Metz J A, Kris-Etherton P M, Morris C D, Mustad V A, Stern J S, Oparil S, Chait A, Haynes R B, Resnick L M, Clark S, Hatton D C, McMahon M, Holcomb S, Snyder G W, Pi-Sunyer F X, McCarron D A
Department of Medicine, Oregon Health Sciences University, Portland 97201, USA.
Am J Clin Nutr. 1997 Aug;66(2):373-85. doi: 10.1093/ajcn/66.2.373.
Noncompliance with therapeutic diets remains a major obstacle to achieving improvements in cardiovascular disease (CVD) morbidity and mortality. This study compared dietary compliance and CVD risk factor response to two dietary interventions designed to treat hypertension, dyslipidemia, and diabetes mellitus. In a multicenter trial, 560 adults were randomly assigned to either a self-selected, mixed-food plan (n = 277), or a nutrient-fortified prepared meal plan (n = 283); each was designed to provide 15-20% of energy from fat, 55-60% from carbohydrate, and 15-20% from protein. Nutrient intake was estimated from 3-d food records collected biweekly throughout the 10-wk intervention. Compliance was determined by evaluating the participants' ability to meet specific criteria for energy intake [+/-420 kJ (100 kcal) from the midpoint of the prescribed energy range], fat intake (< 20%, < 25%, or < 30% of energy from total fat), and the National Cholesterol Education Program/American Heart Association Step 1 and 2 diet recommendations. Compliance with energy, fat, and Step 1 and 2 criteria was better in participants who followed the prepared meal plan than in those who followed the self-selected diet (P < 0.0001). Compliant participants in both groups achieved greater reductions in body weight, systolic and diastolic blood pressure, and total and low-density-lipoprotein cholesterol than noncompliant participants (P < 0.05). In general, better endpoint responses were observed with lower fat intakes regardless of group assignment. The prepared meal plan is a simple and effective strategy for meeting the many nutrient recommendations for CVD risk reduction and improving dietary compliance and CVD endpoints.
不遵守治疗性饮食仍然是改善心血管疾病（CVD）发病率和死亡率的主要障碍。本研究比较了两种旨在治疗高血压、血脂异常和糖尿病的饮食干预措施的饮食依从性和CVD危险因素反应。在一项多中心试验中，560名成年人被随机分配到自我选择的混合食物计划组（n = 277）或营养强化预制餐计划组（n = 283）；每组计划的设计目标是提供15 - 20%的能量来自脂肪，55 - 60%来自碳水化合物，15 - 20%来自蛋白质。在为期10周的干预期间，每两周收集一次3天的食物记录来估算营养摄入量。通过评估参与者满足能量摄入特定标准[规定能量范围中点上下420千焦（100千卡）]、脂肪摄入（总脂肪能量占比< 20%、< 25%或< 30%）以及美国国家胆固醇教育计划/美国心脏协会第一步和第二步饮食建议的能力来确定依从性。遵循预制餐计划的参与者在能量、脂肪以及第一步和第二步标准方面的依从性优于遵循自我选择饮食的参与者（P < 0.0001）。两组中依从的参与者比不依从的参与者在体重、收缩压和舒张压以及总胆固醇和低密度脂蛋白胆固醇方面有更大程度的降低（P < 0.05）。总体而言，无论分组如何，脂肪摄入量较低时观察到更好的终点反应。预制餐计划是一种简单有效的策略，可满足多项降低CVD风险的营养建议，提高饮食依从性和CVD终点指标。
