Mozaffarian Dariush
From Friedman School of Nutrition Science & Policy, Tufts University, Boston, MA.
Circulation. 2016 Jan 12;133(2):187-225. doi: 10.1161/CIRCULATIONAHA.115.018585.
Suboptimal nutrition is a leading cause of poor health. Nutrition and policy science have advanced rapidly, creating confusion yet also providing powerful opportunities to reduce the adverse health and economic impacts of poor diets. This review considers the history, new evidence, controversies, and corresponding lessons for modern dietary and policy priorities for cardiovascular diseases, obesity, and diabetes mellitus. Major identified themes include the importance of evaluating the full diversity of diet-related risk pathways, not only blood lipids or obesity; focusing on foods and overall diet patterns, rather than single isolated nutrients; recognizing the complex influences of different foods on long-term weight regulation, rather than simply counting calories; and characterizing and implementing evidence-based strategies, including policy approaches, for lifestyle change. Evidence-informed dietary priorities include increased fruits, nonstarchy vegetables, nuts, legumes, fish, vegetable oils, yogurt, and minimally processed whole grains; and fewer red meats, processed (eg, sodium-preserved) meats, and foods rich in refined grains, starch, added sugars, salt, and trans fat. More investigation is needed on the cardiometabolic effects of phenolics, dairy fat, probiotics, fermentation, coffee, tea, cocoa, eggs, specific vegetable and tropical oils, vitamin D, individual fatty acids, and diet-microbiome interactions. Little evidence to date supports the cardiometabolic relevance of other popular priorities: eg, local, organic, grass-fed, farmed/wild, or non-genetically modified. Evidence-based personalized nutrition appears to depend more on nongenetic characteristics (eg, physical activity, abdominal adiposity, gender, socioeconomic status, culture) than genetic factors. Food choices must be strongly supported by clinical behavior change efforts, health systems reforms, novel technologies, and robust policy strategies targeting economic incentives, schools and workplaces, neighborhood environments, and the food system. Scientific advances provide crucial new insights on optimal targets and best practices to reduce the burdens of diet-related cardiometabolic diseases.
营养欠佳是健康状况不佳的主要原因。营养与政策科学发展迅速，既造成了困惑，也带来了强大机遇，有助于减少不良饮食对健康和经济的不利影响。本综述探讨了心血管疾病、肥胖症和糖尿病现代饮食及政策重点的历史、新证据、争议及相应经验教训。确定的主要主题包括评估与饮食相关的风险途径的全面多样性的重要性，不仅是血脂或肥胖；关注食物和整体饮食模式，而非单一孤立的营养素；认识到不同食物对长期体重调节的复杂影响，而非简单计算卡路里；以及描述和实施基于证据的策略，包括政策方法，以促进生活方式改变。基于证据的饮食重点包括增加水果、非淀粉类蔬菜、坚果、豆类、鱼类、植物油、酸奶和最少加工的全谷物的摄入；减少红肉、加工肉类（如盐渍肉）以及富含精制谷物、淀粉、添加糖、盐和反式脂肪的食物的摄入。对于酚类物质、乳脂肪、益生菌、发酵、咖啡、茶、可可、鸡蛋、特定植物油和热带油、维生素D、单个脂肪酸以及饮食与微生物群相互作用的心脏代谢影响，还需要更多研究。迄今为止，几乎没有证据支持其他流行重点的心脏代谢相关性：例如，本地、有机、草饲、养殖/野生或非转基因。基于证据的个性化营养似乎更多地取决于非遗传特征（如身体活动、腹部肥胖、性别、社会经济地位、文化）而非遗传因素。食物选择必须得到临床行为改变努力、卫生系统改革、新技术以及针对经济激励措施、学校和工作场所、社区环境及食品系统的有力政策策略的大力支持。科学进展为减少与饮食相关的心脏代谢疾病负担的最佳目标和最佳实践提供了至关重要的新见解。
