低脂饮食与能量平衡:2002年的证据情况如何?

Low-fat diets and energy balance: how does the evidence stand in 2002?

作者信息

Astrup Arne, Astrup Arne, Buemann Benjamin, Flint Anne, Raben Anne

机构信息

The Research Department of Human Nutrition and The Centre for Advanced Food Studies, The Royal Veterinary and Agricultural University, Rolighedsvej 30, DK-1958 Frederiksberg C, Denmark.

出版信息

Proc Nutr Soc. 2002 May;61(2):299-309. doi: 10.1079/PNS2002149.

Abstract

The role of high-fat diets in weight gain and obesity is assessed by evidence-based principles. Four meta-analyses of weight change occurring on ad libitum low-fat diets in intervention trials consistently demonstrate a highly significant weight loss of 3-4 kg in normal-weight and overweight subjects (P < 0.001). The analyses also find a dose-response relationship, i.e. the reduction in percentage energy as fat is positively associated with weight loss. Weight loss is also positively related to initial weight; a 10 % reduction in dietary fat is predicted to produce a 4-5 kg weight loss in an individual with a BMI of 30 kg/m2. The non-fat macronutrient composition of the diet is also important. Whereas the glycaemic index of the carbohydrate may play a role for cardiovascular risk factors, there is so far no evidence that low-glycaemic index foods facilitate weight control. In contrast, intervention studies show that sugar in drinks is more likely to produce weight gain than solid sugar in foods. Although the evidence is weak, alcoholic beverages promote a positive energy balance, and wine may be more obesity-promoting than beer. Protein is more satiating and thermogenic than carbohydrates, and one intervention study has shown that an ad libitum low-fat diet where carbohydrate was replaced by protein produced more weight loss after 6 months (8.1 v. 5.9 kg). The evidence linking particular fatty acids to body fatness is weak. If anything, monounsaturated fat may be more fattening than polyunsaturated and saturated fats, and no ad libitum dietary intervention study has shown that a normal-fat high-monounsaturated fatty acid diet is equivalent or superior to a low-fat diet in the prevention of weight gain and obesity. The evidence strongly supports the low-fat diet as the optimal choice for the prevention of weight gain and obesity, while the use of a normal-fat high-monounsaturated fatty acid diet is unsubstantiated.

摘要

通过循证原则评估高脂饮食在体重增加和肥胖中的作用。四项关于干预试验中随意低脂肪饮食导致体重变化的荟萃分析一致表明,正常体重和超重受试者体重显著减轻3 - 4千克(P < 0.001)。分析还发现了剂量反应关系,即脂肪能量百分比的降低与体重减轻呈正相关。体重减轻也与初始体重呈正相关;预计饮食中脂肪减少10%,体重指数为30 kg/m² 的个体体重将减轻4 - 5千克。饮食中的非脂肪宏量营养素组成也很重要。虽然碳水化合物的血糖生成指数可能对心血管危险因素有影响,但目前尚无证据表明低血糖生成指数食物有助于控制体重。相比之下,干预研究表明,饮料中的糖比食物中的固体糖更易导致体重增加。虽然证据不足,但酒精饮料会促进能量正平衡,葡萄酒可能比啤酒更易导致肥胖。蛋白质比碳水化合物更易产生饱腹感和产热,一项干预研究表明,随意低脂肪饮食中用蛋白质替代碳水化合物,6个月后体重减轻更多(8.1千克对5.9千克)。将特定脂肪酸与体脂联系起来的证据不足。如果有什么不同的话,单不饱和脂肪可能比多不饱和脂肪和饱和脂肪更容易使人发胖,而且尚无随意饮食干预研究表明,正常脂肪高单不饱和脂肪酸饮食在预防体重增加和肥胖方面等同于或优于低脂肪饮食。证据有力地支持低脂肪饮食是预防体重增加和肥胖的最佳选择,而采用正常脂肪高单不饱和脂肪酸饮食则缺乏依据。

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