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加拿大麦克马斯特大学Bradley C Johnston研究组最近探讨了14种流行的常量营养素饮食模式对成人肥胖者体重和心血管危险因素的影响。这一研究成果发表在2020年4月1日出版的《英国医学杂志》上。

为了确定超重或肥胖成年人饮食中常量营养素模式和流行的命名节食计划对减肥和改善心血管危险因素的相对有效性，研究组对Medline、Embase等大型数据库中从开始到2018年9月的相关随机试验进行了一项系统评价和网络荟萃分析。这些随机试验均纳入了超重（体重指数25-29）或肥胖（≥30）的成年人，均使用流行的命名饮食或替代饮食。

研究组共纳入121项合格试验，包括21942名参与者，报告了14种命名饮食和3种对照饮食。与普通饮食相比，低碳水化合物和低脂肪饮食的参与者在六个月内体重分别降低了4.63 kg和4.37 kg，收缩压分别降低了5.14 mmHg和5.05 mmHg，舒张压分别降低了3.21 mmHg和2.85 mmHg。

中常量营养素饮食可导致轻微的体重减轻和血压降低。低碳水化合物饮食将LDL胆固醇降低了1.01 mg/dL，降低幅度低于低脂肪饮食（7.08 mg/dL）和中常量营养素饮食（5.22 mg/dL）；但将HDL胆固醇增加了2.31 mg/dL，优于低脂肪饮食（-1.88 mg/dL）和中常量营养素饮食（-0.89 mg/dL）。

在流行的命名饮食中，与普通饮食相比，6个月时对减肥和血压影响最大的是Atkins，体重减轻5.5 kg，收缩压降低5.1 mmHg，舒张压降低3.3 mmHg；其次为DASH，体重减轻3.6 kg，收缩压降低4.7 mmHg，舒张压降低2.9 mmHg；第三为Zone，体重减轻4.1 kg，收缩压降低3.5 mmHg，舒张压降低2.3 mmHg。

六个月内，没有任何饮食能显著改善HDL胆固醇或C反应蛋白的水平。总体而言，除地中海饮食外，在所有常量营养素模式和流行的命名饮食中，第12个月时体重几乎不再变化，所有干预措施对心血管危险因素的益处也基本消失了。

总之，中度确定性证据表明，大多数常量营养素饮食在六个月以上的饮食中，体重可适当减轻，心血管危险因素（尤其是血压）显著改善。但在12个月时，体重和心血管危险因素的改善幅度消失。

附：英文原文

Title: Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials

Author: Long Ge, Behnam Sadeghirad, Geoff D C Ball, Bruno R da Costa, Christine L Hitchcock, Anton Svendrovski, Ruhi Kiflen, Kalimullah Quadri, Henry Y Kwon, Mohammad Karamouzian, Thomasin Adams-Webber, Waleed Ahmed, Samah Damanhoury, Dena Zeraatkar, Adriani Nikolakopoulou, Ross T Tsuyuki, Jinhui Tian, Kehu Yang, Gordon H Guyatt, Bradley C Johnston

Issue&Volume: 2020/04/01

Abstract: Abstract

Objective To determine the relative effectiveness of dietary macronutrient patterns and popular named diet programmes for weight loss and cardiovascular risk factor improvement among adults who are overweight or obese.

Design Systematic review and network meta-analysis of randomised trials.

Data sources Medline, Embase, CINAHL, AMED, and CENTRAL from database inception until September 2018, reference lists of eligible trials, and related reviews.

Study selection Randomised trials that enrolled adults (≥18 years) who were overweight (body mass index 25-29) or obese (≥30) to a popular named diet or an alternative diet.

Outcomes and measures Change in body weight, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, systolic blood pressure, diastolic blood pressure, and C reactive protein at the six and 12 month follow-up.

Review methods Two reviewers independently extracted data on study participants, interventions, and outcomes and assessed risk of bias, and the certainty of evidence using the GRADE (grading of recommendations, assessment, development, and evaluation) approach. A bayesian framework informed a series of random effects network meta-analyses to estimate the relative effectiveness of the diets.

Results 121 eligible trials with 21942 patients were included and reported on 14 named diets and three control diets. Compared with usual diet, low carbohydrate and low fat diets had a similar effect at six months on weight loss (4.63 v 4.37 kg, both moderate certainty) and reduction in systolic blood pressure (5.14 mm Hg, moderate certainty v 5.05 mm Hg, low certainty) and diastolic blood pressure (3.21 v 2.85 mm Hg, both low certainty). Moderate macronutrient diets resulted in slightly less weight loss and blood pressure reductions. Low carbohydrate diets had less effect than low fat diets and moderate macronutrient diets on reduction in LDL cholesterol (1.01 mg/dL, low certainty v 7.08 mg/dL, moderate certainty v 5.22 mg/dL, moderate certainty, respectively) but an increase in HDL cholesterol (2.31 mg/dL, low certainty), whereas low fat (1.88 mg/dL, moderate certainty) and moderate macronutrient (0.89 mg/dL, moderate certainty) did not. Among popular named diets, those with the largest effect on weight reduction and blood pressure in comparison with usual diet were Atkins (weight 5.5 kg, systolic blood pressure 5.1 mm Hg, diastolic blood pressure 3.3 mm Hg), DASH (3.6 kg, 4.7 mm Hg, 2.9 mm Hg, respectively), and Zone (4.1 kg, 3.5 mm Hg, 2.3 mm Hg, respectively) at six months (all moderate certainty). No diets significantly improved levels of HDL cholesterol or C reactive protein at six months. Overall, weight loss diminished at 12 months among all macronutrient patterns and popular named diets, while the benefits for cardiovascular risk factors of all interventions, except the Mediterranean diet, essentially disappeared.

Conclusions Moderate certainty evidence shows that most macronutrient diets, over six months, result in modest weight loss and substantial improvements in cardiovascular risk factors, particularly blood pressure. At 12 months the effects on weight reduction and improvements in cardiovascular risk factors largely disappear.

DOI: 10.1136/bmj.m696

Source: https://www.bmj.com/content/369/bmj.m696

BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
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