Sun Yajing, Shang Mingjing, Zhang Yujiao, Hu Jun, Wang Haiyan
Nephrology, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
Community Health Service Center, Songnan Town, Baoshan District, Shanghai, 200441, China.
Sci Rep. 2025 Aug 6;15(1):28749. doi: 10.1038/s41598-025-13596-x.
Cardiovascular disease (CVD) is a major global health concern associated with modifiable risk factors including obesity, hypertension, dyslipidemia, and hyperglycemia. While various dietary patterns have demonstrated cardiovascular benefits, their comparative effectiveness remains unclear. This network meta-analysis (NMA) systematically evaluates the impact of eight dietary patterns on cardiovascular risk markers. We included randomized controlled trials (RCTs) assessing low-fat, Mediterranean, ketogenic, low-carbohydrate, high-protein, vegetarian, intermittent fasting, and DASH diets. A random-effects model analyzed mean differences (MD) in body composition (weight, BMI, waist circumference), lipid profiles (triglycerides, total cholesterol, HDL-C, LDL-C), glycemic markers (glucose), and blood pressure (systolic/diastolic). Dietary efficacy was ranked via Surface Under the Cumulative Ranking Curve (SUCRA) scores. Among 21 RCTs (1,663 participants), ketogenic (MD -10.5 kg, 95% CI -18.0 to -3.05; SUCRA 99) and high-protein diets (MD -4.49 kg, 95% CI -9.55 to 0.35; SUCRA 71) showed superior efficacy for weight reduction. For waist circumference, ketogenic (MD -11.0 cm, 95% CI -17.5 to -4.54; SUCRA 100) and low-carbohydrate diets (MD -5.13 cm, 95% CI -8.83 to -1.44; SUCRA 77) achieved greatest reductions. DASH diet most effectively lowered systolic blood pressure (MD -7.81 mmHg, 95% CI -14.2 to -0.46; SUCRA 89), while intermittent fasting also demonstrated significant blood pressure-lowering effects (MD -5.98 mmHg, 95% CI -10.4 to -0.35; SUCRA 76). Low-carbohydrate (MD 4.26 mg/dL, 95% CI 2.46-6.49; SUCRA 98) and low-fat diets (MD 2.35 mg/dL, 95% CI 0.21-4.40; SUCRA 78) optimally increased HDL-C. Diet-specific cardioprotective effects were observed: ketogenic and high-protein diets excel in weight management, DASH and intermittent fasting in blood pressure control, and carbohydrate-restricted diets in lipid modulation. These findings support personalized dietary strategies for targeted CVD risk factor management.
心血管疾病（CVD）是一个主要的全球健康问题，与包括肥胖、高血压、血脂异常和高血糖在内的可改变风险因素相关。虽然各种饮食模式已显示出对心血管有益，但它们的相对有效性仍不明确。这项网络荟萃分析（NMA）系统地评估了八种饮食模式对心血管风险标志物的影响。我们纳入了评估低脂、地中海、生酮、低碳水化合物、高蛋白、素食、间歇性禁食和得舒饮食的随机对照试验（RCT）。随机效应模型分析了身体成分（体重、BMI、腰围）、血脂谱（甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇）、血糖标志物（葡萄糖）和血压（收缩压/舒张压）的平均差异（MD）。通过累积排名曲线下面积（SUCRA）分数对饮食疗效进行排名。在21项RCT（1663名参与者）中，生酮饮食（MD -10.5 kg，95%CI -18.0至-3.05；SUCRA 99）和高蛋白饮食（MD -4.49 kg，95%CI -9.55至0.35；SUCRA 71）在减重方面显示出卓越疗效。对于腰围，生酮饮食（MD -11.0 cm，95%CI -17.5至-4.54；SUCRA 100）和低碳水化合物饮食（MD -5.13 cm，95%CI -8.83至-1.44；SUCRA 77）实现了最大程度的降低。得舒饮食最有效地降低了收缩压（MD -7.81 mmHg，95%CI -14.2至-0.46；SUCRA 89），而间歇性禁食也显示出显著的降压效果（MD -5.98 mmHg，95%CI -10.4至-0.35；SUCRA 76）。低碳水化合物饮食（MD 4.26 mg/dL，95%CI 2.46 - 6.49；SUCRA 98）和低脂饮食（MD 2.35 mg/dL，95%CI 0.21 - 4.40；SUCRA 78）能最佳地提高高密度脂蛋白胆固醇。观察到了特定饮食的心脏保护作用：生酮和高蛋白饮食在体重管理方面表现出色，得舒和间歇性禁食在血压控制方面表现出色，而碳水化合物限制饮食在血脂调节方面表现出色。这些发现支持针对心血管疾病风险因素管理的个性化饮食策略。
