DASH饮食模式治疗高血压的研究进展与挑战

高血压是心血管疾病中导致全球疾病负担及死亡的主要原因，但全球的高血压控制率均较低。终止高血压（DASH）饮食常作为国际高血压联盟及多国高血压防治指南推荐的一线非药物控制血压措施，但因推广性较差、患者依从性低难以有效发挥其作用。改良DASH饮食契合不同的饮食文化和疾病特殊需求，有利于提升饮食外推性、治疗效果及患者依从性。但DASH饮食的改良方法繁多，目前的研究显示其对高血压相关危险因素的防治效果并不统一。本文从改良DASH饮食起源与发展、改良DASH饮食的效果、改良DASH饮食目前的挑战及展望进行阐述，以期为改良DASH饮食降压效果提供依据，为未来改良DASH饮食研究方向提供参考。     

我国西南地区居民饮食误区现况调查

目的 了解西南地区居民饮食误区的现况及其影响因素，为促进居民对饮食误区的正确认知及针对性营养宣教提供参考。方法 采用方便抽样法进行调查，抽取西南地区（重庆、四川、云南、贵州）7 945名居民，面对面问卷调查。结果 48.31%居民了解补钙的最佳食物，仅有21.65%的居民了解补铁食物，有77.10%的居民不赞同“吃野生动物更有营养”，居民对“素食比荤素搭配更有益”、“红色食物补血”的态度持赞同的分别为45.28%、26.86%。有50.80%的居民赞同“食物相生相克”。不同性别、年龄、地区、职业、教育程度、收入、BMI的居民对饮食误区有差异，且差异有统计学意义，P＜0.001；回归分析显示:女性（OR = 0.87，95%CI:0.83～0.90）、城市居民（OR = 0.90，95%CI:0.86～0.94）、学生（OR = 0.74，95%CI:0.68～0.82）及白领（OR = 0.80，95%CI:0.74～0.86）、高教育程度（OR = 0.75，95%CI:0.70～0.80）、高收入（OR = 0.90，95%CI:0.85～0.96）的居民是对饮食误区认知的保护因素，超重（OR = 1.05，95%CI:1.00～1.11）、肥胖（OR = 1.10，95%CI:1.01～1.20）的居民对饮食误区认知是危险因素。结论 我国西南地区居民普遍存在饮食误区，对补铁、补钙食物来源的认知不够，大部分居民存在以下误区:“食物相生相克”、“红色食物补血”、“素食比荤素搭配更有益”。在进行营养健康宣教时应加强对男性、年龄偏大、农村地区、少数民族、教育程度较低、工人、低收入、BMI 不正常的居民进行营养知识科普，着重宣传补铁、补钙的途径，提高营养知识知晓率，纠正饮食文化误区，促进慢性疾病的预防。     

Menú escolar de los centros de enseñanza secundaria de Madrid: conocimiento y cumplimiento de las recomendaciones del Sistema Nacional de Salud

ObjectiveTo establish the degree of knowledge and adherence to the Spanish National Health System recommendations on nutrition in schools in the Autonomous Community of Madrid.MethodsCross-sectional study of a random sample of 182 secondary schools from Madrid, during 2013-2014 school year. Information on the characteristics of the schools and the knowledge of the recommendations was collected by internet and telephone interviews, as well as a copy of the school menu. The average number of rations per week offered for each food item and the percentage of schools within the recommended range were calculated. The overall adherence was obtained as the mean of food items (0-12) within the range.Results65.5% of the schools were unaware of the national recommendations. The supply of rice, pasta, fish, eggs, salad and fruit was lower than recommended, whereas for meat, accompaniment and other desserts was higher. The percentage of schools within the range for each food item varied between 13% and 95%. The mean of overall adherence was 6.3, with no differences depending on whether the menu was prepared or not at schools or there was or not a person in charge of nutrition standards.ConclusionsThe degree of adherence to the recommendations was variable, being advised to increase the supply of cereals, eggs, fish, salad and fruit. Programs for dissemination and implementation of the recommendations, leaded by trained professionals, are required to improve the nutritional value of school menu.     

Associations between dietary factors and urinary concentrations of organophosphate and pyrethroid metabolites in a Canadian general population

ObjectivesFew studies to date have characterized the relationships between diet and urinary concentrations of pesticides. In the current study, associations between dietary factors and urinary concentrations of organophosphate and pyrethroid metabolites were examined in a Canadian general population using data from the Canadian Health Measures Survey (CHMS).MethodsIn the CHMS, urinary concentrations of dialkylphosphate (DAP) and pyrethroid metabolites were measured in 5604 participants aged 6–79 years. Associations between dietary factors and total concentrations of DAP (ΣDAP) and pyrethroid metabolites (ΣPYR) were examined.ResultsOver 90% of participants had at least one type of DAP and 99.8% had pyrethroid metabolites detectable in urine samples. After adjusting for age, sex, race/ethnicity, immigrant status and body mass index, ΣDAP among participants with high (3rd tertile) fruit consumption was 1.43 (95% CI: 1.26–1.61) times the concentration among those with low (1st tertile) consumption. ΣDAP was also positively associated with vegetable consumption, for those with high consumption ΣDAP being 1.33 times (95% CI: 1.16–1.52) the concentration for those with low consumption. ΣPYR among participants with high vegetable consumption was 1.42 (95% CI: 1.23–1.66) times the concentration among those with low vegetable consumption. ΣPYR was also positively associated with pulses/nuts consumption (p-values < 0.01) and household use of chemicals to control head lice or pet flea (p = 0.002).ConclusionsPositive associations between dietary factors and urinary concentrations of organophosphate and pyrethroid metabolites suggest greater regulation of pesticide use on food products may help to reduce pesticide exposures and associated health risks among the general population.     

Maternal dietary pattern in early pregnancy is associated with gestational weight gain and hyperglycemia: A cohort study in South West of Iran

Background and aimsMaternal dietary pattern could influence on fetal health outcome. Thus, this study was conducted to evaluate the relationship between maternal dietary pattern and Gestational Weight Gain (GWG) in each trimester and hyperglycemia amongst Arab pregnant women in south-west of Iran.MethodsThis longitudinally study was performed in urban healthcare centers of south-west of Iran. Among 610 candidates, 488 pregnant women were included in the final analysis. Consequently, two diet patterns were determined by principal component analysis and the association between GWG and blood glucose level was determined using quartile regression. Using generalized linear model, a model was adjusted for pre-pregnancy BMI, maternal age, income, and education levels.ResultsTwo dietary patterns were identified as follows: “high fat –fast food” and “vegetable-fruits & protein” pattern. High adherence to “high fat –fast food” pattern was associated with higher GWG and hyperglycemia in 3rd trimester (adjusted β: 0.029 95%CI 0.012; 0.049 P = 0.001) (adjusted β: 0.029 95%CI 0.012; 0.049 P = 0.001) respectively. High tendency to “vegetable-fruits & protein” pattern was inversely associated with development of hyperglycemia in 3rd trimester. Higher SES level was associated with low adherence to “high fat-fast food” pattern.ConclusionFindings of the study revealed that, higher adherence to high -fat diet is related to excessive GWG and hyperglycemia in late pregnancy.     

Assessing the Public’s Comprehension of Dietary Guidelines: Use of MyPyramid or MyPlate Is Associated with Healthier Diets among US Adults

Background

The Dietary Guidelines for Americans (DGA) provide a framework for food and nutrition programming in the United States as well as the foundation for individualized dietary guidance. Public utilization of the DGA, specifically the MyPyramid or MyPlate tool, is not well studied.

蔬菜、水果、鱼类、豆类膳食模式与乳腺癌关系的Meta分析

目的 总结不同人群健康膳食模式特征及其与乳腺癌的关联证据,为我国乳腺癌的预防提供科学依据.方法 中文文献检索1997年1月-2014年6月国内公开发表的相关研究文献,检索数据库包括：中国知网、万方医学网、中文生物医学文献库和维普电子资源,英文文献检索1997年1月-2014年6月公开发表的相关研究,检索数据库包括：Pubmed、Embase、Cochrane database、Medline和Google Scholar.检索词包括膳食模式/饮食（dietary pattern/ food pattern）和乳腺癌/乳腺肿瘤（breast neoplasma/breast cancer/breast carcinoma/mammary cancer）.文献排除标准：（1）重复发表的仅保留样本量大、信息全的一篇.（2）内容为男性乳腺癌的文章.（3）实验性研究、综述、Meta分析、病例-对照研究以及信息不全的文章.用Meta分析对高摄入蔬菜、水果、鱼类和豆制品的膳食模式与乳腺癌关联的效应量进行合并.总结在该类膳食模式上高摄入人群与低摄入人群乳腺癌患病率的合并效应量.合并效应量采用固定效应模型.统计分析采用Stata11.0软件完成.结果 最终纳入英文文献12篇,均为队列研究,未发现符合纳入标准的中文文献.队列研究样本量总数为623 536例,乳腺癌病例为19 707例.结果显示以高摄入蔬菜、水果、鱼类和豆类健康膳食模式对乳腺癌具有保护作用.在这类膳食模式上高摄入人群同低摄入人群相比,队列研究合并乳腺癌发生的风险比（95％可信区间）为0.86（0.80～0.92）.结论 富含蔬菜、水果、鱼类和豆类的健康膳食模式对乳腺癌发病具有保护作用.     

Changes in body weight and physical performance after receiving dietary advice in patients with chronic obstructive pulmonary disease (COPD): 1-year follow-up

Nutritional studies in patients with chronic obstructive pulmonary disease (COPD) are often based on oral nutritional supplementation and are of short duration. Our aim was to study the changes in body weight and physical performance in COPD patients after receiving the dietary advice for 1 year. Thirty-six patients with COPD as a primary diagnosis (mean age: 68.5 ± 7.8 years), referred to a pulmonary rehabilitation program were studied. Each patient received dietary advice individually. Body weight had increased significantly by 1.3 kg (p = 0.02) and walking distance by 83.2 m (p = 0.007) after 1 year. There was an increase in mean handgrip strength after 1 year (1.6 kg, p = 0.07). The mean intake of energy and protein expressed as percent of energy and protein requirement had increased after 1 year (15%, p < 0.001, and 5.6%, p = 0.09, respectively). Handgrip strength correlated significantly with energy (r = 0.53, p = 0.002), fat (r = 0.50, p = 0.02) and protein intake (r = 0.41, p = 0.002) after 1 year. In conclusion, positive effects on body weight, handgrip strength and walking distance in patients with COPD were seen after receiving dietary advice with a 1-year follow-up.