Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review.
Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review.
复制标题
DOI：
10.1161/circulationaha.115.018585
复制
发表时间：
2016-01-12
期刊：
影响因子：
37.8
通讯作者：
Mozaffarian D
中科院分区：
文献类型：
--
作者：
Mozaffarian D
营养不佳是健康状况不佳的主要原因。营养和政策科学发展迅速，造成了混乱，但也为减少不良饮食对健康和经济的不利影响提供了强有力的机会。这篇综述考虑了心血管疾病、肥胖和糖尿病的历史、新证据、争议以及现代饮食和政策优先事项的相应教训。确定的主要主题包括评估饮食相关风险途径的多样性的重要性，而不仅仅是肥胖和血脂；注重食物和整体饮食模式，而不是单一的孤立营养素；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；描述和实施以证据为基础的战略，包括改变生活方式的政策方法。有证据支持的饮食重点包括增加水果、非淀粉类蔬菜、坚果、豆类、鱼类、植物油、酸奶和最低限度加工的全谷物；少吃红肉、加工肉（如钠腌制）和富含精制谷物、淀粉、添加糖、盐和反式脂肪的食物。需要对酚类物质、乳脂肪、益生菌、发酵、咖啡、茶、可可、鸡蛋、特定蔬菜和热带油、维生素D、个别脂肪酸和饮食-微生物组相互作用的心脏代谢作用进行更多的研究。迄今为止，几乎没有证据支持其他流行的优先事项与心脏代谢的相关性：例如，本地，有机，草饲，养殖/野生，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、卫生系统改革、新技术和强有力的政策战略（包括针对经济激励、学校和工作场所、社区环境和食品系统的政策战略）的大力支持。科学进步为减少与饮食有关的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。
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. Major identified themes include the importance of evaluating the full diversity of diet-related risk pathways, not just obesity and blood lipids; 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 (e.g., sodium-preserved) meats, and foods rich in refined grains, starch, added sugars, salt, and trans fat. More investigation is needed on 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 cardiometabolic relevance of other popular priorities: e.g., local, organic, grass-fed, farmed/wild, non-GMO. Evidence-based personalized nutrition appears to depend more on non-genetic characteristics (e.g., 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, including those 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 burdens of diet-related cardiometabolic diseases.