Fattore Elena, Botta Francesca, Agostoni Carlo, Bosetti Cristina
Department of Environmental Health Science and
Department of Environmental Health Science and.
Am J Clin Nutr. 2017 Jan;105(1):42-56. doi: 10.3945/ajcn.116.139253. Epub 2016 Dec 21.
Sugar has been suggested as a central risk factor in the development of noncommunicable diseases.
We assessed the evidence of the effects of free sugars compared with complex carbohydrates on selected cardiovascular disease risk factors.
We conducted a systematic review and meta-analysis of intervention trials to compare diets that provide a given amount of energy from free sugars with a control diet that provides the same amount of energy from complex carbohydrates. The primary outcomes were: blood pressure, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triacylglycerols, apolipoproteins A-I and B, or very low-density lipoprotein cholesterol. Body weight was also recorded but was not a primary outcome of the studies.
In all, 28 studies involving 510 volunteers were included. When free sugars were substituted for complex carbohydrates, no significant increases were detected in systolic or diastolic blood pressure, and no heterogeneity was observed. There were significant increases in HDL cholesterol, LDL cholesterol, and triacylglycerols, although for LDL cholesterol and triacylglycerols there was significant heterogeneity between studies and evidence of publication bias. After adjustment for missing studies, these increases lost significance. Subgroup analyses showed that diets providing the largest total energy intake and energy exchange enhanced the effect of free sugars on total and LDL cholesterol and triacylglycerols. The increase of triacylglycerols was no longer significant when studies with the highest risk of bias were excluded or when only randomized trials were considered. Free sugars had no effect on body weight.
In short- or moderate-term isoenergetic intervention trials, the substitution of free sugars for complex carbohydrates had no effect on blood pressure or body weight and an unclear effect on blood lipid profile. Further independent trials are required to assess whether the reduction of free sugars improves cardiovascular disease risk factors. This review was registered at http://www.crd.york.ac.uk/prospero as CRD42016042930.
糖被认为是非传染性疾病发展的核心风险因素。
我们评估了游离糖与复合碳水化合物相比对选定心血管疾病风险因素影响的证据。
我们对干预试验进行了系统评价和荟萃分析，以比较提供一定量来自游离糖能量的饮食与提供相同量来自复合碳水化合物能量的对照饮食。主要结局指标为：血压、总胆固醇、低密度脂蛋白（LDL）胆固醇、高密度脂蛋白（HDL）胆固醇、三酰甘油、载脂蛋白A-I和B或极低密度脂蛋白胆固醇。体重也进行了记录，但不是研究的主要结局指标。
总共纳入了28项涉及510名志愿者的研究。当用游离糖替代复合碳水化合物时，收缩压或舒张压未检测到显著升高，也未观察到异质性。高密度脂蛋白胆固醇、低密度脂蛋白胆固醇和三酰甘油有显著升高，尽管对于低密度脂蛋白胆固醇和三酰甘油，研究之间存在显著异质性且有发表偏倚的证据。在对缺失研究进行校正后，这些升高失去了显著性。亚组分析表明，提供最大总能量摄入和能量交换的饮食增强了游离糖对总胆固醇和低密度脂蛋白胆固醇以及三酰甘油的影响。当排除偏倚风险最高的研究或仅考虑随机试验时，三酰甘油的升高不再显著。游离糖对体重没有影响。
在短期或中期等能量干预试验中，用游离糖替代复合碳水化合物对血压或体重没有影响，对血脂谱的影响尚不清楚。需要进一步的独立试验来评估减少游离糖是否能改善心血管疾病风险因素。本综述已在http://www.crd.york.ac.uk/prospero注册，注册号为CRD42016042930。
