Sansom Institute, School of Pharmacy and Medical Sciences, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, PO Box 1471, Adelaide, SA, Australia.
Curr Atheroscler Rep. 2018 Apr 25;20(6):27. doi: 10.1007/s11883-018-0728-8.
In this review, we aimed to answer the question as to whether deliberate weight loss can reduce cardiovascular events or improve cardiovascular risk factors and whether different methods of weight loss can have a differential effect on risk factor improvement.
It would appear that deliberate weight loss reduces total mortality by 16% in obese people with risk factors including type 2 diabetes. People with type 2 diabetes who lose at least 10% of their initial body weight reduce CVD end points by 21% with dietary weight loss while the effect is greater with the greater weight loss induced by bariatric surgery with a 32% reduction in events. Mortality reduction may vary from 29 to up to 79%. Replacing some carbohydrate with protein appears to enhance weight maintenance over 12 months and in addition lowers serum triglyceride and blood pressure. A very-low-carbohydrate diet elevates LDL cholesterol when a high saturated fat "Atkins" style approach is used, but a high unsaturated fat version is safe and effective over a 12-month period and reduces medication requirements in people with type 2 diabetes. A very-low-calorie liquid diet produces excellent weight loss in the short-term, but long-term weight loss is no different to less restrictive dieting. Weight loss lowers CVD events and total mortality and a higher protein (18-25% of energy), lower carbohydrate (< 45% of energy) diet may be superior for weight maintenance and risk factor improvement, but there are no data on event reduction.
在本次综述中，我们旨在解答以下问题：刻意减重是否可以减少心血管事件或改善心血管风险因素，以及不同的减重方法是否会对风险因素的改善产生不同的影响。
对于存在包括 2 型糖尿病在内的危险因素的肥胖人群，刻意减重可使全因死亡率降低 16%。体重减轻至少 10%的 2 型糖尿病患者，通过饮食减重可使 CVD 终点降低 21%，而减重手术诱导的体重减轻程度越大，效果越好，其心血管事件减少 32%。死亡率的降低幅度可能从 29%到高达 79%不等。用蛋白质替代部分碳水化合物似乎可以在 12 个月内更好地维持体重，并且还可以降低血清甘油三酯和血压。当使用高饱和脂肪的“阿特金斯”（Atkins）式方法时，极低碳水化合物饮食会升高 LDL 胆固醇，但高不饱和脂肪版本在 12 个月内是安全且有效的，并且可以减少 2 型糖尿病患者的药物治疗需求。极低热量液体饮食可在短期内产生极好的体重减轻效果，但长期来看，与限制更严格的节食相比，体重减轻并无差异。体重减轻可降低 CVD 事件和全因死亡率，较高蛋白（占能量的 18-25%）、低碳水化合物（<45%的能量）饮食可能更有利于维持体重和改善风险因素，但目前尚无关于降低事件发生率的数据。
