地中海饮食减少心血管事件、癌症、糖尿病风险


  【24drs.com】一篇新回顾研究认为,依循地中海饮食而无限制脂肪摄取,可减少心血管(CV)事件、癌症、第二型糖尿病发生率。
  
  明尼苏达州明尼亚波里斯退伍军人医学中心Hanna E. Bloomfield医师等人写道,我们的主要结论是,随机试验的有限证据显示,地中海饮食而无限制脂肪摄取,与心血管事件、各种癌症、乳癌、第二型糖尿病发生率降低有关,但是不会影响各种原因死亡率。
  
  这篇系统性回顾与统合分析的结果,在线发表于7月18日的内科医学志。
  
  尽管诊断和治疗有所进步,心血管疾病、癌症、糖尿病等慢性病,依旧是美国发病率和死亡率的主因,根据Bloomfield医师等人指出,在过去廿年,全球死于心血管疾病之比率和糖尿病盛行率增加超过40%。
  
  作者们写道,典型的西式饮食富含饱和脂肪、糖、精制谷类,和发生心血管疾病、[第二型]糖尿病、乳癌与结肠直肠癌等某些癌症有因果关联。
  
  地中海饮食富含蔬果、单元不饱和脂肪(占每日总摄取热量的30%-40%) — 特别是橄榄油 —以及豆类和鱼,摄取低到中度的乳制品和肉制品。许多研究显示,地中海饮食可改善多种临床结果,包括降低总死亡率。
  
  Bloomfield医师等人进行研究,评估地中海饮食的健康效益,并确认北美洲人是否可依循这类饮食习惯。
  
  作者们查找了多个电子资料库以确认可纳入之研究,他们纳入研究对象百人以上且追踪死亡率、心血管疾病、高血压、糖尿病与依从性结果至少一年的控制试验,他们也纳入追踪癌症结果的世代研究。
  
  他们将地中海饮食定义为,没有限制总脂肪摄取量且包括以下七种组成的两种以上:单元不饱和脂肪/饱和脂肪比率高、蔬果摄取量高、豆类摄取量高、谷类与穀片摄取量高、适量摄取红酒、适量摄取乳制品、肉类与肉制品摄取量低但鱼类摄取量高。
  
  总共有56项研究的90篇文章符合纳入标准,不过其中3篇研究可能与研究舞弊有关,最后未被纳入分析。
  
  根据作者指出,一篇大型初步预防试验的资料显示,相较于依循对照饮食者,地中海饮食者的重大心血管事件(心肌梗塞、中风或心血管原因死亡;风险比[HR], 0.71; 95%信赖区间[CI], 0.56 - 0.90)、乳癌(HR, 0.43; CI, 0.21 - 0.88)、糖尿病(HR, 0.70; CI, 0.54 - 0.92)发生率较低。
  
  研究者也对探讨癌症结果、比较地中海饮食依从性最高和最低组别的初级预防世代研究进行汇整分析。
  
  结果显示,相较于依从性最低者,地中海饮食依从性最高者的总癌症死亡率降低14%(风险比[RR], 0.86; CI, 0.82 - 0.91; 13篇研究)、所有癌症发生率降低4%(RR, 0.96; CI, 0.95 - 0.97; 3篇研究)、结肠直肠癌发生率降低9%(RR, 0.91; CI, 0.84 - 0.98;9篇研究)。
  
  Bloomfield医师在美国外科医师学院的Soundbites影片中报告指出,我们的研究发现,健康饮食可以包括许多脂肪,特别是健康的脂肪的话;过去至少卅年间,美国一直强调减少脂肪—各种脂肪—脂肪是坏事。
  
  她指出,事实证明,这个国家的肥胖流行病或许主要是因为我们的精制谷类和添加糖类的摄取量增加,而非因为我们的脂肪摄取。
  
  作者们指出,不过,其它结果则是不一致或证据有限或无证据,包括各种原因死亡率、高血压、认知功能、肾脏病、类风湿性关节炎、生活质量等,此外,没有研究符合饮食依从性结果的纳入标准。
  
  他们结论指出,未来的研究应包括美国人口的随机试验,以评估依从性、效果、各项临床结果之影响;模拟研究以确认是否特定的地中海饮食组成或合并哪里些组成更有效;并采用随机试验评估地中海饮食相较于其它健康饮食,如DASH (得舒饮食;停止高血压的饮食法/Dietary Approaches to Stop Hypertension)或谨慎饮食的相对效果。
  
  资料来源:http://www.24drs.com/
  
  Native link:Mediterranean Diet Cuts Risk for CV Events, Cancer, Diabetes

Mediterranean Diet Cuts Risk for CV Events, Cancer, Diabetes

By Nicola M. Parry, DVM
Medscape Medical News

The findings of a new review suggest that following a Mediterranean diet with no restriction on fat intake may reduce the incidence of cardiovascular (CV) events, cancer, and type 2 diabetes.

"Our primary conclusion is that there is limited evidence from randomized trials that a Mediterranean diet with no restriction on fat intake may be associated with a reduced incidence of cardiovascular events, all-cancers, breast cancer, and type 2 diabetes mellitus but does not affect all-cause mortality," write Hanna E. Bloomfield, MD, MPH, from the Minneapolis Veterans Affairs Medical Center, Minnesota, and colleagues.

The results of the systematic review and meta-analysis were published online July 18 in Annals of Internal Medicine.

Despite advances in diagnosis and treatment, chronic illnesses, such as CV disease, cancer, and diabetes, remain among the leading causes of morbidity and mortality in the United States. According to Dr Bloomfield and colleagues, global deaths due to CV disease and the prevalence of diabetes have increased by more than 40% in the past 2 decades.

"Typical Western diets, which are high in saturated fats, sugar, and refined grains, are causally associated with development of cardiovascular disease, [type 2] diabetes, and some types of cancer, including breast and colorectal cancer," the authors write.

The Mediterranean diet is a fruit- and vegetable-rich diet that is high in monounsaturated fats (30% to 40% of total daily calorie intake) — in particular, olive oil — as well as legumes and fish, with a low to moderate intake of dairy and meat products. Several studies have shown its benefit in improving various clinical outcomes, including a reduction in total mortality.

Dr Bloomfield and colleagues conducted their study to evaluate the health benefits of a Mediterranean diet and to determine whether North Americans are likely to adhere to such a diet.

"Healthy Diets Can Include a Lot of Fat"

The authors searched various electronic databases to identify studies for inclusion. They included controlled trials that involved 100 or more persons who were followed for at least 1 year for mortality, CV disease, hypertension, diabetes, and adherence outcomes. They also included cohort studies whose participants were followed for cancer outcomes.

They defined a Mediterranean diet as one without restriction on total fat intake and that included two or more of seven components: high monounsaturated–to–saturated fat ratio, high fruit and vegetable intake, high legume consumption, high grain and cereal intake, moderate red wine intake, moderate dairy product consumption, and low meat and meat product consumption, but with high fish consumption.

A total of 90 articles representing 56 unique studies met their inclusion criteria, although three of these studies were linked to possible research fraud and ultimately were not included in the analysis.

According to the authors, data from one large primary prevention trial showed that, compared with individuals who followed a control diet, participants who followed a Mediterranean diet had a lower incidence of major CV events (myocardial infarction, stroke, or CV death; hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.56 - 0.90), breast cancer (HR, 0.43; CI, 0.21 - 0.88), and diabetes (HR, 0.70; CI, 0.54 - 0.92).

The researchers also performed pooled analyses of primary prevention cohort studies that reported cancer outcomes and that compared groups with the highest and lowest Mediterranean diet adherence.

These results showed that, compared with individuals with the lowest adherence, those with the highest adherence to a Mediterranean diet had a 14% reduction in total cancer mortality (risk ratio [RR], 0.86; CI, 0.82 - 0.91; 13 studies), a 4% reduction in the incidence of all-cancers (RR, 0.96; CI, 0.95 - 0.97; three studies), and a 9% reduction in the incidence of colorectal cancer (RR, 0.91; CI, 0.84 - 0.98; nine studies).

"[W]hat we found in our study is that healthy diets can include a lot of fat, especially if it's healthy fat; and the emphasis in the United States at least for the past thirty years has been [that] it's important to reduce fat — fat of all kind— fat's the bad thing," reports Dr Bloomfield in an American College of Physicians Soundbites video.

"It turns out that the obesity epidemic in this country is probably more due to our increased consumption of refined grains and added sugar and not so much from our fat consumption," she adds.

However, the study found inconsistent, minimal, or no evidence pertaining to other outcomes, including all-cause mortality, hypertension, cognitive function, kidney disease, rheumatoid arthritis, and quality of life. In addition, no studies met the inclusion criteria for dietary adherence outcomes, the authors note.

"Future investigation should include randomized trials in US populations to assess adherence, efficacy, and effect on a wider range of clinical outcomes; modeling studies to determine whether specific Mediterranean diet components or combinations of components are more protective than others; and randomized trials to assess the relative effectiveness of the Mediterranean diet compared with other healthy diets, such as the DASH (Dietary Approaches to Stop Hypertension) or prudent diet," they conclude.

The study was supported by the Department of Veterans Affairs, the Veterans Health Administration, the Office of Research and Development, and the Quality Enhancement Research Initiative. The authors have disclosed no relevant financial relationships.

Ann Intern Med. Published online July 18, 2016.

    
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