食用的可溶性纤维对于有无高胆固醇症的成年人皆有益


  March 25, 2009 — 根据发表于3/4月号家庭医学年监的一篇后设分析,规律使用可溶性纤维适用于不论有没有高胆固醇症之成人的饮食。
  
  康乃迪克大学药学院的Ripple Talati药学博士等人写道,虽然燕麦的抗高血脂效果已经广为研究,但是有关大麦的研究却较少,研究发现显示其对胆固醇的效果相当不一样。即使有多个临床试验探究大麦之乙型葡聚糖对总胆固醇、LDL[低密度脂蛋白]胆固醇、高密度脂蛋白(HDL)胆固醇、三酸甘油脂的效果,却未曾有过对这些效果的后设分析 ;因此,我们进行大麦随机控制试验的后设分析,以更清楚它对各种脂质参数的影响。
  
  回顾者从最早有资料时到2008年1月止,进行系统性文献查找。纳入后设分析之规范为大麦随机控制试验且有关一种以上脂质结果测量之报告。以DerSimonian暨Laird氏随机效应模式衡量平均差异与其95%信心区间[CI],以I2 statistic评估统计异质性。使用漏斗散布图目视检查、Egger氏加权回归统计、整理与填充方法评估发表偏差。
  
  有八篇评估大麦降脂质效果的试验符合纳入规范;研究期间从4到12周,共包括391名病患。使用大麦与显著降低总胆固醇(加权均术差为 –13.38 mg/dL;95% CI为 –18.46 到 –8.31 mg/dL)、LDL胆固醇(加权均术差为–10.02 mg/dL;95% CI为 –14.03到–6.00 mg/dL)以及三酸甘油脂(加权均术差为–11.83 mg/dL;95% CI为–20.12 到 –3.55 mg/dL)有关。不过,对HDL胆固醇值没有任何显著影响(P = .07)。
  
  研究作者写道,大麦衍生的乙型葡聚糖对总胆固醇、LDL胆固醇、三酸甘油脂显示有效,对HDL胆固醇则没有。根据现有资料,大麦耐受良好,胃肠胀气以及腹部不适是最常被报告的不良反应,但是其它少见的不良反应并无有力证据支持。
  
  这个后设分析的限制包括,同时纳入了交叉型与平行型研究,可能有发表偏差,无法评估大麦的可能伤害等。
  
  回顾作者结论表示,我们的研究结果支持于不论有没有高胆固醇症成人的饮食中规律使用可溶性纤维。大麦与其它可溶性纤维来源,燕麦、洋车前子、果胶以及华胶等都可以健康食用。健康执业人员可安心建议病患食用大麦乙型葡聚糖,以帮助降低总胆固醇和LDL胆固醇,如同NCEP指引所建议的。
  
  研究作者宣告没有相关财务关系。

Dietary Soluble Fiber May Be Beneficial for Adults With and Without Hypercholesterolemia

By Laurie Barclay, MD
Medscape Medical News

March 25, 2009 — The routine use of soluble fibers may be indicated in the diets of adult patients with and without hypercholesterolemia, according to the results of a meta-analysis reported in the March/April issue of the Annals of Family Medicine.

"Although the antihyperlipidemic effects of oats have been extensively studied, there are fewer barley studies, and findings have shown more apparent inconsistency in cholesterol effects," write Ripple Talati, PharmD, from University of Connecticut School of Pharmacy in Storrs, and colleagues. "Even though several clinical trials have investigated the impact of barley β-glucan on total cholesterol, LDL [low-density lipoprotein] cholesterol, high density lipoprotein (HDL) cholesterol, and triglycerides, a meta-analysis assessing these effects has not been published. We therefore sought to perform a meta-analysis of randomized controlled trials of barley to better characterize its effect on various lipid parameters."

The reviewers performed a systematic search of the literature from the earliest possible date through January 2008. Inclusion criteria for the meta-analysis were randomized controlled trials of barley reporting efficacy data for 1 or more lipid outcome measures. Weighted mean difference and its 95% confidence interval (CI) were determined by a DerSimonian and Laird random-effects model, and statistical heterogeneity was evaluated with the I2 statistic. Publication bias was assessed with visual inspection of funnel plots, Egger's weighted regression statistics, and the trim-and-fill method.

Eight trials evaluating the lipid-reducing effects of barley met inclusion criteria; these were of 4 to 12 weeks' duration and enrolled a total of 391 patients. The use of barley was associated with significant reduction in levels of total cholesterol (weighted mean difference, –13.38 mg/dL; 95% CI, –18.46 to –8.31 mg/dL), LDL cholesterol (weighted mean difference, –10.02 mg/dL; 95% CI, –14.03 to –6.00 mg/dL), and triglycerides (weighted mean difference, –11.83 mg/dL; 95% CI, –20.12 to –3.55 mg/dL). However, there did not appear to be any significant effect on HDL cholesterol levels (P = .07).

"Barley-derived β-glucan appears to beneficially affect total cholesterol, LDL-cholesterol, and triglycerides, but not HDL-cholesterol," the study authors write. "Based upon available data, barley appears to be well tolerated, with flatulence and abdominal discomfort being reported as the most common adverse effects, but there is not adequate power to look for other less common adverse effects."

Limitations of this meta-analysis are inclusion of crossover and parallel studies, potential for publication bias, and inability to evaluate the potential for harms with barley.

"The results of our study support the routine use of soluble fibers in the diets of adult patients with and without hypercholesterolemia," the review authors conclude. "Barley adds another source of soluble fibers, in addition to oats, psyllium, pectin, and guar gum that patients can consume as part of a healthy diet....Health practitioners should feel comfortable recommending barley β-glucan to their patients to help reduce total cholesterol and LDL cholesterol concentrations as recommended by the NCEP guidelines."

The study authors have disclosed no relevant financial relationships.

Ann Fam Med. 2009;7:157-163.

    
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