Giugliano Dario, Ceriello Antonio, Esposito Katherine
Department of Geriatrics and Metabolic Diseases, Division of Metabolic Diseases, University of Naples SUN, Naples, Italy.
Am J Clin Nutr. 2008 Jan;87(1):8-11. doi: 10.1093/ajcn/87.1.8.
The concept of the metabolic syndrome, although controversial, continues to gain acceptance. Whereas each risk factor of the metabolic syndrome (visceral obesity, atherogenetic dyslipidemia, elevated blood pressure, and dysglycemia) can be dealt with individually, the recommended initial therapeutic approach is to focus on reversing its root causes of atherogenetic diet, sedentary lifestyle, and overweight or obesity. No single diet is currently recommended for patients with the metabolic syndrome, although epidemiologic evidence suggests a lower prevalence of the metabolic syndrome associated with dietary patterns rich in fruit, vegetables, whole grains, dairy products, and unsaturated fats. We conducted a literature search to identify clinical trials specifically dealing with the resolution of the metabolic syndrome by lifestyle, drugs, or obesity surgery. Criteria used for study selection were English language, randomized trials with a placebo or control group (except for surgery), a follow-up lasting>or=6 mo, and a time frame of 5 y. We identified 3 studies based on lifestyle interventions, 5 studies based on drug therapy, and 3 studies based on laparoscopic weight-reduction surgery The striking resolution of the metabolic syndrome with weight-reduction surgery (93%) as compared with lifestyle (25%) and drugs (19%) strongly suggests that obesity is the driving force for the occurrence of this condition. Although there is no "all-inclusive" diet yet, it seems plausible that a Mediterranean-style diet has most of the desired attributes, including a lower content of refined carbohydrates, a high content of fiber, a moderate content of fat (mostly unsaturated), and a moderate-to-high content of vegetable proteins.
代谢综合征的概念尽管存在争议，但仍越来越被认可。虽然代谢综合征的每个风险因素（内脏肥胖、致动脉粥样硬化性血脂异常、血压升高和血糖异常）都可以单独处理，但推荐的初始治疗方法是专注于扭转其致动脉粥样硬化饮食、久坐不动的生活方式以及超重或肥胖等根本原因。目前没有针对代谢综合征患者推荐单一的饮食方案，尽管流行病学证据表明，富含水果、蔬菜、全谷物、乳制品和不饱和脂肪的饮食模式与代谢综合征的患病率较低相关。我们进行了文献检索，以确定专门通过生活方式、药物或肥胖手术来解决代谢综合征的临床试验。研究选择的标准为英文文献、设有安慰剂或对照组的随机试验（手术研究除外）、随访时间≥6个月以及时间范围为5年。我们确定了3项基于生活方式干预的研究、5项基于药物治疗的研究以及3项基于腹腔镜减肥手术的研究。与生活方式干预（25%）和药物治疗（19%）相比，减肥手术对代谢综合征的显著缓解率（93%）有力地表明肥胖是这种疾病发生的驱动因素。虽然目前还没有“包罗万象”的饮食方案，但地中海式饮食似乎具有大多数理想的特性，包括精制碳水化合物含量较低、纤维含量较高、脂肪含量适中（主要是不饱和脂肪）以及植物蛋白含量适中至高。
