碳水化合物和心血管疾病危险因素的研究进展

不合理饮食和心血管疾病风险因素息息相关。碳水化合物作为三大营养素之一,其摄入的量和质对健康的影响近年来备受关注。随着膳食评估方式的不断优化,碳水化合物质量对血压、血脂和血糖的影响逐渐明了,低血糖负荷饮食、增加全谷物和膳食纤维的摄入、控制碳水化合物的摄入总量可以改善血压、血脂、血糖等心血管疾病危险因素。     

膳食纤维与卒中

流行病学研究证实,增加膳食纤维摄入量可降低卒中发病风险.动物实验和临床研究表明,膳食纤维摄入可能通过降低高血压、糖尿病、血脂异常、肥胖等血管危险因素降低卒中发病率.增加膳食纤维摄入降低卒中风险的直接机制有待进一步研究.临床医生应重视膳食纤维对卒中防治的重要作用,并指导卒中患者和高危人群增加富含纤维的水果和蔬菜的摄入.     

老年糖尿病病人膳食中膳食纤维含量的调查分析

对36例62～87岁的城市老年糖尿病病人进行了为期两个季度，每个季度三天的膳食调查，计算出每人每日平均摄入膳食纤维10．1士4．3g。同时对调查对象的热能、营养素摄入情况及食物构成等进行分析。该组老年糖尿病病人热能分配不尽合理，脂肪摄入偏高，碳水化合物偏低，钙、锌和视黄醇当量略低于中国营养学会推荐的供给量（RDA）标准，其他营养素的摄入达到或超过RDA标准。认为要提高膳食中膳食纤维的摄入量，除膳食中增加富含纤维的天然食物外，必要时应采用添加膳食纤维的食品，并应加强对糖尿病患者有关饮食治疗的教育，使病人对此有正确的理解，合理地安排饮食。     

806例超重及肥胖患者的膳食结构调查分析

目的：了解超重及肥胖患者的膳食结构,分析超重及肥胖与膳食结构的关系。方法对806例超重及肥胖患者进行膳食结构调查,收集3日食谱数据,整理后输入营养专家系统软件,分析三大供能物质及几种主要维生素、矿物质及膳食纤维的摄入量及比例。结果随着膳食中碳水化合物摄入及供能比的增加,人群患超重（肥胖）风险升高。能量和17种营养素摄入量中,能量、蛋白质、碳水化合物供能比、脂肪供能比、膳食纤维、维生素A、维生素B1、维生素B2、烟酸、维生素C、维生素E、钠、钾、铁、磷、锌与推荐摄入量比较有统计学差异（P均＜0．01）。结论超重及肥胖患者的膳食结构存在高能量、高脂肪、低膳食纤维、抗氧化营养素摄入不足的特点,针对以上特点改进膳食结构对减肥有重要意义。     

孕期蛋白质、脂肪及碳水化合物的摄入与妊娠糖尿病发病的关系

目的 探讨孕期蛋白质、脂肪及碳水化合物的摄入与妊娠糖尿病(GDM)发病的关系,为GDM的防治提供科学依据. 方法 采用病例对照研究的方法,收集54例GDM患者及191名对照组人群(NC组)的膳食摄入情况.分析膳食因素与GDM发病的关系. 结果 协方差分析显示,GDM组蛋白质摄入量、蛋白质供能比例、动物蛋白质、动物蛋白比率及饱和脂肪酸比例高于NC组(P<0.05),多不饱和脂肪酸、单不饱和脂肪酸比例及P/S值低于NC组(P<0.05). 结论 孕妇增加多不饱和脂肪酸和单不饱和脂肪酸的摄入量、减少蛋白质(尤其是动物蛋白质)及饱和脂肪酸摄入量,可以降低GDM的发病风险.     

对我国高血压较低发区广东的三个人群膳食结构的评价

目的：研究我国高血压患病率较低发区的广东三个人群膳食结构特点，以利于找出预防高血压合理的膳食模型。方法：应用食物频数法，对广东三个主要地方方言及地理环境不同的２５岁以上成人共９２６人，进行膳食营养因素的分析。结果：平均每人每天膳食营养素的摄入量为：蛋白质热量占总热量摄入的１７．５％，脂肪占２０．１％，碳水化合物占６１．２％；本文显示广东人群的饮食特点是较高优质蛋白质和较低钠摄入。结论：提示该膳食模式有利于广东人群的血压维持在较低水平     

盐与中心动脉压和脉搏波传导速度的关系

<正>高血压增加患心血管病的风险,也是脑卒中和慢性肾脏病主要危险因素,高血压及其相关并发症已经在世界范围内造成巨大的社会经济负担。高血压发病的危险因素包括吸烟、年龄、性别、家族史和生活方式等诸多方面。而饮食中盐摄入的多少与人群血压水平和高血压发病率息息相关。计算饮食中钠钾摄入量的方法主要有膳食回顾调查问卷法和24 h留尿法2种,有研究者对双方进行比较后发现,采用     

浙江省三地区不同人群膳食营养现状与血压相关性分析

目的　了解浙江省不同人群膳食营养现状 ,分析膳食营养与血压的相关性。方法　在农村、城市、城镇 2 5～ 74岁自然人群中随机整群抽取 4841人进行高血压危险因素调查的基础上 ,按 1 0∶ 1抽取 496人进行连续三天2 4小时膳食调查 ,对其中资料完整的 470人进行显著性、相关性统计学分析。结果　 (1 )人群每日平均摄入各种营养素及能量热比与 RDA推荐量相比均有显著性差异 (P<0 .0 0 1 )。 (2 )居民膳食食物中碳水化合物 89.9%为米及米制品 ,粗粮谷类仅为 0 .2 % ,肉食类、鱼虾类均超过 RDA推荐量 ,以城市人群及 2 5～ 2 9岁青年组为明显 ;奶制品摄入仅为 RDA推荐量的 8.69% ,以农村人群更明显。 (3 )收缩压水平与脂肪、蛋白质、碳水化合物、钠摄入量相关 (P均 <0 .0 0 1 ) ;舒张压水平与脂肪摄入量相关 (P<0 .0 0 1 )。 (4 )高血压与正常血压人群蛋白质、脂肪、碳水化合物的摄入热比有显著性差异 (P<0 .0 0 1 ) ;视黄醇、硫胺素、尼克酸的摄入量两组人群中有显著性差异 (P<0 .0 5 ) ,高血压与正常血压人群摄入钠 /钾比值分别为 1 .2 9、 1 .3 ,无显著性差异。结论　 (1 )浙江省城乡居民膳食营养摄入存在低蛋白质、高脂肪、高碳水化合物的不合理现状 ,同时存在 B族维生素、钙明显摄入不足 ,钠摄入过多的现?     

哮喘患者膳食营养素摄入与肺功能的相关性

目的研究哮喘患者膳食营养素摄入与肺功能的相关性。方法选取哮喘患者130例,健康对照组60例。采用半定量食物频率问卷调查哮喘患者及健康对照组近3个月饮食中14种营养素摄入量并检测肺功能及体重指数,分析哮喘患者膳食营养素的摄入与肺功能的相关性。结果哮喘患者的年龄、体重、体重指数均高于健康对照组(P<0.05)。重度持续发作组患者1 s用力呼气容积(FEV1)、用力肺活量高于健康对照组及间歇发作、轻度持续发作、中度持续发作组(P<0.05)。膳食因素中,摄入总能量、蛋白质、碳水化合物、钙、镁、磷、铁、锌、维生素C、视黄醇,健康对照组与重度持续发作组相比无统计学差异(P>0.05)。脂肪、纤维、钠、钾,健康对照组与重度持续发作组相比,具有统计学差异(P<0.05)。脂肪与FEV1、用力肺活量(FVC)、比率呈负相关;纤维与FEV1、FVC比率呈正相关。结论重度哮喘患者饮食具有高脂肪、高钠、低钾、低纤维的特点;脂肪、纤维与哮喘患者的肺功能有关;纤维对哮喘患者肺功能具有保护性作用。     

养老院老年人膳食营养素摄入与营养不良

目的了解大连市养老院老年人的膳食营养素摄入水平、营养不良状况及其影响因素。方法采用随机整群抽样法,自行设计调查问卷,了解调查对象的基本人口学资料、健康与饮食行为、体格检查指标;采用简易营养评价法(MNA)调查表了解其营养不良情况;采用3日24 h膳食回顾法,面对面进行膳食调查。结果 1 203例老年人中,男492例,女711例,年龄80～89岁者占49. 0%。营养不良发生率为18. 1%,女性、未接受过营养健康教育培训、未服用保健品、管饲、学历情况不详均为营养不良的危险因素,而未有基础疾病则为营养不良的保护因素(均P<0. 05)。膳食热量、蛋白质、脂肪及碳水化合物的摄入量分别(1 507. 00±305. 75) k Cal、(52. 12±12. 97) g、(56. 60±18. 46) g和(200. 14±51. 45) g,膳食铁、维生素(V)B1摄入量充足,VE及钠摄入过量,VA、钙、硒及膳食纤维摄入量不足。结论大连市养老院老年人营养不良发生率较高,微量营养素摄入失衡明显,政府及养老机构应共同努力,针对造成该人群营养不良的危险因素进行宣传教育,从而提高其整体营养与健康水平。     

The effects of diet on inflammation: emphasis on the metabolic syndrome

Reducing the incidence of coronary heart disease with diet is possible. The main dietary strategies include adequate omega-3 fatty acids intake, reduction of saturated and trans-fats, and consumption of a diet high in fruits, vegetables, nuts, and whole grains and low in refined grains. Each of these strategies may be associated with lower generation of inflammation. This review examines the epidemiologic and clinical evidence concerning diet and inflammation. Dietary patterns high in refined starches, sugar, and saturated and trans-fatty acids, poor in natural antioxidants and fiber from fruits, vegetables, and whole grains, and poor in omega-3 fatty acids may cause an activation of the innate immune system, most likely by an excessive production of proinflammatory cytokines associated with a reduced production of anti-inflammatory cytokines. The whole diet approach seems particularly promising to reduce the inflammation associated with the metabolic syndrome. The choice of healthy sources of carbohydrate, fat, and protein, associated with regular physical activity and avoidance of smoking, is critical to fighting the war against chronic disease. Western dietary patterns warm up inflammation, while prudent dietary patterns cool it down.     

The effects of diet on inflammation: emphasis on the metabolic syndrome.

Reducing the incidence of coronary heart disease with diet is possible. The main dietary strategies include adequate omega-3 fatty acids intake, reduction of saturated and trans-fats, and consumption of a diet high in fruits, vegetables, nuts, and whole grains and low in refined grains. Each of these strategies may be associated with lower generation of inflammation. This review examines the epidemiologic and clinical evidence concerning diet and inflammation. Dietary patterns high in refined starches, sugar, and saturated and trans-fatty acids, poor in natural antioxidants and fiber from fruits, vegetables, and whole grains, and poor in omega-3 fatty acids may cause an activation of the innate immune system, most likely by an excessive production of proinflammatory cytokines associated with a reduced production of anti-inflammatory cytokines. The whole diet approach seems particularly promising to reduce the inflammation associated with the metabolic syndrome. The choice of healthy sources of carbohydrate, fat, and protein, associated with regular physical activity and avoidance of smoking, is critical to fighting the war against chronic disease. Western dietary patterns warm up inflammation, while prudent dietary patterns cool it down.     

A prospective study of nutritional factors and hypertension among US men.

BACKGROUND. An effect of diet in determining blood pressure is suggested by epidemiological studies, but the role of specific nutrients is still unsettled. METHODS AND RESULTS. The relation of various nutritional factors with hypertension was examined prospectively among 30,681 predominantly white US male health professionals, 40-75 years old, without diagnosed hypertension. During 4 years of follow-up, 1,248 men reported a diagnosis of hypertension. Age, relative weight, and alcohol consumption were the strongest predictors for the development of hypertension. Dietary fiber, potassium, and magnesium were each significantly associated with lower risk of hypertension when considered individually and after adjustment for age, relative weight, alcohol consumption, and energy intake. When these nutrients were considered simultaneously, only dietary fiber had an independent inverse association with hypertension. For men with a fiber intake of < 12 g/day, the relative risk of hypertension was 1.57 (95% confidence interval, 1.20-2.05) compared with an intake of > 24 g/day. Calcium was significantly associated with lower risk of hypertension only in lean men. Dietary fiber, potassium, and magnesium were also inversely related to baseline systolic and diastolic blood pressure and to change in blood pressure during the follow-up among men who did not develop hypertension. Calcium was inversely associated with baseline blood pressure but not with change in blood pressure. No significant associations with hypertension were observed for sodium, total fat, or saturated, transunsaturated, and polyunsaturated fatty acids. Fruit fiber but not vegetable or cereal fiber was inversely associated with incidence of hypertension. CONCLUSIONS. These results support hypotheses that an increased intake of fiber and magnesium may contribute to the prevention of hypertension.     

Darm-Nieren-Achse

Chronic kidney diseases (CKD) and cardiovascular diseases (CVD) share several traditional and non-traditional risk factors including so-called lifestyle factors. Diet plays an important role among these factors. A low animal protein/high dietary fiber diet (e.g. Mediterranean diet) can protect against CKD and CVD, while a high animal protein/high fat/low dietary fiber diet (e.g. western diet) confers an increased risk. Diet can modify renal outcomes through disturbances of the lipid, acid-base and mineral metabolic pathways; however, evidence is growing that dysbiosis of the gastrointestinal tract may also be a pivotal link between a western diet and worse renal outcome through increased metabolites from gut bacteria, such as indole and p?cresol promoting the progression of chronic kidney disease. The therapeutic goal should be the reduction of potentially toxic metabolites derived from gut microbiota. Dietary measures by the addition of probiotics, such as non-digestible oligosaccharides and polysaccharides, in order to change the ratio of dietary protein/fiber ingestion could be helpful. The role of adsorbents, such as AST-120 is still controversial. Whether sevelamer can reduce the concentration of metabolites warrants further investigation.     

Diet and risk of Type II diabetes: the role of types of fat and carbohydrate

Although diet and nutrition are widely believed to play an important part in the development of Type II (non-insulin-dependent) diabetes mellitus, specific dietary factors have not been clearly defined. Much controversy exists about the relations between the amount and types of dietary fat and carbohydrate and the risk of diabetes. In this article, we review in detail the current evidence regarding the associations between different types of fats and carbohydrates and insulin resistance and Type II diabetes. Our findings indicate that a higher intake of polyunsaturated fat and possibly long-chain n-3 fatty acids could be beneficial, whereas a higher intake of saturated fat and trans-fat could adversely affect glucose metabolism and insulin resistance. In dietary practice, exchanging nonhydrogenated polyunsaturated fat for saturated and trans-fatty acids could appreciably reduce risk of Type II diabetes. In addition, a low-glycaemic index diet with a higher amount of fiber and minimally processed whole grain products reduces glycaemic and insulinaemic responses and lowers the risk of Type II diabetes. Dietary recommendations to prevent Type II diabetes should focus more on the quality of fat and carbohydrate in the diet than quantity alone, in addition to balancing total energy intake with expenditure to avoid overweight and obesity. [Diabetologia (2001) 44: 805–817]     

Dietary Guidelines for Americans 2010: Implications for Cardiovascular Disease

The 2010 Dietary Guidelines for Americans (DGA) provides science-based advice to promote health and reduce risk of major chronic diseases by diet and physical activity. The primary emphasis is on food-based recommendations that meet energy and nutrient needs. The DGA is made in the context of a total diet designed to reduce the incidence and prevalence of overweight and obesity. In addition, the DGA also targets cardiovascular disease (CVD) risk reduction. DGA recommends nutrient-dense foods including fruits and vegetables, whole grains, low-fat dairy, lean protein foods including seafood, and vegetable oils. This dietary pattern beneficially affects blood lipids and other CVD risk factors. Foods and nutrients to limit include solid fats (saturated fatty acids, trans-fatty acids), dietary cholesterol, added sugars, refined grains, and sodium. Healthy dietary patterns that emphasize nutrient-dense foods will significantly benefit public health, in part, by reducing CVD risk.     

Nutrition and body weight

Certain dietary components play a key role for the development of coronary artery disease (CAD). Complex carbohydrates lower the prevalence of CAD. Protein should provide 15% of daily calories. Populations with a high consumption of soy protein have a low coronary event rate and a high life expectancy. Soy protein has a favorable effect on LDL cholesterol, triglycerides and HDL cholesterol. Dietary cholesterol correlates with an increased incidence of CAD. Saturated fats increase cholesterol levels as well as the activity of clotting factor VII and promote progression of CAD. Mono-(MUFA) and poly-unsaturated fatty acids lower LDL-cholesterol to a similar extent. MUFA are contained in rape seed oil, olive oil and pea nut oil, but also in avocados and almonds. Omega-3-fatty acids are in fatty fish like salmon, tuna and herring and improve survival after myocardial infarction. They improve among others endothelial function (adhesion molecules). Eating 1-2 fish meals per week has a preventive effect on CAD and stroke. Dietary fiber decreases the risk for CAD up to 30% and favorably influences carbohydrate metabolism. Antioxidants have a favorable effect in their natural form (fruits and fresh vegetables). The secondary preventive effect of a mediterranean diet after myocardial infarction (probably by a combination of the above effects) has been validated. Body weight correlates with coronary risk, diabetes and use of health care resources. A reduction of body weight is best achieved by calory reduction plus an increase of physical activity. A calory-adjusted diet, low in total fat with a significant proportion of unsaturated fats and omega-3-fatty acids and rich in fiber is of great importance for primary and secondary prevention of cardiovascular diseases. Fruits, vegetables and whole grain products are important components of this diet, which lowers the coronary event rate, increases longevity and is associated with a low rate of malignancies and osteoporosis.     

Role of Childhood Food Patterns on Adult Cardiovascular Disease Risk

Accumulating evidence indicates that childhood nutrition plays a role in the adulthood cardiovascular health. A lifelong tracking of dietary habits, following a long-term exposure to unhealthy dietary patterns or independent effects, is a potential effect-mediating mechanism. Dietary patterns have been studied by data-driven and hypothesis-based approaches. Typically, either data-driven healthy or prudent childhood dietary patterns have been characterized and found to be associated with lower adulthood cardiovascular disease (CVD) risk in the published cohort studies. With regard to the individual food groups or food quality indices, intakes particularly of vegetables and fruits (or fiber indicating plant food intake) and polyunsaturated fatty acids have shown protective effects. The evidence which could confirm the long-term healthiness of a hypothesis-based Mediterranean diet is limited, requiring further investigation. Overall, the recent literature strengthens the view that a healthy childhood diet is associated with lowered adulthood CVD risk.     

Dietary Nutrients and Urinary Incontinence in Japanese Adults

Objectives: To investigate the association between dietary nutrients and urinary incontinence (UI) among Japanese adults. Methods: A total of 1017 adults (710 men and 307 women) were recruited from the community in central and southern Japan. A structured questionnaire, incorporating the International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF) and a validated food frequency questionnaire, was administered to participants by face‐to‐face interview. Information on dietary nutrients intake from each food item was obtained using the Japanese food composition tables. Logistic regression analyses were performed to determine the association between nutrients intake and the prevalence of UI. Results: The observed prevalence of UI was 8.7% (n = 62) for men (mean age 62.5 years) and 29% (n = 89) for women (mean age 62.0 years) based on the ICIQ‐SF criterion. Of the 50 dietary nutrients and micronutrients considered, soluble fiber (P = 0.03) and omega‐6 polyunsaturated fatty acids (P = 0.01) were found to be inversely associated with the UI prevalence for men, whereas increasing the intake of lutein/zeaxanthin appeared to be marginally associated (P = 0.04) with a reduced risk of UI for women. Conclusion: Three dietary nutrients have been identified to be associated with UI in middle‐aged and older Japanese adults. Further research and clinical trials are needed to ascertain the effects of dietary nutrients on UI.     

Dietary Monounsaturated Fatty Acids Appear Not to Provide Cardioprotection

Dietary interventions have been consistently proposed as a part of a comprehensive strategy to lower the incidence and severity of coronary heart disease (CHD), in the process providing long-term cardioprotection. Replacement of dietary saturated fatty acids (SFA) with higher intakes of monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA) has been reported to be inversely associated with risk of CHD. The observed lower incidence of CHD among populations consuming a Mediterranean-type diet, mainly enriched in MUFA from olive oil, has long supported the belief that MUFA are an optimal substitution for SFA. However, both epidemiologic and interventional studies suggest that although substituting MUFA-rich foods for SFA-rich foods in the diet can potentially lower total plasma cholesterol concentrations, this substitution does not lower the extent of coronary artery atherosclerosis. In addition, although recent evidence suggests that the source of MUFA (animal fat vs vegetable oils) may differentially influence the correlation between MUFA intake and CHD mortality, animal studies suggest that neither source is cardioprotective.