Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan2Japan Society for the Promotion of Science, Tokyo, Japan3Physicians Committee for Responsible Medicine, Washington, DC.
Division of Evidence-Based Medicine and Risk Analysis, Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan 5Department of Nephrology, School of Medicine, Fujita Health University, Aichi, Japan.
JAMA Intern Med. 2014 Apr;174(4):577-87. doi: 10.1001/jamainternmed.2013.14547.
IMPORTANCE Previous studies have suggested an association between vegetarian diets and lower blood pressure (BP), but the relationship is not well established. OBJECTIVE To conduct a systematic review and meta-analysis of controlled clinical trials and observational studies that have examined the association between vegetarian diets and BP. DATA SOURCES MEDLINE and Web of Science were searched for articles published in English from 1946 to October 2013 and from 1900 to November 2013, respectively. STUDY SELECTION All studies met the inclusion criteria of the use of (1) participants older than 20 years, (2) vegetarian diets as an exposure or intervention, (3) mean difference in BP as an outcome, and (4) a controlled trial or observational study design. In addition, none met the exclusion criteria of (1) use of twin participants, (2) use of multiple interventions, (3) reporting only categorical BP data, or (4) reliance on case series or case reports. DATA EXTRACTION AND SYNTHESIS Data collected included study design, baseline characteristics of the study population, dietary data, and outcomes. The data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES Net differences in systolic and diastolic BP associated with the consumption of vegetarian diets were assessed. RESULTS Of the 258 studies identified, 7 clinical trials and 32 observational studies met the inclusion criteria. In the 7 controlled trials (a total of 311 participants; mean age, 44.5 years), consumption of vegetarian diets was associated with a reduction in mean systolic BP (-4.8 mm Hg; 95% CI, -6.6 to -3.1; P < .001; I2 = 0; P = .45 for heterogeneity) and diastolic BP (-2.2 mm Hg; 95% CI, -3.5 to -1.0; P < .001; I2 = 0; P = .43 for heterogeneity) compared with the consumption of omnivorous diets. In the 32 observational studies (a total of 21,604 participants; mean age, 46.6 years), consumption of vegetarian diets was associated with lower mean systolic BP (-6.9 mm Hg; 95% CI, -9.1 to -4.7; P < .001; I2 = 91.4; P < .001 for heterogeneity) and diastolic BP (-4.7 mm Hg; 95% CI, -6.3 to -3.1; P < .001; I2 = 92.6; P < .001 for heterogeneity) compared with the consumption of omnivorous diets. CONCLUSIONS AND RELEVANCE Consumption of vegetarian diets is associated with lower BP. Such diets could be a useful nonpharmacologic means for reducing BP.
重要性 之前的研究表明素食与较低的血压（BP）之间存在关联，但这种关系尚未得到很好的证实。 目的 对已检查素食与 BP 之间关联的对照临床试验和观察性研究进行系统回顾和荟萃分析。 数据来源 从 1946 年到 2013 年 10 月，从 1900 年到 2013 年 11 月，分别在 MEDLINE 和 Web of Science 上搜索了发表的英文文章。 研究选择 所有研究均符合以下纳入标准：（1）参与者年龄大于 20 岁，（2）素食作为暴露或干预，（3）BP 平均值的差异作为结果，以及（4）对照试验或观察性研究设计。 此外，没有一项研究符合以下排除标准：（1）使用双胞胎参与者，（2）使用多种干预措施，（3）仅报告分类 BP 数据，或（4）依赖病例系列或病例报告。 数据提取和综合 收集的数据包括研究设计，研究人群的基线特征，饮食数据和结果。 使用随机效应模型汇总数据。 主要结果和测量 评估与素食饮食相关的收缩压和舒张压的净差异。 结果 在 258 项研究中，有 7 项临床试验和 32 项观察性研究符合纳入标准。 在 7 项对照试验中（共有 311 名参与者；平均年龄为 44.5 岁），与食用杂食性饮食相比，食用素食饮食与收缩压（-4.8mmHg；95％CI，-6.6 至-3.1；P<0.001；I2=0；P=0.45，用于异质性）和舒张压（-2.2mmHg；95％CI，-3.5 至-1.0；P<0.001；I2=0；P=0.43，用于异质性）的平均差异相关。 在 32 项观察性研究中（共有 21,604 名参与者；平均年龄为 46.6 岁），与食用杂食性饮食相比，食用素食饮食与收缩压（-6.9mmHg；95％CI，-9.1 至-4.7；P<0.001；I2=91.4；P<0.001，用于异质性）和舒张压（-4.7mmHg；95％CI，-6.3 至-3.1；P<0.001；I2=92.6；P<0.001，用于异质性）相关。 结论和相关性 食用素食与血压降低有关。 这种饮食可能是降低血压的一种有用的非药物手段。
