地中海飲食減少心血管事件、癌症、糖尿病風險


  【24drs.com】一篇新回顧研究認為,依循地中海飲食而無限制脂肪攝取,可減少心血管(CV)事件、癌症、第二型糖尿病發生率。
  
  明尼蘇達州明尼亞波里斯退伍軍人醫學中心Hanna E. Bloomfield醫師等人寫道,我們的主要結論是,隨機試驗的有限證據顯示,地中海飲食而無限制脂肪攝取,與心血管事件、各種癌症、乳癌、第二型糖尿病發生率降低有關,但是不會影響各種原因死亡率。
  
  這篇系統性回顧與統合分析的結果,線上發表於7月18日的內科醫學誌。
  
  儘管診斷和治療有所進步,心血管疾病、癌症、糖尿病等慢性病,依舊是美國發病率和死亡率的主因,根據Bloomfield醫師等人指出,在過去廿年,全球死於心血管疾病之比率和糖尿病盛行率增加超過40%。
  
  作者們寫道,典型的西式飲食富含飽和脂肪、糖、精製穀類,和發生心血管疾病、[第二型]糖尿病、乳癌與結腸直腸癌等某些癌症有因果關聯。
  
  地中海飲食富含蔬果、單元不飽和脂肪(佔每日總攝取熱量的30%-40%) — 特別是橄欖油 —以及豆類和魚,攝取低到中度的乳製品和肉製品。許多研究顯示,地中海飲食可改善多種臨床結果,包括降低總死亡率。
  
  Bloomfield醫師等人進行研究,評估地中海飲食的健康效益,並確認北美洲人是否可依循這類飲食習慣。
  
  作者們搜尋了多個電子資料庫以確認可納入之研究,他們納入研究對象百人以上且追蹤死亡率、心血管疾病、高血壓、糖尿病與依從性結果至少一年的控制試驗,他們也納入追蹤癌症結果的世代研究。
  
  他們將地中海飲食定義為,沒有限制總脂肪攝取量且包括以下七種組成的兩種以上:單元不飽和脂肪/飽和脂肪比率高、蔬果攝取量高、豆類攝取量高、穀類與穀片攝取量高、適量攝取紅酒、適量攝取乳製品、肉類與肉製品攝取量低但魚類攝取量高。
  
  總共有56項研究的90篇文章符合納入標準,不過其中3篇研究可能與研究舞弊有關,最後未被納入分析。
  
  根據作者指出,一篇大型初步預防試驗的資料顯示,相較於依循對照飲食者,地中海飲食者的重大心血管事件(心肌梗塞、中風或心血管原因死亡;風險比[HR], 0.71; 95%信賴區間[CI], 0.56 - 0.90)、乳癌(HR, 0.43; CI, 0.21 - 0.88)、糖尿病(HR, 0.70; CI, 0.54 - 0.92)發生率較低。
  
  研究者也對探討癌症結果、比較地中海飲食依從性最高和最低組別的初級預防世代研究進行彙整分析。
  
  結果顯示,相較於依從性最低者,地中海飲食依從性最高者的總癌症死亡率降低14%(風險比[RR], 0.86; CI, 0.82 - 0.91; 13篇研究)、所有癌症發生率降低4%(RR, 0.96; CI, 0.95 - 0.97; 3篇研究)、結腸直腸癌發生率降低9%(RR, 0.91; CI, 0.84 - 0.98;9篇研究)。
  
  Bloomfield醫師在美國外科醫師學院的Soundbites影片中報告指出,我們的研究發現,健康飲食可以包括許多脂肪,特別是健康的脂肪的話;過去至少卅年間,美國一直強調減少脂肪—各種脂肪—脂肪是壞事。
  
  她指出,事實證明,這個國家的肥胖流行病或許主要是因為我們的精製穀類和添加糖類的攝取量增加,而非因為我們的脂肪攝取。
  
  作者們指出,不過,其他結果則是不一致或證據有限或無證據,包括各種原因死亡率、高血壓、認知功能、腎臟病、類風濕性關節炎、生活品質等,此外,沒有研究符合飲食依從性結果的納入標準。
  
  他們結論指出,未來的研究應包括美國人口的隨機試驗,以評估依從性、效果、各項臨床結果之影響;模擬研究以確認是否特定的地中海飲食組成或合併哪些組成更有效;並採用隨機試驗評估地中海飲食相較於其他健康飲食,如DASH (得舒飲食;停止高血壓的飲食法/Dietary Approaches to Stop Hypertension)或謹慎飲食的相對效果。
  
  資料來源:http://www.24drs.com/
  
  Native link:Mediterranean Diet Cuts Risk for CV Events, Cancer, Diabetes

Mediterranean Diet Cuts Risk for CV Events, Cancer, Diabetes

By Nicola M. Parry, DVM
Medscape Medical News

The findings of a new review suggest that following a Mediterranean diet with no restriction on fat intake may reduce the incidence of cardiovascular (CV) events, cancer, and type 2 diabetes.

"Our primary conclusion is that there is limited evidence from randomized trials that a Mediterranean diet with no restriction on fat intake may be associated with a reduced incidence of cardiovascular events, all-cancers, breast cancer, and type 2 diabetes mellitus but does not affect all-cause mortality," write Hanna E. Bloomfield, MD, MPH, from the Minneapolis Veterans Affairs Medical Center, Minnesota, and colleagues.

The results of the systematic review and meta-analysis were published online July 18 in Annals of Internal Medicine.

Despite advances in diagnosis and treatment, chronic illnesses, such as CV disease, cancer, and diabetes, remain among the leading causes of morbidity and mortality in the United States. According to Dr Bloomfield and colleagues, global deaths due to CV disease and the prevalence of diabetes have increased by more than 40% in the past 2 decades.

"Typical Western diets, which are high in saturated fats, sugar, and refined grains, are causally associated with development of cardiovascular disease, [type 2] diabetes, and some types of cancer, including breast and colorectal cancer," the authors write.

The Mediterranean diet is a fruit- and vegetable-rich diet that is high in monounsaturated fats (30% to 40% of total daily calorie intake) — in particular, olive oil — as well as legumes and fish, with a low to moderate intake of dairy and meat products. Several studies have shown its benefit in improving various clinical outcomes, including a reduction in total mortality.

Dr Bloomfield and colleagues conducted their study to evaluate the health benefits of a Mediterranean diet and to determine whether North Americans are likely to adhere to such a diet.

"Healthy Diets Can Include a Lot of Fat"

The authors searched various electronic databases to identify studies for inclusion. They included controlled trials that involved 100 or more persons who were followed for at least 1 year for mortality, CV disease, hypertension, diabetes, and adherence outcomes. They also included cohort studies whose participants were followed for cancer outcomes.

They defined a Mediterranean diet as one without restriction on total fat intake and that included two or more of seven components: high monounsaturated–to–saturated fat ratio, high fruit and vegetable intake, high legume consumption, high grain and cereal intake, moderate red wine intake, moderate dairy product consumption, and low meat and meat product consumption, but with high fish consumption.

A total of 90 articles representing 56 unique studies met their inclusion criteria, although three of these studies were linked to possible research fraud and ultimately were not included in the analysis.

According to the authors, data from one large primary prevention trial showed that, compared with individuals who followed a control diet, participants who followed a Mediterranean diet had a lower incidence of major CV events (myocardial infarction, stroke, or CV death; hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.56 - 0.90), breast cancer (HR, 0.43; CI, 0.21 - 0.88), and diabetes (HR, 0.70; CI, 0.54 - 0.92).

The researchers also performed pooled analyses of primary prevention cohort studies that reported cancer outcomes and that compared groups with the highest and lowest Mediterranean diet adherence.

These results showed that, compared with individuals with the lowest adherence, those with the highest adherence to a Mediterranean diet had a 14% reduction in total cancer mortality (risk ratio [RR], 0.86; CI, 0.82 - 0.91; 13 studies), a 4% reduction in the incidence of all-cancers (RR, 0.96; CI, 0.95 - 0.97; three studies), and a 9% reduction in the incidence of colorectal cancer (RR, 0.91; CI, 0.84 - 0.98; nine studies).

"[W]hat we found in our study is that healthy diets can include a lot of fat, especially if it's healthy fat; and the emphasis in the United States at least for the past thirty years has been [that] it's important to reduce fat — fat of all kind— fat's the bad thing," reports Dr Bloomfield in an American College of Physicians Soundbites video.

"It turns out that the obesity epidemic in this country is probably more due to our increased consumption of refined grains and added sugar and not so much from our fat consumption," she adds.

However, the study found inconsistent, minimal, or no evidence pertaining to other outcomes, including all-cause mortality, hypertension, cognitive function, kidney disease, rheumatoid arthritis, and quality of life. In addition, no studies met the inclusion criteria for dietary adherence outcomes, the authors note.

"Future investigation should include randomized trials in US populations to assess adherence, efficacy, and effect on a wider range of clinical outcomes; modeling studies to determine whether specific Mediterranean diet components or combinations of components are more protective than others; and randomized trials to assess the relative effectiveness of the Mediterranean diet compared with other healthy diets, such as the DASH (Dietary Approaches to Stop Hypertension) or prudent diet," they conclude.

The study was supported by the Department of Veterans Affairs, the Veterans Health Administration, the Office of Research and Development, and the Quality Enhancement Research Initiative. The authors have disclosed no relevant financial relationships.

Ann Intern Med. Published online July 18, 2016.

    
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