Prevention Research Center, Yale University School of Public Health, Griffin Hospital, Derby, Connecticut 06418; email:
Annu Rev Public Health. 2014;35:83-103. doi: 10.1146/annurev-publhealth-032013-182351.
Diet is established among the most important influences on health in modern societies. Injudicious diet figures among the leading causes of premature death and chronic disease. Optimal eating is associated with increased life expectancy, dramatic reduction in lifetime risk of all chronic disease, and amelioration of gene expression. In this context, claims abound for the competitive merits of various diets relative to one another. Whereas such claims, particularly when attached to commercial interests, emphasize distinctions, the fundamentals of virtually all eating patterns associated with meaningful evidence of health benefit overlap substantially. There have been no rigorous, long-term studies comparing contenders for best diet laurels using methodology that precludes bias and confounding, and for many reasons such studies are unlikely. In the absence of such direct comparisons, claims for the established superiority of any one specific diet over others are exaggerated. The weight of evidence strongly supports a theme of healthful eating while allowing for variations on that theme. A diet of minimally processed foods close to nature, predominantly plants, is decisively associated with health promotion and disease prevention and is consistent with the salient components of seemingly distinct dietary approaches. Efforts to improve public health through diet are forestalled not for want of knowledge about the optimal feeding of Homo sapiens but for distractions associated with exaggerated claims, and our failure to convert what we reliably know into what we routinely do. Knowledge in this case is not, as of yet, power; would that it were so.
饮食是现代社会对健康最重要的影响因素之一。不合理的饮食是导致早逝和慢性病的主要原因之一。最佳的饮食与延长寿命、显著降低所有慢性病的终身风险以及改善基因表达有关。在这种情况下,各种饮食相对于彼此的竞争优势的说法层出不穷。虽然这些说法,特别是当与商业利益相关联时,强调了差异,但实际上与健康益处有实质性关联的所有饮食模式的基本原理都有很大的重叠。由于各种原因,还没有使用可以避免偏见和混杂因素的严格、长期的研究来比较最佳饮食的竞争者,而且这样的研究不太可能进行。在没有这种直接比较的情况下,声称任何一种特定的饮食比其他饮食更优越的说法都是夸大其词的。大量证据强烈支持健康饮食的主题,同时也允许在这个主题上有所变化。接近自然、以植物为主的最低限度加工食品的饮食与促进健康和预防疾病有决定性的关联,并且与看似不同的饮食方法的显著成分一致。通过饮食改善公众健康的努力受阻,不是因为缺乏关于人类最佳喂养的知识,而是因为与夸大的说法有关的干扰,以及我们未能将我们可靠的知识转化为我们日常的做法。在这种情况下,知识还不是力量;但愿如此。