对高血压有害的是糖而不是盐


  【24drs.com】减少摄取添加糖的加工食品可以减少高血压比率以及心脏代谢疾病,一篇新文献认为,造成与加工食品有关的高血压风险,主要是因为糖,而不是盐。
  
  堪萨斯市圣路克大学中美洲心脏研究院药学博士James J. DiNicolantanio,以及纽约布朗克斯区亚伯特爱因斯坦医学院Sean C. Lucan医师,在Open Heart期刊发表了他们对流行病学研究与实验的回顾结果。作者们结论指出,高糖饮食明显造成心脏代谢风险,他们也认为,未来的饮食指引应建议,以纯天然食品取代精制的加工食品。
  
  未参与该研究的俄亥俄州克里夫兰诊所Richard Krasuski医师表示,这有一点可怕,毕竟我们长久以来一直专注于研究盐的影响。
  
  Krasuski医师解释,这篇回顾文献总结了流行病学研究以及小型介入研究这两类型研究,虽然这两类型研究各有其限制,整合分析可以获得比较有力的结果。
  
  当你做这些流行病学研究时,不一定能控制所有的干扰因素;因此,Krasuski医师形容流行病学研究主要是产生假设。
  
  相对的,小型介入研究透过操控单一因素、在短期内密集检测假设;他解释,这类型研究的限制是「我们不知道这些短期影响是否可代表长期影响。」
  
  Krasuski医师表示,底限是,尽管科学不是完美的,但它整体还不错,他也提醒读者,阅读结论时要了解研究内容。
  
  Krasuski医师表示,结论是糖对心脏的危险大于盐,确实令人「大开眼界」,不过,他也承认,这是可以预见的。他和其它心脏科专家已经注意到,逐渐减少盐摄取量的建议并未导致预期之正面的心血管结果。
  
  DiNicolantanio医师和Lucan医师的文章可能会引起争议,因为它与目前有关饮食与心血管疾病之关连的假设不同。Krasuski医师发表后的结论指出,争论的是盐或糖,或许有一部份原因是与糖摄取量有关。
  
  不过,对于这篇文章提出的建议,大多数医师可接受的是少吃加工食品。
  
  Krasuski医师被问到会如何告诉他的病患时表示,他的建议与这篇文章的作者们一致,建议饮食要富含全谷类与蔬果,他也建议他的病患要避免吃加工食品。
  
  Krasuski医师指出,对于心血管健康,规律运动、不抽菸、维持适当体重都很重要,不过,这些建议都不在此次回顾分析之内。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=7142&x_classno=0&x_chkdelpoint=Y
  

Sugar, Not Salt, May Be at Fault for Hypertension

By Lara C. Pullen, PhD
Medscape Medical News

A reduction in the consumption of added sugars and, in particular, processed foods may translate into decreased rates of hypertension as well as decreased cardiometabolic disease. In particular, a new review article suggests that sugar, not salt, appears to contribute to the majority of the hypertension risk associated with processed food.

James J. DiNicolantanio, PharmD, from Saint Luke's Mid America Heart Institute in Kansas City, Missouri, and Sean C. Lucan, MD, MPH, from Albert Einstein College of Medicine in Bronx, New York, published their review of epidemiological and experimental studies in Open Heart. The authors conclude that high-sugar diets may make a significant contribution to cardiometabolic risk. They also suggest that future dietary guidelines recommend that highly refined processed foods be replaced by natural whole foods.

"It is a little bit frightening that we have been focusing on salt for so long," Richard Krasuski, MD, from the Cleveland Clinic in Ohio, told Medscape Medical News. Dr Krasuski was not affiliated with the research.

Dr Krasuski explained that the review article summarized the results from two types of studies: epidemiological studies and small interventional studies. Although both types of studies have limitations, together they make a rather strong case.

"[W]hen you do these types of epidemiological studies, you are not really controlling for confounding factors." Thus, Dr Krasuski described the epidemiological studies as primarily hypothesis-generating.

In contrast, the small interventional studies test a hypothesis through manipulation of a single factor, intensely, over a short period of time. In this type of study, the limitation is that "we don't know if these acute effects transmit into long-lasting effects," he explained.

The bottom line, Dr Krasuski said, is that although the science is not perfect, it is, in its entirety, good. He cautioned readers, however, to understand the research context when reading the conclusions.

The conclusion that sugar represents a greater danger to the heart than salt, Dr Krasuski said, was an "eye opener." He acknowledged, though, that he should have anticipated it. He and other cardiologists have noticed that the recommendations to increasingly lower salt intake have not resulted in the expected positive cardiovascular outcomes.

The article by Dr DiNicolantanio and Dr Lucan will likely be controversial because it contradicts current assumptions about the relationship between diet and cardiovascular disease. "The controversy here is whether it is the salt or the sugar.... It probably is, at least partially, if not more, related to sugar consumption," Dr Krasuski concluded after reading the paper.

Nevertheless, the bottom line of the article's recommendation should be familiar and comfortable to most physicians: Eat less processed food.

When asked about what he tells his patients, Dr Krasuski stated that his recommendations are consistent with those of the authors of the current article. He recommends a diet that is full of whole grains and fruits and vegetables, and he also recommends that his patients try to avoid processed foods.

Dr Krasuski added that regular exercise, not smoking, and maintaining weight at a level close to target are also all important for cardiovascular health, although these recommendations are beyond the scope of the current review.

Dr DiNicolantanio, Dr Lucan, and Dr Krasuski have disclosed no relevant financial relationships.

Open Heart. 2014;1;e000167.

    
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