目的:已知植物性饮食可以改善普通人群的心脏代谢风险,但它们对心血管疾病(CVDs)高危人群的影响仍不确定。
目的:评估素食与主要心脏代谢危险因素的关系,包括低密度脂蛋白胆固醇(LDL-C),血红蛋白A1c(HbA1c),收缩压(SBP),患有或处于心血管疾病高风险人群的体重。
方法:这项荟萃分析在研究开始前进行。进行的系统搜索包括Embase,MEDLINE,CINAHL,和中央从成立到2021年7月31日。
方法:合格的随机临床试验(RCT),在患有或处于心血管疾病高风险的成年人中提供素食饮食,并测量LDL-C,包括HbA1c或SBP。在筛选的7871条记录中,29项(0.4%;20项研究)符合纳入标准。
方法:两位评审员独立提取数据,包括人口统计,研究设计,样本量,和饮食描述,并进行偏见风险评估。随机效应模型用于评估LDL-C的平均变化,HbA1c,SBP,和体重。使用建议分级评估证据的总体确定性,评估,发展,和评估(等级)工具。
方法:组间LDL-C变化(干预前与干预后)的平均差异,HbA1c,和SBP;次要结局是体重和能量摄入的变化。
结果:20个RCT,涉及1878名参与者(平均年龄范围,28-64岁)被包括在内,平均干预时间为25.4周(范围,2至24个月)。四项研究针对心血管疾病患者,7专注于糖尿病,9名患者至少有2个CVD危险因素。总的来说,相对于所有比较饮食,荟萃分析显示,平均6个月食用素食与LDL-C降低有关,HbA1c,体重为6.6mg/dL(95%CI,-10.1至-3.1),0.24%(95%CI,-0.40至-0.07),和3.4千克(95%CI,-4.9至-2.0),分别,但与SBP的相关性不显著(-0.1mmHg;95%CI,-2.8~2.6).GRADE评估显示LDL-C和HbA1c降低的证据水平中等。
结论:在这项研究中,食用素食与LDL-C的显着改善有关,心血管疾病高危人群的HbA1c和体重超出标准治疗。有必要进行其他高质量的试验,以进一步阐明健康的植物性饮食对心血管疾病患者的影响。
OBJECTIVE: Plant-based diets are known to improve cardiometabolic risk in the general population, but their effects on people at high risk of cardiovascular diseases (CVDs) remain inconclusive.
OBJECTIVE: To assess the association of vegetarian diets with major cardiometabolic risk factors, including low-density lipoprotein cholesterol (LDL-C), hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and body weight in people with or at high risk of CVDs.
METHODS: This meta-analysis was registered before the study was conducted. Systematic searches performed included Embase, MEDLINE, CINAHL, and CENTRAL from inception until July 31, 2021.
METHODS: Eligible randomized clinical trials (RCTs) that delivered vegetarian diets in adults with or at high risk of CVDs and measured LDL-C, HbA1c or SBP were included. Of the 7871 records screened, 29 (0.4%; 20 studies) met inclusion criteria.
METHODS: Two reviewers independently extracted data including demographics, study design, sample size, and diet description, and performed risk of bias assessment. A random-effects model was used to assess mean changes in LDL-C, HbA1c, SBP, and body weight. The overall certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool.
METHODS: Mean differences between groups in changes (preintervention vs postintervention) of LDL-C, HbA1c, and SBP; secondary outcomes were changes in body weight and energy intake.
RESULTS: Twenty RCTs involving 1878 participants (range of mean age, 28-64 years) were included, and mean duration of intervention was 25.4 weeks (range, 2 to 24 months). Four studies targeted people with CVDs, 7 focused on diabetes, and 9 included people with at least 2 CVD risk factors. Overall, relative to all comparison diets, meta-analyses showed that consuming vegetarian diets for an average of 6 months was associated with decreased LDL-C, HbA1c, and body weight by 6.6 mg/dL (95% CI, -10.1 to -3.1), 0.24% (95% CI, -0.40 to -0.07), and 3.4 kg (95% CI, -4.9 to -2.0), respectively, but the association with SBP was not significant (-0.1 mm Hg; 95% CI, -2.8 to 2.6). The GRADE assessment showed a moderate level of evidence for LDL-C and HbA1c reduction.
CONCLUSIONS: In this study, consuming a vegetarian diet was associated with significant improvements in LDL-C, HbA1c and body weight beyond standard therapy in individuals at high risk of CVDs. Additional high-quality trials are warranted to further elucidate the effects of healthy plant-based diets in people with CVDs.