生酮饮食作为一种饮食方法对心血管疾病危险因素的影响：随机临床试验的荟萃分析。

Impact of the ketogenic diet as a dietary approach on cardiovascular disease risk factors: a meta-analysis of randomized clinical trials.

机构信息

Clinical Metabolomics Center, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China.

Surgical Intensive Care Unit, Children's Hospital of Nanjing Medical University, Nanjing, China.

出版信息

Am J Clin Nutr. 2024 Aug;120(2):294-309. doi: 10.1016/j.ajcnut.2024.04.021. Epub 2024 Jul 15.

DOI:10.1016/j.ajcnut.2024.04.021

PMID:39097343

Abstract

BACKGROUND

Cardiovascular diseases (CVD) remain the leading cause of mortality globally, and the scarcity of scientific evidence regarding the impact of ketogenic diets on CVD risk factors necessitates urgent attention and redress.

OBJECTIVES

This meta-analysis evaluates the impact of the ketogenic diet on CVD risk factors compared with control diets through randomized controlled trials (RCTs).

METHODS

The study was registered in advance in the PROSPERO database (CRD42023491853). A systematic search was conducted across PubMed, Web of Science, EMBASE, and Cochrane Library to identify relevant RCTs. Fixed and random effects were employed to calculate the mean differences and 95% confidence intervals (CIs) for changes in CVD risk factors pre- and postketogenic diet intervention.

RESULTS

A total of 27 RCTs with 1278 participants were analyzed. The ketogenic diet intervention presented increase in total cholesterol (mean differences: 0.36 mmol/L; 95% CI: 0.15, 0.57; I: 85.1%), low-density lipoprotein cholesterol (mean differences: 0.35 mmol/L; 95% CI: 0.20, 0.50; I: 73.9%) and high-density lipoprotein cholesterol (mean differences: 0.16 mmol/L; 95% CI: 0.09, 0.23; I: 86.7%) concentrations. Reductions were observed in the triglyceride (mean differences: -0.20 mmol/L; 95% CI: -0.29, -0.11; I: 72.2%), blood glucose (mean differences: -0.18 mmol/L; 95% CI: -0.33, -0.02; I: 76.4%), blood insulin (mean differences: -8.32 pmol/L; 95% CI: -14.52, -2.12; I: 81.5%), diastolic blood pressure (mean differences: -1.41 mmHg; 95% CI: -2.57, -0.26; I: 49.1%), weight (mean differences: -2.59 kg; 95% CI: -3.90, -1.28; I: 87.4%), and body mass index (mean differences: -1.59 kg/m; 95% CI: -2.32, -0.86; I: 84.5%) concentrations after implementing ketogenic diets.

CONCLUSIONS

Although the ketogenic diet demonstrates benefits in terms of triglyceride, blood pressure, weight, and glycemic control, its impact on CVD risk factors, especially the elevated total cholesterol and low-density lipoprotein cholesterol concentrations, warrants a cautious approach.

摘要

背景

心血管疾病（CVD）仍然是全球范围内导致死亡的主要原因，而关于生酮饮食对 CVD 风险因素影响的科学证据匮乏，这需要引起紧急关注和重视。

目的

本荟萃分析通过随机对照试验（RCT）评估生酮饮食与对照饮食相比对 CVD 风险因素的影响。

方法

本研究已提前在 PROSPERO 数据库（CRD42023491853）中注册。通过 PubMed、Web of Science、EMBASE 和 Cochrane Library 进行系统检索，以确定相关 RCT。采用固定效应和随机效应模型计算生酮饮食干预前后 CVD 风险因素的平均差异和 95%置信区间（CI）。

结果

共纳入 27 项 RCT，涉及 1278 名参与者。生酮饮食干预可使总胆固醇（平均差异：0.36 mmol/L；95%CI：0.15，0.57；I：85.1%）、低密度脂蛋白胆固醇（平均差异：0.35 mmol/L；95%CI：0.20，0.50；I：73.9%）和高密度脂蛋白胆固醇（平均差异：0.16 mmol/L；95%CI：0.09，0.23；I：86.7%）浓度升高。同时，三酰甘油（平均差异：-0.20 mmol/L；95%CI：-0.29，-0.11；I：72.2%）、血糖（平均差异：-0.18 mmol/L；95%CI：-0.33，-0.02；I：76.4%）、血胰岛素（平均差异：-8.32 pmol/L；95%CI：-14.52，-2.12；I：81.5%）、舒张压（平均差异：-1.41 mmHg；95%CI：-2.57，-0.26；I：49.1%）、体重（平均差异：-2.59 kg；95%CI：-3.90，-1.28；I：87.4%）和身体质量指数（平均差异：-1.59 kg/m；95%CI：-2.32，-0.86；I：84.5%）浓度降低。