Lichtenstein Alice H, Russell Robert M
Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111, USA.
JAMA. 2005 Jul 20;294(3):351-8. doi: 10.1001/jama.294.3.351.
The consumption of adequate levels and proper balance of essential nutrients is critical for maintaining health. The identification, isolation, and purification of nutrients in the early 20th century raised the possibility that optimal health outcomes could be realized through nutrient supplementation. Recent attempts using this approach for cardiovascular disease and lung cancer have been disappointing, as demonstrated with vitamin E and beta carotene. Moreover, previously unrecognized risks caused by nutrient toxicity and nutrient interactions have surfaced during intervention studies. The most promising data in the area of nutrition and positive health outcomes relate to dietary patterns, not nutrient supplements. These data suggest that other factors in food or the relative presence of some foods and the absence of other foods are more important than the level of individual nutrients consumed. Finally, unknown are the implications on public health behavior of shifting the emphasis away from food toward nutrient supplements. Notwithstanding the justification for targeting recommendations for nutrient supplements to certain segments of the population (eg, the elderly), there are insufficient data to justify an alteration in public health policy from one that emphasizes food and diet to one that emphasizes nutrient supplements.
摄入足够水平且比例恰当的必需营养素对维持健康至关重要。20世纪初对营养素的识别、分离和提纯，使人们有可能通过补充营养素来实现最佳健康效果。近期针对心血管疾病和肺癌采用这种方法的尝试并不理想，维生素E和β-胡萝卜素的情况就是例证。此外，在干预研究中还出现了此前未被认识到的由营养素毒性和营养素相互作用导致的风险。营养与积极健康结果领域最有前景的数据与饮食模式有关，而非营养素补充剂。这些数据表明，食物中的其他因素或某些食物的相对存在以及其他食物的缺失，比所摄入的单一营养素水平更为重要。最后，将重点从食物转向营养素补充剂对公众健康行为的影响尚不清楚。尽管有理由针对某些人群（如老年人）制定营养素补充剂的推荐建议，但目前尚无足够数据证明将公共卫生政策从强调食物和饮食转变为强调营养素补充剂是合理的。
