背景:饮食指南建议转向植物性饮食。强化豆浆,一种典型的植物蛋白食品,用于向植物性饮食过渡,通常含有添加糖,以匹配牛奶的甜味,被归类为超加工食品。豆浆是否可以替代最低限度加工的牛奶,而不会因添加糖和超加工食品而产生不利的心脏代谢影响,目前尚不清楚。我们对随机对照试验进行了系统评价和荟萃分析,评估用豆浆代替牛奶及其添加糖(加糖与不加糖)对中间心脏代谢结果的影响。
方法:MEDLINE,Embase,并在Cochrane中央对照试验注册中心(至2024年6月)中搜索成人≥3周的随机对照试验.结果包括确定的血脂标志物,血糖控制,血压,炎症,肥胖,肾脏疾病,尿酸,和非酒精性脂肪性肝病。两名独立审稿人提取数据并评估偏倚风险。证据的确定性使用等级(建议分级,评估,发展,和评估)。进行了乳制品样基质外的乳糖与蔗糖的子研究,以探索遵循相同方法的增甜豆浆的作用。
结果:17项试验符合资格标准(n=504名具有一系列健康状况的成年人),评估每日中位剂量500mL豆浆(22g大豆蛋白和17.2g或6.9g/250mL添加糖)替代500mL牛奶(24g牛奶蛋白和24g或12g/250mL总糖作为乳糖)对19个中间结局的影响。用豆浆代替牛奶导致非HDL-C的适度减少(平均差,-0.26mmol/L[95%置信区间,-0.43至-0.10]),收缩压(-8.00mmHg[-14.89至-1.11]),和舒张压(-4.74mmHg[-9.17至-0.31]);LDL-C(-0.19mmol/L[-0.29至-0.09])和C-反应蛋白(CRP)(-0.82mg/L[-1.26至-0.37])的小幅重要降低;HDL-C(0.05mmol/L[0.00至0.09])。其他结果无差异。在结果之间添加糖没有有意义的效果修饰。LDL-C和非HDL-C的证据确定性较高;收缩压中等,舒张压,CRP,和HDL-C;所有其他结局通常为中等至低。我们无法进行乳糖与添加糖的影响的子研究,因为无法确定合格的试验.
结论:目前的证据提供了一个很好的迹象,表明用豆浆(包括甜豆浆)代替牛奶不会对已确定的心脏代谢危险因素产生不利影响,并可能导致血脂方面的优势,血压,和患有多种健康状况的成年人的炎症。将豆浆等植物性乳制品替代品分类为超加工可能会产生误导,因为这涉及到它们的心脏代谢作用,并且在向植物性饮食过渡时可能需要重新考虑。
背景:ClinicalTrials.gov标识符,NCT05637866。
BACKGROUND: Dietary guidelines recommend a shift to plant-based diets. Fortified soymilk, a prototypical plant protein food used in the transition to plant-based diets, usually contains added sugars to match the sweetness of cow\'s milk and is classified as an ultra-processed food. Whether soymilk can replace minimally processed cow\'s milk without the adverse cardiometabolic effects attributed to added sugars and ultra-processed foods remains unclear. We conducted a systematic review and meta-analysis of randomized controlled trials, to assess the effect of substituting soymilk for cow\'s milk and its modification by added sugars (sweetened versus unsweetened) on intermediate cardiometabolic outcomes.
METHODS: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched (through June 2024) for randomized controlled trials of ≥ 3 weeks in adults. Outcomes included established markers of blood lipids, glycemic control, blood pressure, inflammation, adiposity, renal disease, uric acid, and non-alcoholic fatty liver disease. Two independent reviewers extracted data and assessed risk of bias. The certainty of evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). A sub-study of lactose versus sucrose outside of a dairy-like matrix was conducted to explore the role of sweetened soymilk which followed the same methodology.
RESULTS: Eligibility criteria were met by 17 trials (n = 504 adults with a range of health statuses), assessing the effect of a median daily dose of 500 mL of soymilk (22 g soy protein and 17.2 g or 6.9 g/250 mL added sugars) in substitution for 500 mL of cow\'s milk (24 g milk protein and 24 g or 12 g/250 mL total sugars as lactose) on 19 intermediate outcomes. The substitution of soymilk for cow\'s milk resulted in moderate reductions in non-HDL-C (mean difference, - 0.26 mmol/L [95% confidence interval, - 0.43 to - 0.10]), systolic blood pressure (- 8.00 mmHg [- 14.89 to - 1.11]), and diastolic blood pressure (- 4.74 mmHg [- 9.17 to - 0.31]); small important reductions in LDL-C (- 0.19 mmol/L [- 0.29 to - 0.09]) and c-reactive protein (CRP) (- 0.82 mg/L [- 1.26 to - 0.37]); and trivial increases in HDL-C (0.05 mmol/L [0.00 to 0.09]). No other outcomes showed differences. There was no meaningful effect modification by added sugars across outcomes. The certainty of evidence was high for LDL-C and non-HDL-C; moderate for systolic blood pressure, diastolic blood pressure, CRP, and HDL-C; and generally moderate-to-low for all other outcomes. We could not conduct the sub-study of the effect of lactose versus added sugars, as no eligible trials could be identified.
CONCLUSIONS: Current evidence provides a good indication that replacing cow\'s milk with soymilk (including sweetened soymilk) does not adversely affect established cardiometabolic risk factors and may result in advantages for blood lipids, blood pressure, and inflammation in adults with a mix of health statuses. The classification of plant-based dairy alternatives such as soymilk as ultra-processed may be misleading as it relates to their cardiometabolic effects and may need to be reconsidered in the transition to plant-based diets.
BACKGROUND: ClinicalTrials.gov identifier, NCT05637866.