Naude Celeste E, Schoonees Anel, Senekal Marjanne, Young Taryn, Garner Paul, Volmink Jimmy
Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Division of Human Nutrition, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
PLoS One. 2014 Jul 9;9(7):e100652. doi: 10.1371/journal.pone.0100652. eCollection 2014.
Some popular weight loss diets restricting carbohydrates (CHO) claim to be more effective, and have additional health benefits in preventing cardiovascular disease compared to balanced weight loss diets.
We compared the effects of low CHO and isoenergetic balanced weight loss diets in overweight and obese adults assessed in randomised controlled trials (minimum follow-up of 12 weeks), and summarised the effects on weight, as well as cardiovascular and diabetes risk. Dietary criteria were derived from existing macronutrient recommendations. We searched Medline, EMBASE and CENTRAL (19 March 2014). Analysis was stratified by outcomes at 3-6 months and 1-2 years, and participants with diabetes were analysed separately. We evaluated dietary adherence and used GRADE to assess the quality of evidence. We calculated mean differences (MD) and performed random-effects meta-analysis. Nineteen trials were included (n = 3209); 3 had adequate allocation concealment. In non-diabetic participants, our analysis showed little or no difference in mean weight loss in the two groups at 3-6 months (MD 0.74 kg, 95%CI -1.49 to 0.01 kg; I2 = 53%; n = 1745, 14 trials; moderate quality evidence) and 1-2 years (MD 0.48 kg, 95%CI -1.44 kg to 0.49 kg; I2 = 12%; n = 1025; 7 trials, moderate quality evidence). Furthermore, little or no difference was detected at 3-6 months and 1-2 years for blood pressure, LDL, HDL and total cholesterol, triglycerides and fasting blood glucose (>914 participants). In diabetic participants, findings showed a similar pattern.
Trials show weight loss in the short-term irrespective of whether the diet is low CHO or balanced. There is probably little or no difference in weight loss and changes in cardiovascular risk factors up to two years of follow-up when overweight and obese adults, with or without type 2 diabetes, are randomised to low CHO diets and isoenergetic balanced weight loss diets.
一些流行的限制碳水化合物（CHO）的减肥饮食声称比均衡减肥饮食更有效，且在预防心血管疾病方面有额外的健康益处。
我们比较了在随机对照试验（最短随访12周）中评估的超重和肥胖成年人中低碳水化合物饮食和等能量均衡减肥饮食的效果，并总结了对体重以及心血管和糖尿病风险的影响。饮食标准源自现有的宏量营养素建议。我们检索了Medline、EMBASE和CENTRAL（2014年3月19日）。分析按3至6个月和1至2年的结果分层，糖尿病参与者单独分析。我们评估了饮食依从性，并使用GRADE评估证据质量。我们计算了平均差异（MD）并进行随机效应荟萃分析。纳入了19项试验（n = 3209）；3项试验有充分的分配隐藏。在非糖尿病参与者中，我们的分析显示，在3至6个月时两组的平均体重减轻几乎没有差异（MD 0.74 kg，95%CI -1.49至0.01 kg；I² = 53%；n = 1745，14项试验；中等质量证据），在1至2年时也几乎没有差异（MD 0.48 kg，95%CI -1.44 kg至0.49 kg；I² = 12%；n = 1025；7项试验，中等质量证据）。此外，在3至6个月和1至2年时，血压、低密度脂蛋白、高密度脂蛋白和总胆固醇、甘油三酯以及空腹血糖方面（超过914名参与者）几乎没有差异。在糖尿病参与者中，结果显示出类似的模式。
试验表明，无论饮食是低碳水化合物还是均衡饮食，短期内都能减轻体重。当超重和肥胖成年人（无论有无2型糖尿病）被随机分配到低碳水化合物饮食和等能量均衡减肥饮食时，在长达两年的随访中，体重减轻和心血管危险因素变化可能几乎没有差异。
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