美国临床营养杂志:吃牛肉可以降低患心脏病风险?

2021-04-16 K.K MedSci原创

食用低饱和脂肪地中海饮食、和500g/周的未加工瘦红肉,5周后,可降低总胆固醇与低密度脂蛋白胆固醇

地中海饮食是膳食指南推荐的一种健康饮食模式,包括每周约354g蛋白质的红肉(50克/天),关键是瘦肉。流行病学研究表明,较高的红肉消费与血管疾病(CVD)风险增加有关。临床证据表明,未加工的红肉可作为心脏健康饮食模式的一部分。一项随机交叉研究发表在近日的《美国临床营养杂志》上,研究显示:食用低饱和脂肪地中海饮食、和500g/周的未加工瘦红肉,5周后,可降低总胆固醇与低密度脂蛋白胆固醇(LDL-c),我们都知道,高浓度的LDL-c是独立的动脉粥样硬化的危险因素。但是,当食用更多的未加工瘦红肉,并不会发挥降低血脂和脂蛋白更大功效。

美国宾夕法尼亚州立大学营养学助理教授Jennifer Fleming说,"牛肉中仍然有重要的营养成分,你可以通过吃瘦肉切割,如腰部或圆形,或93%的瘦牛肉粉来受益。"

Jennifer A Fleming et al.Effect of varying quantities of lean beef as part of a Mediterranean-style dietary pattern on lipids and lipoproteins: a randomized crossover controlled feeding trial.The American Journal of Clinical Nutrition. DOI:10.1093 / ajcn / nqaa375

这项随机对照试验,研究人员测试了3种地中海饮食,分别是:

1)按照地中海饮食的推荐量,以2000大卡饮食为基础,每日14克瘦牛肉/2000千卡,用MED 0.5标记;

2)按照美国的饮食方式,每日71克瘦牛肉/2000千卡,用MED 2.5标记;

3)按照有益心脏健康的饮食方式,每日156克瘦牛肉/2000千卡,用MED 5.5标记;

每种MED饮食都包含196g蛋白质(有瘦牛肉、鱼、家禽、猪肉、坚果、鸡蛋和豆类)、250 mg / EPA和DHA(深海鱼类、贝类等)、胆固醇摄入量<300 mg / 天、钠摄入量<2300 mg /天。又加入橄榄油(26–32 g,约2汤匙)、3–6份水果、6份以上蔬菜。对照组为美国平均饮食(AAD),主要包含碳水化合物52%、蛋白质15%、脂肪33%、饱和脂肪酸12%、单不饱和脂肪酸13%、多不饱和脂肪酸8%

与AAD相比,地中海饮食模式下的总胆固醇、非HDL-c(高密度脂蛋白胆固醇)和LDL-c均显着降低。具体而言,LDL-c分别降低了-10.3 mg/dL、-9.1 mg/dL和-6.9 mg/dL(图3);总胆固醇分别降低了-12.8 mg/dL 、-10.9 mg / dL和-6.9 mg/dL;非HDL-c分别降低了-11.2 mg/dL、-9.8 mg/dL 和-7.0 mg/dL。这些饮食模式都使甘油三酯下降。

不同食物4周之后,脂质和脂蛋白发生变化

 

食用更多的瘦牛肉对总胆固醇、LDL-c、HDL-c、非HDL-c或甘油三酯并没有显示出剂量效益;此外,MED饮食下显着降低了LDL粒子数。与AAD相比,MED 0.5和MED 2.5饮食方式下,总LDL(低密度脂蛋白)和大LDL粒子数减少更多。与MED 0.5相比,MED 5.5饮食方式下,大LDL粒子数减少得没有很明显;LDL偏高可能会引起冠心病、脑卒中和外周动脉病等致死致残的严重性疾病。

所有饮食模式都与HDL粒子数的减少有关。与MED 5.5相比,MED 0.5饮食模式下,中等HDL(高密度脂蛋白)粒子数减少得更明显;在本研究中,HDL浓度和颗粒数量的减少似乎是由小HDL颗粒的损失驱动的,健康成年人中HDL小颗粒数量越多,心血管疾病风险越高。

4周后的脂质亚颗粒浓度

与AAD相比,3种MED饮食模式apoB都减少得更多。MED 0.5、MED 2.5、MED5.5与AAD相比,apoB分别下降了-6.3、-5.9和-3.9,apoB由肝脏合成,是低密度脂蛋白胆固醇的主要结构蛋白。分析显示,与MED 0.5和MED 2.5饮食相比,MED5.5降低了apoA1的下降,apoA1是 HDL中的主要载脂蛋白。

这些饮食模式都引起了PCSK9(血浆原蛋白转化酶亚铁蛋白/激酶9型)浓度的轻微下降,PCSK9可能有降低LDL-c的潜在作用。

MED0.5和MED2.5都属于高依从性地中海饮食模式,与AAD饮食方式相比,采用地中海饮食还能发挥最大的心血管益处。

红肉是西方人口饮食模式的主要组成部分。近几十年来,美国红肉的平均消费量有所下降,但仍是全球平均消费量的两倍多。一些流行病学研究已经分析了红肉消费与死亡风险之间的关系。大量证据表明,摄入较多的红肉,特别是加工红肉,与2型糖尿病、心血管疾病、某些癌症(如结直肠癌)和死亡率的风险增加有关。食用加工类的红肉(如培根、热狗和香肠)与疾病风险有关,如慢性阻塞性肺病、心衰和高血压。

2019年4月25日一项发表在BMJ上的研究中,考察了红肉摄入量的增加是否与特定原因死亡率风险相关。研究发现:红肉的食用增加,特别是加工肉,可能与较高的总死亡率有关。研究人员在随访120万人之后,发现:红肉食用增多与8年内,男女性死亡风险较高相关,每天增加半分红肉与死亡风险增加10%相关,对于增加半份以上的加工红肉,死亡风险增加13%,对于增加半份以上的未加工红肉,死亡风险增加9%,每天减少半份以上的红肉与死亡风险无关。即便按照年龄、体力活动、饮食质量、吸烟状态或饮酒量进行因素调整,红肉食用增加与死亡风险之间的关系也具有一致性。研究期间共有14 019例死亡。

 

无论年龄,体力活动水平,饮食质量,吸烟状况或饮酒情况如何,参加者在红肉消耗量变化与死亡率的关联都是一致的Yan Zheng et al.Association of changes in red meat consumption with total and cause specific mortality among US women and men: two prospective cohort studies.BMJ.doi: https://doi.org/10.1136/bmj.l2110

虽然食用含有不同量瘦牛肉(14、71或156克/天)的健康地中海式饮食模式能改善血脂和脂蛋白。但是,我们并不建议吃得越多越好。因为减少红肉总摄入、增加坚果、鱼、无皮家禽、乳制品、鸡蛋、全谷物或蔬菜的摄入,可能与8年内的死亡风险降低相关。

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    牛肉降低心脏病风险

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createdAvatar=https://img.medsci.cn/20210416/dd5710d543164035b9a3c7b7a202c535/09b11b9dcc3b4159b1bd4dd474f2a982.jpg, createdBy=70a75481216, createdName=ms4000001748837497, createdTime=Fri Apr 16 17:57:20 CST 2021, time=2021-04-16, status=1, ipAttribution=)]
    2021-04-20 ms9000001385554566

    红肉是血红蛋白的重要来源

    0

  4. 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time=2021-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1565755, encodeId=a1451565e5511, content=<a href='/topic/show?id=b8435162302' target=_blank style='color:#2F92EE;'>#心脏病风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51623, encryptionId=b8435162302, topicName=心脏病风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=94f015012402, createdName=mgqwxj, createdTime=Sun Apr 18 07:56:10 CST 2021, time=2021-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=957737, encodeId=2faa95e73724, content=地中海饮食是膳食指南推荐的一种健康饮食模式,包括每周约354g蛋白质的红肉(50克/天),关键是瘦肉, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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createdAvatar=https://img.medsci.cn/20210416/dd5710d543164035b9a3c7b7a202c535/09b11b9dcc3b4159b1bd4dd474f2a982.jpg, createdBy=70a75481216, createdName=ms4000001748837497, createdTime=Fri Apr 16 17:57:20 CST 2021, time=2021-04-16, status=1, ipAttribution=)]
    2021-04-20 xiaohairong002

    非常好的文章

    0

  5. 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time=2021-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1565755, encodeId=a1451565e5511, content=<a href='/topic/show?id=b8435162302' target=_blank style='color:#2F92EE;'>#心脏病风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51623, encryptionId=b8435162302, topicName=心脏病风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=94f015012402, createdName=mgqwxj, createdTime=Sun Apr 18 07:56:10 CST 2021, time=2021-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=957737, encodeId=2faa95e73724, content=地中海饮食是膳食指南推荐的一种健康饮食模式,包括每周约354g蛋白质的红肉(50克/天),关键是瘦肉, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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  6. 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time=2021-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1565755, encodeId=a1451565e5511, content=<a href='/topic/show?id=b8435162302' target=_blank style='color:#2F92EE;'>#心脏病风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51623, encryptionId=b8435162302, topicName=心脏病风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=94f015012402, createdName=mgqwxj, createdTime=Sun Apr 18 07:56:10 CST 2021, time=2021-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=957737, encodeId=2faa95e73724, content=地中海饮食是膳食指南推荐的一种健康饮食模式,包括每周约354g蛋白质的红肉(50克/天),关键是瘦肉, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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  7. 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createdAvatar=https://img.medsci.cn/20210416/dd5710d543164035b9a3c7b7a202c535/09b11b9dcc3b4159b1bd4dd474f2a982.jpg, createdBy=70a75481216, createdName=ms4000001748837497, createdTime=Fri Apr 16 17:57:20 CST 2021, time=2021-04-16, status=1, ipAttribution=)]
    2021-04-16 随梦飞扬

    地中海饮食是膳食指南推荐的一种健康饮食模式,包括每周约354g蛋白质的红肉(50克/天),关键是瘦肉

    0

  9. 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time=2021-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1565755, encodeId=a1451565e5511, content=<a href='/topic/show?id=b8435162302' target=_blank style='color:#2F92EE;'>#心脏病风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51623, encryptionId=b8435162302, topicName=心脏病风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=94f015012402, createdName=mgqwxj, createdTime=Sun Apr 18 07:56:10 CST 2021, time=2021-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=957737, encodeId=2faa95e73724, content=地中海饮食是膳食指南推荐的一种健康饮食模式,包括每周约354g蛋白质的红肉(50克/天),关键是瘦肉, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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createdAvatar=https://img.medsci.cn/20210416/dd5710d543164035b9a3c7b7a202c535/09b11b9dcc3b4159b1bd4dd474f2a982.jpg, createdBy=70a75481216, createdName=ms4000001748837497, createdTime=Fri Apr 16 17:57:20 CST 2021, time=2021-04-16, status=1, ipAttribution=)]
    2021-04-16 jyzxjiangqin

    好文章!

    0

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