Babio Nancy, Toledo Estefanía, Estruch Ramón, Ros Emilio, Martínez-González Miguel A, Castañer Olga, Bulló Mònica, Corella Dolores, Arós Fernando, Gómez-Gracia Enrique, Ruiz-Gutiérrez Valentina, Fiol Miquel, Lapetra José, Lamuela-Raventos Rosa M, Serra-Majem Lluís, Pintó Xavier, Basora Josep, Sorlí José V, Salas-Salvadó Jordi
Human Nutrition Unit (Babio, Bulló, Basora, Salas-Salvadó), Faculty of Medicine and Health Sciences, Biochemistry Biotechnology Department, Universitat Rovira i Virgili, and Hospital Universitari de Sant Joan de Reus, IISPV, Reus, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn) (Babio, Toledo, Estruch, Martínez-González, Castañer, Bulló, Corella, Arós, Gómez-Gracia, Ruiz-Gutiérrez, Fiol, Lapetra, Lamuela-Raventos, Serra-Majem, Pintó, Basora, Sorlí, Salas-Salvadó), Institute of Health Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health (Toledo, Martínez-González), University of Navarra, Pamplona, Spain; Department of Internal Medicine (Estruch), Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain; Lipid Clinic (Ros), Endocrinology and Nutrition Service, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain; Cardiovascular Risk and Nutrition Research Group (Castañer), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona Biomedical Research Park, Barcelona, Spain; Department of Preventive Medicine (Corella, Sorlí), University of Valencia, València, Spain; Department of Cardiology (Arós), University Hospital Txagorritxu, Vitoria, Spain; Department of Preventive Medicine (Gómez-Gracia), University of Malaga, Malaga, Spain; Instituto de la Grasa (Ruiz-Gutiérrez), Consejo Superior de Investigaciones Cientificas, Seville; Instituto de Investigación Sanitaria de Palma (Fiol), Hospital Universitario Son Espases, Mallorca; Department of Family Medicine (Lapetra), Primary Care Division of Seville, San Pablo Health Center, Seville; Department of Nutrition and Food Science (Lamuela-Raventos), School of Pharmacy, Xarxa de Referència en Tecnologia dels Aliments, Instituto de Investigación en Nutrición y Seguridad Alimentaria, University of Barcelona, Barcelona, Spain; De
CMAJ. 2014 Nov 18;186(17):E649-57. doi: 10.1503/cmaj.140764. Epub 2014 Oct 14.
Little evidence exists on the effect of an energy-unrestricted healthy diet on metabolic syndrome. We evaluated the long-term effect of Mediterranean diets ad libitum on the incidence or reversion of metabolic syndrome.
We performed a secondary analysis of the PREDIMED trial--a multicentre, randomized trial done between October 2003 and December 2010 that involved men and women (age 55-80 yr) at high risk for cardiovascular disease. Participants were randomly assigned to 1 of 3 dietary interventions: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with nuts or advice on following a low-fat diet (the control group). The interventions did not include increased physical activity or weight loss as a goal. We analyzed available data from 5801 participants. We determined the effect of diet on incidence and reversion of metabolic syndrome using Cox regression analysis to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).
Over 4.8 years of follow-up, metabolic syndrome developed in 960 (50.0%) of the 1919 participants who did not have the condition at baseline. The risk of developing metabolic syndrome did not differ between participants assigned to the control diet and those assigned to either of the Mediterranean diets (control v. olive oil HR 1.10, 95% CI 0.94-1.30, p = 0.231; control v. nuts HR 1.08, 95% CI 0.92-1.27, p = 0.3). Reversion occurred in 958 (28.2%) of the 3392 participants who had metabolic syndrome at baseline. Compared with the control group, participants on either Mediterranean diet were more likely to undergo reversion (control v. olive oil HR 1.35, 95% CI 1.15-1.58, p < 0.001; control v. nuts HR 1.28, 95% CI 1.08-1.51, p < 0.001). Participants in the group receiving olive oil supplementation showed significant decreases in both central obesity and high fasting glucose (p = 0.02); participants in the group supplemented with nuts showed a significant decrease in central obesity.
A Mediterranean diet supplemented with either extra virgin olive oil or nuts is not associated with the onset of metabolic syndrome, but such diets are more likely to cause reversion of the condition. An energy-unrestricted Mediterranean diet may be useful in reducing the risks of central obesity and hyperglycemia in people at high risk of cardiovascular disease.
ClinicalTrials.gov, no. ISRCTN35739639.
关于能量不受限制的健康饮食对代谢综合征的影响，现有证据很少。我们评估了随意摄入地中海饮食对代谢综合征发病率或逆转情况的长期影响。
我们对PREDIMED试验进行了二次分析，这是一项多中心随机试验，于2003年10月至2010年12月进行，纳入了心血管疾病高危的男性和女性（年龄55 - 80岁）。参与者被随机分配到3种饮食干预中的一种：补充特级初榨橄榄油的地中海饮食、补充坚果的地中海饮食或遵循低脂饮食的建议（对照组）。干预措施不包括以增加身体活动或体重减轻为目标。我们分析了5801名参与者的可用数据。我们使用Cox回归分析来计算风险比（HRs）和95%置信区间（CIs），以确定饮食对代谢综合征发病率和逆转情况的影响。
在4.8年的随访中，1919名基线时无代谢综合征的参与者中有960名（50.0%）患上了代谢综合征。分配到对照饮食组的参与者与分配到任何一种地中海饮食组的参与者相比，发生代谢综合征的风险没有差异（对照组与橄榄油组HR为1.10，95%CI为0.94 - 1.30，p = 0.231；对照组与坚果组HR为1.08，95%CI为0.92 - 1.27，p = 0.3）。3392名基线时患有代谢综合征的参与者中有958名（28.2%）实现了逆转。与对照组相比，任何一种地中海饮食组的参与者更有可能实现逆转（对照组与橄榄油组HR为1.35，95%CI为1.15 - 1.58，p < 0.001；对照组与坚果组HR为1.28，95%CI为1.08 - 1.51，p < 0.001）。补充橄榄油组的参与者中心性肥胖和空腹血糖均显著降低（p = 0.02）；补充坚果组的参与者中心性肥胖显著降低。
补充特级初榨橄榄油或坚果的地中海饮食与代谢综合征的发病无关，但这种饮食更有可能使病情逆转。能量不受限制的地中海饮食可能有助于降低心血管疾病高危人群中心性肥胖和高血糖的风险。
ClinicalTrials.gov，编号ISRCTN35739639。
