Shannon Oliver M, Mendes Inês, Köchl Christina, Mazidi Mohsen, Ashor Ammar W, Rubele Sofia, Minihane Anne-Marie, Mathers John C, Siervo Mario
Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, United Kingdom.
Department of Biology and Biological Engineering, Food and Nutrition Science, Chalmers University of Technology, Gothenburg, Sweden.
J Nutr. 2020 May 1;150(5):1151-1159. doi: 10.1093/jn/nxaa002.
The endothelium plays a key role in the maintenance of vascular health and represents a potential physiological target for dietary and other lifestyle interventions designed to reduce the risk of cardiovascular diseases (CVD) including stroke or coronary heart disease.
To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating the effects of the Mediterranean dietary pattern (MedDiet) on endothelial function.
Medline, Embase, and Scopus databases were searched from inception until January 2019 for studies that met the following criteria: 1) RCTs including adult participants, 2) interventions promoting the MedDiet, 3) inclusion of a control group, and 4) measurements of endothelial function. A random-effects meta-analysis was conducted. Metaregression and subgroup analyses were performed to identify whether effects were modified by health status (i.e., healthy participants versus participants with existing comorbidities), type of intervention (i.e., MedDiet alone or with a cointervention), study duration, study design (i.e., parallel or crossover), BMI, and age of participants.
Fourteen articles reporting data for 1930 participants were included in the meta-analysis. Study duration ranged from 4 wk to 2.3 y. We observed a beneficial effect of the MedDiet on endothelial function [standardized mean difference (SMD): 0.35; 95% CI: 0.17, 0.53; P <0.001; I2 = 73.68%]. MedDiet interventions improved flow-mediated dilation (FMD)-the reference method for noninvasive, clinical measurement of endothelial function-by 1.66% (absolute change; 95% CI: 1.15, 2.17; P <0.001; I2 = 0%). Effects of the MedDiet on endothelial function were not modified by health status, type of intervention, study duration, study design, BMI, or age of participants (P >0.05).
MedDiet interventions improve endothelial function in adults, suggesting that the protective effects of the MedDiet are evident at early stages of the atherosclerotic process with important implications for the early prevention of CVD. This study has the PROSPERO registration number: CRD42018106188.
内皮细胞在维持血管健康方面发挥着关键作用，是旨在降低包括中风或冠心病在内的心血管疾病（CVD）风险的饮食及其他生活方式干预措施的潜在生理靶点。
对研究地中海饮食模式（MedDiet）对内皮功能影响的随机对照试验（RCT）进行系统评价和荟萃分析。
检索Medline、Embase和Scopus数据库，检索时间从建库至2019年1月，纳入符合以下标准的研究：1）包含成年参与者的RCT；2）推广MedDiet的干预措施；3）纳入对照组；4）测量内皮功能。进行随机效应荟萃分析。进行元回归和亚组分析，以确定健康状况（即健康参与者与患有合并症的参与者）、干预类型（即单独的MedDiet或联合干预）、研究持续时间、研究设计（即平行或交叉）、体重指数（BMI）和参与者年龄是否会改变效应。
荟萃分析纳入了14篇报告1930名参与者数据的文章。研究持续时间从4周至2.3年不等。我们观察到MedDiet对内皮功能有有益影响[标准化均数差（SMD）：0.35；95%可信区间（CI）：0.17，0.53；P<0.001；I² = 73.68%]。MedDiet干预使血流介导的血管舒张（FMD）（内皮功能无创临床测量的参考方法）提高了1.66%（绝对变化；95%CI：1.15，2.17；P<0.001；I² = 0%）。MedDiet对内皮功能的影响不受健康状况、干预类型、研究持续时间、研究设计、BMI或参与者年龄的影响（P>0.05）。
MedDiet干预可改善成年人的内皮功能，表明MedDiet的保护作用在动脉粥样硬化过程的早期阶段就很明显，对CVD的早期预防具有重要意义。本研究的PROSPERO注册号为：CRD42018106188。
