七种流行的结构化饮食方案与心血管风险增加患者的死亡和主要心血管事件风险的比较：系统回顾和Meta分析

SCI

30 April 2023

Comparison of seven popular structured dietary programmes and risk of mortality and major cardiovascular events in patients at increased cardiovascular risk: systematic review and network meta-analysis 

(BMJ IF: 30.22)

Giorgio Karam,1 Arnav Agarwal,2 Behnam Sadeghirad,3,4 Matthew Jalink,5 Christine L Hitchcock,6 Long Ge,3,7,8 Ruhi Kiflen,9 Waleed Ahmed,10 Adriana M Zea,11 Jovana Milenkovic,12 Matthew AJ Chedrawe,13 Montserrat Rabassa,14 Regina El Dib,15 Joshua Z Goldenberg,16,17 Gordon H Guyatt,3,18 Erin Boyce,19 Bradley C Johnston16,20 

Correspondence to: BC Johnston bradley.johnston@tamu.edu (or @methodsnerd on Twitter: ORCID 0000-0001-8872-8626) cite this as: BMJ 2023;380:e072003 http://dx.doi.org/10.1136/ bmj-2022-072003 

Objective 目的  

To determine the relative efficacy of structured named diet and health behaviour programmes (dietary programmes) for prevention of mortality and major cardiovascular events in patients at increased risk of cardiovascular disease. 

确定结构化命名的饮食和健康行为方案（饮食方案）对预防心血管疾病高危患者的死亡和主要心血管事件的相对效力。

Design 设计  

Systematic review and network meta-analysis of randomised controlled trials.

随机对照试验的系统回顾和网络meta分析。

Data sources 数据来源  

AMED (Allied and Complementary Medicine Database), CENTRAL (Cochrane Central Register of Controlled Trials), Embase, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and ClinicalTrials.gov were searched up to September 2021. 

AMED（联合和补充医学数据库）、CENTRAL（Cochrane中央控制试验登记册）、Embase、Medline、CINAHL（护理和联合健康文献累积索引）和ClinicalTrials.gov进行了搜索，直至2021年9月。

Study selection 研究选择  

Randomised trials of patients at increased risk of cardiovascular disease that compared dietary programmes with minimal intervention (eg, healthy diet brochure) or alternative programmes with at least nine months of follow-up and reporting on mortality or major cardiovascular events (such as stroke or non-fatal myocardial infarction). In addition to dietary intervention, dietary programmes could also include exercise, behavioural support, and other secondary interventions such as drug treatment. 

针对心血管疾病高危患者的随机试验，比较饮食方案与最低限度的干预（如健康饮食手册）或替代方案，至少有九个月的随访，并报告死亡率或主要心血管事件（如中风或非致命性心肌梗死）。除了饮食干预外，饮食方案还可以包括锻炼、行为支持和其他辅助干预，如药物治疗。

Outcomes and measures 结果和措施  

All cause mortality, cardiovascular mortality, and individual cardiovascular events (stroke, non-fatal myocardial infarction, and unplanned cardiovascular interventions). 

全因死亡率、心血管死亡率和个别心血管事件（中风、非致命性心肌梗死和非计划性心血管干预）。

Review methods 审查方法  

Pairs of reviewers independently extracted data and assessed risk of bias. A random effects network meta-analysis was performed using a frequentist approach and grading of recommendations assessment, development and evaluation (GRADE) methods to determine the certainty of evidence for each outcome.

两位评审员独立提取数据并评估偏倚风险。采用频繁主义方法和建议评估、发展和评价（GRADE）分级方法进行随机效应网络元分析，以确定每个结果的证据的确定性。

Results 结果  

40 eligible trials were identified with 35548 participants across seven named dietary programmes (low fat, 18 studies; Mediterranean, 12; very low fat, 6; modified fat, 4; combined low fat and low sodium, 3; Ornish, 3; Pritikin, 1). At last reported follow-up, based on moderate certainty evidence, Mediterranean dietary programmes proved superior to minimal intervention for the prevention of all cause mortality (odds ratio 0.72, 95% confidence interval 0.56 to 0.92; patients at intermediate risk: risk difference 17 fewer per 1000 followed over five years), cardiovascular mortality (0.55, 0.39 to 0.78; 13 fewer per 1000), stroke (0.65, 0.46 to 0.93; 7 fewer per 1000), and non-fatal myocardial infarction (0.48, 0.36 to 0.65; 17 fewer per 1000). Based on moderate certainty evidence, low fat programmes proved superior to minimal intervention for prevention of all cause mortality (0.84, 0.74 to 0.95; 9 fewer per 1000) and non-fatal myocardial infarction (0.77, 0.61 to 0.96; 7 fewer per 1000). The absolute effects for both dietary programmes were more pronounced for patients at high risk. There were no convincing differences between Mediterranean and low fat programmes for mortality or non-fatal myocardial infarction. The five remaining dietary programmes generally had little or no benefit compared with minimal intervention typically based on low to moderate certainty evidence. 

确定了40项符合条件的试验，有35548名参与者，涉及7个命名的饮食方案（低脂肪，18项研究；地中海，12；极低脂肪，6；改良脂肪，4；结合低脂肪和低钠，3；奥尼什，3；普利特金，1）。在最后一次报告的随访中，基于中等程度的证据，地中海饮食方案被证明优于预防所有原因死亡的最小干预措施（几率比0.72，95%置信区间0.56至0. 92；中度风险患者：每1000人在五年内的风险差异减少17人）、心血管死亡（0.55，0.39至0.78；每1000人减少13人）、中风（0.65，0.46至0.93；每1000人减少7人）和非致命心肌梗死（0.48，0.36至0.65；每1000人减少17人）。基于中等程度的证据，低脂肪方案被证明优于预防所有原因的死亡（0.84，0.74至0.95；每1000人中减少9人）和非致命性心肌梗死（0.77，0.61至0.96；每1000人中减少7人）的最小干预。两种饮食方案的绝对效果对高危患者来说更为明显。在死亡率和非致命性心肌梗死方面，地中海方案和低脂肪方案之间没有令人信服的差异。其余五种饮食方案与通常基于低到中等确定性证据的最低限度干预相比，一般没有什么好处。

Conclusions 结论  

Moderate certainty evidence shows that programmes promoting Mediterranean and low fat diets, with or without physical activity or other interventions, reduce all cause mortality and non-fatal myocardial infarction in patients with increased cardiovascular risk. Mediterranean programmes are also likely to reduce stroke risk. Generally, other named dietary programmes were not superior to minimal intervention.

中度确定的证据显示，推广地中海和低脂饮食的方案，无论是否有体育活动或其他干预措施，都能减少心血管风险增加的病人的所有原因死亡率和非致命性心肌梗死。地中海方案也可能减少中风风险。一般来说，其他命名的饮食方案并不优于最小的干预。

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