膳食模式与亚临床性心脏损伤的相关性：DASH 试验的观察性分析。
Associations Between Dietary Patterns and Subclinical Cardiac Injury: An Observational Analysis From the DASH Trial.
机构信息
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (S.P.J., K.J.M.).
University of Massachusetts Medical School, Worcester, Massachusetts (L.C.K.).
出版信息
Ann Intern Med. 2020 Jun 16;172(12):786-794. doi: 10.7326/M20-0336. Epub 2020 May 19.
BACKGROUND
The DASH diet has been found to lower blood pressure (BP) and low-density lipoprotein cholesterol levels.
OBJECTIVE
To compare diets rich in fruits and vegetables with a typical American diet in their effects on cardiovascular injury in middle-aged adults without known preexisting cardiovascular disease (CVD).
DESIGN
Observational study based on a 3-group, parallel-design, randomized trial conducted in the United States from 1994 to 1996. (ClinicalTrials.gov: NCT00000544).
SETTING
3 of the 4 original clinical trial centers.
PARTICIPANTS
326 of the original 459 trial participants with available stored specimens.
INTERVENTION
Participants were randomly assigned to 8 weeks of monitored feeding with a control diet typical of what many Americans eat; a diet rich in fruits and vegetables but otherwise similar to the control diet; or the DASH diet, which is rich in fruits, vegetables, low-fat dairy, and fiber and has low levels of saturated fat and cholesterol. Weight was kept constant throughout feeding.
MEASUREMENTS
Biomarkers collected at baseline and 8 weeks: high-sensitivity cardiac troponin I (hs-cTnI), -terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hs-CRP).
RESULTS
The mean age of participants was 45.2 years, 48% were women, 49% were black, and mean baseline BP was 131/85 mm Hg. Compared with the control diet, the fruit-and-vegetable diet reduced hs-cTnI levels by 0.5 ng/L (95% CI, -0.9 to -0.2 ng/L) and NT-proBNP levels by 0.3 pg/mL (CI, -0.5 to -0.1 pg/mL). Compared with the control diet, the DASH diet reduced hs-cTnI levels by 0.5 ng/L (CI, -0.9 to -0.1 ng/L) and NT-proBNP levels by 0.3 pg/mL (CI, -0.5 to -0.04 pg/mL). Levels of hs-CRP did not differ among diets. None of the markers differed between the fruit-and-vegetable and DASH diets.
LIMITATION
Short duration, missing specimens, and an inability to isolate the effects of specific foods or micronutrients.
CONCLUSION
Diets rich in fruits and vegetables given over 8 weeks were associated with lower levels of markers for subclinical cardiac damage and strain in adults without preexisting CVD.
PRIMARY FUNDING SOURCE
National Institutes of Health, National Heart, Lung, and Blood Institute.
背景
DASH 饮食已被证明可降低血压（BP）和低密度脂蛋白胆固醇水平。
目的
比较富含水果和蔬菜的饮食与典型的美国饮食对中年人群心血管损伤的影响，这些人没有已知的预先存在的心血管疾病（CVD）。
设计
基于 1994 年至 1996 年在美国进行的 3 组平行设计随机试验的观察性研究。（ClinicalTrials.gov：NCT00000544）。
地点
原始临床试验的 4 个中心中的 3 个。
参与者
原始试验的 459 名参与者中有 326 名有可用的存储标本。
干预措施
参与者被随机分配到 8 周的监测喂养中，接受以下饮食：对照饮食，典型的许多美国人吃的饮食；富含水果和蔬菜但其他方面与对照饮食相似的饮食；或 DASH 饮食，富含水果、蔬菜、低脂奶制品和纤维，饱和脂肪和胆固醇含量低。在喂养期间保持体重不变。
测量
基线和 8 周时采集的生物标志物：高敏心肌肌钙蛋白 I（hs-cTnI）、N 端 pro-B 型利钠肽（NT-proBNP）和高敏 C 反应蛋白（hs-CRP）。
结果
参与者的平均年龄为 45.2 岁，48%为女性，49%为黑人，平均基线血压为 131/85mmHg。与对照饮食相比，水果和蔬菜饮食使 hs-cTnI 水平降低了 0.5ng/L（95%CI，-0.9 至-0.2ng/L），NT-proBNP 水平降低了 0.3pg/mL（CI，-0.5 至-0.1pg/mL）。与对照饮食相比，DASH 饮食使 hs-cTnI 水平降低了 0.5ng/L（95%CI，-0.9 至-0.1ng/L），NT-proBNP 水平降低了 0.3pg/mL（CI，-0.5 至-0.04pg/mL）。三种饮食之间 hs-CRP 水平没有差异。在水果和蔬菜饮食与 DASH 饮食之间，没有一种标志物存在差异。
局限性
持续时间短、标本缺失以及无法分离特定食物或微量营养素的影响。
结论
在没有预先存在的 CVD 的成年人中，富含水果和蔬菜的饮食持续 8 周可降低亚临床心脏损伤和压力的标志物水平。
主要资金来源
美国国立卫生研究院，国家心肺血液研究所。
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