Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Department of Endocrinology, Diabetes and Clinical Pharmacology, Dubrava University Hospital, Zagreb, Croatia.
Prog Cardiovasc Dis. 2018 May-Jun;61(1):43-53. doi: 10.1016/j.pcad.2018.05.004. Epub 2018 May 26.
The evidence for the Portfolio dietary pattern, a plant-based dietary pattern that combines recognized cholesterol-lowering foods (nuts, plant protein, viscous fibre, plant sterols), has not been summarized.
To update the European Association for the Study of Diabetes clinical practice guidelines for nutrition therapy, we conducted a systematic review and meta-analysis of controlled trials using GRADE of the effect of the Portfolio dietary pattern on the primary therapeutic lipid target for cardiovascular disease prevention, low-density lipoprotein cholesterol (LDL-C), and other established cardiometabolic risk factors.
We searched MEDLINE, EMBASE, and The Cochrane Library through April 19, 2018. We included controlled trials ≥ 3-weeks assessing the effect of the Portfolio dietary pattern on cardiometabolic risk factors compared with an energy-matched control diet free of Portfolio dietary pattern components. Two independent reviewers extracted data and assessed risk of bias. The primary outcome was LDL-C. Data were pooled using the generic inverse-variance method and expressed as mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was assessed (Cochran Q statistic) and quantified (I-statistic). GRADE assessed the certainty of the evidence.
Eligibility criteria were met by 7 trial comparisons in 439 participants with hyperlipidemia, in which the Portfolio dietary pattern was given on a background of a National Cholesterol Education Program (NCEP) Step II diet. The combination of a portfolio dietary pattern and NCEP Step II diet significantly reduced the primary outcome LDL-C by ~17% (MD, -0.73 mmol/L, [95% CI, -0.89 to -0.56 mmol/L]) as well as non-high-density lipoprotein cholesterol, apolipoprotein B, total cholesterol, triglycerides, systolic and diastolic blood pressure, C-reactive protein, and estimated 10-year coronary heart disease (CHD) risk, compared with an NCEP Step 2 diet alone (p < 0.05). There was no effect on high-density lipoprotein cholesterol or body weight. The certainty of the evidence was high for LDL-cholesterol and most lipid outcomes and moderate for all others outcomes.
Current evidence demonstrates that the Portfolio dietary pattern leads to clinically meaningful improvements in LDL-C as well as other established cardiometabolic risk factors and estimated 10-year CHD risk.
Portfolio 饮食模式是一种植物性饮食模式，结合了公认的降胆固醇食物（坚果、植物蛋白、粘性纤维、植物固醇），但目前尚未对其进行总结。
为更新欧洲糖尿病研究协会的营养治疗临床实践指南，我们对控制试验进行了系统评价和荟萃分析，并使用 GRADE 评估了 Portfolio 饮食模式对心血管疾病预防的主要治疗性血脂目标——低密度脂蛋白胆固醇（LDL-C）和其他已确立的心血管代谢危险因素的影响。
我们检索了 MEDLINE、EMBASE 和 The Cochrane Library，检索时间截至 2018 年 4 月 19 日。我们纳入了≥3 周的对照试验，评估了 Portfolio 饮食模式与不包含 Portfolio 饮食模式成分的能量匹配对照饮食相比，对心血管代谢危险因素的影响。两位独立的审查员提取数据并评估了偏倚风险。主要结局为 LDL-C。使用通用倒数方差法汇总数据，并表示为均数差值（MD）及其 95%置信区间（CI）。采用 Cochran Q 统计量评估异质性，并采用 I ² 统计量进行量化。GRADE 评估证据的确定性。
共有 7 项试验比较了 439 例高脂血症患者接受 Portfolio 饮食模式和 NCEP Step II 饮食的效果，其中 Portfolio 饮食模式是在 NCEP Step II 饮食的基础上进行的。Portfolio 饮食模式与 NCEP Step II 饮食相结合可显著降低主要结局 LDL-C（MD，-0.73mmol/L，95%CI：-0.89 至 -0.56mmol/L），以及非高密度脂蛋白胆固醇、载脂蛋白 B、总胆固醇、甘油三酯、收缩压和舒张压、C 反应蛋白和估计的 10 年冠心病（CHD）风险，与单独接受 NCEP Step 2 饮食相比（p＜0.05）。高密度脂蛋白胆固醇或体重无变化。LDL-C 及大多数血脂指标的证据确定性为高，其他所有指标的证据确定性为中。
目前的证据表明，Portfolio 饮食模式可显著改善 LDL-C 以及其他已确立的心血管代谢危险因素和估计的 10 年 CHD 风险。
