Impact of Replacement of Individual Dietary SFAs on Circulating Lipids and Other Biomarkers of Cardiometabolic Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials in Humans.
Impact of Replacement of Individual Dietary SFAs on Circulating Lipids and Other Biomarkers of Cardiometabolic Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials in Humans.
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DOI：
10.1093/advances/nmab143
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发表时间：
2022-08-01
影响因子：
9.3
通讯作者：
Lovegrove, Julie A.
中科院分区：
文献类型：
--
作者：
Sellem, Laury;Flourakis, Matthieu;Jackson, Kim G.;Joris, Peter J.;Lumley, James;Lohner, Szimonetta;Mensink, Ronald P.;Soedamah-Muthu, Sabita S.;Lovegrove, Julie A.
关键词：
关于单独的SFA及其与其他SFA或不饱和脂肪酸(UFAs)的等能替代对预防心脏代谢性疾病(CMD)的影响，人们知之甚少。这项系统的文献综述评估了这种饮食替代对一系列空腹CMD风险标记物的影响，包括血脂谱、血糖控制和炎症标记物以及代谢激素浓度。符合条件的随机对照试验(RCT)调查了≥14d等能量替代个体膳食SFA对人类≥-1CMD风险标记物的影响。2021年2月14日，在PubMed、Embase、Scope us和Cochrane中央数据库中搜索到44项随机对照试验，受试者的平均年龄为39.9±15.2岁。使用随机对照试验的Cochrane偏差风险工具2.0评估研究的偏差风险。随机效应荟萃分析评估了≥3类似饮食替代对相同的慢性心脏病风险标记物的影响。其他饮食干预措施在定性合成中进行了描述。我们观察到，用不饱和脂肪酸(−0.36m ol/L；95%CI：−0.50，−0.21m ol/L；I2=0.96.0%，n=18RCT)或油酸(18：1n-9)(−0.16m ol/L；95%CI：−0.28，−0.03m ol/L；I2=89.6%，n=0.9RCT)替代棕榈酸(16：0)后，低密度脂蛋白-胆固醇浓度降低，对总胆固醇和载脂蛋白B浓度的影响相似。对其他CMD风险标记物，包括高密度脂蛋白-胆固醇、三酰甘油、葡萄糖、胰岛素或C-反应蛋白浓度没有明显影响。同样，我们没有发现在CMD风险标记物上用不饱和脂肪酸取代饮食硬脂酸(18：0)有好处的证据(n=4RCT)。总之，用不饱和脂肪酸取代饮食中的棕榈酸对脂质生物标记物的影响与当前的公共卫生建议是一致的。然而，由于高度的异质性和有限的研究，所有个体SFA与心脏代谢健康的生物标志物之间的关系还需要RCT的进一步证实。这项系统评价注册在www.crd.york.ac.uk/propero/上，名称为CRD42020084241。重要声明：这是第一次对随机对照试验的系统回顾和荟萃分析，这些试验评估了单个SFA及其等能量替代对心脏代谢性疾病的广泛风险标记物(包括血脂谱、血糖控制标记物、炎症标记物和代谢激素)的影响。
Little is known of the impact of individual SFAs and their isoenergetic substitution with other SFAs or unsaturated fatty acids (UFAs) on the prevention of cardiometabolic disease (CMD). This systematic literature review assessed the impact of such dietary substitutions on a range of fasting CMD risk markers, including lipid profile, markers of glycemic control and inflammation, and metabolic hormone concentrations. Eligible randomized controlled trials (RCTs) investigated the effect of isoenergetic replacements of individual dietary SFAs for ≥14 d on ≥1 CMD risk markers in humans. Searches of the PubMed, Embase, Scopus, and Cochrane CENTRAL databases on 14 February, 2021 identified 44 RCTs conducted in participants with a mean ± SD age of 39.9 ± 15.2 y. Studies’ risk of bias was assessed using the Cochrane Risk of Bias tool 2.0 for RCTs. Random-effect meta-analyses assessed the effect of ≥3 similar dietary substitutions on the same CMD risk marker. Other dietary interventions were described in qualitative syntheses. We observed reductions in LDL-cholesterol concentrations after the replacement of palmitic acid (16:0) with UFAs (−0.36 mmol/L; 95% CI: −0.50, −0.21 mmol/L; I2 = 96.0%, n = 18 RCTs) or oleic acid (18:1n–9) (−0.16 mmol/L; 95% CI: −0.28, −0.03 mmol/L; I2 = 89.6%, n = 9 RCTs), with a similar impact on total cholesterol and apoB concentrations. No effects on other CMD risk markers, including HDL-cholesterol, triacylglycerol, glucose, insulin, or C-reactive protein concentrations, were evident. Similarly, we found no evidence of a benefit from replacing dietary stearic acid (18:0) with UFAs on CMD risk markers (n = 4 RCTs). In conclusion, the impact of replacing dietary palmitic acid with UFAs on lipid biomarkers is aligned with current public health recommendations. However, owing to the high heterogeneity and limited studies, relations between all individual SFAs and biomarkers of cardiometabolic health need further confirmation from RCTs. This systematic review was registered at www.crd.york.ac.uk/prospero/ as CRD42020084241. Statement of Significance: This is the first systematic review and meta-analysis of randomized controlled trials that assessed the impact of individual SFAs and their isoenergetic substitution on a wide range of risk markers of cardiometabolic diseases (including lipid profile, markers of glycemic control, markers of inflammation, and metabolic hormones).
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