PDF(Pubmed)
Abstract：
Suboptimal nutrition is a leading cause of poor health. Nutrition and policy science have advanced rapidly, creating confusion yet also providing powerful opportunities to reduce the adverse health and economic impacts of poor diets. This review considers the history, new evidence, controversies, and corresponding lessons for modern dietary and policy priorities for cardiovascular diseases, obesity, and diabetes mellitus. Major identified themes include the importance of evaluating the full diversity of diet-related risk pathways, not only blood lipids or obesity; focusing on foods and overall diet patterns, rather than single isolated nutrients; recognizing the complex influences of different foods on long-term weight regulation, rather than simply counting calories; and characterizing and implementing evidence-based strategies, including policy approaches, for lifestyle change. Evidence-informed dietary priorities include increased fruits, nonstarchy vegetables, nuts, legumes, fish, vegetable oils, yogurt, and minimally processed whole grains; and fewer red meats, processed (eg, sodium-preserved) meats, and foods rich in refined grains, starch, added sugars, salt, and trans fat. More investigation is needed on the cardiometabolic effects of phenolics, dairy fat, probiotics, fermentation, coffee, tea, cocoa, eggs, specific vegetable and tropical oils, vitamin D, individual fatty acids, and diet-microbiome interactions. Little evidence to date supports the cardiometabolic relevance of other popular priorities: eg, local, organic, grass-fed, farmed/wild, or non-genetically modified. Evidence-based personalized nutrition appears to depend more on nongenetic characteristics (eg, physical activity, abdominal adiposity, gender, socioeconomic status, culture) than genetic factors. Food choices must be strongly supported by clinical behavior change efforts, health systems reforms, novel technologies, and robust policy strategies targeting economic incentives, schools and workplaces, neighborhood environments, and the food system. Scientific advances provide crucial new insights on optimal targets and best practices to reduce the burdens of diet-related cardiometabolic diseases.
摘要：
营养欠佳是健康状况不佳的主要原因。营养和政策科学发展迅速，制造混乱，但也提供了强大的机会，以减少不良饮食对健康和经济的不利影响。这篇评论考虑了历史，新的证据,争议,以及现代饮食和心血管疾病政策重点的相应教训，肥胖，和糖尿病。确定的主要主题包括评估饮食相关风险途径的全部多样性的重要性，不仅仅是血脂或肥胖；关注食物和整体饮食模式，而不是单一的孤立的营养素；认识到不同食物对长期体重调节的复杂影响，而不是简单地计算卡路里；描述和实施基于证据的策略，包括政策方法，改变生活方式。有证据的饮食优先事项包括增加水果，非淀粉蔬菜，坚果,豆类,鱼,植物油,酸奶,和最少加工的全谷物；更少的红肉，已处理(例如，钠防腐）肉类，和富含精制谷物的食物，淀粉，添加糖，盐,和反式脂肪。需要对酚类物质的心脏代谢作用进行更多的研究，乳制品脂肪，益生菌，发酵，咖啡,茶，可可,鸡蛋,特定的植物和热带油，维生素D,单个脂肪酸，和饮食-微生物组相互作用。迄今为止，几乎没有证据支持其他流行优先事项的心脏代谢相关性：例如，当地,有机,草食，养殖/野生,或非转基因。基于证据的个性化营养似乎更多地依赖于非遗传特征(例如，身体活动,腹部肥胖,性别,社会经济地位,文化)而不是遗传因素。食物选择必须得到临床行为改变努力的大力支持，卫生系统改革，新技术,以及针对经济激励的强有力的政策战略，学校和工作场所，邻里环境，和食物系统。科学进步为减少饮食相关心脏代谢疾病负担的最佳目标和最佳实践提供了重要的新见解。
