碳水化合物质量变化与心血管危险因素的同时变化：PREDIMED-Plus 随机试验中的纵向分析。

Carbohydrate quality changes and concurrent changes in cardiovascular risk factors: a longitudinal analysis in the PREDIMED-Plus randomized trial.

机构信息

Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.

University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, IdiSNA, Pamplona, Spain.

出版信息

Am J Clin Nutr. 2020 Feb 1;111(2):291-306. doi: 10.1093/ajcn/nqz298.

DOI:10.1093/ajcn/nqz298

PMID:31868210

Abstract

BACKGROUND

Overall quality of dietary carbohydrate intake rather than total carbohydrate intake may determine the risk of cardiovascular disease (CVD).

OBJECTIVE

We examined 6- and 12-mo changes in carbohydrate quality index (CQI) and concurrent changes in several CVD risk factors in a multicenter, randomized, primary-prevention trial (PREDIMED-Plus) based on an intensive weight-loss lifestyle intervention program.

METHODS

Prospective analysis of 5373 overweight/obese Spanish adults (aged 55-75 y) with metabolic syndrome (MetS). Dietary intake information obtained from a validated 143-item semiquantitative food-frequency questionnaire was used to calculate 6- and 12-mo changes in CQI (categorized in quintiles), based on 4 criteria (total dietary fiber intake, glycemic index, whole grain/total grain ratio, and solid carbohydrate/total carbohydrate ratio). The outcomes were changes in intermediate markers of CVD.

RESULTS

During the 12-mo follow-up, the majority of participants improved their CQI by increasing their consumption of fruits, vegetables, legumes, fish, and nuts and decreasing their consumption of refined cereals, added sugars, and sugar-sweetened beverages. After 6 mo, body weight, waist circumference (WC), systolic and diastolic blood pressure (BP), fasting blood glucose, glycated hemoglobin (HbA1c), triglyceride levels, triglycerides and glucose (TyG) index, and TyG-WC decreased across successive quintiles of improvement in the CQI. After 12 mo, improvements were additionally observed for HDL cholesterol and for the ratio of total to HDL cholesterol. Favorable improvements (expressed in common units of SD and 95% CI) for quintile 5 compared with quintile 1 of CQI change were observed for most risk factors, including TyG-WC (SD -0.20; 95% CI -0.26, -0.15), HbA1c (SD -0.16; 95% CI -0.23, -0.10), weight (SD -0.12; 95% CI -0.14, -0.09), systolic BP (SD -0.11; 95% CI -0.19, -0.02) and diastolic BP (SD -0.11; 95% CI -0.19, -0.04).

CONCLUSIONS

Improvements in CQI were strongly associated with concurrent favorable CVD risk factor changes maintained over time in overweight/obese adults with MetS. This trial was registered as ISRCTN 89898870.

摘要

背景

饮食中碳水化合物的整体质量，而不是碳水化合物的总量，可能决定心血管疾病（CVD）的风险。

目的

我们在一个基于强化减重生活方式干预计划的多中心、随机、一级预防试验（PREDIMED-Plus）中，检查了碳水化合物质量指数（CQI）在 6 个月和 12 个月的变化，以及同时发生的几种 CVD 风险因素的变化。

方法

对 5373 名超重/肥胖的西班牙成年人（年龄 55-75 岁）进行前瞻性分析，这些成年人患有代谢综合征（MetS）。通过使用经过验证的 143 项半定量食物频率问卷获得的饮食摄入信息，根据 4 个标准（总膳食纤维摄入量、血糖指数、全谷物/总谷物比例和固体碳水化合物/总碳水化合物比例），计算了 6 个月和 12 个月的 CQI（分为五分位数）的变化。结果是 CVD 中间标志物的变化。

结果

在 12 个月的随访期间，大多数参与者通过增加水果、蔬菜、豆类、鱼和坚果的摄入量，减少精制谷物、添加糖和含糖饮料的摄入量，从而改善了他们的 CQI。在 6 个月后，体重、腰围（WC）、收缩压和舒张压（BP）、空腹血糖、糖化血红蛋白（HbA1c）、甘油三酯水平、甘油三酯和葡萄糖（TyG）指数以及 TyG-WC 都随着 CQI 改善的连续五分位数而降低。在 12 个月后，还观察到 HDL 胆固醇和总胆固醇/HDL 胆固醇比值的改善。与 CQI 变化的第 1 五分位相比，第 5 五分位的大多数风险因素都有更好的改善（以标准差和 95%置信区间表示），包括 TyG-WC（SD -0.20；95%CI -0.26，-0.15）、HbA1c（SD -0.16；95%CI -0.23，-0.10）、体重（SD -0.12；95%CI -0.14，-0.09）、收缩压（SD -0.11；95%CI -0.19，-0.02）和舒张压（SD -0.11；95%CI -0.19，-0.04）。