碳水化合物限制膳食干预对减肥或维持体重成年人 LDL 颗粒大小和数量的影响：系统评价和荟萃分析。

Effect of carbohydrate-restricted dietary interventions on LDL particle size and number in adults in the context of weight loss or weight maintenance: a systematic review and meta-analysis.

机构信息

School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada.

School of Medicine, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong, New South Wales, Australia.

出版信息

Am J Clin Nutr. 2021 Oct 4;114(4):1455-1466. doi: 10.1093/ajcn/nqab212.

DOI:10.1093/ajcn/nqab212

PMID:34159352

Abstract

BACKGROUND

LDL particle size and number (LDL-P) are emerging lipid risk factors. Nonsystematic reviews have suggested that diets lower in carbohydrates and higher in fats may result in increased LDL particle size when compared with higher-carbohydrate diets.

OBJECTIVES

This study aimed to systematically review available evidence and conduct meta-analyses of studies addressing the association of carbohydrate restriction with LDL particle size and LDL-P.

METHODS

We searched 6 electronic databases on 4 January, 2021 for randomized trials of any length that reported on dietary carbohydrate restriction (intervention) compared with higher carbohydrate intake (control). We calculated standardized mean differences (SMDs) in LDL particle size and LDL-P between the intervention and control groups of eligible studies, and pooled effect sizes using random-effects models. We performed prespecified subgroup analyses and examined the effect of potential explanatory factors. Internal validity and publication bias were assessed using Cochrane's risk-of-bias tool and funnel plots, respectively. Studies that could not be meta-analyzed were summarized qualitatively.

RESULTS

This review summarizes findings from 38 randomized trials including a total of 1785 participants. Carbohydrate-restricted dietary interventions were associated with an increase in LDL peak particle size (SMD = 0.50; 95% CI: 0.15, 0.86; P < 0.01) and a reduction in LDL-P (SMD = -0.24; 95% CI: -0.43, -0.06; P = 0.02). The effect of carbohydrate-restricted dietary interventions on LDL peak particle size appeared to be partially explained by differences in weight loss between intervention groups and exploratory analysis revealed a shift from small dense to larger LDL subclasses. No statistically significant association was found between carbohydrate-restricted dietary interventions and mean LDL particle size (SMD = 0.20; 95% CI: -0.29, 0.69; P = 0.37).

CONCLUSIONS

The available evidence indicates that dietary interventions restricted in carbohydrates increase LDL peak particle size and decrease the numbers of total and small LDL particles.This review was registered at www.crd.york.ac.uk/prospero/ as CRD42020188745.

摘要

背景

低密度脂蛋白颗粒大小和数量（LDL-P）是新兴的脂质风险因素。非系统性综述表明，与高碳水化合物饮食相比，低碳水化合物和高脂肪的饮食可能导致 LDL 颗粒大小增加。

目的

本研究旨在系统地综述现有证据，并对研究碳水化合物限制与 LDL 颗粒大小和 LDL-P 之间关系的研究进行荟萃分析。

方法

我们于 2021 年 1 月 4 日在 6 个电子数据库中检索了任何长度的随机试验，这些试验报告了饮食中碳水化合物限制（干预）与高碳水化合物摄入（对照）的比较。我们计算了合格研究中干预组和对照组之间 LDL 颗粒大小和 LDL-P 的标准化均数差值（SMD），并使用随机效应模型汇总效应大小。我们进行了预先指定的亚组分析，并检查了潜在解释因素的影响。使用 Cochrane 的偏倚风险工具和漏斗图分别评估内部有效性和发表偏倚。无法进行荟萃分析的研究则进行定性总结。

结果

本综述总结了 38 项随机试验的结果，共纳入 1785 名参与者。低碳水化合物饮食干预与 LDL 峰颗粒大小增加相关（SMD=0.50；95%CI：0.15，0.86；P<0.01）和 LDL-P 减少（SMD=-0.24；95%CI：-0.43，-0.06；P=0.02）。碳水化合物限制饮食干预对 LDL 峰颗粒大小的影响似乎部分归因于干预组之间体重减轻的差异，探索性分析显示从小而密的 LDL 亚类向更大的 LDL 亚类转变。碳水化合物限制饮食干预与平均 LDL 颗粒大小之间无统计学显著关联（SMD=0.20；95%CI：-0.29，0.69；P=0.37）。