车前草纤维对 LDL 胆固醇和其他脂质指标、非 HDL 胆固醇和载脂蛋白 B 的影响：一项随机对照试验的系统评价和荟萃分析。

Effect of psyllium (Plantago ovata) fiber on LDL cholesterol and alternative lipid targets, non-HDL cholesterol and apolipoprotein B: a systematic review and meta-analysis of randomized controlled trials.

机构信息

Clinical Nutrition and Risk Factor Modification Center.

Departments of Nutritional Sciences.

出版信息

Am J Clin Nutr. 2018 Nov 1;108(5):922-932. doi: 10.1093/ajcn/nqy115.

DOI:10.1093/ajcn/nqy115

PMID:30239559

Abstract

BACKGROUND

Studies have identified viscous dietary fiber as potentially attenuating cholesterol, including psyllium, which reduces LDL cholesterol and thus may complement cardiovascular disease (CVD) treatment.

OBJECTIVES

The aims of this study were to update evidence on the effect of psyllium on LDL cholesterol and to provide an assessment of its impact on alternate markers: non-HDL cholesterol and apolipoprotein B (apoB).

DESIGN

Medline, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials were searched through 3 October 2017. Independent reviewers extracted relevant data and assessed risk of bias. We included randomized controlled trials with a duration of ≥3 wk that assessed the effect of psyllium on blood lipids in individuals with or without hypercholesterolemia. Data were pooled by using the generic inverse variance method with random-effects models and expressed as mean differences (MDs) with 95% CIs. Heterogeneity was assessed by Cochran's Q statistic and quantified by the I2 statistic. Overall quality of the evidence was assessed by using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

RESULTS

We included 28 trials in our analysis (n = 1924). Supplementation of a median dose of ∼10.2 g psyllium significantly reduced LDL cholesterol (MD = -0.33 mmol/L; 95% CI: -0.38, -0.27 mmol/L; P < 0.00001), non-HDL cholesterol (MD = -0.39 mmol/L; 95% CI: -0.50, -0.27 mmol/L; P < 0.00001), and apoB (MD = -0.05 g/L; 95% CI: -0.08, -0.03 g/L; P < 0.0001). Effect estimates for LDL cholesterol and non-HDL cholesterol were graded as moderate quality on the basis of downgrades for inconsistency and graded as high quality for apoB.

CONCLUSION

Psyllium fiber effectively improves conventional and alternative lipids markers, potentially delaying the process of atherosclerosis-associated CVD risk in those with or without hypercholesterolemia. This trial is registered at www.clinicaltrials.gov as NCT03346733.

摘要

背景

研究表明粘性膳食纤维可能具有降低胆固醇的作用，其中包括车前子壳，它可以降低 LDL 胆固醇，从而可能对心血管疾病（CVD）的治疗起到辅助作用。

目的

本研究旨在更新车前子壳对 LDL 胆固醇的影响的证据，并评估其对替代标志物（非高密度脂蛋白胆固醇和载脂蛋白 B [apoB]）的影响。

设计

通过 2017 年 10 月 3 日检索 Medline、EMBASE、CINAHL 和 Cochrane 对照试验中心注册库，纳入了持续时间≥3 周、评估车前子壳对血脂的影响的随机对照试验，这些试验纳入了伴有或不伴有高胆固醇血症的个体。采用固定效应模型的通用倒数方差法对数据进行合并，并以均值差（MD）和 95%置信区间（CI）表示。采用 Cochran's Q 统计量评估异质性，并采用 I2 统计量进行量化。采用 GRADE（推荐评估、制定与评价）方法评估证据的总体质量。

结果

我们的分析纳入了 28 项试验（n=1924）。中位剂量约 10.2 g 的车前子壳补充剂可显著降低 LDL 胆固醇（MD=-0.33 mmol/L；95%CI：-0.38，-0.27 mmol/L；P<0.00001）、非高密度脂蛋白胆固醇（MD=-0.39 mmol/L；95%CI：-0.50，-0.27 mmol/L；P<0.00001）和载脂蛋白 B（MD=-0.05 g/L；95%CI：-0.08，-0.03 g/L；P<0.0001）。基于不一致性的降低和对载脂蛋白 B 的高质量评估，LDL 胆固醇和非高密度脂蛋白胆固醇的效应估计被评为中等质量。