利用随机对照试验的标准和网状荟萃分析评估膳食蛋白质的数量和类型对心血管疾病风险因素的影响
Impact of Quantity and Type of Dietary Protein on Cardiovascular Disease Risk Factors Using Standard and Network Meta-analyses of Randomized Controlled Trials.
作者信息
Yao Yueying, Huang Vanessa, Seah Vernice, Kim Jung Eun
机构信息
Department of Food Science and Technology, National University of Singapore, 117543 Singapore.
出版信息
Nutr Rev. 2025 Mar 1;83(3):e814-e828. doi: 10.1093/nutrit/nuae086.
CONTEXT
Higher protein diets (HPDs) have shown favorable outcomes on weight maintenance and body-composition management; however, their protective effects against cardiovascular diseases (CVDs) remain uncertain and contentious. Furthermore, it is important to consider the influence of other macronutrients in the diet and type of dietary protein when studying HPDs, because this aspect has been overlooked in previous studies.
OBJECTIVE
We assessed the impacts of quantity and type of dietary protein on CVD risk factors.
DATA SOURCES
A database search was conducted in PubMed, Embase, CINAHL, Web of Science, and Cochrane Library and a total of 100 articles met the eligibility criteria.
DATA EXTRACTION
Extracted data from 100 articles were analyzed using standard meta-analysis, and 41 articles were also analyzed using network meta-analysis.
DATA ANALYSIS
In the standard meta-analysis, an HPD had significant favorable effects on systolic blood pressure (SBP) (mean difference [MD] = -1.51 mmHg; 95% CI: -2.77, -0.25), diastolic blood pressure (DBP) (MD = -1.08 mmHg; 95% CI: -1.81, -0.35), and flow-mediated dilation (MD = 0.78%; 95% CI: 0.09, 1.47) compared with lower protein diets. The further network meta-analysis supported that the high-protein, high-carbohydrate, low-fat diet was the most recommended diet to ensure a maximum decrease in SBP, DBP, total cholesterol (TC), and low-density-lipoprotein cholesterol (LDL-C). In comparison to animal-protein-rich diets, plant-protein-rich diets (PPRs) exhibited a significant favorable effects on improving TC (MD = -0.12 mmol/L; 95% CI: -0.19, -0.05), triglyceride (MD = -0.05 mmol/L; 95% CI: -0.09, -0.01), LDL-C (MD = -0.11 mmol/L; 95% CI: -0.18, -0.04), and high-density-lipoprotein cholesterol (MD = 0.03 mmol/L; 95% CI: 0.02, 0.04) levels.
CONCLUSION
Consumption of HPDs and PPRs supports improvements in vascular health and lipid-lipoprotein profiles, respectively. Furthermore, macronutrient composition should be carefully designed in the dietary approach to maximize the effectiveness of HPDs in improving CVD risk factors.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration no. CRD42022369931.
背景
高蛋白饮食（HPDs）已显示出在体重维持和身体成分管理方面有良好效果；然而，它们对心血管疾病（CVDs）的保护作用仍不确定且存在争议。此外，在研究高蛋白饮食时，考虑饮食中其他宏量营养素的影响以及膳食蛋白质的类型很重要，因为这一方面在以往研究中被忽视了。
目的
我们评估了膳食蛋白质的数量和类型对心血管疾病风险因素的影响。
数据来源
在PubMed、Embase、CINAHL、Web of Science和Cochrane图书馆进行了数据库搜索，共有100篇文章符合纳入标准。
数据提取
从100篇文章中提取的数据使用标准荟萃分析进行分析，41篇文章还使用网络荟萃分析进行分析。
数据分析
在标准荟萃分析中，与低蛋白饮食相比，高蛋白饮食对收缩压（SBP）（平均差值[MD]= -1.51 mmHg；95%置信区间：-2.77，-0.25）、舒张压（DBP）（MD = -1.08 mmHg；95%置信区间：-1.81，-0.35）和血流介导的血管舒张（MD = 0.78%；95%置信区间：0.09，1.47）有显著的有利影响。进一步的网络荟萃分析支持，高蛋白、高碳水化合物、低脂肪饮食是最推荐的饮食，以确保最大程度降低收缩压、舒张压、总胆固醇（TC）和低密度脂蛋白胆固醇（LDL-C）。与富含动物蛋白的饮食相比，富含植物蛋白的饮食（PPRs）在改善总胆固醇（MD = -0.12 mmol/L；95%置信区间：-0.19，-0.05）、甘油三酯（MD = -0.05 mmol/L；95%置信区间：-0.09，-0.01）、低密度脂蛋白胆固醇（MD = -0.11 mmol/L；95%置信区间：-0.18，-0.04）和高密度脂蛋白胆固醇（MD = 0.03 mmol/L；95%置信区间：0.02，0.04）水平方面有显著的有利影响。
结论
食用高蛋白饮食和富含植物蛋白的饮食分别有助于改善血管健康和血脂 - 脂蛋白谱。此外，在饮食方法中应仔细设计宏量营养素组成，以最大限度提高高蛋白饮食在改善心血管疾病风险因素方面的有效性。
系统评价注册
PROSPERO注册号CRD42022369931。
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