高碳水化合物或高单不饱和脂肪酸膳食对血压的作用(综述)
  • 纳入14项(980例)随机对照临床研究进行荟萃分析,对比等热量的高碳水化合物(高CHO)或高单不饱和脂肪酸(高MUFA)膳食对血压的影响,时限>3周;
  • 等热量高MUFA替代高CHO并不显著降低血压(收缩压−0.08 mmHg [−1.01 to 0.84]; 舒张压0.01 mmHg [95%CI, −0.73 to 0.75]),总体证据质量分级中等,研究观察到的血压变化不具临床意义;
  • 干扰因素包括患者研究前的血压、CHO质量、添加膳食纤维、选用低GI食物、钠钾摄入情况等。
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Nutrition Reviews [IF:5.779]

Effect of high-carbohydrate or high-monounsaturated fatty acid diets on blood pressure: a systematic review and meta-analysis of randomized controlled trials

高碳水化合物或高单不饱和脂肪酸膳食对血压的作用:随机对照临床试验的系统综述和荟萃分析

10.1093/nutrit/nuy040

2018-08-24, Article

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Context: Current dietary guidelines for cardiovascular disease risk management recommend restricting intake of saturated fatty acids (SFAs). However, the optimal macronutrient profile, in the context of a low-SFA diet, remains controversial. The blood-pressure effect of replacing SFAs in diets with monounsaturated fatty acids (MUFAs) compared with carbohydrate has not been quantified to date.
Objective: To synthesize the evidence for the effect of substituting a high-carbohydrate (high-CHO) diet for a high-monounsaturated fatty acid (high-MUFA) diet on blood pressure, a systematic review and meta-analysis of randomized clinical trials in a population without health restrictions was conducted.
Data Sources: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Clinical Trials were searched through June 7, 2017. Randomized controlled trials of > 3 weeks duration that assessed the effect of high-MUFA diets in isocaloric substitution for high-CHO diets on systolic blood pressure (SBP) and diastolic blood pressure (DBP) were included.
Data Extraction: Data were pooled using the generic-inverse variance method with random effects models and expressed as mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was assessed by Cochran Q statistic and quantified by the I2 statistic. The quality of the evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.
Results: Fourteen trials (n = 980 participants) were included in the analysis. Comparatively, the high-MUFA diets in isocaloric substitution for high-CHO diets did not demonstrate a greater reduction in blood pressure (SBP: MD, -0.08 mmHg [95%CI, -1.01 to 0.84], P = 0.86; DBP: MD = 0.01 mmHg [95%CI, -0.73 to 0.75], P = 0.98). The overall quality of the evidence was assessed as moderate.
Conclusions: In the context of low SFAs, high-MUFA diets in isocaloric substitution for high-CHO diets did not affect blood pressure in individuals with and without hypertension. Large-scale trials achieving higher MUFA targets are required to support these findings.
ClinicalTrials.gov ID: NCT02626325.

First Authors:
Elena Jovanovski,Any de Castro Ruiz Marques,Dandan Li

Correspondence Authors:
Vladimir Vuksan

All Authors:
Elena Jovanovski,Any de Castro Ruiz Marques,Dandan Li,Hoang V T Ho,Sonia Blanco Mejia,John L Sievenpiper,Andreea Zurbau,Allison Komishon,Lea Duvnjak,Roberto B Bazotte,Vladimir Vuksan

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