限制饱和脂肪摄入对心血管疾病的预防作用：一项随机对照试验的系统评价和荟萃分析
Saturated Fat Restriction for Cardiovascular Disease Prevention: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
作者信息
Yamada Satoru, Shirai Tomomi, Inaba Sakiko, Inoue Gaku, Torigoe Minami, Fukuyama Naoto
机构信息
Diabetes Center, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan.
Department of Nutritional Science, Tokyo University of Agriculture, Tokyo, Japan.
出版信息
JMA J. 2025 Apr 28;8(2):395-407. doi: 10.31662/jmaj.2024-0324. Epub 2025 Mar 21.
BACKGROUND
The recommendation to limit dietary saturated fat intake is primarily drawn from observational studies rather than randomized controlled trials of cardiovascular disease prevention. Thus, we aimed to investigate the efficacy of saturated fat reduction in preventing mortality and cardiovascular diseases.
METHODS
In this systematic review and meta-analysis of randomized controlled trials, Cochrane CENTRAL, PubMed, and Ichu-shi databases were searched for articles up to April 2023. Randomized controlled trials on saturated fat reduction to prevent cardiovascular diseases were selected. Cardiovascular and all-cause mortality and cardiovascular outcomes were evaluated. Changes in electrocardiography or coronary angiography findings were excluded because they could be evaluated arbitrarily. Two or more reviewers independently extracted and assessed the data. A random-effects meta-analysis was performed.
RESULTS
Nine eligible trials with 13,532 participants were identified (2 were primary and 7 were secondary prevention studies). No significant differences in cardiovascular mortality (relative risk [RR] = 0.94, 95% confidence interval [CI]: 0.75-1.19), all-cause mortality (RR = 1.01, 95% CI: 0.89-1.14), myocardial infarction (RR = 0.85, 95% CI: 0.71-1.02), and coronary artery events (RR = 0.85, 95% CI: 0.65-1.11) were observed between the intervention and control groups. However, owing to limited reported cases, the impact of stroke could not be evaluated.
CONCLUSIONS
The findings indicate that a reduction in saturated fats cannot be recommended at present to prevent cardiovascular diseases and mortality. Clinical trials are needed to evaluate the effects of saturated fat reduction under the best possible medical care, including statin administration.
SYSTEMATIC REVIEW REGISTRATION NUMBER
This systematic review and meta-analysis was registered with the International Prospective Register of Systematic Reviews (CRD42023428498).
背景
限制饮食中饱和脂肪摄入量的建议主要基于观察性研究，而非预防心血管疾病的随机对照试验。因此，我们旨在研究降低饱和脂肪摄入量在预防死亡和心血管疾病方面的效果。
方法
在这项对随机对照试验的系统评价和荟萃分析中，检索了截至2023年4月的Cochrane CENTRAL、PubMed和Ichushi数据库中的文章。选取了关于降低饱和脂肪摄入量以预防心血管疾病的随机对照试验。评估了心血管和全因死亡率以及心血管结局。排除了心电图或冠状动脉造影结果的变化，因为这些结果可能会被任意评估。两名或更多的评审员独立提取和评估数据。进行了随机效应荟萃分析。
结果
确定了9项符合条件的试验，共13532名参与者（2项为一级预防研究，7项为二级预防研究）。干预组和对照组在心血管死亡率（相对风险[RR]=0.94，95%置信区间[CI]：0.75-1.19）、全因死亡率（RR=1.01，95%CI：0.89-1.14）、心肌梗死（RR=0.85，95%CI：0.71-1.02）和冠状动脉事件（RR=0.85，95%CI：0.65-1.11）方面未观察到显著差异。然而，由于报告的病例有限，无法评估中风的影响。
结论
研究结果表明，目前不建议通过降低饱和脂肪摄入量来预防心血管疾病和死亡。需要进行临床试验，以评估在包括使用他汀类药物在内的最佳医疗护理下降低饱和脂肪摄入量的效果。
系统评价注册号
本系统评价和荟萃分析已在国际前瞻性系统评价注册库（CRD42023428498）注册。
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