ÙÚÔÊ‹ ÁÈ· ÔÏÏÔ‡˜ ·ÈÒÓ˜ ÂÚÈÔÚÈ˙fiÙ·Ó Û ÂΛÓË Ô˘ ÌÂÙ¿ ÙËÓ
ηٷӿψۋ Ù˘ ‰ÂÓ ·Ú·ÙËÚÔ‡ÓÙ·Ó ¿ÌÂÛ˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ. ªfiÓÔ
Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Á›ÓÂÙ·È Ï¤ÔÓ Û˘ÛÙËÌ·ÙÈ΋ ¤Ú¢ӷ ÁÈ· ÙËÓ ˘ÁÈÂÈÓ‹ ‰È·-
ÙÚÔÊ‹ Î·È Ù· Û˘ÛÙ·ÙÈο Ù˘ Î·È ÁÈ· ÙȘ ·ÒÙÂÚ˜ ÂȉڿÛÂȘ Ù˘ ÛÙËÓ ˘Á›·
ÙÔ˘ ·ÙfiÌÔ˘. √ Û‡Á¯ÚÔÓÔ˜ ÙÚfiÔ˜ ˙ˆ‹˜ ¿ÏÏ·Í ÙȘ ‰È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ,
·ÏÏ¿ Î·È ÙȘ Û˘Ó‹ıÂȘ Ù˘ ηıËÌÂÚÈÓfiÙËÙ·˜, ÔÏÏÒÓ ·ÈÒÓˆÓ ÙÔ˘ ·ÓıÚÒ-
Ô˘. ∞ÔÙ¤ÏÂÛÌ· ÙÔ˘ Ó¤Ô˘ «modus vivendi» Â›Ó·È ÔÈ ·Ûı¤ÓÂȘ Ù˘ ÂÔ¯‹˜,
ÔÈ ÓfiÛÔÈ Ô˘ Ê·›ÓÂÙ·È Ó· Û¯ÂÙ›˙ÔÓÙ·È ¿ÌÂÛ· Ì ÙËÓ ÔÈfiÙËÙ· Ù˘ ÙÚÔÊ‹˜,
·ÏÏ¿ Î·È Ì ÙÔ ıÂÙÈÎfi ÈÛÔ˙‡ÁÈÔ Ù˘ ÚÔÛÏ·Ì‚·ÓfiÌÂÓ˘ Ì ÙËÓ ÙÚÔÊ‹ ÂÓ¤Ú-
ÁÂÈ·˜. ŒÙÛÈ, Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘ Ù‡Ô˘ 2, ÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ, Ë
·¯˘Û·ÚΛ· Î·È Ù· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù· Â›Ó·È ÔÈ ÔÓÙfiÙËÙ˜ ÂΛӘ Ô˘
Ï·Ì‚¿ÓÔÓÙ·˜ ÌÔÚÊ‹ ÂȉËÌ›·˜ ÎÚÔ‡Ô˘Ó ÙÔÓ ÎÒ‰ˆÓ· ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Û¯ÂÙÈο
Ì ÙȘ ‰È·ÙÚÔÊÈΤ˜ Ì·˜ Û˘Ó‹ıÂȘ Î·È ÙÔÓ ÙÚfiÔ ˙ˆ‹˜ Ì·˜ Î·È ÎÈÓËÙÔÔÈÔ‡Ó
ÙË ¢ÈÂıÓ‹ ÎÔÈÓfiÙËÙ· Ó· ÂΉÒÛÔ˘Ó Î·Ù¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜.
™ÙȘ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ Ù˘ ∂˘Úˆ·˚΋˜ ∂ÈÙÚÔ‹˜ ªÂϤÙ˘ Ù˘
www.hndc.gr
¢È·ÙÚÔÊ‹˜ ÛÙÔ ¢È·‚‹ÙË Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó Î·È ÔÈ Ôԛ˜ ·Â‰fiıËÛ·Ó ÛÙËÓ
∂ÏÏËÓÈ΋ °ÏÒÛÛ· ·fi ÙÔÓ ∫·ıËÁËÙ‹ ¡ÈÎfiÏ·Ô ∫·ÙÛÈÏ¿ÌÚÔ, Ô ÔÔ›Ô˜ ÙÔÓ›-
˙ÂÙ·È fiÙÈ Â›Ó·È Î·È Ì¤ÏÔ˜ Ù˘ Û˘ÓÙ·ÎÙÈ΋˜ ÂÈÙÚÔ‹˜ ÙˆÓ Ô‰ËÁÈÒÓ ·˘ÙÒÓ,
·ÏÏ¿ Î·È Ì ÙË ‚Ô‹ıÂÈ· ÙÔ˘ Û˘ÓÂÚÁ¿ÙÔ˘ ÙÔ˘ Î. ∫. ª·ÎÚ˘Ï¿ÎË, ·Ó·Ù‡ÛÛÂ-
Ù·È ‰ÈÂÍÔ‰Èο ÔÈÔ˜ Â›Ó·È Ô ‰ÚfiÌÔ˜ Ô˘ Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ı› ηÓ›˜ ÁÈ· ÌÈ·
ÛˆÛÙ‹ ‰È·ÙÚÔÊ‹ Î·È ÂȉÈÎfiÙÂÚ· Ù· ¿ÙÔÌ· Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË.
√È Ô‰ËÁ›Â˜ ·˘Ù¤˜ Â›Ó·È ‚·ÛÈṲ̂Ó˜ Û ÂӉ›ÍÂȘ Ô˘ ‰ÚÔÌÔÏÔÁÔ‡Ó ÙȘ ‰È·È-
ÙËÙÈΤ˜ ηÙ¢ı‡ÓÛÂȘ Î·È ¤ÙÛÈ ÁÈ· ÙËÓ Î·ıËÌÂÚÈÓ‹ ‰È·ÙÚÔÊ‹ ‰ÚÔÌÔÏÔÁ›ٷÈ
ÙÔ ·˘ÙÔÓfiËÙÔ, ‹ Ì ¿ÏÏ· ÏfiÁÈ· ÙÔ «ÛÔÊfi» Â›Ó·È ÙÔ «Ì¤ÙÚÔ Î·È ÙÔ ·¤ÚÈÙÙÔ».
™˘Á¯·›Úˆ ıÂÚÌfiٷٷ ÙÔÓ ∫·ıËÁËÙ‹ ¡. ∫·ÙÛÈÏ¿ÌÚÔ Î·È ÙÔÓ §¤ÎÙÔÚ· ∫.
ª·ÎÚ˘Ï¿ÎË ÁÈ· ÙËÓ ÂÈÙ˘¯Ë̤ÓË ÚÔÛ¿ıÂÈ· ÙÔ˘˜ Î·È ÙËÓ ÚÔÛÊÔÚ¿ ÙÔ˘˜
ÛÙÔÓ ŒÏÏËÓ· ÁÈ·ÙÚfi ÁÈ· ÙÔ Î·Ïfi ÙˆÓ ·ÛıÂÓÒÓ.
∆Ô ∂ıÓÈÎfi ∫¤ÓÙÚÔ ŒÚ¢ӷ˜, ¶ÚfiÏ˄˘ Î·È £Âڷ›·˜ ÙÔ˘ ™·Î¯·ÚÒ‰Ë
5
¢È·‚‹ÙË Î·È ÙˆÓ ∂ÈÏÔÎÒÓ ÙÔ˘ (∂.∫∂.¢π.) Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÈ Ì ¯·Ú¿ ÛÙËÓ
ÛÂÈÚ¿ ÙˆÓ ‰ËÌÔÛȇÛÂˆÓ ÙÔ˘, ÙȘ ‰È·ÙÚÔÊÈΤ˜ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ıÂڷ›· ηÈ
ÚfiÏË„Ë ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË, Ù˘ ∂˘Úˆ·˚΋˜ ∂Ù·ÈÚ›·˜ Ù˘ ªÂϤÙ˘
ÙÔ˘ ¢È·‚‹ÙË (EASD) Î·È Â‡¯ÂÙ·È ÙÔ ·Ú¿‰ÂÈÁÌ· ÙÔ˘ ηıËÁËÙÔ‡ ¡.
∫·ÙÛÈÏ¿ÌÚÔ˘ Ó· ÙÔ ÌÈÌËıÔ‡Ó Î·È ¿ÏÏÔÈ Û˘Ó¿‰ÂÏÊÔÈ ÁÈ· ÙËÓ ÚÔ·ÁˆÁ‹ Ù˘
ÀÁ›·˜ ÛÙË ¯ÒÚ· Ì·˜.
ªÂ Û˘Ó·‰ÂÏÊÈÎÔ‡˜ ¯·ÈÚÂÙÈÛÌÔ‡˜
∫∞£∏°∏∆∏™ ™ø∆. ∞. ƒ∞¶∆∏™
¶Úfi‰ÚÔ˜ ¢.™. ÙÔ˘ ∂.∫∂.¢π.
EI™A°ø°H
H∏ ∂ÈÙÚÔ‹ ªÂϤÙ˘ Ù˘ ¢È·ÙÚÔÊ‹˜ ÛÙÔ ¢È·‚‹ÙË (Diabetes and Nutrition
Study Group [DNSG]) Ù˘ ∂˘Úˆ·˚΋˜ ∂Ù·ÈÚ›·˜ ÁÈ· ÙË ªÂϤÙË ÙÔ˘ ¢È·‚‹ÙË
(European Association for the Study of Diabetes [EASD]) ¤¯ÂÈ ÂΉÒÛÂÈ ÌÈ·
ÛÂÈÚ¿ ·fi Ô‰ËÁ›Â˜ Û¯ÂÙÈο Ì ÙË ‰È·ÙÚÔÊÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ‰È·-
‚‹ÙË (1-3). √È Ô‰ËÁ›Â˜ ·˘Ù¤˜ ‚·Û›ÛÙËÎ·Ó ÛÙ· ηχÙÂÚ· ‰È·ı¤ÛÈÌ· ‰Â‰Ô̤ӷ Ù˘
ÂÈÛÙËÌÔÓÈ΋˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ Î·È ÙË Û˘ÓÔÏÈ΋ ÎÏÈÓÈ΋ ÂÌÂÈÚ›· ÙˆÓ ÌÂÏÒÓ Ù˘
ÂÈÙÚÔ‹˜. ∆ÂÏÂ˘Ù·›· ¤¯ÂÈ ÚÔÙ·ı› ÌÈ· ÈÔ Â›ÛËÌË ÚÔÛ¤ÁÁÈÛË ÁÈ· ÙËÓ ·Ó¿-
Ù˘ÍË Ô‰ËÁÈÒÓ Ô˘ ‚·Û›˙ÔÓÙ·È Û ‰Â‰Ô̤ӷ (evidence-based guidelines). √È
ÙÂÏÂ˘Ù·›Â˜ ·˘Ù¤˜ Ô‰ËÁ›Â˜ ÙÔ˘ 2004 ¯ÚËÛÈÌÔÔ›ËÛ·Ó ÙȘ ‰È·‰Èηۛ˜ Ô˘ ÚÔÙ¿-
ıËÎ·Ó ·fi ÙÔ Agency for the Health Care Policy and Research and the Scottish
Intercollegiate Guidelines Network (4). ¶ÂÚÈÏËÙÈο, Ë ‰È·‰Èηۛ· ÂÚÈÏ·Ì‚¿-
ÓÂÈ ÌÈ· Ù˘È΋ ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÌÈ· Û˘Ìʈ-
ÓË̤ÓË ÛÂÈÚ¿ ·Ú·ÁfiÓÙˆÓ Î·È ÙȘ Û¯ÂÙÈΤ˜ ‚¿ÛÂȘ ‰Â‰ÔÌ¤ÓˆÓ (.¯. Medline,
6
Embase). °È· ÙËÓ Î¿ı Èı·Ó‹ Û‡ÛÙ·ÛË, ÔÈ Û¯ÂÙÈΤ˜ ÂÚ¢ÓËÙÈΤ˜ ÌÂϤÙ˜ ηٷ-
Ù¿ÛÛÔÓÙ·È Û 1 ·fi 5 ηÙËÁÔڛ˜ ‰Â‰ÔÌ¤ÓˆÓ (¶›Ó·Î·˜ 1), ·Ó¿ÏÔÁ· Ì ÙÔÓ Ù‡Ô
Î·È ÙËÓ ÔÈfiÙËÙ· Ù˘ ÌÂϤÙ˘ (¯·Ú·ÎÙËÚÈ˙fiÌÂÓ˜ Ì ϷÙÈÓÈÎÔ‡˜ ·ÚÈıÌÔ‡˜, ÛÂ
·Ú¤ÓıÂÛË, ÌÂÙ¿ ·fi ÙÔÓ ·ÚÈıÌfi ‚È‚ÏÈÔÁÚ·ÊÈ΋˜ ·Ú·ÔÌ‹˜). ªÈ· ͯˆÚÈ-
ÛÙ‹ ηÙËÁÔÚ›· ‰Â‰ÔÌ¤ÓˆÓ (IV) ¤¯ÂÈ ÔÚÈÛÙ› ÁÈ· ÙȘ Û˘ÛÙ¿ÛÂȘ ·fi ÂÈÙÚÔ¤˜
ÂȉÈÎÒÓ. √È ›‰È˜ ÔÈ Û˘ÛÙ¿ÛÂȘ ‚·ıÌÔÏÔÁÔ‡ÓÙ·È ·Ó¿ÏÔÁ· Ì ÙË ÛÔ‚·ÚfiÙËÙ· ÙˆÓ
‰Â‰ÔÌ¤ÓˆÓ ·fi Ù· ÔÔ›· ÚÔ¤Ú¯ÔÓÙ·È. √È Û˘ÛÙ¿ÛÂȘ µ·ıÌÔ‡ ∞ ‚·Û›˙ÔÓÙ·È ÛÙȘ
ηÙËÁÔڛ˜ ‰Â‰ÔÌ¤ÓˆÓ Ia Î·È Ib, ÔÈ Û˘ÛÙ¿ÛÂȘ µ·ıÌÔ‡ µ ÛÙȘ ηÙËÁÔڛ˜ ‰Â‰Ô-
Ì¤ÓˆÓ IIa, ππb ‹ πππ, Î·È µ·ıÌÔ‡ C ÛÙËÓ Î·ÙËÁÔÚ›· ‰Â‰ÔÌ¤ÓˆÓ IV. π‰·ÓÈο, ÔÈ
Ô‰ËÁ›Â˜ Ô˘ ‚·Û›˙ÔÓÙ·È Û ‰Â‰Ô̤ӷ ÛÙËÚ›˙ÔÓÙ·È Û ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Ì ı·Ó·-
ÙËÊfiÚ· Î·È ÌË-ı·Ó·ÙËÊfiÚ· ÎÏÈÓÈο ηٷÏËÎÙÈο ÛËÌ›·. ŸÙ·Ó ÔÈ ÏËÚÔÊÔ-
ڛ˜ ·˘Ù¤˜ ‰ÂÓ Â›Ó·È ‰È·ı¤ÛÈ̘, ÔÈ Û˘ÛÙ¿ÛÂȘ ‚·Û›˙ÔÓÙ·È ÛÙ· Û˘ÌʈÓË̤ӷ
¤ÌÌÂÛ· ηٷÏËÎÙÈο ÛËÌ›· Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ∆· ÎÚÈÙ‹ÚÈ· Ô˘
¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ÙËÓ ·ÍÈÔÏfiÁËÛË ÌÂÌÔÓˆÌ¤ÓˆÓ ÌÂÏÂÙÒÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È
ÛÙÔÓ ¶›Ó·Î· 3. √ ÛËÌ·ÓÙÈÎfi˜ ÚfiÏÔ˜ Ù˘ Ù·ÎÙÈ΋˜ ۈ̷ÙÈ΋˜ ¿ÛÎËÛ˘ ˆ˜
www.hndc.gr
Û˘ÛÙ·ÙÈÎfi ÙˆÓ ·ÚÂÌ‚¿ÛÂˆÓ ·ÏÏ·Á‹˜ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË
Î·È ÚfiÏË„Ë ÙÔ˘ ‰È·‚‹ÙË, ·Ó·ÁÓˆÚ›˙ÂÙ·È ·ÏÏ¿ ‰ÂÓ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È Û’ ·˘Ù¤˜
ÙȘ Ô‰ËÁ›Â˜. √È Ô‰ËÁ›Â˜ ›Û˘ ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÏÂÙÔÌÂÚ‹ ·Ó·ÊÔÚ¿ ÛÂ
˙ËÙ‹Ì·Ù· Û¯ÂÙÈο Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ‰È·ÙÚÔÊÈÎÒÓ Û˘ÛÙ¿ÛÂˆÓ Û ‰È·ÊÔÚÂ-
ÙÈΤ˜ ∂˘Úˆ·˚Τ˜ ¯ÒÚ˜, Ô‡Ù ‰›ÓÔ˘Ó ÂȉÈΤ˜ Û˘ÛÙ¿ÛÂȘ ÁÈ· ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂ-
Ó›˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ÂȉÈΤ˜ Û˘Óı‹Î˜ (.¯. ÂÁ΢ÌÔÛ‡ÓË, ‚·ÚȤ˜ ·Ûı¤ÓÂȘ
ÎÏ). ªÈ· ÚfiÛÊ·ÙË ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ó·ÛÎfiËÛË Ù‡Ô˘ Cochrane [5 (Ia)]
η٤ÏËÍ ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ ‰ÂÓ ˘¿Ú¯Ô˘Ó ˘„ËÏ‹˜ ÔÈfiÙËÙ·˜ ‰Â‰Ô̤ӷ Û¯Â-
ÙÈο Ì ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ‰È·ÈÙËÙÈ΋˜ ıÂڷ›·˜ ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·-
‚‹ÙË Ù‡Ô˘ 2 (™¢2). ŸÌˆ˜ Ë ·Ó·ÛÎfiËÛË ·˘Ù‹ ÂÚÈÏ¿Ì‚·Ó ÌfiÓÔ ÙȘ ÌÂϤÙ˜
ÂΛӘ Ì ‰È¿ÚÎÂÈ· ÌÂÁ·Ï‡ÙÂÚË ·fi 6 Ì‹Ó˜. ¶ÔÏϤ˜ ·’ ·˘Ù¤˜ ›¯·Ó Ú¿ÁÌ·ÙÈ
ÚÔ‚Ï‹Ì·Ù· ۯ‰ȷÛÌÔ‡ ‹ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·Ó ·fi ÊÙˆ¯‹ Û˘ÌÌfiÚʈÛË ÙˆÓ
Û˘ÌÌÂÙ¯fiÓÙˆÓ. ∏ ∂ÈÙÚÔ‹ ªÂϤÙ˘ Ù˘ ¢È·ÙÚÔÊ‹˜ ÛÙÔ ¢È·‚‹ÙË (DNSG)
7
ıˆÚ› fï˜ fiÙÈ ·ÚÎÂÙ¤˜ ηϿ ۯ‰ȷṲ̂Ó˜ ÌÂϤÙ˜, ÌÈÎÚfiÙÂÚ˘ ‰È¿ÚÎÂÈ·˜,
¤¯Ô˘Ó ÌÂÁ¿ÏË ÛËÌ·Û›· ÁÈ· ÙÔÓ Î·ıÔÚÈÛÌfi ÙˆÓ ‰˘ÓËÙÈÎÒÓ ‰È·ÙÚÔÊÈÎÒÓ ·ÚÂÌ-
‚¿ÛÂˆÓ ÁÈ· ÙÔÓ ÂËÚ·ÛÌfi ÙÔ˘ ÁÏ˘Î·ÈÌÈÎÔ‡ ÂϤÁ¯Ô˘ Î·È ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÈÏÔ-
ÎÒÓ (¶›Ó·Î·˜ 2).
√È ÚÔËÁÔ‡ÌÂÓ˜ Û˘ÛÙ¿ÛÂȘ ·Û¯ÔÏ‹ıËÎ·Ó ÌfiÓÔ ‚Ú·¯¤ˆ˜ Ì ÙÔ ˙‹ÙËÌ· Ù˘
Ì›ˆÛ˘ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ·Ó¿Ù˘Í˘ ‰È·‚‹ÙË. ∏ ‰ËÌÔÛ›Â˘ÛË ·ÚÎÂÙÒÓ ÚfiÛÊ·-
ÙˆÓ Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÂÏÂÁ¯fiÌÂÓˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ ÂÈÙÚ¤ÂÈ ÙË ‰È·Ù‡ˆÛË
ÈÔ ÛÙ¤ÚÂˆÓ Û˘ÛÙ¿ÛˆÓ, ·’ fiÙÈ ‹Ù·Ó ‰˘Ó·ÙfiÓ ÛÙÔ ·ÚÂÏıfiÓ, Û¯ÂÙÈο Ì ÙÔ
ÚfiÏÔ ÙˆÓ ·ÏÏ·ÁÒÓ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ ÛÙËÓ ÚfiÏË„Ë ÙÔ˘ ™¢2 (6, 7).
§¤ÍÂȘ ÎÏÂȉȿ: ¢È·ÙÚÔÊ‹, ‰È·‚‹Ù˘, ‰È·ÈÙËÙÈÎfi ϛԘ, ‰È·ÈÙËÙÈÎÔ› ˘‰·Ù¿ÓıڷΘ,
‰È·ÈÙËÙÈΤ˜ ÚˆÙ½Ó˜, Ô‰ËÁ›Â˜
∞ÏÏËÏÔÁÚ·Ê›·: Prof. Jim I. Mann, for the DNSG of the EASD, Edgar National
Centre for Diabetes Research, Medical and Surgical Sciences, University of Otago,
P.O Box 56, Dunedin, New Zealand.
E-mail: jim.mann@stonebow.otago.ac.nz
¶π¡∞∫∞™ 1
∫·ÙËÁÔڛ˜ Î·È ‚·ıÌÔ› ‰Â‰ÔÌ¤ÓˆÓ ÁÈ· ÙȘ Û˘ÛÙ¿ÛÂȘ Ô˘ ÚÔÙ›ÓÔÓÙ·È ·fi
ÙÔ Scottish Intercollegiate Guidelines Network (SIGN)
∫·ÙËÁÔڛ˜ ‰Â‰ÔÌ¤ÓˆÓ Ù˘ SIGN µ·ıÌÔ› Û˘ÛÙ¿ÛÂˆÓ Ù˘ SIGN
∞ ∞·ÈÙ› ÙÔ˘Ï¿¯ÈÛÙÔÓ ÌÈ·
πa ¢Â‰Ô̤ӷ ·fi ÌÂÙ··Ó¿Ï˘ÛË
Ù˘¯·ÈÔÔÈË̤ÓË ÂÏÂÁ¯fiÌÂÓË ÌÂϤÙË
Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÂÏÂÁ¯fiÌÂÓˆÓ
ˆ˜ ÙÌ‹Ì· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÁÂÓÈο
ÌÂÏÂÙÒÓ
ηϋ˜ ÔÈfiÙËÙ·˜ Î·È ÛÙ·ıÂÚfiÙËÙ·˜
πb ¢Â‰Ô̤ӷ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi Ô˘ Ó· ·Ó·Ê¤ÚÂÙ·È ÛÙË
ÙÔ˘Ï¿¯ÈÛÙÔÓ ÌÈ· Ù˘¯·ÈÔÔÈË̤ÓË Û˘ÁÎÂÎÚÈ̤ÓË Û‡ÛÙ·ÛË
ÂÏÂÁ¯fiÌÂÓË ÌÂϤÙË (∫·ÙËÁÔڛ˜ ‰Â‰ÔÌ¤ÓˆÓ Ia, Ib)
IIa ¢Â‰Ô̤ӷ ·fi ÙÔ˘Ï¿¯ÈÛÙÔÓ µ ∞·ÈÙ› ÙË ‰È·ıÂÛÈÌfiÙËÙ·
ÌÈ· ηϿ ۯ‰ȷṲ̂ÓË ÂÏÂÁ¯fiÌÂÓË ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ Ì ۈÛÙ‹
8 ÌÂϤÙË ¯ˆÚ›˜ Ù˘¯·ÈÔÔ›ËÛË ‰ÈÂÍ·ÁˆÁ‹, ·ÏÏ¿ fi¯È
Ù˘¯·ÈÔÔÈË̤Ó˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜
Iπb ¢Â‰Ô̤ӷ ·fi ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó·Ó
ÛÙÔ ı¤Ì· Ù˘ Û‡ÛÙ·Û˘
¿ÏÏÔ Ù‡Ô Î·Ï¿ ۯ‰ȷṲ̂Ó˘
(∫·ÙËÁÔڛ˜ ‰Â‰Ô̤ӈÓ
ËÌÈ-ÂÈÚ·Ì·ÙÈ΋˜ ÌÂϤÙ˘
Iπa, Iπb, πππ)
πππ ¢Â‰Ô̤ӷ ·fi ηϿ ۯ‰ȷṲ̂Ó˜
ÌË ÂÈÚ·Ì·ÙÈΤ˜ ÂÚÈÁÚ·ÊÈΤ˜
ÌÂϤÙ˜, fiˆ˜ Û˘ÁÎÚÈÙÈΤ˜, ÌÂϤÙ˜
Û˘Û¯¤ÙÈÛ˘ Î·È ÌÂϤÙ˜
ÂÚÈÙÒÛˆÓ.
IV ¢Â‰Ô̤ӷ ·fi ·Ó·ÎÔÈÓÒÛÂȘ ‹ C ∞·ÈÙ› ‰Â‰Ô̤ӷ ·fi ·Ó·ÎÔÈÓÒÛÂȘ
ÁÓÒ̘ ÂÈÙÚÔ‹˜ ÂȉÈÎÒÓ Î·È/‹ ‹ ÁÓÒ̘ ÂÈÙÚÔ‹˜ ÂȉÈÎÒÓ Î·È/‹
ÎÏÈÓÈ΋ ÂÌÂÈÚ›· ηٷÍÈˆÌ¤ÓˆÓ ÎÏÈÓÈ΋ ÂÌÂÈÚ›· ηٷÍȈ̤ӈÓ
·˘ıÂÓÙÈÒÓ ÛÙÔÓ ·Ó¿ÏÔÁÔ ÙÔ̤·. ·˘ıÂÓÙÈÒÓ ÛÙÔÓ ·Ó¿ÏÔÁÔ ÙÔ̤·.
ÀÔ‰ËÏÒÓÂÈ ÙËÓ ¤ÏÏÂÈ„Ë ÎÏÈÓÈÎÒÓ
ÌÂÏÂÙÒÓ Î·Ï‹˜ ÔÈfiÙËÙ·˜ Ô˘ Ó·
Û¯ÂÙ›˙ÔÓÙ·È ¿ÌÂÛ· Ì ÙÔ ı¤Ì·.
(∫·ÙËÁÔÚ›· ‰Â‰ÔÌ¤ÓˆÓ IV)
www.hndc.gr
I™√ƒƒ√¶π∞ E¡∂ƒ°∂π∞™ ∫∞π
™øª∞∆π∫√ B∞ƒ√™
√‰ËÁ›Â˜ ÁÈ· ÙËÓ Î·ı’ Ë̤ڷ Ú¿ÍË
ñ °È· ÂΛÓÔ˘˜ Ô˘ Â›Ó·È ˘¤Ú‚·ÚÔÈ (¢ª™ >25 kg/m2), Ë ÚfiÛÏË„Ë
ÂÓ¤ÚÁÂÈ·˜ Ú¤ÂÈ Ó· ÌÂȈı› Î·È Ë Î·Ù·Ó¿ÏˆÛË ÂÓ¤ÚÁÂÈ·˜ Ó· ·˘ÍËı›,
¤ÙÛÈ ÒÛÙÂ Ô ¢ª™ Ó· ·ӤÏıÂÈ ÛÙ· Û˘ÓÈÛÙÒÌÂÓ· fiÚÈ·. µ·ıÌfi˜ ∞
ñ ∏ ÚfiÏË„Ë Ù˘ ·ӿÎÙËÛ˘ ÙÔ˘ ‚¿ÚÔ˘˜ Â›Ó·È ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ÛÙfi¯Ô˜
fiÙ·Ó ÂÈÙ¢¯ı› ·ÒÏÂÈ· ‚¿ÚÔ˘˜ (µ·ıÌfi˜ ∞). ∂ΛÓÔÈ Ô˘ Â›Ó·È ˘¤Ú-
‚·ÚÔÈ ‹ ·¯‡Û·ÚÎÔÈ Î·È ‰ÂÓ Î·Ù·Ê¤ÚÓÔ˘Ó Ó· ¯¿ÛÔ˘Ó ‚¿ÚÔ˜ Ú¤ÂÈ Ó·
ÂÓı·ÚÚ‡ÓÔÓÙ·È ÛıÂÓ·Ú¿ ÁÈ· ÙË Ï‹„Ë Ì¤ÙÚˆÓ ÒÛÙ ӷ ·ÔÊ¢¯ı› Ë
ÂÚ·ÈÙ¤Úˆ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜. µ·ıÌfi˜ C
ñ °È· ÂΛÓÔ˘˜ Ì ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ÂÓÙfi˜ ÙˆÓ Û˘ÓÈÛÙÒÌÂÓˆÓ
ÔÚ›ˆÓ ÁÈ· ÙÔ˘˜ ÂÓ‹ÏÈΘ (18,5-25 kg/m2), ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È Û˘Ó‹ıˆ˜ Ë
9
¯ÔÚ‹ÁËÛË Ô‰ËÁÈÒÓ ÁÈ· ÂÓÂÚÁÂȷ΋ ÚfiÛÏË„Ë. µ·ıÌfi˜ C
ñ ∏ ÔÛfiÙËÙ· ۈ̷ÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ˘fi„Ë
fiÙ·Ó ÌÂÏÂÙÒÓÙ·È Û˘ÛÙ¿ÛÂȘ Û¯ÂÙÈο Ì ÙË Û˘ÓÔÏÈ΋ ÂÓ¤ÚÁÂÈ·. µ·ıÌfi˜ C
ñ ™˘Ì‚Ô˘Ï¤˜ Ô˘ ·ÊÔÚÔ‡Ó ÙË Ì›ˆÛË Î·Ù·Ó¿ÏˆÛ˘ ÙÚÔÊ›ÌˆÓ ÏÔ‡ÛȈÓ
Û ıÂÚÌ›‰Â˜, ȉȷ›ÙÂÚ· ÏÔ‡ÛÈˆÓ Û ÎÔÚÂṲ̂ӷ Ï›Ë Î·È ·Ï¿ ۿί·Ú·,
ı· ‚ÔËı‹ÛÔ˘Ó Û˘Ó‹ıˆ˜ ÛÙËÓ Â›Ù¢ÍË ·ÒÏÂÈ·˜ ‚¿ÚÔ˘˜ ¯ˆÚ›˜ ÙËÓ ·Ó¿-
ÁÎË ¯ÔÚ‹ÁËÛ˘ ÏÂÙÔÌÂÚÒÓ ÂÓÂÚÁÂÈ·ÎÒÓ Û˘Ì‚Ô˘ÏÒÓ. µ·ıÌfi˜ C
ñ ∞Ó Ù· ̤ÙÚ· ·˘Ù¿ ‰ÂÓ Ô‰ËÁ‹ÛÔ˘Ó ÛÙËÓ Â›Ù¢ÍË Ù˘ ÂÈı˘ÌËÙ‹˜ ·Ò-
ÏÂÈ·˜ ‚¿ÚÔ˘˜, ÌÔÚ› Ó· ··ÈÙËıÔ‡Ó ÂÚÈÛÛfiÙÂÚÔ Û˘ÁÎÂÎÚÈ̤Ó˜ Ô‰Ë-
Á›Â˜ ÁÈ· ÙËÓ Â›Ù¢ÍË ÂÓÂÚÁÂÈ·ÎÔ‡ ÂÏÏ›ÌÌ·ÙÔ˜ ÈηÓÔ‡ Ó· ÚÔηϤÛÂÈ
·ÒÏÂÈ· ‚¿ÚÔ˘˜ Ì ÙÔÓ ÂÈı˘ÌËÙfi Ú˘ıÌfi. µ·ıÌfi˜ C
™¯fiÏÈ·
™ÙË ÌÂϤÙË Ù˘ ∞ÌÂÚÈοÓÈ΢ ∞ÓÙÈηÚÎÈÓÈ΋˜ ∂Ù·ÈÚ›·˜ (American Cancer
Society Study) [8 (III)] Ë ıÓËÛÈÌfiÙËÙ· ÙˆÓ ‰È·‚ËÙÈÎÒÓ ·ÙfiÌˆÓ ‹Ù·Ó ηٿ
Ôχ ÌÂÁ·Ï‡ÙÂÚË fiÙ·Ó Ô ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ˘ÂÚ¤‚·ÈÓ ٷ 25
kg/m2. ¢Â‰Ô̤ӷ ·fi ÙË ªÂϤÙË ÙˆÓ ¡ÔÛËÏ¢ÙÚÈÒÓ (Nurses Health Study)
˘Ô‰ËÏÒÓÔ˘Ó ÌÈ· ÛÙ·‰È·Î‹ ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ηıÒ˜ Ô ¢ª™ ˘ÂÚ‚·›-
ÓÂÈ Ù· 22 kg/m2 Ú¿ÁÌ· Ô˘ Â›Ó·È ÈÔ ¤Î‰ËÏÔ ÌÂٷ͇ ÙˆÓ ‰È·‚ËÙÈÎÒÓ [9
(πππ)]. ŒÙÛÈ Â›Ó·È ÏÔÁÈÎfi Ó· ˘Ôı¤ÛÔ˘Ì fiÙÈ Ù· ηٿÏÏËÏ· fiÚÈ· ÙÔ˘ ¢ª™ ÛÙ·
¿ÙÔÌ· Ì ‰È·‚‹ÙË Â›Ó·È Ù· ›‰È· Ì ÂΛӷ (18,5-25 kg/m2) Ô˘ Û˘ÓÈÛÙÒÓÙ·È
ÁÈ· Ù· ÌË ‰È·‚ËÙÈο ¿ÙÔÌ· [10-12 (πa)]. ™ÙÔ˘˜ ˘¤Ú‚·ÚÔ˘˜, Ë Â˘·ÈÛıËÛ›·
ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Â›Ó·È ÌÂȈ̤ÓË Î·È ·Ú·ÙËÚÂ›Ù·È Âȉ›ӈÛË ÙˆÓ ÂÚÈÛÛfi-
ÙÂÚˆÓ ·Ú·Ì¤ÙÚˆÓ ÙÔ˘ ÁÏ˘Î·ÈÌÈÎÔ‡ ÂϤÁ¯Ô˘ [3 (IV), 13 (Ia)]. ∞ÎfiÌ· ηÈ
ÌÈ· ̤ÙÚÈ· ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ÏÈÁfiÙÂÚÔ ·fi 10% ÙÔ˘ ·Ú¯ÈÎÔ‡ ۈ̷ÙÈÎÔ‡
‚¿ÚÔ˘˜, ‚ÂÏÙÈÒÓÂÈ ÙËÓ Â˘·ÈÛıËÛ›· ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Î·È ÙËÓ ·ÓÔ¯‹ ÛÙË ÁÏ˘-
Îfi˙Ë Î·È ÌÂÈÒÓÂÈ Ù· ›‰· ÏÈȉ›ˆÓ Î·È ›ÂÛ˘ ÙÔ˘ ·›Ì·ÙÔ˜ ([14,15 (πb)].
∆Ô ÌÂȈ̤ÓÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘ ÙˆÓ ˘¤Ú‚·ÚˆÓ ·ÙfiÌˆÓ Ì ‰È·‚‹ÙË
10
‚ÂÏÙÈÒÓÂÙ·È Û’ ÂΛÓÔ˘˜ Ô˘ ¯¿ÓÔ˘Ó ‚¿ÚÔ˜ Î·È ÌÔÚ› ·ÎfiÌ· Î·È Ó· ·ӤÏ-
ıÂÈ ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ¯ˆÚ›˜ ÙËÓ Â›Ù¢ÍË ¢ª™ οو ·fi 25 kg/m2 [16, 17
(IIb)]. ∏ ‰È·Ù‹ÚËÛË Ù˘ ·ÒÏÂÈ·˜ ‚¿ÚÔ˘˜ Â›Ó·È ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ÛÙfi¯Ô˜ Ù˘
ıÂڷ›·˜ [18, 19]. √È ‰È·‚ËÙÈÎÔ› ·ÛıÂÓ›˜ ¤¯Ô˘Ó ˘„ËÏ¿ ÔÛÔÛÙ¿ ÂÓ‰ÔÎÔÈ-
ÏÈ·ÎÔ‡ Ï›Ô˘˜ Î·È Î·Ù¿ Û˘Ó¤ÂÈ· ·˘ÍË̤ÓÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ÁÈ· ÙËÓ ˘Á›· ÙÔ˘˜,
Û¯ÂÙÈ˙fiÌÂÓÔ˘˜ Ì ÙËÓ ‡·ÚÍË ·ÓÙ›ÛÙ·Û˘ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, ‰˘ÛÏÈȉ·ÈÌ›·˜
Î·È ˘¤ÚÙ·Û˘ (20). ∏ ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÌÂÁ·Ï‡ÙÂÚË
‚ÂÏÙ›ˆÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Û ¿ÙÔÌ· Ì ·˘ÍË̤-
ÓÔ ÏfiÁÔ ÂÚÈʤÚÂÈ·˜ ̤Û˘ ÚÔ˜ ÈÛ¯›· ‹ ·˘ÍË̤ÓË ÂÚÈʤÚÂÈ· ̤Û˘ (21).
∏ ÚfiÏË„Ë Î·È ıÂڷ›· Ù˘ ·¯˘Û·ÚΛ·˜ ·ÔÙÂÏÔ‡Ó Ì›˙ÔÓ ı¤Ì· ‰ËÌfi-
ÛÈ·˜ ˘Á›·˜ Û ·ÁÎfiÛÌÈÔ Â›Â‰Ô [22, 23 (IV)].
À¤Ú‚·ÚÔÈ ·ÛıÂÓ›˜ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 1 (™¢1) ÌÔÚ› ›Û˘
Ó· Á›ÓÔ˘Ó ·ÓıÂÎÙÈÎÔ› ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Î·È Ë ·ÒÏÂÈ· ‚¿ÚÔ˘˜ Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ
Ì›ˆÛË Ù˘ ‰fiÛ˘ Ù˘ ÈÓÛÔ˘Ï›Ó˘ Î·È ‚ÂÏÙ›ˆÛË ÙÔ˘ ÁÏ˘Î·ÈÌÈÎÔ‡ ÂϤÁ¯Ô˘
(24, 25).
www.hndc.gr
¶π¡∞∫∞™ 2
ŒÌÌÂÛ· ηٷÏËÎÙÈο ÛËÌ›· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û ‰È·ÙÚÔÊÈΤ˜ ÌÂϤÙ˜
Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ¿ÙÔÌ· Ì ‰È·‚‹ÙË
°Ï˘Î·ÈÌ›· ñ °Ï˘Îfi˙Ë Ï¿ÛÌ·ÙÔ˜ ÓËÛÙ›·˜
ñ ªÂÙ·ÁÂ˘Ì·ÙÈ΋ ÁÏ˘Îfi˙Ë
Ï¿ÛÌ·ÙÔ˜
ñ °Ï˘ÎÔ˙˘ÏȈ̤ÓË ·ÈÌÔÛÊ·ÈÚ›ÓË
(HbA1c)
™‡ÛÙ·ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜ ñ ¶·¯˘Û·ÚΛ·
ñ ™ˆÌ·ÙÈÎfi ‚¿ÚÔ˜
ñ ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™)
ñ ¶ÂÚÈʤÚÂÈ· ̤Û˘
§ÈÔÚˆÙÂ˚ÓÈÎfi ÚÔÊ›Ï ñ √ÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË
ñ LDL-¯ÔÏËÛÙÂÚfiÏË 11
ñ HDL-¯ÔÏËÛÙÂÚfiÏË
ñ ∆ÚÈÁÏ˘ÎÂÚ›‰È·
¶›ÂÛË ÙÔ˘ ·›Ì·ÙÔ˜
∂˘·ÈÛıËÛ›· ÛÙËÓ ÈÓÛÔ˘Ï›ÓË ñ πÓÛÔ˘Ï›ÓË ÓËÛÙ›·˜
ñ ªÂÙ·ÁÂ˘Ì·ÙÈ΋ ÈÓÛÔ˘Ï›ÓË
ñ ¢Â›ÎÙ˘ ¢·ÈÛıËÛ›·˜
ÛÙËÓ ÈÓÛÔ˘Ï›ÓË (ISI)
ñ ÃÚËÛÈÌÔÔ›ËÛË ÁÏ˘Îfi˙˘
·’ fiÏÔ ÙÔ ÛÒÌ·
¡ÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· ñ ªÈÎÚÔÏÂ˘ÎˆÌ·ÙÈÓÔ˘Ú›·
ñ ¶ÚˆÙÂ˚ÓÔ˘Ú›·
ñ ƒ˘ıÌfi˜ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘
¶PøTE´NE™
√‰ËÁ›Â˜ ÁÈ· ÙËÓ Î·ı’ Ë̤ڷ Ú¿ÍË
ñ ™Â ·ÛıÂÓ›˜ ¯ˆÚ›˜ ÂӉ›ÍÂȘ ‡·Ú͢ ÓÂÊÚÔ¿ıÂÈ·˜, Ë ÚfiÛÏË„Ë Úˆ-
ÙÂ˚ÓÒÓ ÌÔÚ› Ó· ·Ú¤¯ÂÈ 10-20% Ù˘ Û˘ÓÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜. µ·ıÌfi˜ µ
ñ ™Â ·ÛıÂÓ›˜ Ì ™¢1 Î·È ÂӉ›ÍÂȘ ÂÁηÙÂÛÙË̤Ó˘ ÓÂÊÚÔ¿ıÂÈ·˜, Ë
ÚfiÛÏË„Ë ÚˆÙÂ˚ÓÒÓ ı· Ú¤ÂÈ Ó· Â›Ó·È ÛÙÔ Î·ÙÒÙÂÚÔ ¿ÎÚÔ ÙˆÓ ·Ô-
‰ÂÎÙÒÓ ÔÚ›ˆÓ (0,8 g/kg Ê˘ÛÈÔÏÔÁÈÎÔ‡ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜/Ë̤ڷ).
µ·ıÌfi˜ ∞
ñ °È· ·ÛıÂÓ›˜ Ì ™¢1 Î·È ·Ú¯fiÌÂÓË ÓÂÊÚÔ¿ıÂÈ· (ÌÈÎÚÔÏÂ˘ÎˆÌ·ÙÈÓÔ˘-
Ú›·), ηıÒ˜ Î·È ÁÈ· ÂΛÓÔ˘˜ Ì ™¢2 Î·È ÂÁηÙÂÛÙË̤ÓË ‹ ·Ú¯fiÌÂÓË
ÓÂÊÚÔ¿ıÂÈ·, ‰ÂÓ ˘¿Ú¯Ô˘Ó ·Ú΋ ‰Â‰Ô̤ӷ ÁÈ· ÙË ‰È·Ù‡ˆÛË ·˘ÛÙË-
ÚÒÓ Û˘ÛÙ¿ÛÂˆÓ Û¯ÂÙÈο Ì ÙÔÓ ÂÚÈÔÚÈÛÌfi Ù˘ ÚfiÛÏ˄˘ ÚˆÙÂ˚ÓÒÓ.
µ·ıÌfi˜ C
12 ñ ¢ÂÓ ˘¿Ú¯Ô˘Ó ·Ú΋ ‰Â‰Ô̤ӷ ÁÈ· ÙË ‰È·Ù‡ˆÛË Û˘ÛÙ¿ÛÂˆÓ Û¯ÂÙÈο
Ì ÙÔ ÂÈı˘ÌËÙfi ›‰Ô˜ ÙˆÓ ‰È·ÈÙËÙÈÎÒÓ ÚˆÙÂ˚ÓÒÓ. µ·ıÌfi˜ C
™¯fiÏÈ·
∏ ÚfiÛÏË„Ë ÚˆÙÂ˚ÓÒÓ ÛÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ‰˘ÙÈÎÔ‡˜ ÏËı˘ÛÌÔ‡˜ ÔÈ-
ΛÏÏÂÈ ÌÂٷ͇ 10 Î·È 20% Ù˘ Û˘ÓÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜. ∆fiÛÔ Û ·ÛıÂÓ›˜ ÌÂ
™¢1 fiÛÔ Î·È Ì ™¢2 Ë ‰È·ÈÙËÙÈ΋ ÚfiÛÏË„Ë ÚˆÙÂ˚ÓÒÓ Û˘Ì‚¿ÏÏÂÈ 15-20%
Ù˘ ÔÏÈ΋˜ ÚÔÛÏ·Ì‚·ÓfiÌÂÓ˘ ÂÓ¤ÚÁÂÈ·˜, Ô˘ ·ÓÙÈÛÙÔȯ› Û 1,3-2,0 g/kg
ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜. ∞˘Ù‹ ·ÓÙÈÚÔۈ‡ÂÈ ÌÈ· ÚfiÛÏË„Ë Ô˘ ˘ÂÚ‚·›ÓÂÈ
ÙȘ ·Ó¿ÁΘ Î·È Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ·fi ÙËÓ ÚfiÛÏË„Ë ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘-
ÛÌÔ‡ ›‰È·˜ ËÏÈΛ·˜ (26-29). ™Â Ù¤ÛÛÂÚȘ ÌÂϤÙ˜ ÂÈÔÏ·ÛÌÔ‡ ‰Â ‰È·ÈÛÙÒ-
ıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ÚfiÛÏ˄˘ ÚˆÙÂ˚ÓÒÓ ÛÙ· Û˘ÓËıÈṲ̂ӷ fiÚÈ·
Î·È Ù˘ ·ÚÔ˘Û›·˜ ÌÈÎÚÔÏÂ˘ÎˆÌ·ÙÈÓÔ˘Ú›·˜ Û ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ 1 [30-33
(III)]. ŸÌˆ˜ Û ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ 1 Ì ÚfiÛÏË„Ë ÚˆÙÂ˚ÓÒÓ ¿Óˆ ·fi
20% Ù˘ Û˘ÓÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜, Ô Ú˘ıÌfi˜ ·¤ÎÎÚÈÛ˘ ÏÂ˘ÎˆÌ·Ù›Ó˘ ·˘Í¿ÓÂÈ
Ì ÙËÓ ·˘Í·ÓfiÌÂÓË ÚfiÛÏË„Ë ÚˆÙÂ˚ÓÒÓ, ȉȷ›ÙÂÚ· fiÙ·Ó Û˘Ó˘¿Ú¯Ô˘Ó ›-
www.hndc.gr
Û˘ ˘¤ÚÙ·ÛË Î·È/‹ Ùˆ¯fi˜ ÁÏ˘Î·ÈÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ [34 (III)]. ¶ÔÏÏÔ› ‰È·‚Ë-
ÙÈÎÔ› ·ÛıÂÓ›˜ Ù‡Ô˘ 1 ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛÂÈÚ·Ì·ÙÈ΋ ˘ÂډȋıËÛË Î·Ù¿ ÙË
‰È¿ÁÓˆÛË ÙÔ˘ ‰È·‚‹ÙË ÙÔ˘˜, ·ÏÏ¿ Ë ÛËÌ·Û›· Ù˘ ˆ˜ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘
ÁÈ· ÌÂÏÏÔÓÙÈ΋ ·Ó¿Ù˘ÍË ‰È·‚ËÙÈ΋˜ ÓÂÊÚÔ¿ıÂÈ·˜ ‰ÂÓ ¤¯ÂÈ ·ÔÛ·ÊËÓÈÛÙ›.
∂ÈÚfiÛıÂÙ·, Û ÌÂϤÙ˜ ÂÈÔÏ·ÛÌÔ‡ ‰ÂÓ ¤¯ÂÈ ·Ú·ÙËÚËı› Û˘Û¯¤ÙÈÛË
ÌÂٷ͇ Ù˘ ÚfiÛÏ˄˘ ÚˆÙÂ˚ÓÒÓ Î·È ÙÔ˘ Ú˘ıÌÔ‡ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘
(ƒ™¢) (35, 36). ¢ÂÓ ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¤˜ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÙÔ ‰È·‚‹ÙË
Ù‡Ô˘ 2. ¢˘Ô ÌÂϤÙ˜ ÂÈÔÏ·ÛÌÔ‡ ¤‰ÂÈÍ·Ó fiÙÈ ‰ÂÓ ˘‹Ú¯Â Û˘Û¯¤ÙÈÛË ÌÂÙ·-
͇ ÚfiÛÏ˄˘ ÚˆÙÂ˚ÓÒÓ Î·È ÌÈÎÚÔÏÂ˘ÎˆÌ·ÙÈÓÔ˘Ú›·˜ ‹ ÂÌÊ¿ÓÈÛ˘ ÚˆÙÂ-
˚ÓÔ˘Ú›·˜ Ì ÙË ‰ÔÎÈÌ·Û›· ÂͤٷÛ˘ ÙˆÓ Ô‡ÚˆÓ Ì ٷÈӛ˜ Albustix [37, 38
(III)].
™Â ‰È·‚ËÙÈο ¿ÙÔÌ· Ù‡Ô˘ 1 Ì ÂӉ›ÍÂȘ ÂÁηÙÂÛÙË̤Ó˘ ÓÂÊÚÈ΋˜ ÓfiÛÔ˘,
·ÚÎÂÙ¤˜ Ù˘¯·ÈÔÔÈË̤Ó˜, ÂÏÂÁ¯fiÌÂÓ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ÂȂ‚·ÈÒÛÂÈ ÙÔ ‰˘ÓË-
13
ÙÈÎfi fiÊÂÏÔ˜ ÙÔ˘ ‰È·ÈÙËÙÈÎÔ‡ ÂÚÈÔÚÈÛÌÔ‡ ÙˆÓ ÚˆÙÂ˚ÓÒÓ. ªÈ· ÌÂÙ··Ó¿Ï˘-
ÛË ¤ÓÙÂ Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÂÏÂÁ¯fiÌÂÓˆÓ ÌÂÏÂÙÒÓ (RCTs, randomized
controlled trials) Û ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ 1, ‰È¿ÚÎÂÈ·˜ ̤¯ÚÈ ÙÚÈÒÓ ÂÙÒÓ, ¤‰ÂÈ-
Í fiÙÈ ÌÈ· ‰›·ÈÙ· ¯·ÌËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ڈÙ½ÓË ÂÈ‚Ú¿‰˘Ó ÛËÌ·-
ÓÙÈο ÙËÓ ÂÌÊ¿ÓÈÛË ·Ï‚Ô˘ÌÈÓÔ˘Ú›·˜ Î·È ÙË Ì›ˆÛË ÙÔ˘ ƒ™¢ [39 (Ia)]. ™Â
Ù¤ÛÛÂÚȘ Ù˘¯·ÈÔÔÈË̤Ó˜ ÂÏÂÁ¯fiÌÂÓ˜ ÌÂϤÙ˜ (RCTs ), Ô˘ Ë Î·ıÂÌÈ¿ ÂÚÈ-
Ï¿Ì‚·Ó ·fi 15 ¤ˆ˜ 35 ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Ù‡Ô˘ 1 Ì ‰È·‚ËÙÈ΋ ÓÂÊÚÔ-
¿ıÂÈ· Î·È ‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘ ·fi 3 ‚‰ÔÌ¿‰Â˜ ¤ˆ˜ 3 ¤ÙË, ·Ú·ÙË-
Ú‹ıËΠÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙfiÛÔ ÛÙËÓ ·Ï‚Ô˘ÌÈÓÔ˘Ú›· fiÛÔ Î·È ÛÙÔ Ú˘ıÌfi Ì›-
ˆÛ˘ ÙÔ˘ ƒ™¢ (40-43). ™ÙËÓ ÈÔ ÚfiÛÊ·ÙË Ù˘¯·ÈÔÔÈË̤ÓË ÂÏÂÁ¯fiÌÂÓË
ÌÂϤÙË Ô˘ ÂÚÈÏ¿Ì‚·Ó 82 ¿ÙÔÌ·, ÙË ÌÂÁ·Ï‡ÙÂÚË Ô˘ ¤¯ÂÈ Ú·ÁÌ·ÙÔÔÈË-
ı› ¤ˆ˜ Û‹ÌÂÚ· (4 ¤ÙË), ÔÈ ‰È·‚ËÙÈÎÔ› ·ÛıÂÓ›˜ Ù‡Ô˘ 1 Ô˘ Ù˘¯·ÈÔÔÈ‹ıË-
Î·Ó ÛÙËÓ ÔÌ¿‰· Ù˘ ‰›·ÈÙ·˜ ¯·ÌËÏ‹˜ ÚˆÙÂ˚ÓÈ΋˜ ÚfiÛÏ˄˘ (ÛÙfi¯Ô˜ Úfi-
ÛÏ˄˘: 0,6 g/kg/Ë̤ڷ, ÂÈÙ¢¯ı›۷ ÚfiÛÏË„Ë: 0,89 g/kg/Ë̤ڷ) ÂÌÊ¿-
ÓÈÛ·Ó ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË (Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ÁÈ· ÓÂÊÚÈ΋ ÓfiÛÔ ÙÂÏÈÎÔ‡
ÛÙ·‰›Ô˘ ‹ ı¿Ó·ÙÔ, ÌÂÙ¿ ·fi ÂÍÔÌÔ›ˆÛË ÁÈ· ¿ÏÏÔ˘˜ ηډȷÁÁÂÈ·ÎÔ‡˜ ·Ú¿-
ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘: 0,23) Û ۇÁÎÚÈÛË Ì ÂΛÓÔ˘˜ Ô˘ ηٷÓÂÌ‹ıËÎ·Ó Ù˘¯·›·
ÛÙËÓ ÔÌ¿‰· Ù˘ Û˘Ó‹ıÔ˘˜ ÚˆÙÂ˚ÓÈ΋˜ ÚfiÛÏ˄˘ (1,2 g/kg/Ë̤ڷ) [44
(Ib)]. ∫·Ù¿ Û˘Ó¤ÂÈ· Ô ÂÚÈÔÚÈÛÌfi˜ Ù˘ ÚˆÙÂ˚ÓÈ΋˜ ÚfiÛÏ˄˘ Û˘ÓÈÛٿٷÈ
ÁÈ· ÙË ‰È·‚ËÙÈ΋ ÓÂÊÚÔ¿ıÂÈ· ÛÙÔ ™¢1. ¶·Ú’ fiÏ· ·˘Ù¿, ÔÈ ·ÛıÂÓ›˜ Ì ‰È·-
‚‹ÙË, ȉȷ›ÙÂÚ· fiÙ·Ó ¤¯Ô˘Ó Ùˆ¯fi ¤ÏÂÁ¯Ô ‹ Â›Ó·È Û ·ÈÌÔοı·ÚÛË, ¤¯Ô˘Ó
·˘ÍË̤ÓÔ ÚˆÙÂ˚ÓÈÎfi ÌÂÙ·‚ÔÏÈÛÌfi Î·È ÔÈ ÚˆÙÂ˚ÓÈΤ˜ ÙÔ˘˜ ·Ó¿ÁΘ ÌÔÚ›
Ó· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚ˜ ·fi ÙȘ ËÌÂÚ‹ÛȘ Û˘ÓÈÛÙÒÌÂÓ˜ (RDA) (45-48). ŒÙÛÈ
Ë ÚˆÙÂ˚ÓÈ΋ ÚfiÛÏË„Ë ‰ÂÓ Ú¤ÂÈ Ó· ÌÂÈÒÓÂÙ·È Î¿Ùˆ ·fi 0,6 g/kg Ê˘ÛÈÔ-
ÏÔÁÈÎÔ‡ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜/Ë̤ڷ ‰ÈfiÙÈ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ˘ÔıÚ„›·.
ªÂϤÙ˜ ÚˆÙÂ˚ÓÈÎÔ‡ ÂÚÈÔÚÈÛÌÔ‡ Û ·ÛıÂÓ›˜ Ì ™¢1 Î·È ·Ú¯fiÌÂÓË ÓÂÊÚÔ-
¿ıÂÈ· (ÌÈÎÚÔÏÂ˘ÎˆÌ·ÙÈÓÔ˘Ú›·) ¤¯Ô˘Ó ‰Â›ÍÂÈ ‰ÈÊÔÚÔ‡ÌÂÓ· ·ÔÙÂϤÛÌ·Ù·.
™Â ‰˘Ô ÌÂϤÙ˜ ·Ú·ÙËÚ‹ıËÎ·Ó ÌÈÎÚ¤˜ (5-7 Ìg/min) ·ÏÏ¿ ÛËÌ·ÓÙÈΤ˜ ÌÂÈÒ-
14
ÛÂȘ ÛÙÔ Ú˘ıÌfi ·¤ÎÎÚÈÛ˘ ÏÂ˘ÎˆÌ·Ù›Ó˘ (AER) Ì ‰›·ÈÙ˜ ¯·ÌËÏ‹˜ ÂÚÈÂ-
ÎÙÈÎfiÙËÙ·˜ Û ڈÙ½Ó˜, ·ÏÏ¿ Û ¿ÏÏË ÌÂϤÙË ‰ÂÓ ·Ú·ÙËÚ‹ıËΠ‰È·ÊÔÚ¿
(49-51). ™Â Ù˘¯·ÈÔÔÈË̤Ó˜ ÂÏÂÁ¯fiÌÂÓ˜ ÌÂϤÙ˜ ‰È¿ÚÎÂÈ·˜ ÌÂÚÈÎÒÓ Â‚‰Ô-
Ì¿‰ˆÓ, ‰›·ÈÙ˜ ¯·ÌËϤ˜ Û ڈÙ½Ó˜ Ì›ˆÛ·Ó ÙÔ ƒ™¢ Û ·ÛıÂÓ›˜ Ì ·˘ÍË-
̤ÓË ÛÂÈÚ·Ì·ÙÈ΋ ˘ÂډȋıËÛË ¯ˆÚ›˜ ›‰Ú·ÛË ÛÙË ÌÈÎÚÔÏÂ˘ÎˆÌ·ÙÈÓÔ˘-
Ú›· (52, 53). ™Â ‰˘Ô RCTs Û ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Ù‡Ô˘ 2 Ì ÌÈÎÚÔÏ¢-
Έ̷ÙÈÓÔ˘Ú›·, ÚˆÙÂ˚ÓÔ˘Ú›· ‹ ¤Î‰ËÏË ÓÂÊÚÔ¿ıÂÈ·, Ô ÂÚÈÔÚÈÛÌfi˜ Ù˘
ÚˆÙ½Ó˘ ÛÙË ‰›·ÈÙ· ‰ÂÓ Â›¯Â ηÌÈ¿ ›‰Ú·ÛË ÛÙËÓ ·Ï‚Ô˘ÌÈÓÔ˘Ú›· ‹ ÙÔ
ƒ™¢ (54, 55), ÂÓÒ Û ¿ÏÏË Ù˘¯·ÈÔÔÈË̤ÓË ÌÂϤÙË 12 ‰È·‚ËÙÈÎÒÓ ·ÛıÂÓÒÓ
Ù‡Ô˘ 2 Ì ÌÈÎÚÔÏÂ˘ÎˆÌ·ÙÈÓÔ˘Ú›·, ·Ú·ÙËÚ‹ıËΠ̛ˆÛË ÙfiÛÔ ÙÔ˘ ƒ™¢
fiÛÔ Î·È Ù˘ ÌÈÎÚÔÏÂ˘ÎˆÌ·ÙÈÓÔ˘Ú›·˜ (56).
∞Ó Î·È Â›¯·Ó ۯ‰ȷÛÙ› Î·È Ú·ÁÌ·ÙÔÔÈËı› ÛˆÛÙ¿, ÔÈ ·Ú·¿Óˆ ÌÂϤ-
Ù˜ ‹Ù·Ó ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜ Î·È ¯ÚËÛÈÌÔÔ›ËÛ·Ó ¤ÌÌÂÛÔ˘˜ ‰Â›ÎÙ˜ ÓÂÊÚÈ΋˜
ÏÂÈÙÔ˘ÚÁ›·˜ (·Ï‚Ô˘ÌÈÓÔ˘Ú›·, ˘ÂډȋıËÛË) Î·È fi¯È ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·
ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ‹ ı¿Ó·ÙÔ ˆ˜ ηٷÏËÎÙÈο ÛËÌ›·. ŒÙÛÈ Ù· ·ÔÙÂϤÛÌ·Ù¿
www.hndc.gr
ÙÔ˘˜ ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙËÓ ˘ÔÛÙ‹ÚÈÍË ¤ÁÎ˘ÚˆÓ
Û˘ÛÙ¿ÛˆÓ.
∞ÚÎÂÙ¤˜ ÌÂϤÙ˜ ÂÍ¤Ù·Û·Ó ÙËÓ ËÁ‹ Î·È ÔÈfiÙËÙ· ÙˆÓ ÚˆÙÂ˚ÓÒÓ fiÛÔÓ
·ÊÔÚ¿ ÙËÓ Â›‰Ú·Û‹ ÙÔ˘˜ ÛÙË ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›·. ™Â ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜
Ù‡Ô˘ 1, ÌÈ· ‰›·ÈÙ· Ì ڈÙ½Ó˜ Ê˘ÙÈ΋˜ ÚÔ¤Ï¢Û˘ Ì›ˆÛ ÙÔ ƒ™¢ Û ÌÈ·
ÌÂϤÙË (57) Î·È ÙÔ Ú˘ıÌfi ·¤ÎÎÚÈÛ˘ ÏÂ˘ÎˆÌ·Ù›Ó˘ Û ÌÈ· ¿ÏÏË (58). ŸÌˆ˜
Û ÌÈ· Ù˘¯·ÈÔÔÈË̤ÓË ÂÏÂÁ¯fiÌÂÓË ÌÂϤÙË Û ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ 2 Ì ÌÈÎÚÔ-
ÏÂ˘ÎˆÌ·ÙÈÓÔ˘Ú›·, Ë ¯ÔÚ‹ÁËÛË ÁÈ· 6 ‚‰ÔÌ¿‰Â˜ ‰›·ÈÙ·˜ Ì ڈÙ½Ó˜ Ê˘ÙÈ-
΋˜ ÚÔ¤Ï¢Û˘ ‰ÂÓ Â›¯Â η̛· ›‰Ú·ÛË ÛÙÔ Ú˘ıÌfi ·¤ÎÎÚÈÛ˘ ÏÂ˘ÎˆÌ·-
Ù›Ó˘ Û ۇÁÎÚÈÛË Ì ‰›·ÈÙ· Ì ڈÙ½ÓË ˙ˆÈ΋˜ ÚÔ¤Ï¢Û˘ (59). ™Â Ù‡Ô˘
1 ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜, Ë ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘ Ë̛ۈ˜ Ù˘ ÚˆÙÂ˚ÓÈ΋˜
ÚfiÛÏ˄˘ Ì ڈÙ½ÓË ·fi ÛfiÁÈ·, ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË Ì›ˆÛË Ù˘
·¤ÎÎÚÈÛ˘ ÏÂ˘ÎˆÌ·Ù›Ó˘ ÛÙ· Ô‡Ú· Û ÌÈ· ÌÂϤÙË (60), ·ÏÏ¿ ‰ÂÓ ¤‰ÂÈÍÂ
15
ηӤӷ ·ÔÙ¤ÏÂÛÌ· Û ¿ÏÏË ÌÂϤÙË (61). ™Â ÌÈ· ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË ‰È·‚Ë-
ÙÈÎÒÓ Ù‡Ô˘ 1, ˘„ËÏ‹ ÚfiÛÏË„Ë ÚˆÙ½Ó˘ ·fi „¿ÚÈ· Û¯ÂÙ›ÛÙËΠ̠ÌÂÈ-
ˆÌ¤ÓÔ Î›Ó‰˘ÓÔ ÌÈÎÚÔÏÂ˘ÎˆÌ·ÙÈÓÔ˘Ú›·˜ (62). ™Â Ù˘¯·ÈÔÔÈË̤Ó˜ ÂÏÂÁ¯fiÌÂ-
Ó˜ ÌÂϤÙ˜ Û ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Ù‡Ô˘ 1, Ë ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘ ÎfiÎÎÈ-
ÓÔ˘ ÎÚ¤·ÙÔ˜ Ì ÎÔÙfiÔ˘ÏÔ ÁÈ· 4 ‚‰ÔÌ¿‰Â˜ Ì›ˆÛ ÙÔ ƒ™¢ ÛÙÔÓ ›‰ÈÔ ‚·ıÌfi
fiˆ˜ Î·È ÌÈ· ‰›·ÈÙ· ¯·ÌËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ڈÙ½ÓË Û ·ÛıÂÓ›˜ ÌÂ
ÓÂÊÚÈ΋ ˘ÂډȋıËÛË. ∂ÈÚfiÛıÂÙ· ÌÂÈÒıËÎÂ Ô Ú˘ıÌfi˜ ·¤ÎÎÚÈÛ˘ Ï¢-
Έ̷ٛÓ˘ Û ·ÛıÂÓ›˜ Ì ÌÈÎÚÔÏÂ˘ÎˆÌ·ÙÈÓÔ˘Ú›· (63, 64). ŸÌˆ˜, ÏfiÁˆ Ù˘
ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜ ÙˆÓ ÌÂÏÂÙÒÓ ·˘ÙÒÓ Î·È Ù˘ ¤ÏÏÂȄ˘ ÎÏÈÓÈÎÒÓ Î·Ù·ÏËÎÙÈ-
ÎÒÓ ÛËÌ›ˆÓ, ‰ÂÓ ‰›‰ÔÓÙ·È ÚÔ˜ ÙÔ ·ÚfiÓ Ô‰ËÁ›Â˜ Û¯ÂÙÈο Ì ÙË Ê‡ÛË Ù˘
‰È·ÙÚÔÊÈ΋˜ ÚˆÙ½Ó˘.
¶π¡∞∫∞™ 3
∫ÚÈÙ‹ÚÈ· ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÌÂÌÔÓˆÌ¤ÓˆÓ ÌÂÏÂÙÒÓ Û¯ÂÙÈÎÒÓ Ì ÙȘ Û˘ÛÙ¿ÛÂȘ
ÁÈ· ¿ÙÔÌ· Ì ‰È·‚‹ÙË
ñ ∆· ¤ÌÌÂÛ· ηٷÏËÎÙÈο ÛËÌ›· Ú¤ÂÈ Ó· Â›Ó·È Î·Ù¿ÏÏËÏ· (‚Ϥ ¶›Ó·Î· 2)
·Ó ‰ÂÓ Â›Ó·È ‰È·ı¤ÛÈÌ· ı·Ó·ÙËÊfiÚ· ‹ ÎÏÈÓÈο ηٷÏËÎÙÈο ‰Â‰Ô̤ӷ
ñ √ Ù‡Ô˜ ÙÔ˘ ‰È·‚‹ÙË Î·È Ë ıÂڷ›· Ú¤ÂÈ Ó· ¤¯Ô˘Ó ÔÚÈÛı›
ñ √È Û˘ÌÌÂÙ¤¯ÔÓÙ˜ Ú¤ÂÈ Ó· ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ÙË Û¯ÂÙÈ΋ ÔÌ¿‰· ·ÛıÂÓÒÓ
ñ ™Â ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜, ÔÈ Û˘ÌÌÂÙ¤¯ÔÓÙ˜ Ú¤ÂÈ Ó· Ù˘¯·ÈÔÔÈËıÔ‡Ó Û ‰›·È-
Ù˜ ÂϤÁ¯Ô˘ ‹ ÂÈÚ·Ì·ÙÈΤ˜
ñ √È ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜ ı· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û˘Ó‹ıˆ˜ ·Ú¿ÏÏËÏÔ Û¯Â‰È·ÛÌfi
(parallel design) ‹ ‰È·ÛÙ·˘ÚÔ‡ÌÂÓÔ Û¯Â‰È·ÛÌfi (crossover design), ·Ó¿ÏÔÁ· ÌÂ
16 Ù· ηٷÏËÎÙÈο ÛËÌ›· Ô˘ ‰ÈÂÚ¢ÓÒÓÙ·È
ñ √È ‰È·ÙÚÔÊÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ ı· Ú¤ÂÈ Ó· Â›Ó·È Î·ı·Ú¿ ÔÚÈṲ̂Ó˜ Î·È ÔÈ
̤ıÔ‰ÔÈ ÂϤÁ¯Ô˘ Ù˘ Û˘ÌÌfiÚʈÛ˘ Ó· ¤¯Ô˘Ó ÔÚÈÛı› fiÙ·Ó ÔÈ ÌÂϤÙ˜ ÂÚÈ-
Ï·Ì‚¿ÓÔ˘Ó Ù˘¯·›· ¿ÙÔÌ· Ù˘ ÎÔÈÓfiÙËÙ·˜
ñ ∏ ‰È¿ÚÎÂÈ· Ú¤ÂÈ Ó· Â›Ó·È Î·Ù¿ÏÏËÏË ÁÈ· ÙÔ Î·Ù·ÏËÎÙÈÎfi ÛËÌÂ›Ô Ô˘ ‰ÈÂÚ¢-
Ó¿Ù·È. °ÂÓÈο ÌÂϤÙ˜ Ô˘ ‰ÈÂÍ¿ÁÔÓÙ·È ÁÈ· ‚‰ÔÌ¿‰Â˜ ‹ Ì‹Ó˜ Â›Ó·È ÚÔÙÈÌfiÙÂ-
Ú˜ ·fi Ôͤ· ‰È·ÙÚÔÊÈο ÂÈÚ¿Ì·Ù·
ñ √È ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ (ÔÈ Ôԛ˜ Û˘Ó‹ıˆ˜ Â›Ó·È ÚÔÔÙÈΤ˜ ‹ Û˘ÁÎÚÈÙÈ-
Τ˜ ÌÂϤÙ˜) Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÔ‡Ó ÂÈÎ˘ÚˆÌ¤Ó· ‰È·ÈÙËÙÈο fiÚÁ·Ó· ηÈ
ÛÙËÓ ÂÚ›ÙˆÛË ÙˆÓ ÚÔÔÙÈÎÒÓ ÌÂÏÂÙÒÓ ı· Ú¤ÂÈ Î·Ù¿ ÚÔÙ›ÌËÛË Ó· ‚·Û›-
˙ÔÓÙ·È Û ÂÚÈÛÛfiÙÂÚ˜ ·fi ÌÈ· ÂÚÈfi‰Ô˘˜ ÂÎÙ›ÌËÛ˘
ñ √È ÛÙ·ÙÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ Ú¤ÂÈ Ó· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ηı·Ú¿ Î·È Ó· ›ӷÈ
ηٿÏÏËϘ
ñ ¶Ú¤ÂÈ Ó· ÔÚ›˙ÔÓÙ·È ÔÈ Ì¤ıÔ‰ÔÈ ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓ Î·Ù¿ÏÏËÏˆÓ ÌÂÏÂÙÒÓ
(.¯. Ì˯·Ó¤˜ ·Ó·˙‹ÙËÛ˘ Î·È ÂÚÈÁÚ·Ê‹˜)
www.hndc.gr
¢IAITHTIKO §I¶O™
√‰ËÁ›Â˜ ÁÈ· ÙËÓ Î·ı’ Ë̤ڷ Ú¿ÍË
ñ ∆· ÎÔÚÂṲ̂ӷ Î·È Ù· trans-ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· ı· Ú¤ÂÈ Ó·
·ÔÙÂÏÔ‡Ó Î¿Ùˆ ·fi 10% Ù˘ Û˘ÓÔÏÈ΋˜ ËÌÂÚ‹ÛÈ·˜ ÂÓ¤ÚÁÂÈ·˜.
÷ÌËÏfiÙÂÚË ÚfiÛÏË„Ë (<8% Ù˘ ÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜) ÌÔÚ› Ó· ›ӷÈ
¢ÂÚÁÂÙÈ΋ Â¿Ó Ë LDL-¯ÔÏËÛÙÂÚfiÏË Â›Ó·È ·˘ÍË̤ÓË. µ·ıÌfi˜ ∞
ñ ŒÏ·È· ÏÔ‡ÛÈ· Û ÌÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· (MUFA) Â›Ó·È ¯Ú‹ÛÈ̘
ËÁ¤˜ Ï›Ô˘˜ Î·È ·Ó¿ÏÔÁ· Ì ÙȘ ·ÙÔÌÈΤ˜ ÚÔÙÈÌ‹ÛÂȘ ÌÔÚ› Ó· ·Ô-
ÙÂÏÔ‡Ó ÙÔ 10% ¤ˆ˜ 20% Ù˘ Û˘ÓÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜, ˘fi ÙËÓ ÚÔ¸fiıÂ-
ÛË fiÙÈ Ë Û˘ÓÔÏÈ΋ ÚfiÛÏË„Ë Ï›Ô˘˜ ‰ÂÓ ı· ÍÂÂÚÓ¿ ÂÚÈÛÛfiÙÂÚÔ ·fi
35% Ù˘ Û˘ÓÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜. µ·ıÌfi˜ µ
ñ ∆· ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· (PUFA) ‰ÂÓ ı· Ú¤ÂÈ Ó· ÍÂÂÚÓÔ‡Ó ÙÔ
10% Ù˘ ÔÏÈ΋˜ ËÌÂÚ‹ÛÈ·˜ ÂÓ¤ÚÁÂÈ·˜. µ·ıÌfi˜ C
ñ ∏ Û˘ÓÔÏÈ΋ ÚfiÛÏË„Ë Ï›Ô˘˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ÍÂÂÚÓ¿ ÙÔ 35% Ù˘ 17
ÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜. µ·ıÌfi˜ C
ñ °È· ÂΛÓÔ˘˜ Ô˘ Â›Ó·È ˘¤Ú‚·ÚÔÈ, ÚfiÛÏË„Ë Ï›Ô˘˜ οو ·fi 30%
ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÛÙËÓ ·ÒÏÂÈ· ‚¿ÚÔ˘˜. µ·ıÌfi˜ C
ñ ∏ ηٷӿψÛË ‰˘Ô ¤ˆ˜ ÙÚÈÒÓ ÌÂÚ›‰ˆÓ „·ÚÈÎÒÓ (ηٿ ÚÔÙ›ÌËÛË ÏÈ·-
Ú¿ „¿ÚÈ·) οı ‚‰ÔÌ¿‰· ηıÒ˜ Î·È ‰È·ÊfiÚˆÓ Ê˘ÙÈÎÒÓ ËÁÒÓ ˆ-3
ÏÈ·ÚÒÓ ÔͤˆÓ (.¯. ÛÔÁȤϷÈÔ, ÍËÚÔ› ηÚÔ› Î·È ÌÂÚÈο Ú¿ÛÈÓ· Ê˘Ï-
ÏÒ‰Ë Ï·¯·ÓÈο) ı· ‚ÔËı‹ÛÂÈ ÛÙËÓ Â·Ú΋ ÚfiÛÏË„Ë ˆ-3 ÏÈ·ÚÒÓ
ÔͤˆÓ. µ·ıÌfi˜ µ
ñ ∏ ÚfiÛÏË„Ë ¯ÔÏËÛÙÂÚfiÏ˘ ‰ÂÓ Ú¤ÂÈ Ó· ÍÂÂÚÓ¿ Ù· 300 mg/Ë̤ڷ
Î·È Ó· Â›Ó·È ·ÎfiÌ· ÌÈÎÚfiÙÂÚË ·Ó Ë LDL-¯ÔÏËÛÙÂÚfiÏË Â›Ó·È ·˘ÍË̤ÓË.
µ·ıÌfi˜ ∞
™¯fiÏÈ·
√È Û˘ÛÙ¿ÛÂȘ ÁÈ· ÙË ‰È·ÈÙËÙÈ΋ ÚfiÛÏË„Ë Ï›Ô˘˜ ÛÙÔ Û·Î¯·ÚÒ‰Ë ‰È·‚‹-
ÙË ‚·Û›˙ÔÓÙ·È Î˘Ú›ˆ˜ Û ÌÂϤÙ˜ Û ÌË ‰È·‚ËÙÈο ¿ÙÔÌ·, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ-
Ì¤ÓˆÓ ÂÏÂÁ¯fiÌÂÓˆÓ ‰È·ÈÙËÙÈÎÒÓ Î·È ÂȉËÌÈÔÏÔÁÈÎÒÓ ÌÂÏÂÙÒÓ. ¢ÂÓ ˘¿Ú-
¯Ô˘Ó ÂÏÂÁ¯fiÌÂÓ˜ ‰È·ÈÙËÙÈΤ˜ ·ÚÂÌ‚·ÙÈΤ˜ ÌÂϤÙ˜ Û ¿ÙÔÌ· Ì ‰È·‚‹ÙË ÌÂ
ÈηӋ ‰‡Ó·ÌË Ó· ‰Â›ÍÔ˘Ó ÂȉڿÛÂȘ Ù˘ ‰È·ÈÙËÙÈ΋˜ ÚfiÛÏ˄˘ Ï›Ô˘˜ ÛÂ
ηډȷÁÁÂȷο ‹ ¿ÏÏ· ηٷÏËÎÙÈο ÛËÌ›·. ∂›Û˘ ˘¿Ú¯Ô˘Ó Ôχ ÂÚÈÔ-
ÚÈṲ̂ӷ ‰Â‰Ô̤ӷ ·fi ÌÂϤÙ˜ ·Ú·Ù‹ÚËÛ˘ ÁÈ· ÙȘ Û¯¤ÛÂȘ ÌÂٷ͇ ‰È·ÈÙË-
ÙÈ΋˜ ÚfiÛÏ˄˘ Ï›Ô˘˜ Î·È ÓfiÛÔ˘ ‹ ı·Ó¿ÙÔ˘ Û ¿ÙÔÌ· Ì ‰È·‚‹ÙË.
À¿Ú¯ÂÈ ¤Ó·˜ ·ÚÈıÌfi˜ ÌÂÏÂÙÒÓ Ô˘ Û˘ÁÎÚ›ÓÂÈ ‰›·ÈÙ˜ Ì ˘„ËÏ‹ ÂÚÈÂÎÙÈÎfi-
ÙËÙ· Û ϛԘ (΢ڛˆ˜ ÏfiÁˆ ·˘ÍË̤Ó˘ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û MUFA) Ì ÂΛ-
Ó˜ Ô˘ ÂÚȤ¯Ô˘Ó ˘„ËÏfiÙÂÚË ·Ó·ÏÔÁ›· ˘‰·Ù·ÓıڿΈÓ, Î·È ¤Ó·˜ ·ÚÈıÌfi˜
ÂÏÂÁ¯fiÌÂÓˆÓ ÌÂÏÂÙÒÓ Ô˘ ‰ÈÂÚ¢ÓÔ‡Ó ÙËÓ Â›‰Ú·ÛË ÙÔ˘ Ù‡Ô˘ ÙÔ˘ ‰È·ÈÙË-
ÙÈÎÔ‡ Ï›Ô˘˜ Û ·ÛıÂÓ›˜ Ì ‰È·‚‹ÙË. √È ÌÂϤÙ˜ ·˘Ù¤˜, ÔÈ Ôԛ˜ Û˘ÁÎÚ›-
ÓÔ˘Ó ÙȘ ÂȉڿÛÂȘ Ù˘ ÙÚÔÔÔ›ËÛ˘ Ù˘ ÚfiÛÏ˄˘ Ï›Ô˘˜ ÛÙÔ˘˜ ·Ú¿-
ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÓfiÛÔ ‹ Û ¤ÌÌÂÛ· ηٷÏËÎÙÈο ÛËÌ›· (.¯. ÙË Û˘ÁΤ-
18
ÓÙÚˆÛË ÙˆÓ ÏÈȉ›ˆÓ ‹ ÏÈÔÚˆÙÂ˚ÓÒÓ ÙÔ˘ ÔÚÔ‡, ÙËÓ ·¯˘Û·ÚΛ·, ÙË ÁÏ˘-
ηÈÌ›·, ÙËÓ Â˘·ÈÛıËÛ›· ÛÙËÓ ÈÓÛÔ˘Ï›ÓË) Û˘ÌÏËÚÒÓÔ˘Ó Ù· ‰Â‰Ô̤ӷ ·fi ÙȘ
ÌÂϤÙ˜ Û ÌË ‰È·‚ËÙÈο ¿ÙÔÌ·.
£ÂˆÚÂ›Ù·È fiÙÈ Â›Ó·È ·Ô‰ÂÎÙfi Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÌÂϤÙ˜ Û «˘ÁÈ‹» ÌË
‰È·‚ËÙÈο ¿ÙÔÌ· ÁÈ· ÙË ‰È·Ù‡ˆÛË ‰È·ÈÙËÙÈÎÒÓ Û˘ÛÙ¿ÛÂˆÓ Û ¿ÙÔÌ· Ì ‰È·-
‚‹ÙË Ù‡Ô˘ 2, ηıÒ˜ Ô ‰È·¯ˆÚÈÛÌfi˜ ÌÂٷ͇ ÙˆÓ ·ÙfiÌˆÓ Ì ·¯˘Û·ÚΛ·
ηÈ/‹ ÎÏËÚÔÓÔÌÈο ÛÙ›ÁÌ·Ù· ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Î·È ÙˆÓ ·ÙfïÓ
Ì ™¢2 ‚·Û›˙ÂÙ·È Û ·˘ı·›ÚÂÙ· fiÚÈ· ÁÏ˘Îfi˙˘ ÙÔ˘ ·›Ì·ÙÔ˜. ŸÏ˜ ÔÈ ÂӉ›-
ÍÂȘ ˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ Ë ·Ó¿Ù˘ÍË ÙÔ˘ ‰È·‚‹ÙË Â›Ó·È ÌÈ· ‰È·‰Èηۛ· Ô˘
Û˘Ì‚·›ÓÂÈ Û ‰È¿ÛÙËÌ· ÂÙÒÓ ‹ ‰ÂηÂÙÈÒÓ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÌÈ· ÚÔԉ¢ÙÈ΋
‰È·Ù·Ú·¯‹ Ù˘ ¢·ÈÛıËÛ›·˜ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Î·È ÙËÓ ·Ó¿Ù˘ÍË Û¯ÂÙÈÎÒÓ
ÌÂÙ·‚ÔÏÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ. √ ΛӉ˘ÓÔ˜ ηډȷÁÁÂÈ·ÎÒÓ ÂÈÏÔÎÒÓ Â›Ó·È
˘„ËÏfi˜ ÚÈÓ ·fi ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ‰È·‚‹ÙË Î·È ÔÈ ›‰ÈÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡-
ÓÔ˘ ˘¿Ú¯Ô˘Ó ÚÈÓ fiˆ˜ Î·È ÌÂÙ¿ ÙË ‰È¿ÁÓˆÛË. ŸÌˆ˜ Ë ÛËÌ·Û›· ÙˆÓ
·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ÂÎÛÂÛËÌ·Ṳ̂ÓË ÛÙ· ‰È·‚ËÙÈο
www.hndc.gr
¿ÙÔÌ·. ŸÏ· Ù· ‰È·ı¤ÛÈÌ· ‰Â‰Ô̤ӷ ˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ ÔÈ ›‰È˜ ‰È·ÈÙËÙÈΤ˜
·ÏÏ·Á¤˜ Ô˘ ¤¯ÂÈ ‰È·ÈÛÙˆı› fiÙÈ ÌÂÈÒÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ Î·Ú‰È·ÁÁÂȷ΋˜
ÓfiÛÔ˘ ÛÙ· ÌË ‰È·‚ËÙÈο ¿ÙÔÌ· Â›Ó·È ·ÎfiÌ· ÂÚÈÛÛfiÙÂÚÔ Û¯ÂÙÈΤ˜ Î·È ¯Ú‹-
ÛÈ̘ ÛÙÔ ‰È·‚ËÙÈÎfi ÏËı˘ÛÌfi, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û¯Â-
Ù›˙ÔÓÙ·È Ì ·ÎfiÌ· ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÛÙ· ¿ÙÔÌ· Ì ‰È·‚‹ÙË. ∞Ó Î·È Ë
·ıÔÁ¤ÓÂÈ· ÙÔ˘ ™¢1 Â›Ó·È ‰È·ÊÔÚÂÙÈ΋ ·fi ÂΛÓË ÙÔ˘ ™¢2, ÔÈ ÂÚÈÛÛfiÙÂ-
ÚÔÈ ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ηډȷÁÁÂȷΤ˜ ÓfiÛÔ˘˜ Ô˘ ¤¯ÂÈ ‰ÂÈ-
¯Ù› fiÙÈ ÂȉÚÔ‡Ó ÛÙ· ˘ÁÈ‹ ¿ÙÔÌ· Î·È ÙÔ ‰È·‚‹ÙË Ù‡Ô˘ 2 Ê·›ÓÂÙ·È fiÙÈ Û¯Â-
Ù›˙ÔÓÙ·È Î·È Ì ÙÔ ™¢1. ŒÙÛÈ ÁÂÓÈο ‰›‰ÔÓÙ·È ·ÚfiÌÔȘ Û˘ÛÙ¿ÛÂȘ ÁÈ· ÙÔ
‰È·‚‹ÙË Ù‡Ô˘ 1 Î·È 2.
∏ ΢ÚÈfiÙÂÚË Û‡ÛÙ·ÛË Ô˘ ‰›‰ÂÙ·È Û¯ÂÙÈο Ì ÙÔ ÔÏÈÎfi ϛԘ Â›Ó·È fiÙÈ Ë
ÚfiÛÏË„‹ ÙÔ˘ ‰ÂÓ ı· Ú¤ÂÈ Ó· ÍÂÂÚÓ¿ ÙÔ 35% Ù˘ Û˘ÓÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜
ÏfiÁˆ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ·‡ÍËÛ˘ ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Ì ‰›·ÈÙ˜ ˘„ËÏ‹˜
19
ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ϛԘ [65 (π·)]. ∂ÈÚfiÛıÂÙ·, Ì ‰›·ÈÙ· ˘„ËÏ‹˜ ÂÚÈÂ-
ÎÙÈÎfiÙËÙ·˜ Û ÔÏÈÎfi ϛԘ ÌÔÚ› Ó· ÛËÌÂȈıÔ‡Ó ·ÚÓËÙÈΤ˜ ÂȉڿÛÂȘ ÛÙËÓ
¢·ÈÛıËÛ›· ÛÙËÓ ÈÓÛÔ˘Ï›ÓË ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ Â›‰Ô˜ ÙÔ˘ ‰È·ÈÙËÙÈÎÔ‡
Ï›Ô˘˜, fiˆ˜ ‰È·ÈÛÙÒıËΠ۠ÌÈ· ÌÂϤÙË ˘ÁÈÒÓ ·ÙfiÌˆÓ [66 (Ib)]. °È· Ù·
ÂÚÈÛÛfiÙÂÚ· ¿ÙÔÌ· Â›Ó·È ·Ô‰ÂÎÙfi ¤Ó· ÌÂÁ¿ÏÔ Â‡ÚÔ˜ ÚfiÛÏ˄˘ Î·È ı·
ÂÍ·ÚÙËı› ·fi ÙȘ ·ÙÔÌÈΤ˜ ÚÔÙÈÌ‹ÛÂȘ Î·È ¯·Ú·ÎÙËÚÈÛÙÈο. °È· ÙÔ˘˜ ˘¤Ú-
‚·ÚÔ˘˜, ÌÈ· Û˘ÓÔÏÈ΋ ÚfiÛÏË„Ë Ï›Ô˘˜ ÏÈÁfiÙÂÚÔ ·fi 30% Ù˘ Û˘ÓÔÏÈ΋˜
ÂÓ¤ÚÁÂÈ·˜ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÛÙËÓ ·ÒÏÂÈ· ‚¿ÚÔ˘˜ [3 (IV)].
∫√ƒ∂™ª∂¡∞ §π¶∞ƒ∞ √•∂∞
À¿Ú¯Ô˘Ó ÂÈÛÙÈο ‰Â‰Ô̤ӷ ·fi ÌÂÙ·-·Ó·Ï‡ÛÂȘ ÂÏÂÁ¯fiÌÂÓˆÓ ÌÂÏÂÙÒÓ ÛÂ
¿ÙÔÌ· ¯ˆÚ›˜ ‰È·‚‹ÙË [67-69 (Ia)] fiÙÈ ÌÈ· ·ÓÙ·ÏÏ·Á‹ ‰È·ÈÙËÙÈÎÒÓ ÎÔÚÂṲ̂-
ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Ì ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· (ÂÎÙfi˜ ÙˆÓ trans ÏÈ·ÚÒÓ
ÔͤˆÓ – ‚Ϥ ·Ú·Î¿Ùˆ) ‹ Ì ˘‰·Ù¿ÓıڷΘ ı· ÌÂÈÒÛÂÈ ÙËÓ LDL-¯ÔÏË-
ÛÙÂÚfiÏË. ∆Ô ÁÂÁÔÓfi˜ fiÙÈ Ë ·ÓÙ·ÏÏ·Á‹ ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Ì ·Îfi-
ÚÂÛÙ· ı· ÌÂÈÒÛÂÈ ÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË ‚Ú›ÛÎÂÈ Â›Û˘ ˘ÔÛÙ‹ÚÈÍË ·fi
Ï›Á˜ ÂÏÂÁ¯fiÌÂÓ˜ ÌÂϤÙ˜ Û ‰È·‚ËÙÈο ¿ÙÔÌ· [70 (Ib)] Î·È ¿ÙÔÌ· Ì ‰˘Û·-
ÓÂÍ›· ÛÙË ÁÏ˘Îfi˙Ë [71 (Ib)]. ¶ÚfiÛÊ·Ù·, ÙÚÂȘ ÂÏÂÁ¯fiÌÂÓ˜ ‰È·ÈÙËÙÈΤ˜ ÌÂϤ-
Ù˜ ·Ú¤Ì‚·Û˘ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ˘fi ÈÛÔÂÓÂÚÁËÙÈΤ˜ Û˘Óı‹Î˜ ÛÂ
˘ÁÈ‹ [72, 66 (Ib)] Î·È ·¯‡Û·Úη ¿ÙÔÌ· (ÌÂÚÈο Ì¿ÏÈÛÙ· Î·È Ì ‰È·‚‹ÙË)
˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ ÌÈ· ·ÓÙ·ÏÏ·Á‹ ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Ì ·ÎfiÚÂÛÙ·
ÛÙË ‰È·ÙÚÔÊ‹ ı· ‚ÂÏÙÈÒÛÂÈ ÛËÌ·ÓÙÈο ÙËÓ Â˘·ÈÛıËÛ›· ÛÙËÓ ÈÓÛÔ˘Ï›ÓË. ∞Ó
Î·È Ï›Á· Â›Ó·È ÁÓˆÛÙ¿ Û¯ÂÙÈο Ì ÙȘ ÌÂÙ·‚ÔÏÈΤ˜ ÂȉڿÛÂȘ ÙˆÓ ‰È·ÊfiÚˆÓ
ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ ÛÙÔ ‰È·‚‹ÙË ¤¯ÂÈ ‰ÂȯÙ› ηı·Ú¿ fiÙÈ ÙÔ ÛÙ·ÙÈ-
Îfi Ô͇, Û ·ÓÙ›ıÂÛË Ì ¿ÏÏ· ÎÔÚÂṲ̂ӷ ÏÈ·Ú¿ Ôͤ· (Ï·Ô˘ÚÈÎfi, Ì˘ÚÈÛÙÈÎfi
Î·È ·ÏÌÈÙÈÎfi) ‰ÂÓ ·˘Í¿ÓÂÈ ÙË ¯ÔÏËÛÙÂÚfiÏË (74). ∂ÈÚfiÛıÂÙ·, Ê·›ÓÂÙ·È
Èı·Ófi fiÙÈ ÔÈ ‰È·‚ËÙÈÎÔ›, fiˆ˜ Û˘Ì‚·›ÓÂÈ Î·È ÌÂ’ ÂΛÓÔ˘˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó
‰È·‚‹ÙË, ı· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË ÛÙËÓ ÔÏÈ΋ Î·È LDL-¯ÔÏË-
20
ÛÙÂÚfiÏË fiÙ·Ó ÙÔ Ì˘ÚÈÛÙÈÎfi Î·È ÙÔ ·ÏÌÈÙÈÎfi Ô͇ Û˘ÁÎÚ›ÓÔÓÙ·È Ì ÙÔ Ï·Ô˘-
ÚÈÎfi Ô͇ (75).
∆· ÎÔÚÂṲ̂ӷ ÏÈ·Ú¿ Ôͤ· ÌÔÚ› ›Û˘ Ó· ÚÔηϤÛÔ˘Ó ‰˘ÛÌÂÓ¤˜ ÌÂÙ·-
ÁÂ˘Ì·ÙÈÎfi ÏÈȉ·ÈÌÈÎfi ÚÔÊ›Ï Û ۇÁÎÚÈÛË Ì ٷ ÌÔÓÔ·ÎfiÚÂÛÙ· Ôͤ· ÙfiÛÔ
ÛÂ Ê˘ÛÈÔÏÔÁÈο (76) fiÛÔ Î·È Û ‰È·‚ËÙÈο [77(Ib)] ¿ÙÔÌ·. ∆· ÎÔÚÂṲ̂ӷ
ÏÈ·Ú¿ Ôͤ· Î·È Ù· trans ÏÈ·Ú¿ Ôͤ· ÚÔοÏÂÛ·Ó ·‡ÍËÛË Ù˘ ÌÂÙ·ÁÂ˘Ì·ÙÈ-
΋˜ ÈÓÛÔ˘ÏÈÓ·ÈÌ›·˜ Û ·¯‡Û·Úη ¿ÙÔÌ· Ì ™¢2 [78 (Ib)]. ™Â ‰˘Ô ÚÔÔÙÈ-
Τ˜ ÌÂϤÙ˜ ‰È·‚ËÙÈÎÒÓ ·ÙfiÌˆÓ [79, 80 (πππ)] Ë ·Ó·ÏÔÁ›· ÙˆÓ ÎÔÚÂṲ̂ӈÓ
ÏÈ·ÚÒÓ ÔͤˆÓ ÛÙË ‰›·ÈÙ· (‹ Ô ÏfiÁÔ˜ ¶/∫) Û¯ÂÙÈ˙fiÙ·Ó ÛËÌ·ÓÙÈο Ì ÙËÓ
›وÛË Ó¤ˆÓ ÂÂÈÛÔ‰›ˆÓ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘.
∞ÚÎÂÙ¤˜ ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ [81-83 (πππ)] ˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ ÌÈ· ˘„ËÏ‹
·Ó·ÏÔÁ›· ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ ÛÙÔ˘˜ ÂÛÙ¤Ú˜ ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘ Ï¿-
ÛÌ·ÙÔ˜, Û˘Ì‚·Ù‹ Ì ˘„ËÏ‹ ‰È·ÈÙËÙÈ΋ ÚfiÛÏË„Ë ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ
ÔͤˆÓ, Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ·Ó¿Ù˘Í˘ ™¢2. ™Â ÌÂϤÙ˜ ·Ú·-
Ù‹ÚËÛ˘ fï˜ [84-89 (πππ)], ‰Â ‚Ú¤ıËΠηı·Ú‹ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙÔ˘
www.hndc.gr
ÎÔÚÂṲ̂ÓÔ˘ Ï›Ô˘˜ Ù˘ ‰›·ÈÙ·˜ Î·È Ù˘ ·Ó¿Ù˘Í˘ ‰È·‚‹ÙË, ÌÂÙ¿ ·fi ÂÍÔ-
ÌÔ›ˆÛË ÁÈ· ÙÔ ¢ª™.
TRANS ∞∫√ƒ∂™∆∞ §π¶∞ƒ∞ √•∂∞
ªÈ· ÌÂÙ·-·Ó¿Ï˘ÛË [90 (πa)] Î·È ÂÏÂÁ¯fiÌÂÓ˜ ‰È·ÈÙËÙÈΤ˜ ÌÂϤÙ˜ Û ¿ÙÔÌ·
¯ˆÚ›˜ ‰È·‚‹ÙË ˘Ô‰ËÏÒÓÔ˘Ó ‰˘ÛÌÂÓ›˜ ÂȉڿÛÂȘ ÙˆÓ trans ÏÈ·ÚÒÓ
ÔͤˆÓ Ù˘ ‰È·ÙÚÔÊ‹˜ ÛÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË, ÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏË, ÙÔ
̤ÁÂıÔ˜ ÙˆÓ LDL Î·È Ù· ›‰· Ù˘ Lp(a). ∆· trans ÏÈ·Ú¿ Ôͤ· ÚÔοÏÂ-
Û·Ó ÌÈ· ·‡ÍËÛË ÛÙË ÌÂÙ·ÁÂ˘Ì·ÙÈ΋ ÈÓÛÔ˘ÏÈÓ·ÈÌ›· Û ·¯‡Û·Úη ¿ÙÔÌ· ÌÂ
™¢2 [78 (πb)]. ªÂÚÈΤ˜ ÌÂϤÙ˜ ·Ú·Ù‹ÚËÛ˘ ˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ ÌÈ· ˘„ËÏ‹
ÚfiÛÏË„Ë trans ÏÈ·ÚÒÓ ÔͤˆÓ ÌÔÚ› Ó· ·˘Í‹ÛÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ·Ó¿Ù˘Í˘
‰È·‚‹ÙË Ù‡Ô˘ 2 [87 (πππ)]. ŸÌˆ˜ ÙÔ ÂÚȯfiÌÂÓÔ ÙˆÓ trans ÏÈ·ÚÒÓ ÔͤˆÓ
ÛÙȘ ‰›·ÈÙ˜ ÛÙȘ ÌÂϤÙ˜ ·Ú·Ù‹ÚËÛ˘ ‰ÂÓ Â›Ó·È Î·Ï¿ ¯·Ú·ÎÙËÚÈṲ̂ÓÔ.
21
ª√¡√∞∫√ƒ∂™∆∞ §π¶∞ƒ∞ √•∂∞
∏ ·ÓÙÈηٿÛÙ·ÛË ÙˆÓ ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Ì ÌÔÓÔ·ÎfiÚÂÛÙ· ¤¯ÂÈ
¢ÂÚÁÂÙÈΤ˜ ÂȉڿÛÂȘ ÛÙ· ›‰· ÏÈȉ›ˆÓ ÙÔ˘ ÔÚÔ‡ Î·È ÛÙË Û˘ÁΤÓÙÚˆ-
ÛË Î·È Û‡ÓıÂÛË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ [67-69 (Ia)] ηıÒ˜ Î·È ÛÙËÓ Â˘·ÈÛıË-
Û›· ÛÙËÓ ÈÓÛÔ˘Ï›ÓË ÙfiÛÔ Û ¿ÙÔÌ· Ì ‰˘Û·ÓÂÍ›· ÛÙË ÁÏ˘Îfi˙Ë (71) fiÛÔ Î·È
Û ˘ÁÈ‹ ¿ÙÔÌ·, ˘fi ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ Ë ÔÏÈ΋ ÚfiÛÏË„Ë Ï›Ô˘˜ ‰ÂÓ Â›Ó·È
Ôχ ˘„ËÏ‹ [66 (π‚)]. À¿Ú¯Ô˘Ó ›Û˘ ÂÏÂÁ¯fiÌÂÓ˜ ÌÂϤÙ˜ Ô˘ ‰Â›¯ÓÔ˘Ó
fiÙÈ Ë ·ÓÙÈηٿÛÙ·ÛË ˘‰·Ù·ÓıÚ¿ÎˆÓ ·fi ÌÈ· Û˘ÁÎÂÎÚÈ̤ÓË ÔÛfiÙËÙ· ÌÔÓÔ-
·ÎfiÚÂÛÙÔ˘ Ï›Ô˘˜ (MUFA) ÌÔÚ› Ó· ÂÈʤÚÂÈ Î¿ÔÈÔ fiÊÂÏÔ˜ Û¯ÂÙÈο ÌÂ
Ù· ›‰· ÏÈȉ›ˆÓ ÙÔ˘ ÔÚÔ‡, ·Ó Ë ËÁ‹ ÙˆÓ ˘‰·Ù·ÓıÚ¿ÎˆÓ Â›Ó·È Î˘Ú›ˆ˜
·fi ÙÚfiÊÈÌ· ÏÔ‡ÛÈ· Û ¿Ì˘ÏÔ Ì ¯·ÌËÏfi ÂÚȯfiÌÂÓÔ Ê˘ÙÈÎÒÓ ÈÓÒÓ Î·È
˘„ËÏfi ÁÏ˘Î·ÈÌÈÎfi ‰Â›ÎÙË [91 (Ia)]. ∞˘Ùfi ·ÊÔÚ¿ ΢ڛˆ˜ ‰È·‚ËÙÈο ¿ÙÔÌ·
Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‚¿ÚÔ˘˜, Èı·ÓÒ˜ ȉȷ›ÙÂÚ· ‰È·‚‹ÙË Ù‡Ô˘ 1. ¢ÂÓ ˘¿Ú¯Ô˘Ó
·fi ÙËÓ ¿ÏÏË ÌÂÚÈ¿ ÛÙÔȯ›· Ô˘ Ó· ›ıÔ˘Ó fiÙÈ Ë «ÌÂٷΛÓËÛË» ·fi ÌÈ·
‰›·ÈÙ· ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ˘‰·Ù¿ÓıڷΘ Ì ˘„ËÏfi Â›Â‰Ô ÈÓÒÓ Î·È
¯·ÌËÏfi ÁÏ˘Î·ÈÌÈÎfi ‰Â›ÎÙË ÚÔ˜ ÌÈ· ‰›·ÈÙ· Ô˘ ÂÚȤ¯ÂÈ ÂÚÈÛÛfiÙÂÚ· MUFA
ı· ‚ÂÏÙÈÒÛÂÈ ÙÔ ÌÂÙ·‚ÔÏÈÎfi ¤ÏÂÁ¯Ô ÛÙÔ ‰È·‚‹ÙË (72, 76, 92-95). ªÈ· Ù¤ÙÔÈ·
ÌÂÙ·‚ÔÏ‹ ÌÔÚ› Ì¿ÏÏÔÓ Ó· ·˘Í‹ÛÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÚfiÛÏ˄˘ ‚¿ÚÔ˘˜ ÏfiÁˆ
·˘ÍË̤Ó˘ ÂÓÂÚÁÂȷ΋˜ ÚfiÛÏ˄˘. ™˘ÌÌfiÚʈÛË Ì ÌÈ· ‰›·ÈÙ· ¯·ÌËÏ‹ ÛÂ
ϛԘ, Ô˘ ÂÚȤ¯ÂÈ ˘„ËÏfi ÔÛÔÛÙfi Ê˘ÙÈÎÒÓ ÈÓÒÓ Î·È ˘‰·Ù¿ÓıڷΘ ¯·ÌË-
ÏÔ‡ ÁÏ˘Î·ÈÌÈÎÔ‡ ‰Â›ÎÙË ÌÔÚ› Ó· ÚÔ·Á¿ÁÂÈ ÙËÓ ·ÒÏÂÈ· ‚¿ÚÔ˘˜ Î·È ÙË
ÌÂÙ·‚ÔÏÈ΋ ÂÈÎfiÓ· Û ¿ÙÔÌ· Ì ‰È·‚‹ÙË Ù‡Ô˘ 1 (96), Ì ÌÂÙ·‚ÔÏÈÎfi Û‡Ó-
‰ÚÔÌÔ (97) ‹ ‰˘Û·ÓÂÍ›· ÛÙË ÁÏ˘Îfi˙Ë (98). ™Â ÌÂÚÈΤ˜ ·ÚÂÌ‚·ÙÈΤ˜ ÌÂϤ-
Ù˜ Û ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ 2 Ë ·˘ÍË̤ÓË ÚfiÛÏË„Ë MUFA Ê·›ÓÂÙ·È Ó· Û¯Â-
Ù›˙ÂÙ·È Ì ¯·ÌËÏfiÙÂÚË ·ÚÙËÚȷ΋ ›ÂÛË ·fi ÌÈ· ‰›·ÈÙ· Ì ˘„ËÏfi ÔÛÔÛÙfi
ÔÏ˘·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ (PUFA) (99) ‹ ˘‰·Ù·ÓıÚ¿ÎˆÓ (100). ∫·Ù¿
Û˘Ó¤ÂÈ·, ¤Ï·È· Ô˘ Â›Ó·È ÏÔ‡ÛÈ· Û MUFA Â›Ó·È ¯Ú‹ÛÈ̘ ËÁ¤˜ Ï›Ô˘˜
22
Î·È ·Ó¿ÏÔÁ· Ì ٷ ÌÂÙ·‚ÔÏÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È ÙȘ ·ÙÔÌÈΤ˜ ÚÔÙÈÌ‹ÛÂȘ,
Ù· MUFA ÌÔÚ› Ó· ·ÔÙÂÏÔ‡Ó ÙÔ 10-20% Ù˘ Û˘ÓÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜, ˘fi
ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ ÙÔ Û˘ÓÔÏÈÎfi ϛԘ ‰ÂÓ ÍÂÂÚÓ¿ ÙÔ 35% Ù˘ ÔÏÈ΋˜ ÂÓ¤Ú-
ÁÂÈ·˜.
ˆ-6 ¶√§À∞∫√ƒ∂™∆∞ §π¶∞ƒ∞ √•∂∞
∏ ·ÓÙÈηٿÛÙ·ÛË ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Ì ÔÏ˘·ÎfiÚÂÛÙ· (PUFA)
¤¯ÂÈ Â˘ÂÚÁÂÙÈΤ˜ ÂȉڿÛÂȘ ÛÙ· ›‰· ÏÈȉ›ˆÓ ÙÔ˘ ÔÚÔ‡ Î·È ÛÙË Û˘ÁΤ-
ÓÙÚˆÛË Î·È Û‡ÓıÂÛË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ [67-69 (Ia)] ηıÒ˜ Î·È ÛÙËÓ Â˘·È-
ÛıËÛ›· ÛÙËÓ ÈÓÛÔ˘Ï›ÓË [73 (πb)]. ™¯ÂÙÈο Ì ٷ ›‰· ÙfiÛÔ Ù˘ ÁÏ˘Îfi˙˘
fiÛÔ Î·È ÙˆÓ ÏÈȉ›ˆÓ ·›Ì·ÙÔ˜ Û ™¢1 Î·È ™¢2, Ê·›ÓÂÙ·È fiÙÈ ˘¿Ú¯Ô˘Ó
ÌÈÎÚ¤˜ ‰È·ÊÔÚ¤˜ fiÙ·Ó Û˘ÁÎÚ›ÓÔÓÙ·È ‰›·ÈÙ˜ ÌÔÓÔ- Î·È ÔÏ˘-·ÎfiÚÂÛÙˆÓ
ÏÈ·ÚÒÓ ÔͤˆÓ (101). ¶ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ¤Ó· ˘„ËÏfi ÔÛÔÛÙfi
ÔÏ˘·ÎfiÚÂÛÙÔ˘ Ê˘ÙÈÎÔ‡ Ï›Ô˘˜ ÛÙË ‰›·ÈÙ· (ÏÔ‡ÛÈÔ˘ Û ÏÈÓÔÏÂ˚Îfi Ô͇)
[84, 85, 88 (πππ)], ‹ ¤Ó· ˘„ËÏfi ÔÛÔÛÙfi ÏÈÓÔÏÂ˚ÎÔ‡ ÔͤԘ ÛÙÔ˘˜ ÂÛÙ¤Ú˜
www.hndc.gr
ÏÈȉ›ˆÓ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ [81-83 (III)] Ô˘ ˘Ô‰ËÏÒÓÔ˘Ó ˘„ËÏ‹ ‰È·ÈÙËÙÈ΋
ÚfiÛÏË„Ë, Û¯ÂÙ›˙ÂÙ·È Ì ¯·ÌËÏfi ΛӉ˘ÓÔ ·Ó¿Ù˘Í˘ ‰È·‚‹ÙË Ù‡Ô˘ 2.
ŒÓ·˜ ˘„ËÏfi˜ ‰Â›ÎÙ˘ ¶/∫ (ÔÏ˘·ÎfiÚÂÛÙˆÓ ÚÔ˜ ÎÔÚÂṲ̂ӷ ÏÈ·Ú¿ Ôͤ·)
¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ¯·ÌËÏfi ΛӉ˘ÓÔ ı·Ó·ÙËÊfiÚˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ-
‰›ˆÓ Û ¿ÙÔÌ· Ì ‰È·‚‹ÙË [79, 80 (πππ)]. ¶¿ÓÙˆ˜ ¤¯ÂÈ ÚÔÙ·ı› fiÙÈ Ë Úfi-
ÛÏË„Ë ÏÈÓÔÏÂ˚ÎÔ‡ ÔͤԘ ÛÙË ‰È·‚ËÙÈ΋ ‰›·ÈÙ· Ú¤ÂÈ Ó· ÌÂȈı› Û ÏÈÁfiÙÂ-
ÚÔ ·fi 10% Ù˘ ÂÓÂÚÁÂȷ΋˜ ÚfiÛÏ˄˘ ÏfiÁˆ Ù˘ Èı·ÓfiÙËÙ·˜ Ë ˘„ËÏfi-
ÙÂÚË ÚfiÛÏË„Ë Ó· ·˘Í‹ÛÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ˘ÂÚÔÍ›‰ˆÛ˘ ÙˆÓ ÏÈÒÓ ÛÙÔ
ÛÒÌ·. ¢ÂÓ ˘¿Ú¯Ô˘Ó ¿ÌÂÛ˜ ÂӉ›ÍÂȘ Ô˘ Ó· ˘ÔÛÙËÚ›˙Ô˘Ó ÙË Û‡ÛÙ·ÛË
·˘Ù‹ [3 (IV)] ·ÏÏ¿ ·Ó·Ê¤ÚÂÙ·È ˆ˜ Ú·ÎÙÈ΋ Û˘Ì‚Ô˘Ï‹ ÁÈ· ÏfiÁÔ˘˜ ·ÛÊ·-
Ï›·˜. ∂ÈϤÔÓ, ÌÂÁ·Ï‡ÙÂÚË ÚfiÛÏË„Ë ‰ÂÓ Â›Ó·È Ú·ÏÈÛÙÈ΋ Ì ‰Â‰Ô̤ÓË ÙË
¯·ÌËÏ‹ ÚfiÛÏË„Ë PUFA ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ∂˘Úˆ·˚Τ˜ ¯ÒÚ˜ (102).
23
ˆ-3 §π¶∞ƒ∞ √•∂∞
ªÂϤÙ˜ ·Ú·Ù‹ÚËÛ˘ ˘ÔÛÙËÚ›˙Ô˘Ó ÙË Û‡ÛÙ·ÛË fiÙÈ Ë ÚfiÛÏË„Ë
„·ÚÈÒÓ Î·È ˆ-3 ÏÈ·ÚÒÓ ÔͤˆÓ ·fi Ê˘ÙÈΤ˜ ËÁ¤˜ (¿ÏÊ· ÏÈÓÔÏÂÓÈÎfi Ô͇)
ÌÔÚ› Ó· ÌÂÈÒÛÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Î·Ú‰È·ÎÔ‡ ı·Ó¿ÙÔ˘ Î·È ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈ-
ÛÔ‰›ˆÓ [103, 104 (πππ)]. ∏ Û˘ÌÏËڈ̷ÙÈ΋ ¯ÔÚ‹ÁËÛË ˆ-3 ÏÈ·ÚÒÓ ÔͤˆÓ
ÛÙÔ ‰È·‚‹ÙË ÌÂÈÒÓÂÈ Ù· ›‰· ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÙÔ˘ ÔÚÔ‡, ·ÏÏ¿ ÌÔÚ› Ù·˘-
Ùfi¯ÚÔÓ· Ó· Û¯ÂÙ›˙ÂÙ·È Ì ̤ÙÚÈ· ·‡ÍËÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ [105 (Ia)].
Œ¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Ë Û˘ÌÏËڈ̷ÙÈ΋ ¯ÔÚ‹ÁËÛË ˆ-3 ÏÈ·ÚÒÓ ÔͤˆÓ
Ì·ÎÚ¿˜ ·Ï‡ÛÔ˘ ÌÔÚ› Ó· ·˘Í‹ÛÂÈ Ù· ›‰· ÁÏ˘Îfi˙˘ ÙÔ˘ ·›Ì·ÙÔ˜, ·ÏÏ¿
ÚfiÛÊ·Ù˜ ÌÂÙ··Ó·Ï‡ÛÂȘ [106, 107 (πa)] ‰Â›¯ÓÔ˘Ó fiÙÈ Ë Â›‰Ú·ÛË ·˘Ù‹
Â›Ó·È ·ÌÂÏËÙ¤·. ¢ÂÓ ˘¿Ú¯Ô˘Ó ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÏÂÁ¯fiÌÂÓ˜ ÌÂϤÙ˜ Ô˘ Ó·
‰Â›¯ÓÔ˘Ó fiÙÈ Ë Û˘ÌÏËڈ̷ÙÈ΋ ¯ÔÚ‹ÁËÛË ˆ-3 ÏÈ·ÚÒÓ ÔͤˆÓ ÛÙÔ˘˜
·ÓıÚÒÔ˘˜ ı· ‚ÂÏÙÈÒÛÂÈ ÙËÓ Â˘·ÈÛıËÛ›· ÛÙËÓ ÈÓÛÔ˘Ï›ÓË. ¢È·‚ËÙÈΤ˜ Á˘Ó·›-
Θ Ô˘ ‰È·ÙÚ¤ÊÔÓÙ·È Ù·ÎÙÈο Ì „¿ÚÈ ¤¯Ô˘Ó ¯·ÌËÏfiÙÂÚË Â›ÙˆÛË ÛÙÂÊ·-
ÓÈ·›·˜ ÓfiÛÔ˘ Î·È ÌÈÎÚfiÙÂÚË ıÓËÛÈÌfiÙËÙ· Û ۇÁÎÚÈÛË Ì’ ÂΛӘ Ô˘ ¤¯Ô˘Ó
ÌÈÎÚfiÙÂÚË ÚfiÛÏË„Ë „·ÚÈÒÓ [108 (πππ)]. ∞Ó Î·È ÔÈ ¤ˆ˜ ÙÒÚ· ÂӉ›ÍÂȘ ˘Ô-
ÛÙËÚ›˙Ô˘Ó ÙȘ Û˘ÛÙ¿ÛÂȘ Û¯ÂÙÈο Ì ÙË ‰È·ÈÙËÙÈ΋ ÚfiÛÏË„Ë „·ÚÈÒÓ Î·È ˆ-
3 ÏÈ·ÚÒÓ ÔͤˆÓ ·fi Ê˘ÙÈΤ˜ ËÁ¤˜, ‰ÂÓ ˘¿Ú¯ÂÈ ÚÔ˜ ÙÔ ·ÚfiÓ ÔÌÔʈӛ·
ÁÈ· ÙË ¯Ú‹ÛË Û˘ÌÏËÚˆÌ¿ÙˆÓ Ô˘ Ó· ÂÚȤ¯Ô˘Ó ˆ-3 ÏÈ·Ú¿ Ôͤ· ÛÙÔ ‰È·-
‚‹ÙË (‚Ϥ ÙÌ‹Ì· ÁÈ· ™˘ÌÏËÚÒÌ·Ù·). ∂ÈÚfiÛıÂÙ· ‰ÂÓ ˘¿Ú¯Ô˘Ó ·Ú-
΋ ‰Â‰Ô̤ӷ ÁÈ· ·ÎÚȂ›˜ Û˘ÛÙ¿ÛÂȘ Û¯ÂÙÈο Ì ÙËÓ È‰·ÓÈ΋ ·Ó·ÏÔÁ›· ˆ-3/ˆ-
6 ÏÈ·ÚÒÓ ÔͤˆÓ. ¶¿ÓÙˆ˜ ÂÓı·ÚÚ‡ÓÂÙ·È Ë ·˘ÍË̤ÓË ‰È·ÈÙËÙÈ΋ ÚfiÛÏË„Ë
ˆ-3 ÏÈ·ÚÒÓ ÔͤˆÓ ÛÂ Û˘Ìʈӛ· Ì ÙȘ ÙÚ¤¯Ô˘Û˜ Û˘ÛÙ¿ÛÂȘ ÛÙÔ ÁÂÓÈÎfi
ÏËı˘ÛÌfi.
¢π∞π∆∏∆π∫∏ Ã√§∏™∆∂ƒ√§∏
¢Â‰Ô̤ӷ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ÌË ‰È·‚ËÙÈο ¿ÙÔÌ· [109 (πa)] ηıÒ˜ ηÈ
Û ¿ÙÔÌ· Ì ™¢1 [110 (πb), 111 (III)] ˘ÔÛÙËÚ›˙Ô˘Ó ÙË Û‡ÛÙ·ÛË ÁÈ· Ì›ˆ-
24
ÛË Ù˘ ÚfiÛÏ˄˘ ¯ÔÏËÛÙÂÚfiÏ˘ Ì ÙË ‰›·ÈÙ·, ‰ÈfiÙÈ Ù· ›‰· ¯ÔÏËÛÙÂÚfi-
Ï˘ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ ·˘Í¿ÓÔ˘Ó Ì ÙËÓ ·˘Í·ÓfiÌÂÓË ÚfiÛÏË„Ë ¯ÔÏËÛÙÂÚfiÏ˘
Ì ÙËÓ ÙÚÔÊ‹. ™Â ÌÈ· ÚÔÔÙÈ΋ ÌÂϤÙË ‰È·‚ËÙÈÎÒÓ Á˘Ó·ÈÎÒÓ, ÌÈ· ˘„ËÏ‹
ÚfiÛÏË„Ë ¯ÔÏËÛÙÂÚfiÏ˘ Û¯ÂÙÈ˙fiÙ·Ó Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Î·Ú‰È·ÁÁÂȷ΋˜
ÓfiÛÔ˘ [80 (πππ)]. ™ÙË ÌÂϤÙË EURODIAB Complications Study, Ë ·˘ÍË̤-
ÓË ÚfiÛÏË„Ë ÔÏÈÎÔ‡ Ï›Ô˘˜, ÎÔÚÂṲ̂ÓÔ˘ Ï›Ô˘˜ Î·È ¯ÔÏËÛÙÂÚfiÏ˘ Û¯ÂÙ›-
ÛÙËΠÛËÌ·ÓÙÈο Ì ·˘ÍË̤ÓÔ ÂÈÔÏ·ÛÌfi ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. √È
Û˘Û¯ÂÙ›ÛÂȘ ·˘Ù¤˜ fï˜ ‰ÂÓ ‹Ù·Ó È· ÛËÌ·ÓÙÈΤ˜ ÌÂÙ¿ ·fi ÂÍÔÌÔ›ˆÛË ÁÈ· ÙË
‰È·ÈÙËÙÈ΋ ÚfiÛÏË„Ë Ê˘ÙÈÎÒÓ ÈÓÒÓ, ÁÈ· ÙȘ Ôԛ˜ ¤¯ÂÈ ‰ÂȯÙ› ·ÓÂÍ¿ÚÙËÙË
Û˘Û¯¤ÙÈÛË Ì ÙÔ Â›Â‰Ô ¯ÔÏËÛÙÂÚfiÏ˘ ÙÔ˘ ÔÚÔ‡ Î·È Ù· ηډȷÁÁÂȷο
ÓÔÛ‹Ì·Ù· [111 (πππ)].
www.hndc.gr
Y¢ATAN£PAKE™
√‰ËÁ›Â˜ ÁÈ· ÙËÓ Î·ı’ Ë̤ڷ Ú¿ÍË
ñ ∏ ÚfiÛÏË„Ë ˘‰·Ù·ÓıÚ¿ÎˆÓ ÌÔÚ› Ó· ÔÈΛÏÂÈ ÌÂٷ͇ 45% Î·È 60%
Ù˘ ÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜. µ·ıÌfi˜ C
ñ ªÂÙ·‚ÔÏÈΤ˜ ·Ú¿ÌÂÙÚÔÈ ˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ Ë ÈÔ Î·Ù¿ÏÏËÏË ÚfiÛÏË„Ë
‚Ú›ÛÎÂÙ·È ÌÂٷ͇ ·˘ÙÒÓ ÙˆÓ ÔÚ›ˆÓ ÁÈ· Ù· ¿ÙÔÌ· Ì ™¢1 Î·È ™¢2.
µ·ıÌfi˜ ∞
ñ §·¯·ÓÈο, fiÛÚÈ·, ÊÚÔ‡Ù· Î·È ‰ËÌËÙÚȷο ÔÏÈ΋˜ ·Ï¤Ûˆ˜ ı· Ú¤ÂÈ
Ó· ÂÓۈ̷وıÔ‡Ó ÛÙË ‰È·ÙÚÔÊ‹ ÙˆÓ ·ÙfiÌˆÓ Ì ™¢1 Î·È ™¢2. ŸÙ·Ó Ë
ÚfiÛÏË„Ë ˘‰·Ù·ÓıÚ¿ÎˆÓ ‚Ú›ÛÎÂÙ·È ÛÙÔ ·ÓÒÙÂÚÔ ¿ÎÚÔ ÙˆÓ Û˘ÓÈÛÙÒÌÂ-
ÓˆÓ ÔÚ›ˆÓ, ÙfiÙÂ Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎfi Ó· ‰Ôı› ¤ÌÊ·ÛË Û ÙÚfiÊÈÌ·
Ì ˘„ËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· ÛÂ Ê˘ÙÈΤ˜ ›Ó˜ Î·È Ì ¯·ÌËÏfi ÁÏ˘Î·ÈÌÈÎfi ‰Â›-
ÎÙË. (µÏ¤Â Û˘ÛÙ¿ÛÂȘ ÁÈ· ÙȘ ›Ó˜, ÙÔ ÁÏ˘Î·ÈÌÈÎfi ‰Â›ÎÙË Î·È Ù· ÌÈÎÚÔ-
ıÚÂÙÈο Û˘ÛÙ·ÙÈο). µ·ıÌfi˜ ∞ 25
ñ ¢ÂÓ ˘¿Ú¯ÂÈ Î·Ì›· ‚¿ÛË Ô˘ Ó· ‰ÈηÈÔÏÔÁ› ÙȘ Û˘ÛÙ¿ÛÂȘ ÁÈ· ‰›·ÈÙ·
Ôχ ¯·ÌËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ˘‰·Ù¿ÓıڷΘ ÁÈ· Ù· ¿ÙÔÌ· Ì ‰È·‚‹-
ÙË (‚Ï¤Â Û˘ÛÙ¿ÛÂȘ ÁÈ· ÙÔ Ï›Ô˜). µ·ıÌfi˜ µ
ñ ∏ ÔÛfiÙËÙ·, Ë ËÁ‹ Î·È Ë Î·Ù·ÓÔÌ‹ ÙˆÓ ˘‰·Ù·ÓıÚ¿ÎˆÓ Î·Ù¿ ÙË ‰È¿Ú-
ÎÂÈ· Ù˘ Ë̤ڷ˜ ı· Ú¤ÂÈ Ó· ÂÈϤÁÂÙ·È ¤ÙÛÈ ÒÛÙ ӷ ‚ÔËı¿ÂÈ ÛÙÔ Û¯Â-
‰fiÓ Ê˘ÛÈÔÏÔÁÈÎfi Ì·ÎÚÔ¯ÚfiÓÈÔ ÁÏ˘Î·ÈÌÈÎfi ¤ÏÂÁ¯Ô (›‰· HbA1c). ™Â
fiÛÔ˘˜ ıÂڷ‡ÔÓÙ·È Ì ÈÓÛÔ˘Ï›ÓË ‹ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ˘ÔÁÏ˘Î·ÈÌÈο
Ê¿Ú̷η, Ô ¯ÚfiÓÔ˜ Î·È Ë ‰fiÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ı· Ú¤ÂÈ Ó· Û˘ÓÙÔÓ›˙Ô-
ÓÙ·È Ì ÙËÓ ÔÛfiÙËÙ· Î·È Ê‡ÛË ÙˆÓ ˘‰·Ù·ÓıڿΈÓ. µ·ıÌfi˜ C
™¯fiÏÈ·
∆· Û˘ÓÈÛÙÒÌÂÓ· fiÚÈ· ÁÈ· ÙËÓ ÚfiÛÏË„Ë ˘‰·Ù·ÓıÚ¿ÎˆÓ (45%-60% Ù˘
Û˘ÓÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜) ‚·Û›˙ÔÓÙ·È ÛÙ· fiÚÈ· ÁÈ· ÙËÓ ÚfiÛÏË„Ë ÔÏÈÎÔ‡ Ï›Ô˘˜
Î·È ÚˆÙÂ˚ÓÒÓ (‚Ï¤Â Û˘ÛÙ¿ÛÂȘ ÁÈ· ÙȘ ÚˆÙ½Ó˜ Î·È ÙÔ Ï›Ô˜ Û’ ·˘Ùfi ÙÔ
¿ÚıÚÔ), [3, 28, 112-113 (IV)]. ªÈ· ÌÂÙ··Ó¿Ï˘ÛË (91 [Ia]) Û˘Ó¤ÎÚÈÓ ٷ
·ÔÙÂϤÛÌ·Ù· ‰È·ÈÙÒÓ ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ˘‰·Ù¿ÓıڷΘ (49-60%
˘‰·Ù¿ÓıڷΘ, 20-32% ϛԘ, 7-13% MUFA) Ì ‰›·ÈÙ˜ ˘„ËÏ‹˜ ÂÚÈÂÎÙÈ-
ÎfiÙËÙ·˜ Û ÌÔÓÔ·ÎfiÚÂÛÙÔ Ï›Ô˜ Î·È ¯·ÌËÏ‹˜ Û ˘‰·Ù¿ÓıڷΘ (36-40%
˘‰·Ù¿ÓıڷΘ, 37-50% ϛԘ, 22-33% MUFA) ÛÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÏÈȉ›ˆÓ
ÙÔ˘ ÔÚÔ‡ Î·È ÙÔ ÁÏ˘Î·ÈÌÈÎfi ¤ÏÂÁ¯Ô ÁÈ· ¿ÙÔÌ· Ì ™¢2. ∞ÚÎÂÙ¤˜ ·fi ÙȘ ÌÂϤ-
Ù˜ ÂÚÈÏ¿Ì‚·Ó·Ó ‰›·ÈÙ˜ ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ˘‰·Ù¿ÓıڷΘ ÔÈ ÔÔ›-
˜ ‹Ù·Ó ÏÔ‡ÛȘ Û ·Ì˘ÏÔ‡¯· ÙÚfiÊÈÌ· ·Ú¿ Û ÙÚfiÊÈÌ· ˘„ËÏ‹˜ ÂÚÈÂÎÙÈ-
ÎfiÙËÙ·˜ Û ›Ó˜ Î·È Ì ¯·ÌËÏfi ÁÏ˘Î·ÈÌÈÎfi ‰Â›ÎÙË. ∂Ï‹ÊıËÛ·Ó ˘fi„ÈÓ ÌfiÓÔ
Ù˘¯·ÈÔÔÈË̤Ó˜ ÌÂϤÙ˜ [100, 114-121 (πb)] Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ÈÛÔÂ-
ÓÂÚÁËÙÈΤ˜ ‰›·ÈÙ˜ Û˘ÓÙ‹ÚËÛ˘ ÙÔ˘ ‚¿ÚÔ˘˜. √È ÌÂϤÙ˜ ÂÚÈÏ¿Ì‚·Ó·Ó 8 ¤ˆ˜
42 ¿ÙÔÌ· Ì ™¢2 (ÓÔÛËÏ¢fiÌÂÓÔ˘˜ ‹ Û Â͈ÙÂÚÈ΋ ‚¿ÛË Ô˘ ¤·ÈÚÓ·Ó
ıÂڷ›· Ì ‰›·ÈÙ· ÌfiÓÔ, Ì ‰È¿ÊÔÚÔ˘˜ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·Ú¿ÁÔÓÙ˜ ‹ ÌÂ
ÈÓÛÔ˘Ï›ÓË). ∏ ‰È¿ÚÎÂÈ· ÙˆÓ ÌÂÏÂÙÒÓ ‹Ù·Ó 2-6 ‚‰ÔÌ¿‰Â˜.
26
∏ ‰›·ÈÙ· ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ÌÔÓÔ·ÎfiÚÂÛÙÔ Ï›Ô˜ Î·È ¯·ÌËÏ‹˜ ÛÂ
˘‰·Ù¿ÓıڷΘ, Û ۇÁÎÚÈÛË Ì ‰›·ÈÙ· ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ˘‰·Ù¿Ó-
ıڷΘ, ÚÔοÏÂÛ ÌÈ· ηٿ ̤ÛÔ fiÚÔ Ì›ˆÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÙÔ˘ ÔÚÔ‡
ηٿ 19% [ÛËÌ·ÓÙÈ΋ Û 5 ÌÂϤÙ˜, ÌË ÛËÌ·ÓÙÈ΋ Û 3 ÌÂϤÙ˜ (117, 120,
121), η̛· ·ÏÏ·Á‹ Û 1 ÌÂϤÙË (100)], ÌÈ· ·‡ÍËÛË Î·Ù¿ 4% ÛÙËÓ HDL-
¯ÔÏËÛÙÂÚfiÏË [·‡ÍËÛË Û 5 ÌÂϤÙ˜, η̛· ·ÏÏ·Á‹ Û 4 ÌÂϤÙ˜ (100, 118,
120, 121)], Ì›ˆÛË Î·Ù¿ 3% ÛÙËÓ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË [Ì›ˆÛË Û 6 ÌÂϤÙ˜,
η̛· ·ÏÏ·Á‹ Û 1 ÌÂϤÙË (121), ·‡ÍËÛË Û 2 ÌÂϤÙ˜ (115, 117)] Î·È Î·Ì›·
ÌÂÙ·‚ÔÏ‹ ÛÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË. ∏ ·fiÏ˘ÙË Ì›ˆÛË ÛÙË Û˘ÁΤÓÙÚˆÛË
Ù˘ ÁÏ˘Îfi˙˘ ·›Ì·ÙÔ˜ ÓËÛÙ›·˜ ‹Ù·Ó ηٿ 4 mg/dl ÌÈÎÚfiÙÂÚË ÛÙË ‰›·ÈÙ· ÌÂ
˘„ËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ÌÔÓÔ·ÎfiÚÂÛÙÔ Ï›Ô˜ (p<0,05). ¢ÂÓ ·Ú·ÙËÚ‹ıË-
Π̛ˆÛË ÛÙȘ Û˘ÁÎÂÓÙÚÒÛÂȘ Ù˘ ÈÓÛÔ˘Ï›Ó˘ ·›Ì·ÙÔ˜ ÓËÛÙ›·˜. √È Âȉڿ-
ÛÂȘ ÛÙË Ì¤ÛË ÚÔÁÂ˘Ì·ÙÈ΋ ÁÏ˘Îfi˙Ë Ï¿ÛÌ·ÙÔ˜ ‹Ù·Ó ›Ù ÛËÌ·ÓÙÈο ÌÂȈ-
̤Ó˜ (114) ›Ù ·ÌÂÙ¿‚ÏËÙ˜ (116). ¶¤ÓÙ ÌÂϤÙ˜ ·Ó¤ÊÂÚ·Ó ÛËÌ·ÓÙÈ΋ Ì›-
ˆÛË ÛÙȘ ÌÂÙ·ÁÂ˘Ì·ÙÈΤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÁÏ˘Îfi˙˘ ·›Ì·ÙÔ˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜
www.hndc.gr
Ì ‰›·ÈÙ· ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û MUFA Î·È ¯·ÌËÏ‹˜ Û ˘‰·Ù¿ÓıڷΘ,
·ÏÏ¿ η̛· ÌÂϤÙË ‰ÂÓ ¤‰ÂÈÍ ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÛÙË HbA1c ‹ ÙË ÊÚÔ˘-
ÎÙÔ˙·Ì›ÓË Û ۇÁÎÚÈÛË Ì ÂΛÓÔ˘˜ Ô˘ Î·Ù·Ó¿ÏˆÓ·Ó ‰›·ÈÙ· ˘„ËÏ‹˜ ÂÚÈÂ-
ÎÙÈÎfiÙËÙ·˜ Û ˘‰·Ù¿ÓıڷΘ. ŒÙÛÈ, ÔÈ Ì·ÎÚÔ¯ÚfiÓȘ ÂȉڿÛÂȘ ÛÙÔ ÁÏ˘Î·È-
ÌÈÎfi ¤ÏÂÁ¯Ô ‹Ù·Ó Û˘ÁÎÚ›ÛÈ̘ ·Ó¿ÌÂÛ· ÛÙȘ ‰›·ÈÙ˜ Ì ̤ÙÚÈ· ¤ˆ˜ ˘„ËÏ‹
Û˘ÁΤÓÙÚˆÛË ˘‰·Ù·ÓıÚ¿ÎˆÓ (49-60%) Î·È Û ÂΛӘ Ì ¯·ÌËÏ‹ ¤ˆ˜ ̤ÙÚÈ·
Û˘ÁΤÓÙÚˆÛË (37-50%) ·ÓÙ›ÛÙÔȯ·. ∞˘Ù‹ Ë ÌÂÙ··Ó¿Ï˘ÛË ‰Â›¯ÓÂÈ fiÙÈ ¤Ó·
ÌÂÁ¿ÏÔ Â‡ÚÔ˜ ÚfiÛÏ˄˘ ˘‰·Ù·ÓıÚ¿ÎˆÓ Â›Ó·È Û˘Ì‚·Ùfi Ì ÙÔÓ ÔÏÈÎfi ÁÏ˘-
ηÈÌÈÎfi ¤ÏÂÁ¯Ô Û ¿ÙÔÌ· Ì ™¢2 [91 (Ia)]. √È ·ÓÂÈı‡ÌËÙ˜ ÂȉڿÛÂȘ ÙˆÓ
Û¯ÂÙÈο ˘„ËÏÒÓ ÚÔÛÏ‹„ÂˆÓ ·Ì‡ÏÔ˘ ÛÙ· ›‰· ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÓËÛÙ›·˜
Î·È Èı·ÓÒ˜ ÛÙ· ÌÂÙ·ÁÂ˘Ì·ÙÈο ›‰· ÁÏ˘Îfi˙˘ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÂ
ÌÂÚÈΤ˜ ·fi ÙȘ ÌÂϤÙ˜ Ô˘ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó ÛÙË ÌÂÙ··Ó¿Ï˘ÛË ·˘Ù‹ ÌÔ-
Ú› Ó· ·ÔÊ¢¯ıÔ‡Ó Â¿Ó ÔÈ ÙÚÔʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ˘‰·Ù¿ÓıڷΘ Â›Ó·È ˘„Ë-
27
Ï‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ ÛÂ Ê˘ÙÈΤ˜ ›Ó˜ ηÈ/‹ ¤¯Ô˘Ó ¯·ÌËÏfi ÁÏ˘Î·ÈÌÈÎfi ‰Â›ÎÙË
(122 Î·È ‚Ϥ ÙÌ‹Ì·Ù· ÁÈ· ÙȘ Ê˘ÙÈΤ˜ ›Ó˜ Î·È ÙÔ ÁÏ˘Î·ÈÌÈÎfi ‰Â›ÎÙË). ∆·
Û˘ÓÈÛÙÒÌÂÓ· fiÚÈ· ÁÈ· ÚfiÛÏË„Ë ˘‰·Ù·ÓıÚ¿ÎˆÓ Â›Ó·È Â›Û˘ ηٿÏÏËÏ· ÁÈ·
ÙÔ ™¢1 [123 (Ib)], ȉȷ›ÙÂÚ· ·Ó Ù· ÊÚÔ‡Ù·, Ù· Ï·¯·ÓÈο Î·È Ù· ‰ËÌËÙÚȷο
ÔÏÈ΋˜ ·Ï¤Ûˆ˜ Â›Ó·È ÙÌ‹Ì· Ù˘ ‰È·ÙÚÔÊ‹˜ [124 (πππ)].
ªÂÚÈο ¿ÙÔÌ· Ì ™¢2 ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ‚ÂÏÙ›ˆÛË ÛÙ· ›‰·
ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ fiÙ·Ó Ë ÚfiÛÏË„Ë ÙˆÓ ˘‰·Ù·ÓıÚ¿ÎˆÓ Â›Ó·È ÛÙÔ Î·ÙÒ-
ÙÂÚÔ Û˘ÓÈÛÙÒÌÂÓÔ fiÚÈÔ [114, 115, 116, 118, 119, 121 (Ib)], ¤ÙÛÈ ÒÛÙÂ ÁÈ·
ÂΛÓÔ˘˜ Ì ÂÈ̤ÓÔÓÙ· ˘„ËÏ¿ ›‰· ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÌÔÚ› Ó· ›ӷÈ
ÛˆÛÙ‹ ÌÈ· ‰ÔÎÈÌ·ÛÙÈ΋ ÚÔÛ¿ıÂÈ· Ì›ˆÛ˘ Ù˘ ÚfiÛÏ˄˘ ÙˆÓ ˘‰·Ù·Ó-
ıÚ¿ÎˆÓ ÛÙÔ Î·ÙÒÙÂÚÔ Û˘ÓÈÛÙÒÌÂÓÔ fiÚÈÔ. ∞˘Ùfi ÌÔÚ› ›Û˘ Ó· ‰ÔÎÈÌ·ÛÙ›
Û ¿ÙÔÌ· Ì ™¢1 Î·È ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· [125 (πb)].
¢ÂÓ ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ Ì·ÎÚÔ¯ÚfiÓÈÔ˘ ÔʤÏÔ˘˜ ·fi ‰›·ÈÙ˜ ¯·ÌËÏ‹˜ ‹
Ôχ ¯·ÌËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ˘‰·Ù¿ÓıڷΘ. √È ‰›·ÈÙ˜ ·˘Ù¤˜ ı· ›¯·Ó
·ÓÂÈı‡ÌËÙ· ˘„ËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ϛԘ Î·È ı· ÌÔÚÔ‡Û·Ó Ó· ·˘Í‹-
ÛÔ˘Ó ÙÔ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜ Î·È Ó· ÌÂÈÒÛÔ˘Ó ÙËÓ Â˘·ÈÛıËÛ›· ÛÙËÓ ÈÓÛÔ˘Ï›ÓË
[66 (πb), 96 (III), 126 (III)]. √È ‰›·ÈÙ˜ ¯·ÌËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ˘‰·-
Ù¿ÓıڷΘ Î·È ˘„ËÏ‹˜ Û ϛԘ ‰ÂÓ ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ ÂÈÙ˘Á¯¿ÓÔ˘Ó Ì·ÎÚÔ-
¯ÚfiÓÈ· ·ÒÏÂÈ· ‚¿ÚÔ˘˜ [127, 128 (Ib)]. ¢Â‰Ô̤ÓÔ˘ fiÙÈ Ë ‰È·ÙÚÔÊ‹ ÙˆÓ
·ÙfiÌˆÓ Ì ‰È·‚‹ÙË Û fiϘ ÙȘ ∂˘Úˆ·˚Τ˜ ¯ÒÚ˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ˘„ËÏ‹ ·Ó·-
ÏÔÁ›· ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ (14% Î·È ¿Óˆ ÛÙÔ Û‡ÓÔÏÔ Ù˘ ÂÓ¤ÚÁÂÈ·˜)
[28, 111 (πππ), 112] ıˆÚÂ›Ù·È fiÙÈ ÔÈ ‰›·ÈÙ˜ ·˘Ù¤˜ ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó
·‡ÍËÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ ÔÏÈ΋˜ Î·È Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ (‚Ï¤Â Û˘ÛÙ¿-
ÛÂȘ ÁÈ· ÙËÓ ÚfiÛÏË„Ë ÙÔ˘ Ï›Ô˘˜). ∂ÈÚfiÛıÂÙ·, ‰ÂÓ ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ
¿Óˆ ÛÙȘ Ôԛ˜ Ó· ‚·ÛÈÛÙÔ‡Ó Û˘ÛÙ¿ÛÂȘ ÁÈ· ·‡ÍËÛË Ù˘ ÚfiÛÏ˄˘ Úˆ-
ÙÂ˚ÓÒÓ ¿Óˆ ·fi 20% Ù˘ ÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜ Ô‡Ùˆ˜ ÒÛÙ ӷ ÌÂȈı› Ë Úfi-
ÛÏË„Ë ˘‰·Ù·ÓıڿΈÓ. ¶ÔÏϤ˜ ÙÚÔʤ˜ ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ڈ-
Ù½Ó˜ Â›Ó·È Â›Û˘ ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ÎÔÚÂṲ̂ÓÔ Ï›Ô˜, Î·È Ê·›ÓÂ-
28
Ù·È fiÙÈ ‰ÂÓ Â›Ó·È ÛˆÛÙfi Ó· Û˘ÓÈÛÙ¿ ηÓ›˜ ÌÈ· ˘„ËÏ‹ ÚfiÛÏË„Ë Ï›Ô˘˜ ÛÂ
¿ÙÔÌ· Ì ‰È·‚‹ÙË ÛÙȘ ∂˘Úˆ·˚Τ˜ ¯ÒÚ˜, fiÔ˘ ‹‰Ë ΢Úȷگ› Ë ˘„ËÏ‹
ÚfiÛÏË„Ë ÔÏÈÎÔ‡ Î·È ÎÔÚÂṲ̂ÓÔ˘ Ï›Ô˘˜ [29, 96, 102, 129, 130 (πππ)].
¶Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÂÎÙfi˜ ·fi ÙËÓ ÂÍ·ÛÊ¿ÏÈÛË Ù˘ ÚfiÛÏ˄˘ ÂÈ-
ı˘ÌËÙÒÓ ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ ·fi Ù· ¿ÙÔÌ· Ì ™¢1 Î·È ™¢2, Ë Î·Ù¿ÏÏË-
ÏË ÔÛfiÙËÙ·, ËÁ‹ Î·È Î·Ù·ÓÔÌ‹ ÙˆÓ ÙÚÔÊ›ÌˆÓ Ô˘ ÂÚȤ¯Ô˘Ó ˘‰·Ù¿ÓıÚ·-
Θ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÛÙÔ Û¯Â‰fiÓ Ê˘ÛÈÔÏÔÁÈÎfi Ì·ÎÚÔ¯ÚfiÓÈÔ ÌÂÙ·‚ÔÏÈÎfi
¤ÏÂÁ¯Ô [124, 131-134 (πππ)]. ∏ ÂÈÏÔÁ‹ Ù˘ ÔÛfiÙËÙ·˜ Î·È Ù˘ ËÁ‹˜ ÙˆÓ
˘‰·Ù·ÓıÚ¿ÎˆÓ Î·ıÒ˜ Î·È Ë Î·Ù·ÓÔÌ‹ ÙˆÓ ÙÚÔÊÒÓ ·˘ÙÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·
Ù˘ Ë̤ڷ˜ ÌÔÚ› Ó· ηÙ¢ı˘Óı› ·fi ÙȘ ·˘ÙÔÌÂÙÚ‹ÛÂȘ ÙÔ˘ ۷ί¿ÚÔ˘
·›Ì·ÙÔ˜ ·fi ÙÔ ‰È·‚ËÙÈÎfi ¿ÙÔÌÔ [3, 135, 136 (πV)]. ∂ΛÓÔÈ Ô˘ Ï·Ì‚¿ÓÔ˘Ó
·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ˘ÔÁÏ˘Î·ÈÌÈο Ê¿Ú̷η ÂÎÙfi˜ Ù˘ ‰È·ÈÙËÙÈ΋˜ ·ÁˆÁ‹˜,
ı· Ú¤ÂÈ Ó· ÁÓˆÚ›˙Ô˘Ó ÙÔÓ ÙÚfiÔ ‰Ú¿Û˘ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Î·È ÙË ÛˆÛÙ‹
¯ÚÔÓÈ΋ Û¯¤ÛË Ï‹„˘ ·˘ÙÒÓ ÛÂ Û˘Ó¿ÚÙËÛË Ì ٷ Á‡̷ٷ Î·È Ù· ÂӉȿÌÂÛ·
ÁÂ˘Ì·Ù›‰È· (snacks). ∆· ‰È·‚ËÙÈο ¿ÙÔÌ· Ô˘ ıÂڷ‡ÔÓÙ·È Ì ÈÓÛÔ˘Ï›ÓË ı·
www.hndc.gr
Ú¤ÂÈ Ó· Â›Ó·È ÂÓ‹ÌÂÚ· Ù˘ ‰È¿ÚÎÂÈ·˜ ‰Ú¿Û˘ Ù˘ ÈÓÛÔ˘Ï›Ó˘ Ô˘ ¯ÚËÛÈÌÔ-
ÔÈÔ‡Ó, ¤ÙÛÈ ÒÛÙ ӷ Â›Ó·È ‚¤ÏÙÈÛÙË Ë Û¯¤ÛË ·Ó¿ÌÂÛ· ÛÙËÓ ÔÛfiÙËÙ· Î·È ÙË
ʇÛË ÙˆÓ ÚÔÛÏ·Ì‚·ÓfiÌÂÓˆÓ ˘‰·Ù·ÓıÚ¿ÎˆÓ Î·È Ù˘ ¯ÔÚËÁÔ‡ÌÂÓ˘ ÈÓÛÔ˘-
Ï›Ó˘ [113 (IV), 137 (III), 138, 139 (IV)]. °È· ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·ÛıÂÓ›˜
Ì ™¢1 Î·È ™¢2 Ô˘ ıÂڷ‡ÔÓÙ·È Ì ÈÓÛÔ˘Ï›ÓË ‹ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·ÓÙÈ-
‰È·‚ËÙÈο ‰ÈÛΛ· Â›Ó·È Û˘Ó‹ıˆ˜ ‰˘Ó·ÙfiÓ Ó· ÙÚÔÔÔÈËı› Ë ıÂڷ›· Û‡Ì-
ʈӷ Ì ÙÔ ÔÛfi Î·È ÙÔÓ Ù‡Ô ÙˆÓ ˘‰·Ù·ÓıÚ¿ÎˆÓ ¤ÙÛÈ ÒÛÙ ӷ Â›Ó·È ‰˘Ó·-
ÙfiÓ Ó· Û˘ÌÂÚÈÏËÊı› ÌÈ· ÔÈÎÈÏ›· ˘‰·Ù·ÓıÚ·ÎÔ‡¯ˆÓ ËÁÒÓ ÛÙË ‰È·ÙÚÔÊ‹
¯ˆÚ›˜ Âȉ›ӈÛË ÙÔ˘ ÁÏ˘Î·ÈÌÈÎÔ‡ ÂϤÁ¯Ô˘ [124 (πππ)]. ŸÙ·Ó ÂÈϤÁÔÓÙ·È
ÙÚfiÊÈÌ· Ô˘ ÂÚȤ¯Ô˘Ó ˘‰·Ù¿ÓıڷΘ, ı· Ú¤ÂÈ Â›Û˘ Ó· Ï·Ì‚¿ÓÂÙ·È
˘fi„Ë Ë Â›‰Ú·Û‹ ÙÔ˘˜ ÛÙËÓ Â˘·ÈÛıËÛ›· ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, ÛÙ· ÏÈ›‰È· ÙÔ˘
ÔÚÔ‡ Î·È ÛÙËÓ ÂÓÂÚÁÂȷ΋ ÈÛÔÚÚÔ›· [96, 97, 140, 141 (πππ)]. √È ÂȉڿÛÂȘ
ÙˆÓ Ê˘ÙÈÎÒÓ ÈÓÒÓ, ÙÔ˘ ÁÏ˘Î·ÈÌÈÎÔ‡ ‰Â›ÎÙË Î·È ÙÔ˘ ›‰Ô˘˜ ÙˆÓ Û·Î¯¿ÚˆÓ Û’
29
·˘ÙÔ‡˜ ÙÔ˘˜ ÛËÌ·ÓÙÈÎÔ‡˜ ‰Â›ÎÙ˜ ˘Á›·˜ Û˘˙ËÙÔ‡ÓÙ·È Ì ÂÚÈÛÛfiÙÂÚ˜
ÏÂÙÔ̤ÚÂȘ ÛÙ· ÎÂÊ¿Ï·È· Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó. ŸÌˆ˜, Â›Ó·È Û¯ÂÙÈÎfi Ó· ·Ó·-
ÊÂÚı› Â‰Ò fiÙÈ Ë Ù·ÎÙÈ΋ ηٷӿψÛË Ï·¯·ÓÈÎÒÓ, ÔÛÚ›ˆÓ, ÊÚ¤ÛΈÓ
ÊÚÔ‡ÙˆÓ Î·È ‰ËÌËÙÚÈ·ÎÒÓ ÔÏÈ΋˜ ·Ï¤Ûˆ˜ ı· Ú¤ÂÈ Ó· Â›Ó·È Ì¤ÚÔ˜ Ù˘
‰È·ÙÚÔÊ‹˜ ÙˆÓ ·ÙfiÌˆÓ Ì ™¢1 Î·È ™¢2, ηıÒ˜ Ù· ÙÚfiÊÈÌ· ·˘Ù¿ ‚ÔËıÔ‡Ó
ÛÙÔ Ó· ÂÍ·ÛÊ·ÏÈÛÙ› ÈηӋ ÚfiÛÏË„Ë Ê˘ÙÈÎÒÓ ÈÓÒÓ Î·È ÌÈÎÚÔıÚÂÙÈÎÒÓ
Û˘ÛÙ·ÙÈÎÒÓ. ∂ÈϤÔÓ, ·˘Ù¿ Ù· ÙÚfiÊÈÌ· ‰ÂÓ ÚÔ¿ÁÔ˘Ó ÙËÓ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ-
‰·ÈÌ›· Î·È ÌÔÚ› Ó· ‚ÔËı‹ÛÔ˘Ó ÛÙËÓ ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ÚÔ¿ÁÔÓÙ·˜ ÙÔ
·›ÛıËÌ· ÎÔÚÂÛÌÔ‡ [142, 143 (πππ)]. ∫·Ù¿ Û˘Ó¤ÂÈ· Ù· ÂÓ ÏfiÁˆ ÙÚfiÊÈÌ· ı·
Ú¤ÂÈ Ó· Û˘ÓÈÛÙÒÓÙ·È È‰È·›ÙÂÚ· ÁÈ· Ù· ¿ÙÔÌ· ÂΛӷ Ô˘ Â›Ó·È ˘¤Ú‚·Ú· ‹
·¯‡Û·Úη, Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ Î·È ÂΛӷ Ô˘ ¤¯Ô˘Ó
ȉȷ›ÙÂÚË ÚÔÙ›ÌËÛË ÁÈ· ηٷӿψÛË Û¯ÂÙÈο ˘„ËÏÒÓ ÔÛÔÙ‹ÙˆÓ ˘‰·Ù·Ó-
ıڿΈÓ.
ºYTIKE™ (¢IAITHTIKE™) INE™
√‰ËÁ›Â˜ ÁÈ· ÙËÓ Î·ı’ Ë̤ڷ Ú¿ÍË
ñ √È ¿ÓıÚˆÔÈ Ì ™¢1 Î·È ™¢2 ı· Ú¤ÂÈ Ó· ÂÓı·ÚÚ‡ÓÔÓÙ·È Ó· ηٷ-
Ó·ÏÒÓÔ˘Ó Ê˘ÛÈΤ˜ ÙÚÔʤ˜ Ô˘ Ó· Â›Ó·È ÏÔ‡ÛȘ ÛÂ Ê˘ÙÈΤ˜ ›Ó˜.
µ·ıÌfi˜ ∞
ñ ∏ ÚfiÛÏË„Ë ÙˆÓ Ê˘ÙÈÎÒÓ ÈÓÒÓ ı· Ú¤ÂÈ È‰·ÓÈο Ó· Â›Ó·È ¿Óˆ ·fi 40
g/Ë̤ڷ (‹ 20 g/1000 kcal/Ë̤ڷ), ÔÈ ÌÈÛ¤˜ ·fi ÙȘ Ôԛ˜ ı· Ú¤ÂÈ Ó·
Â›Ó·È ‰È·Ï˘Ù¤˜. ∂˘ÂÚÁÂÙÈΤ˜ ÂȉڿÛÂȘ ÂÍ·ÛÎÔ‡ÓÙ·È Î·È ·fi ÌÈÎÚfiÙÂÚ˜,
Î·È Î·Ù¿ ÌÂÚÈÎÔ‡˜, ÂÚÈÛÛfiÙÂÚÔ ·Ô‰ÂÎÙ¤˜ ÔÛfiÙËÙ˜. µ·ıÌfi˜ ∞
ñ ∏ ηıËÌÂÚÈÓ‹ ηٷӿψÛË ÙÔ˘Ï¿¯ÈÛÙÔÓ 5 ÌÂÚ›‰ˆÓ ÏÔ‡ÛÈˆÓ Û ›Ó˜
Ï·¯·ÓÈÎÒÓ ‹ ÊÚÔ‡ÙˆÓ Î·È ÙÔ˘Ï¿¯ÈÛÙÔÓ 4 ÌÂÚ›‰ˆÓ ÔÛÚ›ˆÓ ÙËÓ Â‚‰ÔÌ¿-
‰· ÌÔÚ› Ó· ÂÍ·ÛÊ·Ï›ÛÂÈ ÙËÓ ÚfiÛÏË„Ë ÙˆÓ ÂÏ¿¯ÈÛÙˆÓ ··ÈÙÔ‡ÌÂÓˆÓ
ÔÛÔÙ‹ÙˆÓ Ê˘ÙÈÎÒÓ ÈÓÒÓ. µ·ıÌfi˜ C
30 ñ ∆· ÙÚfiÊÈÌ· Ô˘ ÂÚȤ¯Ô˘Ó ‰ËÌËÙÚȷο ı· Ú¤ÂÈ, fiÔÙÂ Â›Ó·È ‰˘Ó·ÙfiÓ,
Ó· Â›Ó·È ÔÏÈ΋˜ ·Ï¤Ûˆ˜ Î·È ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ›Ó˜. µ·ıÌfi˜ µ
™¯fiÏÈ·
∆Ë ‰ÂηÂÙ›· ÙÔ˘ 1980, Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó Û ·ÛıÂÓ›˜ Ì ™¢1 Î·È ™¢2
‚Ú·¯˘ÚfiıÂÛ̘, Ù˘¯·ÈÔÔÈË̤Ó˜, ÂÏÂÁ¯fiÌÂÓ˜ ÌÂϤÙ˜ (Ì ۯ‰ȷÛÌfi
·ÓÙ·ÏÏ·Á‹˜ ÙˆÓ ÔÌ¿‰ˆÓ – crossover design) ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ‰˘Ô ‰›·ÈÙ˜
Ô˘ ÂÚÈÏ¿Ì‚·Ó·Ó Ê˘ÛÈΤ˜ ÙÚÔʤ˜ ·ÏÏ¿ Ô˘ ‰È¤ÊÂÚ·Ó ÛÙËÓ ÔÛfiÙËÙ· ÙˆÓ
Ê˘ÙÈÎÒÓ ÈÓÒÓ (16 g/Ë̤ڷ Û ۇÁÎÚÈÛË Ì 54 g/Ë̤ڷ, ΢ڛˆ˜ ‰È·Ï˘Ù¤˜
›Ó˜). ∆· ̤۷ ËÌÂÚ‹ÛÈ· ›‰· ÁÏ˘Îfi˙˘ ·›Ì·ÙÔ˜ ÌÂÈÒıËÎ·Ó Î·Ù¿ 10-
15% Î·È Ù· ÌÂÙ·ÁÂ˘Ì·ÙÈο ηٿ 25% ÛÙË ‰›·ÈÙ· Ì ˘„ËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ·
Û ›Ó˜ [144, 145 (πb)]. ∂›Û˘, ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ›‰È·˜ ÂÚÈfi‰Ô˘, ¿ÏϘ
ÂÏÂÁ¯fiÌÂÓ˜ ÌÂϤÙ˜ Û ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ 1 Î·È Ù‡Ô˘ 2 Û˘Ó¤ÎÚÈÓ·Ó ÙȘ ÂÈ-
‰Ú¿ÛÂȘ ‰È·ÈÙÒÓ ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ˘‰·Ù¿ÓıڷΘ Î·È Ê˘ÙÈΤ˜ ›Ó˜
(ÂÚÈÛÛfiÙÂÚÔ ·fi 50g/Ë̤ڷ, ÙÔ˘Ï¿¯ÈÛÙÔÓ 50% ‰È·Ï˘Ù¤˜ ›Ó˜) Ì ÙȘ ÙfiÙÂ
Û˘Ì‚·ÙÈΤ˜ ‰›·ÈÙ˜ ¯·ÌËÏÒÓ ˘‰·Ù·ÓıڿΈÓ-¯·ÌËÏÒÓ ÈÓÒÓ. ∫·È Û ·˘Ù‹ ÙËÓ
www.hndc.gr
ÂÚ›ÙˆÛË, ÔÈ ‰›·ÈÙ˜ Ì ˘„ËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ˘‰·Ù¿ÓıڷΘ Î·È Ê˘ÙÈ-
Τ˜ ›Ó˜ Û¯ÂÙ›ÛÙËÎ·Ó Ì ‚ÂÏÙ›ˆÛË ÙÔ˘ ÁÏ˘Î·ÈÌÈÎÔ‡ ÂϤÁ¯Ô˘, Û˘ÌÂÚÈÏ·Ì‚·-
ÓÔÌ¤ÓˆÓ ¯·ÌËÏfiÙÂÚˆÓ ÂȤ‰ˆÓ HbA1c [146, 147 (πb)]. ¢Â‰Ô̤ÓÔ˘ fiÙÈ
¿ÏϘ ÌÂϤÙ˜ ÂΛӢ Ù˘ ÂÚÈfi‰Ô˘ ‰ÂÓ ¤‰ÂÈÍ·Ó fiÊÂÏÔ˜ ‹ ¤‰ÂÈÍ·Ó ‰˘ÛÌÂÓ‹
›‰Ú·ÛË ÛÙÔ ÁÏ˘Î·ÈÌÈÎfi ¤ÏÂÁ¯Ô fiÙ·Ó ÌÈ· ‰›·ÈÙ· ¯·ÌËÏÒÓ ˘‰·Ù·ÓıڿΈÓ
Û˘ÁÎÚ›ıËΠ̠‰›·ÈÙ· ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ˘‰·Ù¿ÓıڷΘ Î·È ¿Ì˘ÏÔ
Î·È ¯·ÌËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ›Ó˜ [148, 149, 150 (Ib)], Ë Â˘ÂÚÁÂÙÈ΋ ›-
‰Ú·ÛË ·Ô‰›‰ÂÙ·È ÛÙËÓ ˘„ËÏ‹ ÚfiÛÏË„Ë ÙˆÓ ÈÓÒÓ [151, 152]. ¢˘Ô Úfi-
ÛÊ·Ù˜ Ù˘¯·ÈÔÔÈË̤Ó˜, ÂÏÂÁ¯fiÌÂÓ˜ ÌÂϤÙ˜ ÌÂÁ·Ï‡ÙÂÚ˘ ‰È¿ÚÎÂÈ·˜ Ú·Á-
Ì·ÙÔÔÈ‹ıËÎ·Ó Û ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ 1 (Ì ·Ú¿ÏÏËÏÔ Û¯Â‰È·ÛÌfi – parallel
design) Î·È ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ 2 (Ì ‰È·ÛÙ·˘ÚÔ‡ÌÂÓÔ Û¯Â‰È·ÛÌfi – crossover
design). ™ÙË ÌÂϤÙË ÙˆÓ ‰È·‚ËÙÈÎÒÓ Ù‡Ô˘ 1, 60 ·ÛıÂÓ›˜ ηٷÓÂÌ‹ıËηÓ
Ù˘¯·›· Û ‰˘Ô ‰›·ÈÙ˜ Ô˘ ‰È¤ÊÂÚ·Ó ÌfiÓÔ fiÛÔÓ ·ÊÔÚ¿ ÙÔ ÔÛfi ÙˆÓ Ê˘ÙÈÎÒÓ 31
ÈÓÒÓ Î·È ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó Û Â͈ÙÂÚÈ΋ ‚¿ÛË ÁÈ· 6 Ì‹Ó˜. ∏ ˘„ËÏ‹ ÛÂ
›Ó˜ ‰›·ÈÙ· Û¯ÂÙ›ÛÙËΠ̠ÌÂȈ̤ÓÔ ·ÚÈıÌfi ˘ÔÁÏ˘Î·ÈÌÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ,
‚ÂÏÙ›ˆÛË ÙˆÓ Ì¤ÛˆÓ ËÌÂÚ‹ÛÈˆÓ Î·È ÌÂÙ·ÁÂ˘Ì·ÙÈÎÒÓ ÂȤ‰ˆÓ ÁÏ˘Îfi˙˘
Î·È ÛÙÔ 83% ÙˆÓ ·ÛıÂÓÒÓ Ô˘ Û˘ÌÌÔÚÊÒıËÎ·Ó Ì ÙȘ Ô‰ËÁ›Â˜, Ì Ì›ˆÛË
Ù˘ HbA1c [153 (Ib)]. ∞Ó Î·È Û˘ÛÙ‹ıËÎ·Ó 50 g ÈÓÒÓ/Ë̤ڷ, ÛÙËÓ Ú¿ÍË
ηٷӷÏÒıËÎ·Ó ÌfiÓÔ 40 g/Ë̤ڷ (ÔÈ ÌÈÛ¤˜ ÙÔ˘ Ù‡Ô˘ ÙˆÓ ‰È·Ï˘ÙÒÓ ÈÓÒÓ,
·fi fiÛÚÈ·, ÊÚÔ‡Ù· Î·È Ï·¯·ÓÈο). ∏ ¿ÏÏË ÌÂϤÙË Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ
Û ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ 2 [154 (πb)] ‰Â›¯ÓÂÈ ·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù·: 10%
Ì›ˆÛË ÛÙ· ̤۷ ›‰· ÁÏ˘Îfi˙˘ ·›Ì·ÙÔ˜, 25% ÛÙ· ÌÂÙ·ÁÂ˘Ì·ÙÈο ›Â-
‰· ÁÏ˘Îfi˙˘ Î·È ÌÈ· ÛËÌ·ÓÙÈ΋ ›Û˘ Ì›ˆÛË ÛÙ· ËÌÂÚ‹ÛÈ· ›‰· ÈÓÛÔ˘-
Ï›Ó˘. ŒÙÛÈ, Ë È‰·ÓÈ΋ ÔÛfiÙËÙ· Ê˘ÙÈÎÒÓ ÈÓÒÓ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È 40
g/Ë̤ڷ (ÂÚ›Ô˘ 20 g/1000 kcal/Ë̤ڷ) ‹ ÂÚÈÛÛfiÙÂÚÔ, ÔÈ ÌÈÛ¤˜ ·fi ÙȘ
Ôԛ˜ Ó· Â›Ó·È ‰È·Ï˘Ù¤˜. ¶¿ÓÙˆ˜, ¢ÂÚÁÂÙÈΤ˜ ÂȉڿÛÂȘ ÂÍ·ÛÎÔ‡ÓÙ·È Â›-
Û˘ Î·È ·fi ÌÈÎÚfiÙÂÚ˜, Î·È Î·Ù¿ ÌÂÚÈÎÔ‡˜, ÂÚÈÛÛfiÙÂÚÔ ·Ô‰ÂÎÙ¤˜ ÔÛfi-
ÙËÙ˜.
√È Ï›Á˜ ÌÂϤÙ˜ Ô˘ ‰ÂÓ ¤‰ÂÈÍ·Ó Â›‰Ú·ÛË ÙˆÓ ‰È·ÈÙÒÓ ˘„ËÏ‹˜ ÂÚÈÂÎÙÈ-
ÎfiÙËÙ·˜ ÛÂ Ê˘ÙÈΤ˜ ›Ó˜ ÛÙÔÓ ¤ÏÂÁ¯Ô ÙÔ˘ ۷ί¿ÚÔ˘ ÙÔ˘ ·›Ì·ÙÔ˜ ¯ÚËÛÈÌÔ-
Ô›ËÛ·Ó ‰›·ÈÙ˜ ÏÔ‡ÛȘ Û ·‰È¿Ï˘Ù˜ ›Ó˜ (155). ∂ȉËÌÈÔÏÔÁÈο ‰Â‰Ô̤-
Ó· ·Ú·Ù‹ÚËÛ˘ ‚·ÛÈ˙fiÌÂÓ· ÛÙË ÌÂϤÙË EURODIAB Complications Study
Ô˘ ÂÚÈÏ¿Ì‚·Ó ¿Óˆ ·fi 2000 ·ÛıÂÓ›˜ Ì ™¢1 ·fi 31 Â˘Úˆ·˚ο
ΤÓÙÚ· ¤‰ÂÈÍ ÌÈ· ·ÓÙ›ÛÙÚÔÊË Û¯¤ÛË ÌÂٷ͇ Ù˘ ÚfiÛÏ˄˘ Ê˘ÙÈÎÒÓ ÈÓÒÓ
Î·È Ù˘ HbA1c, Ô˘ ‹Ù·Ó ·ÓÂÍ¿ÚÙËÙË ·fi Èı·ÓÔ‡˜ Û˘Á¯˘ÙÈÎÔ‡˜ ·Ú¿ÁÔ-
ÓÙ˜. √ ΛӉ˘ÓÔ˜ ÎÂÙÔÔͤˆÛ˘ ÌÂȈÓfiÙ·Ó ÛÂ Û˘Û¯¤ÙÈÛË Ì ÙËÓ ˘„ËÏ‹ Úfi-
ÛÏË„Ë ÈÓÒÓ [131 (πππ)].
√È ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙȘ Ù˘¯·ÈÔÔÈË̤Ó˜ ÌÂϤÙ˜ Ô˘ ·Ó·Ê¤ÚıËηÓ
·Ú·¿Óˆ ÌÂϤÙËÛ·Ó Â›Û˘ ÙȘ ÂȉڿÛÂȘ ÙˆÓ Ê˘ÙÈÎÒÓ ÈÓÒÓ ÛÙ· ÏÈ›‰È·
Î·È ÙȘ ÏÈÔÚˆÙ½Ó˜. ∞ÚÎÂÙ¤˜ [143, 145, 146, 154 (Ib)], ·Ó Î·È fi¯È fiϘ
(153), ·fi ÙȘ ÌÂϤÙ˜ Ô˘ ÂÚÈÏ¿Ì‚·Ó·Ó ‰›·ÈÙ˜ ÏÔ‡ÛȘ Û ‰È·Ï˘Ù¤˜ ›Ó˜
32
‰È·›ÛÙˆÛ·Ó ¯·ÌËÏfiÙÂÚ· ›‰· ÔÏÈ΋˜ Î·È LDL-¯ÔÏËÛÙÂÚfiÏ˘. ∫·Ì›·
‰ÂÓ ¤‰ÂÈÍ ‰˘ÛÌÂÓ‹ ›‰Ú·ÛË. ¢Â‰Ô̤ӷ ·Ú·Ù‹ÚËÛ˘ ·fi ÙË EURODIAB
Complications Study ‰Â›¯ÓÔ˘Ó ·ÓÙ›ÛÙÚÔÊË Û¯¤ÛË ÌÂٷ͇ ÙˆÓ Ê˘ÙÈÎÒÓ ÈÓÒÓ
Î·È Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ (ÛÙÔ˘˜ ¿Ó‰Ú˜ ÌfiÓÔ) Î·È ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂÙ·-
͇ Ù˘ ÚfiÛÏ˄˘ ÈÓÒÓ Î·È Ù˘ HDL-¯ÔÏËÛÙÂÚfiÏ˘ (ÙfiÛÔ ÛÙÔ˘˜ ¿Ó‰Ú˜
fiÛÔ Î·È ÛÙȘ Á˘Ó·›Î˜) [156 (πππ)].
∏ ‰È·ÈÙËÙÈ΋ ÚfiÛÏË„Ë Ê˘ÙÈÎÒÓ ÈÓÒÓ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› ·ÓÙÈÛÙÚfiʈ˜ ·Ó¿-
ÏÔÁ· Î·È ÛËÌ·ÓÙÈο Ì ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ Û ÌÈ·
ÌÂϤÙË ·Ú·Ù‹ÚËÛ˘ Û ™¢1 [156 (πππ)] ηıÒ˜ Î·È Û ·ÚÎÂÙ¤˜ ÚÔÔÙÈΤ˜
ÌÂϤÙ˜ Û ÌË ‰È·‚ËÙÈο ¿ÙÔÌ· [157-160 (πππ)]. √È Ê˘ÙÈΤ˜ ›Ó˜ Û¯ÂÙ›˙ÔÓÙ·È
›Û˘ Ì ÌÈÎÚfiÙÂÚ· ›‰· ¢ª™ Û ™¢1 (96) Î·È ÚÔÔÙÈο Û ¿ÙÔÌ·
¯ˆÚ›˜ ‰È·‚‹ÙË (161) ηıÒ˜ Î·È Ì ˘„ËÏfiÙÂÚË Â˘·ÈÛıËÛ›· ÛÙËÓ ÈÓÛÔ˘Ï›ÓË
ÛÙÔ ÌË ‰È·‚ËÙÈÎfi ÏËı˘ÛÌfi (162).
www.hndc.gr
°§YKAIMIKO™ ¢EIKTH™
√‰ËÁ›Â˜ ÁÈ· ÙËÓ Î·ı’ Ë̤ڷ Ú¿ÍË
ñ À‰·Ù·ÓıÚ·ÎÔ‡¯· ÙÚfiÊÈÌ· Ì ¯·ÌËÏfi ÁÏ˘Î·ÈÌÈÎfi ‰Â›ÎÙË Â›Ó·È Î·Ù¿ÏÏË-
Ï· ˆ˜ ËÁ¤˜ ˘‰·Ù·ÓıڿΈÓ, ˘fi ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ Î·È Ù· ¿ÏÏ·
Û˘ÛÙ·ÙÈο ÙˆÓ ÙÚÔÊ›ÌˆÓ Â›Ó·È Â›Û˘ ηٿÏÏËÏ·. µ·ıÌfi˜ ∞
™¯fiÏÈ·
√ ÁÏ˘Î·ÈÌÈÎfi˜ ‰Â›ÎÙ˘ (°¢) ÔÚ›˙ÂÙ·È ˆ˜ Ë ÂÚÈÔ¯‹ οو ·fi ÙË ÁÏ˘Î·È-
ÌÈ΋ η̇ÏË (¿ÓˆıÂÓ Ù˘ ‚·ÛÈ΋˜ ÙÈÌ‹˜ ÂÎÎÈÓ‹Ûˆ˜) ÌÂÙ¿ ÙËÓ Î·Ù·Ó¿Ïˆ-
ÛË 25-50 g ˘‰·Ù·ÓıÚ¿ÎˆÓ Ù˘ ˘fi ÂͤٷÛË ÙÚÔÊ‹˜, ÂÎÊÚ·Ṳ̂ÓË ˆ˜ ÔÛÔ-
ÛÙfi Ù˘ ·ÓÙ›ÛÙÔȯ˘ ÂÚÈÔ¯‹˜ ÌÂÙ¿ ÙËÓ Î·Ù·Ó¿ÏˆÛË ˘‰·Ù·ÓıÚ¿ÎˆÓ ·fi ÌÈ·
ÙÚÔÊ‹ ·Ó·ÊÔÚ¿˜ (ÁÏ˘Îfi˙Ë ‹ Ï¢Îfi „ˆÌ›). ∆fiÛÔ ÙÔ Â›‰Ô˜ fiÛÔ Î·È Ë ÔÛfi-
ÙËÙ· ÙˆÓ ˘‰·Ù·ÓıÚ¿ÎˆÓ ÂËÚ¿˙Ô˘Ó ÙË ÁÏ˘Î·ÈÌÈ΋ ·¿ÓÙËÛË [133, 141
(πππ)]. ∂›Û˘, ¤¯ÂÈ ÌÂÁ¿ÏË ÛËÌ·Û›· Â¿Ó Ë Î˘ÙÙ·ÚÈ΋ ‰ÔÌ‹ ÙÔ˘ ˘‰·Ù¿ÓıÚ·- 33
η ·Ú·Ì¤ÓÂÈ ¿ıÈÎÙË (163). ŒÙÛÈ ÛÙËÓ Ú¿ÍË ÙÔ Ú·ÁÌ·ÙÈÎfi ÊÔÚÙ›Ô ˘‰·-
Ù·ÓıÚ¿ÎˆÓ ·fi ÌÈ· ηÓÔÓÈ΋ ÌÂÚ›‰· ÌÔÚ› Ó· ‰È·Ê¤ÚÂÈ ÛËÌ·ÓÙÈο. °È· Ó·
Ï˘ı› ÙÔ Úfi‚ÏËÌ· ·˘Ùfi, ˘ÈÔıÂÙ‹ıËÎÂ Ë ¤ÓÓÔÈ· ÙÔ˘ ÁÏ˘Î·ÈÌÈÎÔ‡ ÊÔÚÙ›Ô˘
(°º). ∆Ô °º ·ÓÙÈÚÔۈ‡ÂÈ ÙÔ ÁÈÓfiÌÂÓÔ ÙˆÓ ÁÚ·ÌÌ·Ú›ˆÓ ˘‰·Ù·ÓıڿΈÓ
Ô˘ ÂÚȤ¯ÂÙ·È Û ÌÈ· ÌÂÚ›‰· ÂÓfi˜ ÙÚÔÊ›ÌÔ˘ Î·È ÙÔ˘ °¢ ÙÔ˘ ‰Â‰Ô̤ÓÔ˘ ÙÚÔ-
Ê›ÌÔ˘. ∞˘Ùfi ÂÈÙÚ¤ÂÈ Û˘ÁÎÚ›ÛÂȘ ÙˆÓ Èı·ÓÒÓ ÁÏ˘Î·ÈÌÈÎÒÓ ÂȉڿÛˆÓ
«Ú·ÏÈÛÙÈÎÒÓ» ÌÂÚ›‰ˆÓ ‰È·ÊfiÚˆÓ ÙÚÔÊ›ÌˆÓ [164 (IV)]. À¿Ú¯ÂÈ ¿ÓÙˆ˜
·ÚÎÂÙ‹ ÌÂÙ·‚ÏËÙfiÙËÙ· ÛÙÔ ›‰ÈÔ ¿ÙÔÌÔ ·ÏÏ¿ Î·È ÌÂٷ͇ ÙˆÓ ·ÙfiÌˆÓ ÛÙË ÁÏ˘-
ηÈÌÈ΋ ·¿ÓÙËÛË ÙÔ˘ ›‰ÈÔ˘ ÁÏ˘Î·ÈÌÈÎÔ‡ ÊÔÚÙ›Ô˘, Û ‰È·ÊÔÚÂÙÈΤ˜ Ë̤Ú˜
(165, 166).
Œ¯Ô˘Ó Ú·ÁÌ·ÙÔÔÈËı› ·ÚÎÂÙ¤˜ ÂÏÂÁ¯fiÌÂÓ˜ ÌÂϤÙ˜ ‰È·ÈÙËÙÈ΋˜ ·Ú¤Ì-
‚·Û˘ Ô˘ Û˘Ó¤ÎÚÈÓ·Ó ‰›·ÈÙ˜ Ì ÙÚfiÊÈÌ· ˘„ËÏÔ‡ Î·È ¯·ÌËÏÔ‡ °¢, Ì ÔÈ-
ΛϷ ·ÔÙÂϤÛÌ·Ù· [93, 153, 167-175 (Ib)]. ªÈ· ÚfiÛÊ·ÙË ÌÂÙ··Ó¿Ï˘ÛË
[176 (Ia)] ·Ó¤ÊÂÚ ‚ÂÏÙ›ˆÛË ÛÙÔ Ì¤ÛÔ ¤ÏÂÁ¯Ô ÁÏ˘Îfi˙˘ ·›Ì·ÙÔ˜, Ì ̤ÛË
Ì›ˆÛË Ù˘ HbA1c ηٿ 0,43% Ì ‰›·ÈÙ· ¯·ÌËÏÔ‡, Û ۇÁÎÚÈÛË Ì ‰›·ÈÙ·
˘„ËÏÔ‡ ÁÏ˘Î·ÈÌÈÎÔ‡ ‰Â›ÎÙË Û ‰È·‚ËÙÈο ¿ÙÔÌ·. ∞Ó Î·È Ë Â›‰Ú·ÛË ÌÈ·˜
‰›·ÈÙ·˜ ¯·ÌËÏÔ‡ ÁÏ˘Î·ÈÌÈÎÔ‡ ‰Â›ÎÙË ÛÙÔ ÁÏ˘Î·ÈÌÈÎfi ¤ÏÂÁ¯Ô Â›Ó·È ÌÈÎÚfiÙÂÚË
·fi ·˘Ù‹Ó Ô˘ ·Ú·ÙËÚÂ›Ù·È Ì ¿ÏϘ ‰È·ÈÙËÙÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ, ‰ÂÓ ı· Ú¤-
ÂÈ Ó· ıˆÚËı› ·ÌÂÏËÙ¤·, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ·˘Ù‹ ÂÂÙ‡¯ıË ¤Ú·Ó ÙˆÓ ÂÈ-
‰Ú¿ÛÂˆÓ ¿ÏÏˆÓ ‰È·ÈÙËÙÈÎÒÓ ÌÂÙ·‚ÔÏÒÓ, fiˆ˜ Â›Ó·È Ë Ì›ˆÛË ÙÔ˘ Û˘ÓÔÏÈ-
ÎÔ‡ ÔÛÔ‡ ˘‰·Ù·ÓıڿΈÓ, Ë ·‡ÍËÛË Ù˘ ÚfiÛÏ˄˘ ÙˆÓ Ê˘ÙÈÎÒÓ ÈÓÒÓ ‹
Ë Ì›ˆÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ [177, 178 (IV)]. ∏ ‚ÂÏÙ›ˆÛË ·˘Ù‹ ›ӷÈ
·ÚfiÌÔÈ· Ì ÂΛÓË Ô˘ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ÔÚÈṲ̂ӷ ˘ÔÁÏ˘Î·ÈÌÈο Ê¿ÚÌ·-
η Î·È Â›Ó·È Û˘Ì‚·Ù‹ Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ EURODIAB
Complications Study, Ë ÔÔ›· ¤‰ÂÈÍ fiÙÈ Ô °¢ Ù˘ ‰›·ÈÙ·˜ Û¯ÂÙÈ˙fiÙ·Ó ıÂÙÈο
Î·È ·ÓÂÍ¿ÚÙËÙ· ÚÔ˜ Ù· ›‰· Ù˘ HbA1c [132 (πππ)].
ŸÙ·Ó ·Ó·ÛÎÔ› ηÓ›˜ Ù· ·ÔÙÂϤÛÌ·Ù· ·ÚÂÌ‚·ÙÈÎÒÓ ÌÂÏÂÙÒÓ, ‰ÂÓ
˘¿Ú¯Ô˘Ó ÔÌÔÈfiÌÔÚÊ· ‰Â‰Ô̤ӷ ÁÈ· ¢ÂÚÁÂÙÈ΋ ›‰Ú·ÛË ‰È·ÈÙÒÓ ¯·ÌËÏÔ‡
34
°¢ ÛÙ· ›‰· ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜. ¶¿ÓÙˆ˜ Û ÌÈ· ηϿ ÂÏÂÁ¯fiÌÂÓË ÌÂϤ-
ÙË Û ‰È·‚ËÙÈο ¿ÙÔÌ· Ù‡Ô˘ 2 [174 (πb)] ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ Ì›ˆ-
ÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙÔ˘ PAI-1 (·Ó·ÛÙÔϤ· Ù˘ ÂÓÂÚÁÔÔ›ËÛ˘
ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘-1) Ì ÌÈ· ‰›·ÈÙ· ¯·ÌËÏÔ‡ °¢. ∞˘Ùfi ˘Ô‰ËÏÒÓÂÈ ‚ÂÏ-
Ù›ˆÛË, Û ۯ¤ÛË Ì ‰›·ÈÙ· ˘„ËÏÔ‡ °¢. ªÈ· ¿ÏÏË ÈÔ ÚfiÛÊ·ÙË ÌÂϤÙË,
‰È¿ÚÎÂÈ·˜ 4 ‚‰ÔÌ¿‰ˆÓ, ¤‰ÂÈÍ ÂÈÚfiÛıÂÙ· ÙË ‰˘Ó·ÙfiÙËÙ· ÌÈ·˜ ‰›·ÈÙ·˜
¯·ÌËÏÔ‡ °¢ Ó· ÚÔ¿ÁÂÈ ÙË ¯ÚËÛÈÌÔÔ›ËÛË Ù˘ ÁÏ˘Îfi˙˘ Î·È Ó· ‚ÂÏÙÈÒÛÂÈ
ÙË ‰˘Ó·ÙfiÙËÙ· ÈÓˆ‰fiÏ˘Û˘ Û ‰È·‚ËÙÈο ¿ÙÔÌ· Ù‡Ô˘ 2 [179 (Ib)].
∏ ¤ÓÓÔÈ· ÙÔ˘ °¢ ı· ¤Ú ηْ ·Ú¯‹Ó Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙËÓ Ù·ÍÈ-
ÓfiÌËÛË ÙˆÓ ÏÔ‡ÛÈˆÓ Û ˘‰·Ù¿ÓıڷΘ ÙÚÔÊ›ÌˆÓ Î·È ¤¯ÂÈ ÓfiËÌ· ÌfiÓÔ fiÙ·Ó
Û˘ÁÎÚ›ÓÔÓÙ·È ÙÚÔʤ˜ Ô˘ ·Ó‹ÎÔ˘Ó Û ÌÈ· ·ÚfiÌÔÈ· ÔÌ¿‰·, fiˆ˜ .¯. ‰È·-
ÊfiÚˆÓ ÂȉÒÓ „ˆÌÈ¿, ÊÚÔ‡Ù·, ‰È¿ÊÔÚÔÈ Ù‡ÔÈ ˙˘Ì·ÚÈÎÒÓ ‹ Ú˘˙ÈÔ‡. √È
ÙÈ̤˜ ÙÔ˘ °¢ ‰ÂÓ ı· Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ·fi ÌfiÓ˜ ÙÔ˘˜, ·ÏÏ¿ Ó·
ÌÂÙ·ÊÚ¿˙ÔÓÙ·È ÛÂ Û˘Ó¿ÚÙËÛË Ì ¿ÏÏ· Û¯ÂÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÙÚÔÊÒÓ,
.¯. ÙÔ ÂÓÂÚÁÂÈ·Îfi ÂÚȯfiÌÂÓÔ, ÙÔ ÂÚȯfiÌÂÓÔ Û ¿ÏÏ· Ì·ÎÚÔıÚÂÙÈο
www.hndc.gr
Û˘ÛÙ·ÙÈο, ÙÔ˘˜ ‰È·ı¤ÛÈÌÔ˘˜ ˘‰·Ù¿ÓıڷΘ Î·È ÙȘ Ê˘ÙÈΤ˜ ›Ó˜ [132 (πππ),
180 (IV)]. °È· ·Ú¿‰ÂÈÁÌ·, ÔÚÈṲ̂ӷ ÙÚfiÊÈÌ· ÌÔÚ› Ó· Â›Ó·È ÏÔ‡ÛÈ· ÛÂ
ÎÔÚÂṲ̂ÓÔ Ï›Ô˜ Î·È ·Ï¿ ۿί·Ú· Î·È Ó· ¤¯Ô˘Ó ¯·ÌËÏfi °¢. Àfi ÙËÓ ÚÔ-
¸fiıÂÛË fiÙÈ Ï·Ì‚¿ÓÔÓÙ·È ˘fi„Ë fiÏ· Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÙÚÔÊÒÓ, Ù·
‰È·ı¤ÛÈÌ· ‰Â‰Ô̤ӷ ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ ¿Ô„Ë fiÙÈ Ë ¤ÓÓÔÈ· ÙÔ˘ °¢ ÙˆÓ ÙÚÔ-
ÊÒÓ ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ ¤Ó·Ó ÂÈÚfiÛıÂÙÔ ‚ÔËıËÙÈÎfi ‰Â›ÎÙË Ù˘ ηٷÏ-
ÏËÏfiÙËÙ·˜ ÙˆÓ ˘‰·Ù·ÓıÚ·ÎÔ‡¯ˆÓ ÙÚÔÊ›ÌˆÓ ÁÈ· Û˘Ó˘ÔÏÔÁÈÛÌfi ÛÙË ‰È·-
ÙÚÔÊ‹. ¶·Ú’ fiÏ· ·˘Ù¿, ı· Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜
Ô˘ ‰Â›¯ÓÔ˘Ó Â˘ÂÚÁÂÙÈΤ˜ ÂȉڿÛÂȘ ‰È·ÈÙÒÓ Ì ¯·ÌËÏfi °¢ ‹Ù·Ó Û¯ÂÙÈο
‚Ú·¯˘¯ÚfiÓȘ.
35
™AKXAPOZH KAI A§§A A¶§A ™AKXAPA1
√‰ËÁ›Â˜ ÁÈ· ÙËÓ Î·ı’ Ë̤ڷ Ú¿ÍË
ñ ∂¿Ó Â›Ó·È ÂÈı˘ÌËÙfi Î·È Â¿Ó Ù· ›‰· ÁÏ˘Îfi˙˘ ·›Ì·ÙÔ˜ Â›Ó·È ÈηÓÔÔÈË-
ÙÈο, ÌÈ· ̤ÙÚÈ· ÚfiÛÏË„Ë ·ÏÒÓ Û·Î¯¿ÚˆÓ (¤ˆ˜ 50 g/Ë̤ڷ) ÌÔÚ› Ó·
ÂÓۈ̷وı› ÛÙË ‰›·ÈÙ· ÙˆÓ ·ÙfiÌˆÓ Ì ™¢1 Î·È ™¢2. µ·ıÌfi˜ ∞
ñ Ÿˆ˜ ÈÛ¯‡ÂÈ Î·È ÁÈ· ÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi, Ë Û˘ÓÔÏÈ΋ ÚfiÛÏË„Ë ·ÏÒÓ
۷ί¿ÚˆÓ ‰ÂÓ ı· Ú¤ÂÈ Ó· ÍÂÂÚÓ¿ ÙÔ 10% Ù˘ ÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜. °È· ÂΛ-
ÓÔ˘˜ Ô˘ ¯ÚÂÈ¿˙ÂÙ·È Ó· ¯¿ÛÔ˘Ó ‚¿ÚÔ˜, Èı·ÓÒ˜ ı· Â›Ó·È ¯Ú‹ÛÈ̘ ÈÔ
ÂÚÈÔÚÈÛÙÈΤ˜ Û˘Ì‚Ô˘Ï¤˜ Û¯ÂÙÈο Ì ÙËÓ ÚfiÛÏË„Ë ·ÏÒÓ Û·Î¯¿ÚˆÓ.
µ·ıÌfi˜ C
™¯fiÏÈ·
∆Ë ‰ÂηÂÙ›· ÙÔ˘ 1980, ·ÚÎÂÙ¤˜ Ù˘¯·ÈÔÔÈË̤Ó˜, ÂÏÂÁ¯fiÌÂÓ˜ ÌÂϤÙ˜ (Ì ۯÂ-
36 ‰È·ÛÌfi ·ÓÙ·ÏÏ·Á‹˜ ÙˆÓ ÔÌ¿‰ˆÓ – crossover design) ‰ÂÓ ¤‰ÂÈÍ·Ó ‰˘ÛÌÂÓ›˜ ÂÈ-
‰Ú¿ÛÂȘ ÛÙÔ ÁÏ˘Î·ÈÌÈÎfi ¤ÏÂÁ¯Ô, ÛÙ· ÏÈ›‰È· Î·È ÛÙȘ ÏÈÔÚˆÙ½Ó˜ ÙÔ˘ ÔÚÔ‡
fiÙ·Ó Û˘Ó¤ÎÚÈÓ·Ó ‰›·ÈÙ˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ÌÈÎÚ¤˜ ÔÛfiÙËÙ˜ ۷ί·Úfi˙˘
(Û˘Ó‹ıˆ˜ ÂÚ›Ô˘ 50 g) Ì ‰›·ÈÙ˜ Ô˘ÛÈ·ÛÙÈο ÂχıÂÚ˜ ۷ί·Úfi˙˘ Û ·ÛıÂ-
Ó›˜ Ì ™¢1 Î·È ™¢2 [181-183 (Ib), 184]. √È ÌÂϤÙ˜ ·˘Ù¤˜ Ô‰‹ÁËÛ·Ó Û ÌÈ· ÈÔ
ÂχıÂÚË ·ÓÙÈÌÂÙÒÈÛË ·’ fiÙÈ Â›¯Â ˘ÈÔıÂÙËı› ÚÔËÁÔ˘Ì¤Óˆ˜, fiÙ·Ó Û˘ÛÙËÓfi-
Ù·Ó Ô fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÌÂÁ·Ï‡ÙÂÚÔ˜ ÂÚÈÔÚÈÛÌfi˜ Ù˘ ۷ί·Úfi˙˘.
∞Ó Î·È ˘¿Ú¯Ô˘Ó Û·Ê›˜ ÂӉ›ÍÂȘ ÁÈ· ÙËÓ ·Ô‰Ô¯‹ Ù˘ ̤ÙÚÈ·˜ ηٷӿψÛ˘
۷ί·Úfi˙˘ ·fi Ù· ÂÚÈÛÛfiÙÂÚ· ¿ÙÔÌ· Ì ‰È·‚‹ÙË, ˘¿Ú¯Ô˘Ó ÏÈÁfiÙÂÚ· ‰Â‰Ô-
̤ӷ ÛÙ· ÔÔ›· Ó· ‚·ÛÈÛÙÔ‡Ó Û˘ÛÙ¿ÛÂȘ ÁÈ· ·Ô‰ÂÎÙ¿ ·ÓÒÙÂÚ· fiÚÈ·. ∂›Ó·È ··-
Ú·›ÙËÙÔ Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó Û˘ÛÙ¿ÛÂȘ ÚÔÂÚ¯fiÌÂÓ˜ ·fi ÌÂϤÙ˜ Û ˘ÁÈ‹
¿ÙÔÌ·, ˘¤Ú‚·ÚÔ˘˜ Î·È ·¯‡Û·ÚÎÔ˘˜, ηıÒ˜ Î·È ¿ÙÔÌ· Ì ÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó-
‰ÚÔÌÔ Î·È Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó Ù· ›‰· ÏÈȉ›ˆÓ Î·È ÂÓÂÚÁÂȷ΋˜ ÈÛÔÚÚÔ-
›·˜ ˆ˜ ¤ÌÌÂÛÔÈ ‰Â›ÎÙ˜ ηٷÏËÎÙÈÎÒÓ ÛËÌ›ˆÓ (185). ™Ù· ÌË ‰È·‚ËÙÈο ¿ÙÔÌ·
[186 (Ib)] Î·È Û ÂΛӷ Ì ÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ [97 (πππ)], ‰›·ÈÙ˜ Ì ˘„ËÏ‹
ÂÚÈÂÎÙÈÎfiÙËÙ· Û ۿί·Ú· Û¯ÂÙ›ÛÙËÎ·Ó Ì ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· fiÙ·Ó Û˘ÁÎÚ›-
ıËηÓ, ÛÂ Ù˘¯·ÈÔÔÈË̤Ó˜ ÂÏÂÁ¯fiÌÂÓ˜ ÌÂϤÙ˜, Ì ‰›·ÈÙ˜ ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfi-
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ÙËÙ·˜ Û ¿Ì˘ÏÔ Î·È Ì ÌË ·Ì˘ÏÔ‡¯Ô˘˜ ÔÏ˘Û·Î¯·Ú›Ù˜. ™Ù· ¿ÙÔÌ· Ì ÙÔ ÌÂÙ·-
‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ, ÌÈ· ‰›·ÈÙ· ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ¿Ì˘ÏÔ Î·È Û¯ÂÙÈο
˘„ËÏ‹ ÛÂ Ê˘ÙÈΤ˜ ›Ó˜ Û¯ÂÙ›ÛÙËΠ̠·ÒÏÂÈ· ‚¿ÚÔ˘˜ fiÙ·Ó Û˘ÁÎÚ›ıËΠ̠ÌÈ·
‰›·ÈÙ· ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ۿί·Ú· [97 (πππ)].
¢›·ÈÙ˜ Ô˘ ÂÚÈÏ¿Ì‚·Ó·Ó ÚÔÊ‹Ì·Ù· ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ۷ί·Úfi˙Ë
Û¯ÂÙ›˙ÔÓÙ·Ó Ì ·‡ÍËÛË ÛÙËÓ ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜, ÛÙÔ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜, ÛÙË
ÏÈÒ‰Ë Ì¿˙· ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È ÛÙ· ÏÈ›‰È· ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ fiÙ·Ó Û˘ÁÎÚ›ıËÎ·Ó ÌÂ
‰›·ÈÙ˜ ÛÙȘ Ôԛ˜ ›¯·Ó ÚÔÛÙÂı› Ù¯ÓËÙ¿ ÁÏ˘Î·ÓÙÈο ÛÙ· ÚÔÊ‹Ì·Ù· [187
(Ib)]. º·›ÓÂÙ·È fiÙÈ ÔÈ ¿ÓıÚˆÔÈ ¤¯Ô˘Ó ÌÂȈ̤ÓË ÂÓ‰ÔÁÂÓ‹ ÈηÓfiÙËÙ· Ó· ·Ó·-
ÁÓˆÚ›˙Ô˘Ó Ù· ÁÏ˘Î¿ ÚÔÊ‹Ì·Ù· Î·È Ó· ÌÂÈÒÓÔ˘Ó Î·Ù¿ÏÏËÏ· ÙËÓ Î·Ù·Ó¿ÏˆÛË
Ù¤ÙÔÈˆÓ ÚÔÊËÌ¿ÙˆÓ ¤ÙÛÈ ÒÛÙ ӷ ‰È·ÙËÚ‹ÛÔ˘Ó ÂÓÂÚÁÂȷ΋ ÈÛÔÚÚÔ›·. ∏ ·-
ÎfiÏÔ˘ıË ˘ÂÚηٷӿψÛË ÂÓ¤ÚÁÂÈ·˜, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ËÁ‹ ·fi ÙËÓ ÔÔ›·
ÚÔ¤Ú¯ÂÙ·È, ¯ˆÚ›˜ Ù·˘Ùfi¯ÚÔÓË ·‡ÍËÛË Ù˘ ηٷӿψÛ˘ ÂÓ¤ÚÁÂÈ·˜, ı· Ô‰ËÁ‹-
ÛÂÈ Û ÚfiÛÏË„Ë ‚¿ÚÔ˘˜, ÌÂȈ̤ÓË Â˘·ÈÛıËÛ›· ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Î·È ÛÙȘ Û¯ÂÙÈ- 37
Τ˜ Ì ·˘Ù‹Ó ‰È·Ù·Ú·¯¤˜, fiˆ˜ Ë ‰˘ÛÏÈȉ·ÈÌ›· Î·È Ë ˘¤ÚÙ·ÛË. ŒÙÛÈ Â›Ó·È
Ê·ÓÂÚfi fiÙÈ Ë ˘ÂÚ‚ÔÏÈ΋ ηٷӿψÛË ·ÏÒÓ Û·Î¯¿ÚˆÓ ÌÔÚ› ÂÌ̤ۈ˜ Ó·
Û˘Ì‚¿ÏÂÈ Û ‰È·Ù·Ú·¯¤˜ Ô˘ Úԉȷı¤ÙÔ˘Ó Û ‰˘ÛÌÂÓ‹ ÎÏÈÓÈο ·ÔÙÂϤÛÌ·Ù·.
¶¿ÓÙˆ˜ Ë Û‡ÛÙ·ÛË ÁÈ· ÌÈ· ̤ÁÈÛÙË ÚfiÛÏË„Ë 10% Ù˘ ÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜ ›ӷÈ
οˆ˜ ·˘ı·›ÚÂÙË Î·È ÚÔ¤Ú¯ÂÙ·È ·fi Û˘ÛÙ¿ÛÂȘ ¿ÏÏˆÓ ÂȉÈÎÒÓ ÂÈÙÚÔÒÓ,
Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ∂ȉÈ΋˜ ∂ÈÙÚÔ‹˜ ÁÈ· ÙË ¢›·ÈÙ·, ÙË ¢È·ÙÚÔÊ‹ ηÈ
ÙËÓ ¶ÚfiÏË„Ë ÙˆÓ ÃÚfiÓÈˆÓ ¡fiÛˆÓ (Expert Consultation on Diet, Nutrition
and the Prevention of Chronic Diseases) [23 (IV)].
™Â ˘ÁÈ‹ ¿ÙÔÌ· Ë ˘„ËÏ‹ ÚfiÛÏË„Ë ÊÚÔ˘ÎÙfi˙˘ (17% Ù˘ ÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜)
Û¯ÂÙ›˙ÂÙ·È Ì ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· [188 (Ib)]. ŸÌˆ˜, ÌÈ· ̤ÙÚÈ· ÚfiÛÏË„Ë
ÊÚÔ˘ÎÙfi˙˘ (¤ˆ˜ 30 g/Ë̤ڷ) Ê·›ÓÂÙ·È Ó· ÌËÓ ¤¯ÂÈ ‰˘ÛÌÂÓ›˜ ÂȉڿÛÂȘ fiÛÔÓ
·ÊÔÚ¿ ÙËÓ ÈÓÛÔ˘Ï›ÓË Î·È Ù· ÏÈ›‰È· ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ fiÙ·Ó ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË
‰›·ÈÙ· ·ÙfiÌˆÓ Ì ™¢2 [189 (Ib)].
1
ø˜ ·Ï¿ ۿί·Ú· ÔÚ›˙ÔÓÙ·È: fiÏÔÈ ÔÈ ÌÔÓÔ۷ί·Ú›Ù˜ Î·È ‰È۷ί·Ú›Ù˜ Ô˘ ÚÔÛÙ›ıÂÓÙ·È ÛÙ· ÙÚfi-
ÊÈÌ· ·fi ÙÔÓ Î·Ù·Û΢·ÛÙ‹, ÙÔ Ì¿ÁÂÈÚ· ‹ ÙÔÓ Î·Ù·Ó·ÏˆÙ‹, Û˘Ó Ù· Ê˘ÛÈÎÒ˜ ˘¿Ú¯ÔÓÙ· ۿί·Ú· ÛÙÔ
̤ÏÈ, Ù· ÛÈÚfiÈ· Î·È ÙÔ˘˜ ¯˘ÌÔ‡˜ ÊÚÔ‡ÙˆÓ.
∞¡∆π√•∂π¢ø∆π∫∞ £ƒ∂¶∆π∫∞
™À™∆∞∆π∫∞, µπ∆∞ªπ¡∂™, ª∂∆∞§§∞
∫∞π πá√™∆√πÃ∂π∞
√‰ËÁ›Â˜ ÁÈ· ÙËÓ Î·ı’ Ë̤ڷ Ú¿ÍË
ñ ¶Ú¤ÂÈ Ó· ÂÓı·ÚÚ‡ÓÂÙ·È Ë ÚfiÛÏË„Ë Ê˘ÛÈÎÒÓ ÙÚÔÊÒÓ ÏÔ‡ÛÈˆÓ ÛÂ
‰È·ÈÙËÙÈο ·ÓÙÈÔÍÂȉˆÙÈο (ÙÔÎÔÊÂÚfiϘ, ηÚÔÙÈÓÔÂȉ‹, ‚ÈÙ·Ì›ÓË C,
ÊÏ·‚ÔÓÔÂȉ‹, ÔÏ˘ÊÂÓfiϘ, Ê˘ÙÈÎfi Ô͇), ȯÓÔÛÙÔȯ›· Î·È ¿ÏϘ ‚ÈÙ·Ì›-
Ó˜. µ·ıÌfi˜ C
ñ ∂Óı·ÚÚ‡ÓÂÙ·È Ë Î·ıËÌÂÚÈÓ‹ ηٷӿψÛË ÌÈ·˜ ÔÈÎÈÏ›·˜ Ï·¯·ÓÈÎÒÓ Î·È
ÊÚÔ‡ÙˆÓ ‰Â‰Ô̤ÓÔ˘ fiÙÈ ·˘Ù¿ Â›Ó·È ÏÔ‡ÛȘ ËÁ¤˜ ÔÏÏÒÓ ‚ÈÙ·ÌÈÓÒÓ
Î·È ·ÓÙÈÔÍÂȉˆÙÈÎÒÓ ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ. µ·ıÌfi˜ C
38 ñ ∏ Ù·ÎÙÈ΋ ηٷӿψÛË „ˆÌÈÔ‡ ÔÏÈ΋˜ ·Ï¤Ûˆ˜, ‰ËÌËÙÚÈ·ÎÒÓ Î·È
ÏÈ·ÚÒÓ „·ÚÈÒÓ ‰È¢ÎÔχÓÂÈ ÙËÓ ÚÔÙÂÈÓfiÌÂÓË ÚfiÛÏË„Ë ÙˆÓ ˘fiÏÔÈ-
ˆÓ ÏÈÔ‰È·Ï˘ÙÒÓ ‚ÈÙ·ÌÈÓÒÓ Î·È ÓÂÚÔ‡. µ·ıÌfi˜ C
ñ Ÿˆ˜ Î·È ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi, ÔÈ ¿ÓıÚˆÔÈ Ì ‰È·‚‹ÙË ı· Ú¤ÂÈ Ó·
ÂÚÈÔÚ›˙Ô˘Ó ÙËÓ ÚfiÛÏË„Ë ·Ï·ÙÈÔ‡ Û ÔÛ¿ ÌÈÎÚfiÙÂÚ· ·fi 6 g/Ë̤ڷ.
¶ÂÚ·ÈÙ¤Úˆ Ì›ˆÛË ÌÔÚ› Ó· ¯ÚÂÈ¿˙ÂÙ·È ÁÈ· fiÛÔ˘˜ ¤¯Ô˘Ó ˘„ËÏ‹ ·ÚÙË-
Úȷ΋ ›ÂÛË. µ·ıÌfi˜ ∞
™¯fiÏÈ·
À¿Ú¯Ô˘Ó ·ÚÎÂÙ¿ ‰Â‰Ô̤ӷ ·fi ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ Û ÌË ‰È·‚ËÙÈο ¿ÙÔÌ·
Ô˘ ˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ ÌÈ· ÔÈÎÈÏ›· ·ÓÙÈÔÍÂȉˆÙÈÎÒÓ ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ
Î·È ‚ÈÙ·ÌÈÓÒÓ Î·ıÒ˜ Î·È ÙÚÔÊ›ÌˆÓ ÏÔ‡ÛÈˆÓ Û ·˘Ù¿, fiˆ˜ ÊÚÔ‡Ù·, Ï·¯·-
ÓÈο, ÍËÚÔ› ηÚÔ› Î·È ÌÔ‡Ú·, ÚÔÛÙ·ÙÂ‡Ô˘Ó ¤Ó·ÓÙÈ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛË-
Ì¿ÙˆÓ [190-200 (πππ)]. ∂ÈϤÔÓ, Ë Ù·ÎÙÈ΋ ηٷӿψÛË „ˆÌÈÔ‡ ÔÏÈ΋˜ ¿ÏÂ-
Û˘, ‰ËÌËÙÚÈ·ÎÒÓ Î·È ÏÈ·ÚÒÓ „·ÚÈÒÓ ‰È¢ÎÔχÓÂÈ ÙËÓ ÂÓ‰ÂÈÎÓ˘fiÌÂÓË Úfi-
ÛÏË„Ë ÙˆÓ ˘fiÏÔÈˆÓ ‚ÈÙ·ÌÈÓÒÓ [157, 201-204 (πππ)]. µÚ·¯˘ÚfiıÂÛ̘
www.hndc.gr
ÌÂϤÙ˜ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ Î·Ù·Ó¿ÏˆÛË ÙÚÔÊÒÓ ÏÔ‡ÛÈˆÓ Û ·˘Ù¿ Ù·
ıÚÂÙÈο Û˘ÛÙ·ÙÈο Î·È Û˘ÌÏËڈ̷ÙÈ΋ ¯ÔÚ‹ÁËÛË ÌÈ·˜ ÔÈÎÈÏ›·˜ Û˘ÓıÂÙÈ-
ÎÒÓ ÌÈÎÚÔıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ ÂȂ‚·ÈÒÓÔ˘Ó, ÙfiÛÔ Û ‰È·‚ËÙÈο fiÛÔ Î·È
Û ÌË ‰È·‚ËÙÈο ¿ÙÔÌ·, fiÙÈ ÔÈ ‰Â›ÎÙ˜ ÔÍÂȉˆÙÈÎÔ‡ stress ÌÔÚ› Ó· ÂËÚ·-
ÛÙÔ‡Ó Â˘ÂÚÁÂÙÈο ·fi Ù¤ÙÔȘ ÚÔÛÏ‹„ÂȘ (205-208). ŸÌˆ˜, ÌÂϤÙ˜ Ì ÎÏÈ-
ÓÈο ηٷÏËÎÙÈο ÛËÌ›· (΢ڛˆ˜ Û ¿ÙÔÌ· Ô˘ ‰ÂÓ ¤¯Ô˘Ó ‰È·‚‹ÙË) ‰ÂÓ
¤¯Ô˘Ó ‰Â›ÍÂÈ Ì¤¯ÚÈ ÙÒÚ· ¢ÂÚÁÂÙÈο ·ÔÙÂϤÛÌ·Ù·. ŒÙÛÈ, Û ¿ÙÔÌ· Ì ‰È·‚‹-
ÙË Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ÛˆÛÙfi Ó· Û˘ÓÈÛÙÒÓÙ·È ÙÚfiÊÈÌ· ÏÔ‡ÛÈ· Û ٤ÙÔÈ· ıÚÂ-
ÙÈο Û˘ÛÙ·ÙÈο, ·ÏÏ¿ fi¯È Û˘ÌÏËÚÒÌ·Ù· ÙÚÔÊÒÓ (209).
√ ̤ÙÚÈÔ˜ ÂÚÈÔÚÈÛÌfi˜ ÙÔ˘ Ó·ÙÚ›Ô˘ Ù˘ ÙÚÔÊ‹˜ ¤¯ÂÈ ‰Âȯı› fiÙÈ ÚÔηÏ›
ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ Û˘ÛÙÔÏÈ΋˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Û ÂÏ·ÊÚ¿ ˘ÂÚÙ·ÛÈ-
ÎÔ‡˜ ·ÛıÂÓ›˜ Ì ™¢2 [210 (πb)] Î·È fiÙÈ Â·˘Í¿ÓÂÈ ÙËÓ ˘ÔÙ·ÛÈ΋ ›‰Ú·ÛË
¿ÏÏˆÓ ‰È·ÈÙËÙÈÎÒÓ ¯ÂÈÚÈÛÌÒÓ (Á·Ï·ÎÙÔÎÔÌÈο ¯·ÌËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ ÛÂ
ϛԘ, ÊÚÔ‡Ù· Î·È Ï·¯·ÓÈο) Û ÌË ‰È·‚ËÙÈο ¿ÙÔÌ· [211-213 (Ib)]. 39
Œ¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ ¤Ó· ÔÛÔÛÙfi 20 ¤ˆ˜ 25% ÙˆÓ ·ÙfiÌˆÓ Ì ‰È·‚‹ÙË
ÂÌÊ·Ó›˙ÂÈ ¯·ÌËÏ¿ ›‰· Ì·ÁÓËÛ›Ô˘ ÙÔ˘ ·›Ì·ÙÔ˜. ∞˘Ùfi ȉȷ›ÙÂÚ· ·ÊÔÚ¿
¿ÙÔÌ· Ì ™¢1 Î·È Ùˆ¯fi ÁÏ˘Î·ÈÌÈÎfi ¤ÏÂÁ¯Ô (214, 215) Î·È ¿ÙÔÌ· Ì ÌÂȈ-
̤ÓË ·ÔÚÚfiÊËÛË ÏfiÁˆ ·˘ÙfiÓÔÌ˘ Ó¢ÚÔ¿ıÂÈ·˜ (216). Œ¯ÂÈ ∂ÈϤÔÓ
·Ú·ÙËÚËı› ¤ÏÏÂÈ„Ë Ì·ÁÓËÛ›Ô˘ ·fi ÙÔ Ì˘˚Îfi (217) Î·È ÔÛÙ›ÙË ÈÛÙfi (218)
Î·È ·˘Ùfi ¤¯ÂÈ Û˘Û¯ÂÙÈÛı› Ì ·ÌÊÈ‚ÏËÛÙÚÔÂȉԿıÂÈ· (219) Î·È ÔÏ˘Ó¢ÚÔ-
¿ıÂÈ· (220). Œ¯ÂÈ Â›Û˘ ÚÔÙ·ı› fiÙÈ Ë Û˘ÌÏËڈ̷ÙÈ΋ ¯ÔÚ‹ÁËÛË
Ì·ÁÓËÛ›Ô˘ ÌÔÚ› Ó· ·›˙ÂÈ Î¿ÔÈÔ ÚfiÏÔ ÛÙËÓ ÂÈ‚Ú¿‰˘ÓÛË Ù˘ ÂͤÏÈ͢
Ù˘ Ó¢ÚÔ¿ıÂÈ·˜ Î·È ·ÌÊÈ‚ÏËÛÙÚÔÂȉԿıÂÈ·˜ Î·È Èı·ÓÒ˜ ÁÈ· fiÏÔ˘˜ ÙÔ˘˜
·ÛıÂÓ›˜ Ì و¯¿ ÂÏÂÁ¯fiÌÂÓÔ ™¢1 (221). °È’ ·˘ÙÔ‡˜ ÙÔ˘˜ ÏfiÁÔ˘˜, ÙÚfiÊÈÌ·
ÏÔ‡ÛÈ· Û ̷ÁÓ‹ÛÈÔ ÌÔÚ› Ó· Û˘ÓÈÛÙÒÓÙ·È. ŸÌˆ˜ ··ÈÙÂ›Ù·È ÂȂ‚·›ˆÛË
·˘ÙÒÓ ÙˆÓ ·Ú·ÙËÚ‹ÛˆÓ.
÷ÌËÏ¿ ›‰· „¢‰·ÚÁ‡ÚÔ˘ Î·È ¯ÚˆÌ›Ô˘ Î·È ˘„ËÏ¿ ›‰· ¯·ÏÎÔ‡
¤¯Ô˘Ó ·Ó·ÊÂÚı› Û ¿ÙÔÌ· Ì ‰È·‚‹ÙË, ·ÏÏ¿ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ Ô˘ Ó·
˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ ÔÈ ·Ú·ÙËÚ‹ÛÂȘ ·˘Ù¤˜ ı· Ú¤ÂÈ Ó· ÂËÚ¿ÛÔ˘Ó ÙȘ ‰È·È-
ÙËÙÈΤ˜ Û˘ÛÙ¿ÛÂȘ.
OINO¶NEYMA
√‰ËÁ›Â˜ ÁÈ· ÙËÓ Î·ı’ Ë̤ڷ Ú¿ÍË
ñ ∏ ̤ÙÚÈ· ÚfiÛÏË„Ë ÔÈÓÔÓ‡̷ÙÔ˜ (¤ˆ˜ 10 g/Ë̤ڷ ÁÈ· ÙȘ Á˘Ó·›Î˜
Î·È 20 g/Ë̤ڷ ÁÈ· ÙÔ˘˜ ¿Ó‰Ú˜) Â›Ó·È ·Ô‰ÂÎÙ‹ ÁÈ· Ù· ¿ÙÔÌ· ÂΛӷ ÌÂ
‰È·‚‹ÙË Ô˘ ÂÈϤÁÔ˘Ó Ó· ›ÓÔ˘Ó ÔÈÓÔÓÂ˘Ì·ÙÒ‰Ë. µ·ıÌfi˜ µ
ñ ŸÙ·Ó ÙÔ ÔÈÓfiÓÂ˘Ì· ηٷӷÏÒÓÂÙ·È ·fi ¿ÙÔÌ· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó
ÈÓÛÔ˘Ï›ÓË, Â›Ó·È ÛˆÛÙfi Ó· ηٷӷÏÒÓÂÙ·È Ì·˙› Ì ¤Ó· Á‡̷ Ô˘ ÂÚÈ-
Ï·Ì‚¿ÓÂÈ ÙÚfiÊÈÌ· Ì ˘‰·Ù¿ÓıڷΘ, ÏfiÁˆ ÙÔ˘ ‰˘ÓËÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘
ÛÔ‚·Ú‹˜ Î·È ·Ú·ÙÂٷ̤Ó˘ ˘ÔÁÏ˘Î·ÈÌ›·˜. µ·ıÌfi˜ µ
ñ ∏ ηٷӿψÛË ÔÈÓÔÓ‡̷ÙÔ˜ ı· Ú¤ÂÈ Ó· Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË ·fi Ù·
¿ÙÔÌ· ÂΛӷ Ô˘ Â›Ó·È ˘¤Ú‚·Ú·, ˘ÂÚÙ·ÛÈο ‹ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌÈο.
∏ ·Ô¯‹ ·fi ÔÈÓfiÓÂ˘Ì· Û˘ÓÈÛÙ¿Ù·È Â›Û˘ ÛÙȘ Á˘Ó·›Î˜ ηٿ ÙË ‰È¿Ú-
ÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ Î·È Û fiÛÔ˘˜ ¤¯Ô˘Ó ÈÛÙÔÚÈÎfi ·ÁÎÚ·ٛÙȉ·˜ ‹
40 ηٿ¯ÚËÛ˘ ÔÈÓÔÓ‡̷ÙÔ˜, ÂÎÛÂÛËÌ·Ṳ̂ÓË ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·,
ÚÔ¯ˆÚË̤ÓË Ó¢ÚÔ¿ıÂÈ· Î·È ÛÙ˘ÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·. µ·ıÌfi˜ C
™¯fiÏÈ·
ŒÓ· ˘„ËÏfi ÔÛÔÛÙfi ÂÓËÏ›ÎˆÓ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi, Î·È ÔÏÏÔ› ¿ÓıÚˆ-
ÔÈ Ì ‰È·‚‹ÙË, ›ÓÔ˘Ó ÔÈÓÔÓÂ˘Ì·ÙÒ‰Ë ÔÙ¿. ∆Ô ÔÈÓfiÓÂ˘Ì· ÌÔÚ› Ó·
¤¯ÂÈ ÙfiÛÔ ·ÓÂÈı‡ÌËÙ˜ fiÛÔ Î·È Â˘ÂÚÁÂÙÈΤ˜ ÂȉڿÛÂȘ. ¶ÔÏϤ˜ ·Ó·‰ÚÔÌÈ-
Τ˜ Î·È ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ Û ¿ÙÔÌ· ¯ˆÚ›˜ ‰È·‚‹ÙË ‰Â›¯ÓÔ˘Ó fiÙÈ Ë Ì¤ÙÚÈ·
¯Ú‹ÛË ÌÈ·˜ ÔÈÎÈÏ›·˜ ÔÈÓÔÓÂ˘Ì·Ùˆ‰ÒÓ ÔÙÒÓ Û¯ÂÙ›˙ÂÙ·È Ì ÌÂȈ̤ÓÔ Î›Ó-
‰˘ÓÔ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ [222 (ππb)] Î·È ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ [223 (πππ)].
ŒÓ·˜ ÂÚÈÔÚÈṲ̂ÓÔ˜ ·ÚÈıÌfi˜ ÏËÚÔÊÔÚÈÒÓ ·fi Ù¤ÛÛÂÚȘ ÌÂϤÙ˜ Û ¿ÙÔÌ·
Ì ™¢2 ÂȂ‚·ÈÒÓÂÈ ·˘Ù‹ ÙË Û˘Û¯¤ÙÈÛË. ∆Ô fiÊÂÏÔ˜ Ê·›ÓÂÙ·È Ó· ÚÔ¤Ú¯ÂÙ·È
΢ڛˆ˜ ·fi ÙÔ ÔÈÓfiÓÂ˘Ì· ·˘Ùfi ηı·˘Ùfi, ·Ú¿ ·fi Ù· ¿ÏÏ· Û˘ÛÙ·ÙÈο
ÙˆÓ ‰È·ÊfiÚˆÓ Ù‡ˆÓ ÔÙÒÓ [224 (πππ)]. ∏ ̤ÙÚÈ· ηٷӿψÛË ÔÈÓÔÓ‡-
Ì·ÙÔ˜ ÌÔÚ› Ó· ¤¯ÂÈ Â˘ÂÚÁÂÙÈο ·ÔÙÂϤÛÌ·Ù· ·˘Í¿ÓÔÓÙ·˜ Ù· ›‰· ÙˆÓ
ÏÈÔÚˆÙÂ˚ÓÒÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜, ÌÂÈÒÓÔÓÙ·˜ ÙËÓ ˘ÂÚËÎÙÈÎfiÙËÙ· ηÈ
www.hndc.gr
ÙËÓ ÔÍ›‰ˆÛË ÙˆÓ ÏÈȉ›ˆÓ ̤ۈ ·ÓÙÈÔÍÂȉˆÙÈÎÒÓ ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ.
∏ Ù·ÎÙÈ΋ ·ÏÏ¿ ̤ÙÚÈ· ηٷӿψÛË ÔÈÓÔÓ‡̷ÙÔ˜ (ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ¤ˆ˜ 4
ÊÔÚ¤˜/‚‰ÔÌ¿‰·) ¤¯ÂÈ ÂÚÈÛÛfiÙÂÚÔ Â˘ÂÚÁÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ·Ú¿ Ë Â˘Î·È-
Úȷ΋ ¯Ú‹ÛË ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ [225 (πππ)]. ∆Ô ·Ó·ÌÂÓfiÌÂÓÔ fiÊÂÏÔ˜ ‰Â
ÌÂÙ·‚¿ÏÏÂÙ·È Ô‡Ù ·fi ÙÔ ¯ÚfiÓÔ Î·Ù·Ó¿ÏˆÛ˘ ÙÔ˘ ÔÈÓÔÓ‡̷ÙÔ˜ Û ۯ¤ÛË
Ì ٷ Á‡̷ٷ Ô‡Ù ·fi ÙÔ Â›‰Ô˜ ÙˆÓ ÔÙÒÓ Ô˘ ηٷӷÏÒÓÔÓÙ·È [225 (πππ),
226 (ππb)].
∆Ô ÔÈÓfiÓÂ˘Ì· ÌÔÚ› Ó· Â›Ó·È ÌÈ· ÛËÌ·ÓÙÈ΋ ËÁ‹ ÂÓ¤ÚÁÂÈ·˜ ÁÈ· ÙÔ˘˜
˘¤Ú‚·ÚÔ˘˜. ∂ÈÚfiÛıÂÙ·, Ë ÌÂÁ¿ÏË ¯Ú‹ÛË ÔÈÓÔÓ‡̷ÙÔ˜ Û¯ÂÙ›˙ÂÙ·È ÌÂ
·˘ÍË̤ÓÔ ‰Â›ÎÙË ÂÚÈʤÚÂÈ·˜ ̤Û˘ ÚÔ˜ ÈÛ¯›·, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ ‰Â›ÎÙË
Ì¿˙·˜ ÛÒÌ·ÙÔ˜ [227 (πππ)]. ∞fi ÙËÓ ¿ÏÏË ÌÂÚÈ¿, ̤ÙÚȘ ÔÛfiÙËÙ˜ ÔÈÓÔ-
Ó‡̷ÙÔ˜ ÌÔÚ› Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓË Â˘·ÈÛıËÛ›· ÛÙËÓ ÈÓÛÔ˘Ï›ÓË
[228 (πb), 229 (IIb), 230 (πππ)]. ∆Ô ÔÈÓfiÓÂ˘Ì· ÌÔÚ› ›Û˘ Ó· Û¯ÂÙ›˙ÂÙ·È 41
Ì ·˘ÍË̤ӷ ›‰· ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Î·È Î›Ó‰˘ÓÔ ˘Ô-
ÁÏ˘Î·ÈÌÈÒÓ [231, 232 (πππ)]. ¢ÂÓ ˘¿Ú¯Ô˘Ó ·Ú΋ ‰Â‰Ô̤ӷ ÁÈ· ÙÔ Î·Ù¿Ï-
ÏËÏÔ ·ÓÒÙÂÚÔ fiÚÈÔ Î·Ù·Ó¿ÏˆÛ˘ ÔÈÓÔÓ‡̷ÙÔ˜ Û ¿ÙÔÌ· Ì ‰È·‚‹ÙË. ŒÙÛÈ
ÔÈ Û˘ÛÙ¿ÛÂȘ ‚·Û›˙ÔÓÙ·È Û ‰Â‰Ô̤ӷ ·fi ÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi (233).
∞Ô¯‹ ·fi ÔÈÓfiÓÂ˘Ì· Ú¤ÂÈ Ó· Û˘ÓÈÛÙ¿Ù·È ÛÙȘ Á˘Ó·›Î˜ ηٿ ÙË ‰È¿Ú-
ÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ Î·È Û fiÛÔ˘˜ ¤¯Ô˘Ó ÈÛÙÔÚÈÎfi ·ÁÎÚ·ٛÙȉ·˜ ‹ ηٿ-
¯ÚËÛ˘ ÔÈÓÔÓ‡̷ÙÔ˜, ÂÎÛÂÛËÌ·Ṳ̂ÓË ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·, ÚÔ¯ˆÚË̤-
ÓË Ó¢ÚÔ¿ıÂÈ· Î·È ÛÙ˘ÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·. °È’ ·˘Ùfi ÔÈ Û˘ÛÙ¿ÛÂȘ Û¯ÂÙÈο ÌÂ
ÙÔ ÔÈÓfiÓÂ˘Ì· ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜ ı· Ú¤ÂÈ Ó· ÂÍ·ÚÙÒÓÙ·È ·fi Ù·
ȉȷ›ÙÂÚ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ οı ·ÛıÂÓÔ‡˜ Î·È Ó· ÌËÓ ·Ú·‚ϤÔÓÙ·È ÔÈ
ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈΤ˜ Û˘Ó¤ÂȘ Ù˘ ηٿ¯ÚËÛ˘ ÔÈÓÔÓ‡̷ÙÔ˜. ¢ÂÓ ˘¿Ú-
¯Ô˘Ó ·ÚÎÂÙ¤˜ ÏËÚÔÊÔڛ˜ Ô˘ Ó· ÂÈÙÚ¤Ô˘Ó ÙËÓ ÂÓı¿ÚÚ˘ÓÛË ÙˆÓ ·ÛıÂ-
ÓÒÓ Ô˘ ‰ÂÓ ›ÓÔ˘Ó ÔÈÓÔÓÂ˘Ì·ÙÒ‰Ë Ó· ·Ú¯›ÛÔ˘Ó Ó· ›ÓÔ˘Ó.
∏ Û‡ÛÙ·ÛË Û¯ÂÙÈο Ì ÙËÓ ·Ó¿ÁÎË Î·Ù·Ó¿ÏˆÛ˘ ˘‰·Ù·ÓıÚ¿ÎˆÓ Ì·˙› ÌÂ
ÙÔ ÔÈÓfiÓÂ˘Ì· Á›ÓÂÙ·È ÏfiÁˆ ÙÔ˘ ÂӉ¯Ô̤ÓÔ˘ ÛÔ‚·Ú‹˜ ˘ÔÁÏ˘Î·ÈÌ›·˜ ·fi
ÙÔ ÔÈÓfiÓÂ˘Ì·. ¶·ÚfiÏÔ Ô˘ ̤ÙÚÈ· ÔÛfiÙËÙ· ÔÈÓÔÓ‡̷ÙÔ˜ ÌÔÚ› Û˘Ó‹-
ıˆ˜ Ó· ηٷӷψı› ¯ˆÚ›˜ Ó· ÚÔηϤÛÂÈ ¿ÌÂÛ· ˘ÔÁÏ˘Î·ÈÌ›·, Ô Î›Ó‰˘ÓÔ˜
·˘Í¿ÓÂÈ Ì ÙËÓ ·‡ÍËÛË Ù˘ ÔÛfiÙËÙ·˜ Ô˘ ηٷӷÏÒÓÂÙ·È [3 (IV)].
42
www.hndc.gr
¶PO§HæH TOY ¢IABHTH
√‰ËÁ›Â˜ ÁÈ· ÙËÓ Î·ı’ Ë̤ڷ Ú¿ÍË
ñ ∏ ·ÔÊ˘Á‹ Ù˘ ·¯˘Û·ÚΛ·˜ Î·È Ë Ù·ÎÙÈ΋ ۈ̷ÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·
·ÔÙÂÏÔ‡Ó ¤Ó· ̤ÛÔ ÁÈ· ÙË Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ™¢2.
µ·ıÌfi˜ ∞
ñ ∏ Ì›ˆÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È Ë ‰È·Ù‹ÚËÛË Ù˘ ·ÒÏÂÈ·˜ ÙÔ˘
‚¿ÚÔ˘˜ Û ˘¤Ú‚·Ú· ¿ÙÔÌ· ·ÔÙÂÏ› ¤Ó· ‚·ÛÈÎfi Û˘ÛÙ·ÙÈÎfi ÙÔ˘ ÚÔ-
ÁÚ¿ÌÌ·ÙÔ˜ ·ÏÏ·Á‹˜ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜. ∞˘Ùfi ÌÔÚ› Ó· ·Ó·Ì¤ÓÂÙ·È Ó·
ÌÂÈÒÛÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ·Ó¿Ù˘Í˘ ™¢2. µ·ıÌfi˜ ∞
ñ ∏ ηٿÏÏËÏË Û‡ÛÙ·ÛË Ì·ÎÚÔıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ ÛÙȘ ‰›·ÈÙ˜ Ô˘
ÛÎÔÂ‡Ô˘Ó ÛÙË Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ™¢2 Â›Ó·È Ë ·ÎfiÏÔ˘ıË:
ÚfiÛÏË„Ë ÔÏÈÎÔ‡ Ï›Ô˘˜ <30% Ù˘ ÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜, ÚfiÛÏË„Ë ÎÔÚÂ-
Ṳ̂ÓÔ˘ Ï›Ô˘˜ <10% Ù˘ ÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜, ÚfiÛÏË„Ë Ê˘ÙÈÎÒÓ ÈÓÒÓ
>15 g/1000 kcal. µ·ıÌfi˜ ∞ 43
™¯fiÏÈ·
ªÈ· ÂÓÙ˘ˆÛȷ΋ ÛÂÈÚ¿ ‰Â‰ÔÌ¤ÓˆÓ ·fi ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ ‰Â›¯ÓÂÈ ÌÂȈ-
̤ÓÔ Î›Ó‰˘ÓÔ ·Ó¿Ù˘Í˘ ™¢2 Û ÂΛÓÔ˘˜ Ô˘ ‰ÂÓ Â›Ó·È ˘¤Ú‚·ÚÔÈ, οÓÔ˘Ó
ÌÂÁ¿ÏË Î·Ù·Ó¿ÏˆÛË Ê˘ÙÈÎÒÓ ÈÓÒÓ (΢ڛˆ˜ ›Ó˜ ·fi ‰ËÌËÙÚȷο) Î·È ÙÚÔ-
Ê›ÌˆÓ ¯·ÌËÏÔ‡ ÁÏ˘Î·ÈÌÈÎÔ‡ ‰Â›ÎÙË ‹ ηٷӷÏÒÓÔ˘Ó Û¯ÂÙÈο ÌÈÎÚ¤˜ ÔÛfi-
ÙËÙ˜ ÎÔÚÂṲ̂ÓÔ˘ Ï›Ô˘˜ Î·È ¤¯Ô˘Ó Ù·ÎÙÈ΋ ۈ̷ÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· [85,
234-243 (πππ)]. ªÂÁ¿ÏË Î·Ù·Ó¿ÏˆÛË ÚÔÊËÌ¿ÙˆÓ ÂÌÏÔ˘ÙÈÛÌ¤ÓˆÓ Ì ˙¿¯·-
ÚË ¤¯ÂÈ Û˘Û¯ÂÙÈÛı› Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ™¢2 Û Á˘Ó·›Î˜ [244 (πππ)]. ªÈ·
ηϿ ۯ‰ȷṲ̂ÓË Ù˘¯·ÈÔÔÈË̤ÓË ÂÏÂÁ¯fiÌÂÓË ÌÂϤÙË ¤‰ÂÈÍ ·˘ÍË̤ÓË Â˘·È-
ÛıËÛ›· ÛÙËÓ ÈÓÛÔ˘Ï›ÓË fiÙ·Ó Ù· ÎÔÚÂṲ̂ӷ ÏÈ·Ú¿ Ôͤ· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi
·ÎfiÚÂÛÙ· Ê˘ÙÈ΋˜ ÚÔ¤Ï¢Û˘ Ï›Ë ÛÙ· Ï·›ÛÈ· ÌÈ·˜ ‰›·ÈÙ·˜ Ô˘ ÂÚȤ¯ÂÈ
̤ÙÚȘ ÔÛfiÙËÙ˜ ÔÏÈÎÔ‡ Ï›Ô˘˜, ‰ËÏ·‰‹ <37% Ù˘ ÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜ [66
(πb)]. ∆ÚÂȘ Ù˘¯·ÈÔÔÈË̤Ó˜ ÂÏÂÁ¯fiÌÂÓ˜ ÌÂϤÙ˜ Ô˘ ‰ÈÂÓÂÚÁ‹ıËÎ·Ó ÛÙËÓ
∫›Ó·, ÙË ºÈÓÏ·Ó‰›· Î·È ÙȘ ∏ӈ̤Ó˜ ¶ÔÏÈÙ›˜ Û ¿ÙÔÌ· Ì ‰È·Ù·Ú·Á̤ÓË
·ÓÔ¯‹ ÛÙË ÁÏ˘Îfi˙Ë (IGT) ¤‰ÂÈÍ·Ó ÌÈ· Ì›ˆÛË ÛÙËÓ ÚfiÔ‰Ô ·fi IGT ÛÂ
™¢2 ηٿ ÂÚ›Ô˘ 60% Û ÌÈ· ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô ÂÚ›Ô˘ 3,5 ÂÙÒÓ ÛÂ Û˘Û¯¤-
ÙÈÛË Ì ̤ÙÚÈ· ·ÒÏÂÈ· ‚¿ÚÔ˘˜ [245, 6, 7 (Ib)]. ∆Ô fiÊÂÏÔ˜ Ê·›ÓÂÙ·È fiÙÈ
‹Ù·Ó ·Ú·ÙÂٷ̤ÓÔ ÛÙË ºÈÓÏ·Ó‰È΋ ÌÂϤÙË [246 (Ib)]. ™Â ‰˘Ô ·fi ÙȘ ÙÚÂȘ
·˘Ù¤˜ ÌÂϤÙ˜ (6, 7) Ë ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ÂÂÙ‡¯ıË ÌÂ Û˘Ó‰˘·ÛÌfi ‰›·ÈÙ·˜ ηÈ
¿ÛÎËÛ˘. ∏ Û˘ÁÎÂÎÚÈ̤ÓË ‰›·ÈÙ· ÂÚÈ›¯Â ÌÂȈ̤Ó˜ ÔÛfiÙËÙ˜ ÔÏÈÎÔ‡ ηÈ
ÎÔÚÂṲ̂ÓÔ˘ Ï›Ô˘˜ Î·È ·˘ÍË̤Ó˜ ÔÛfiÙËÙ˜ Ê˘ÙÈÎÒÓ ÈÓÒÓ. ™ÙËÓ ÙÚ›ÙË
ÌÂϤÙË (245) Ë Ù˘¯·ÈÔÔ›ËÛË ‹Ù·Ó ηٿ ÎÏÈÓÈ΋, fiÔ˘ ÔÈ Û˘ÌÌÂÙ¤¯ÔÓÙ˜
¤Ï·‚·Ó Û˘Ì‚Ô˘Ï¤˜ Ó· ·˘Í‹ÛÔ˘Ó ÙÔ Â›Â‰Ô Ù˘ ۈ̷ÙÈ΋˜ ÙÔ˘˜ ‰Ú·ÛÙË-
ÚÈfiÙËÙ·˜, Ó· ÌÂÙ·‚¿ÏÔ˘Ó ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜, Ó· ·ÏÏ¿ÍÔ˘Ó ÙfiÛÔ ÙË ‰È·ÙÚÔÊ‹
fiÛÔ Î·È ÙËÓ ¿ÛÎËÛË ‹ Ó· ÌËÓ Î¿ÓÔ˘Ó Î·Ì›· ·ÏÏ·Á‹ ÛÙÔÓ ÙÚfiÔ ˙ˆ‹˜ ÙÔ˘˜.
™Â οı ÌÈ· ·fi ÙȘ ÔÌ¿‰Â˜ ·Ú¤Ì‚·Û˘ ·Ú·ÙËÚ‹ıËÎÂ Û˘ÁÎÚ›ÛÈÌÔ fiÊÂÏÔ˜.
∆Ô fiÊÂÏÔ˜ Ê·›ÓÂÙ·È fiÙÈ ÔÊ›ÏÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ·ÒÏÂÈ· ‚¿ÚÔ˘˜ Î·È ÙË
44
ۈ̷ÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· [247 (Ib)]. ŒÙÛÈ ÁÈ· ÂΛÓÔ˘˜ Ô˘ Â›Ó·È ˘¤Ú‚·ÚÔÈ
‹ ·¯‡Û·ÚÎÔÈ, ȉȷ›ÙÂÚ· Â¿Ó ¤¯Ô˘Ó ÈÛ¯˘Úfi ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi ™¢2 ‹
¤¯Ô˘Ó ‰È·Ù·Ú·Á̤ÓÔ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ÁÏ˘Îfi˙˘, Ë ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ı· Ú¤-
ÂÈ ˙ˆËÚ¿ Ó· ÂÓı·ÚÚ‡ÓÂÙ·È. √ ÛÙfi¯Ô˜ ÁÈ· fiÛÔ˘˜ Â›Ó·È ˘¤Ú‚·ÚÔÈ ‹ ·¯‡-
Û·ÚÎÔÈ Â›Ó·È ¤Ó·˜ ¢ª™ ̤۷ ÛÙ· Û˘ÓÈÛÙÒÌÂÓ· fiÚÈ·, ·ÏÏ¿ ÌÈ· ÂÚÈÛÛfiÙÂÚÔ
Ú·ÎÙÈ΋ ÚÔÛ¤ÁÁÈÛË, Î·È Û˘ÁÎÂÎÚÈ̤ӷ ·˘Ù‹ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠÛÙË
ºÈÓÏ·Ó‰È΋ ÌÂϤÙË, Â›Ó·È Ó· Û˘ÛÙËı› Ì›ˆÛË ÙÔ˘ ‚¿ÚÔ˘˜ ηٿ 5-7% ÙÔ˘
·Ú¯ÈÎÔ‡ ‚¿ÚÔ˘˜ ‹ ·ÒÏÂÈ· ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ηٿ 5-10 ÎÈÏ¿, ·Ó¿ÏÔÁ· ÌÂ
ÙÔ ‚·ıÌfi Ù˘ ·¯˘Û·ÚΛ·˜. ∆fiÛÔ ÛÙË ºÈÓÏ·Ó‰È΋ fiÛÔ Î·È ÛÙËÓ
∞ÌÂÚÈηÓÈ΋ ÌÂϤÙË ·Ú¤Ì‚·Û˘ Ë Û˘¯Ó‹ ηٷӿψÛË ÚÔ˚fiÓÙˆÓ ÔÏÈ΋˜
·Ï¤Ûˆ˜, Ï·¯·ÓÈÎÒÓ, ÊÚÔ‡ÙˆÓ, Á·Ï·ÎÙÔÎÔÌÈÎÒÓ Î·È ÚÔ˚fiÓÙˆÓ ÎÚ¤·ÙÔ˜
¯·ÌËÏÔ‡ Ï›Ô˘˜, Ì·ÚÁ·ÚÈÓÒÓ Î·È ÛÔÚÂÏ·›ˆÓ ÏÔ‡ÛÈˆÓ Û MUFA (ÌÔÓÔ·-
ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ·) ‹Ù·Ó Ù· ‚·ÛÈο ÛÙÔȯ›· ÙˆÓ Û¯ÂÙÈÎÒÓ Û˘ÛÙ¿ÛÂˆÓ Û’
fiÙÈ ·ÊÔÚ¿ Ù· Ì·ÎÚÔıÚÂÙÈο Û˘ÛÙ·ÙÈο. ∂ÈϤÔÓ, Ë ·Ú·‰ÔÛȷ΋
ªÂÛÔÁÂȷ΋ ‰È·ÙÚÔÊ‹ ηıÒ˜ Î·È ¿ÏϘ ·Ú·‰ÔÛȷΤ˜ ‰›·ÈÙ˜ ÌÔÚ› Ó·
www.hndc.gr
Â›Ó·È ÂÍ›ÛÔ˘ ·ÔÙÂÏÂÛÌ·ÙÈΤ˜. ™ˆÌ·ÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘Ï¿¯ÈÛÙÔÓ
̤ÙÚÈ·˜ ¤ÓÙ·Û˘ (.¯. ÁÚ‹ÁÔÚÔ ‚¿‰ÈÛÌ·) ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 30 ÏÂÙ¿ ÙËÓ
Ë̤ڷ Â›Ó·È ¤Ó· ÛËÌ·ÓÙÈÎfi Û˘ÛÙ·ÙÈÎfi Ù˘ ÙÚÔÔÔ›ËÛ˘ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜
Ô˘ ÛÎÔ‡ÂÈ ÛÙË Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ·Ó¿Ù˘Í˘ ™¢2. ∞˘Ùfi Ì·˙› Ì ÌÈ·
·‡ÍËÛË Ù˘ ηٷӿψÛ˘ ÙˆÓ Ê˘ÙÈÎÒÓ ÈÓÒÓ ¤¯ÂÈ ‰Âȯı› fiÙÈ Û˘Ì‚¿ÏÏÂÈ ÛÙË
Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ·ÒÏÂÈ· ‚¿ÚÔ˘˜. ŒÓ· ·ÚfiÌÔÈÔ
ÚfiÁÚ·ÌÌ· ¿ÛÎËÛ˘ Î·È ‰›·ÈÙ·˜ ¤¯ÂÈ ‰Âȯı› fiÙÈ ‚ÂÏÙÈÒÓÂÈ ÙËÓ Â˘·ÈÛıËÛ›·
ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Û ¿ÙÔÌ· Ì ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË ÚÈÓ ·fi ÙËÓ ·Ó¿-
Ù˘ÍË ‰˘Û·ÓÂÍ›·˜ ÛÙË ÁÏ˘Îfi˙Ë (248). ¢ÂÓ ˘¿Ú¯Ô˘Ó ÚÔ˜ ÙÔ ·ÚfiÓ ‰ËÌÔ-
ÛÈÂ˘Ì¤Ó· ‰Â‰Ô̤ӷ Ô˘ Ó· ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ·ÒÏÂÈ· ‚¿ÚÔ˘˜ Ì ‰›·ÈÙ˜ ˘„Ë-
Ï‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ϛԘ ‹ ÚˆÙ½Ó˜ Î·È ¯·ÌËÏ‹˜ Û ˘‰·Ù¿ÓıڷΘ ı·
ÂÈÙ‡¯Ô˘Ó ·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù· Û ¿ÙÔÌ· Ì ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË ‹
‰È·Ù·Ú·Á̤ÓË ·ÓÔ¯‹ ÛÙË ÁÏ˘Îfi˙Ë.
45
∏ Û˘ÌÏËڈ̷ÙÈ΋ ¯ÔÚ‹ÁËÛË ‚ÈÙ·Ì›Ó˘ D Û ٷÎÙÈ΋ ‚¿ÛË ‹ Ë ˘„ËÏ‹
‰È·ÈÙËÙÈ΋ ÚfiÛÏË„Ë ·fi ÌÈÎÚ¿ ·È‰È¿ ¤¯ÂÈ ‰Âȯı› fiÙÈ Û¯ÂÙ›˙ÂÙ·È Ì ÌÈÎÚfiÙÂ-
ÚÔ Î›Ó‰˘ÓÔ ·Ó¿Ù˘Í˘ ™¢1 [249 (πππ)]. ∆ÚÂȘ ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó ÌÈ·
ÛÙ·ıÂÚ‹ ·ÓÙ›ÛÙÚÔÊË Û¯¤ÛË ÌÂٷ͇ Ù˘ ÚfiÛÏ˄˘ Ì·ÁÓËÛ›Ô˘ Î·È ÙˆÓ ÂȤ-
‰ˆÓ ÈÓÛÔ˘Ï›Ó˘ ÓËÛÙ›·˜ ηıÒ˜ Î·È ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ·Ó¿Ù˘Í˘ ™¢2 (250-253).
÷ÌËÏ¿ ›‰· Ì·ÁÓËÛ›Ô˘ ¤¯Ô˘Ó ›Û˘ Û˘Û¯ÂÙÈÛı› Ì ¿ÏÏ· ¯·Ú·ÎÙËÚÈÛÙÈ-
ο ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Û ÌË ‰È·‚ËÙÈο ¿ÙÔÌ· (254). À„ËÏ‹ Úfi-
ÛÏË„Ë Ì·ÁÓËÛ›Ô˘ Ì ÙÔ fiÛÈÌÔ ÓÂÚfi (>2,61 mg/l) Ê·›ÓÂÙ·È Ó· Â›Ó·È ÚÔÛÙ·-
Ù¢ÙÈ΋ ¤Ó·ÓÙÈ Ù˘ ·Ó¿Ù˘Í˘ ™¢1 ÛÙËÓ ·È‰È΋ ËÏÈΛ· (255). Œ¯ÂÈ Â›Û˘
·Ó·ÊÂÚı› ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË ·Ó¿ÌÂÛ· ÛÙËÓ Î·Ù·Ó¿ÏˆÛË Î·Ê¤ Î·È ÛÙÔÓ Î›Ó-
‰˘ÓÔ ·Ó¿Ù˘Í˘ ™¢2 (256-260). ¶¿ÓÙˆ˜ Ë ¤ÏÏÂÈ„Ë ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ ‰ÂÓ
ÂÈÙÚ¤ÂÈ ÚÔ˜ ÙÔ ·ÚfiÓ ÙË ‰È·Ù‡ˆÛË ‚‚·›ˆÓ Û˘ÛÙ¿ÛÂˆÓ Û¯ÂÙÈο Ì ÙÔ˘˜
ÚfiÏÔ˘˜ Ù˘ ‚ÈÙ·Ì›Ó˘ D ‹ ÙÔ˘ Ì·ÁÓËÛ›Ô˘ ÛÙËÓ ÚfiÏË„Ë ÙÔ˘ ‰È·‚‹ÙË. √È ÎÏÈ-
ÓÈΤ˜ ÌÂϤÙ˜ ‰ÂÓ ÂȂ‚·›ˆÛ·Ó ÙËÓ ·Ï·ÈfiÙÂÚ· ÚÔÙ·ı›۷ ¿Ô„Ë ÁÈ· ¢ÂÚ-
ÁÂÙÈ΋ ›‰Ú·ÛË Ù˘ ÓÈÎÔÙÈÓ·Ì›‰Ë˜ ÛÙËÓ ÚfiÏË„Ë ÙÔ˘ ™¢1 (261).
™YM¶§HPøMATA ¢IATPOºH™
KAI «§EITOYP°IKA» TPOºIMA
ñ ¢ÂÓ ˘¿Ú¯Ô˘Ó Û˘ÛÙ¿ÛÂȘ Û¯ÂÙÈο Ì ٷ Û˘ÌÏËÚÒÌ·Ù· ‰È·ÙÚÔÊ‹˜ Î·È Ù·
«ÏÂÈÙÔ˘ÚÁÈο» ÙÚfiÊÈÌ· (functional foods). ™‹ÌÂÚ· ‰È·Ù›ıÂÓÙ·È ÛÙËÓ
·ÁÔÚ¿ ·ÚÎÂÙ¿ Ù¤ÙÔÈ· ÚÔ˚fiÓÙ·.
™¯fiÏÈ·
¶ÔÏÏ¿ «ÏÂÈÙÔ˘ÚÁÈο» ÙÚfiÊÈÌ· Î·È Û˘ÌÏËÚÒÌ·Ù· ‰È·ÙÚÔÊ‹˜ ‰È·ÊËÌ›˙Ô-
ÓÙ·È Û‹ÌÂÚ· ˆ˜ ¢ÂÚÁÂÙÈο ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ‰È·‚ËÙÈÎÒÓ ·ÙfiÌˆÓ ‹ ÁÈ·
ÙË Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ·Ó¿Ù˘Í˘ ‰È·‚‹ÙË Î·È ÙˆÓ ÂÈÏÔÎÒÓ ÙÔ˘. ∞˘Ù¿
ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÚÔ˚fiÓÙ· ÂÌÏÔ˘ÙÈṲ̂ӷ Ì ›Ó˜ Î·È Ì·ÚÁ·Ú›Ó˜ Ô˘ ÂÚȤ-
¯Ô˘Ó Ê˘ÙÔÛÙÂÚfiϘ ‹ ÛÙ·ÓfiϘ Î·È Û˘ÌÏËÚÒÌ·Ù· ‰È·ÙÚÔÊ‹˜ Ô˘ ÂÚȤ-
46 ¯Ô˘Ó ‰È¿ÊÔÚ˜ Ê˘ÙÈΤ˜ ›Ó˜, ˆ-3 ÏÈ·Ú¿ Ôͤ·, ̤ٷÏÏ·, ȯÓÔÛÙÔȯ›· ηÈ
‚fiÙ·Ó·. ¶ÔÏÏ¿ ·fi Ù· ÚÔ˚fiÓÙ· ·˘Ù¿ ¤¯ÂÈ ‰Âȯı› fiÙÈ ¤¯Ô˘Ó ‰˘ÓËÙÈο Û¯ÂÙÈ-
Τ˜ ÂȉڿÛÂȘ ÛÙȘ ÏÂÈÙÔ˘ÚÁ›Â˜ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, ·ÏÏ¿ ‰ÂÓ ¤¯Ô˘Ó ÂÏÂÁ¯ı› ÛÂ
Ì·ÎÚÔ¯ÚfiÓȘ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜. ∏ ∂ÈÙÚÔ‹ ªÂϤÙ˘ Ù˘ ¢È·ÙÚÔÊ‹˜ ÛÙÔ
¢È·‚‹ÙË (DNSG) ıˆÚ› fiÙÈ, ˘fi ÙÔ Ú›ÛÌ· ÙˆÓ ·ÚfiÓÙˆÓ ‰Â‰Ô̤ӈÓ, Ù·
·ÚÈ· ÔʤÏË ÙˆÓ ‰È·ÈÙËÙÈÎÒÓ Ô‰ËÁÈÒÓ ÁÈ· ÙË ıÂڷ›· Î·È ÚfiÏË„Ë ÙÔ˘
‰È·‚‹ÙË ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙËÓ Î·Ù¿ÏÏËÏË ÚfiÛÏË„Ë ÙˆÓ Û˘Ó‹ıˆÓ ÙÚÔÊ›-
̈Ó. ∂Âȉ‹ Ù· «ÏÂÈÙÔ˘ÚÁÈο ÙÚfiÊÈÌ·» Î·È Ù· Û˘ÌÏËÚÒÌ·Ù· ‰È·ÙÚÔÊ‹˜
‰ÂÓ ·ÔÙÂÏÔ‡Ó Û˘ÛÙ·ÙÈÎfi ηÌÈ¿˜ ·Ú·‰ÔÛȷ΋˜ ‰›·ÈÙ·˜ Ë ∂ÈÙÚÔ‹ ÈÛÙ‡-
ÂÈ fiÙÈ ¯ÚÂÈ¿˙ÂÙ·È Ì·ÎÚÔ¯ÚfiÓÈ· ÂÎÙ›ÌËÛË Ì¤Ûˆ ÙˆÓ Û˘Ó‹ıˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂ-
ÙÒÓ ÚÔÙÔ‡ ‰ÔıÔ‡Ó ÛÔ‚·Ú¤˜ Û˘ÛÙ¿ÛÂȘ.
www.hndc.gr
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