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Antioxidants and Fertility in Women with Ovarian Aging: A Systematic Review and Meta-Analysis 抗氧化剂与卵巢衰老妇女的生育能力:系统回顾与元分析》(Antioxidants and Fertility in Women with Ovarian Ageing: a Systematic Review and Meta-Analysis)。
IF 8 1区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-08-01 DOI: 10.1016/j.advnut.2024.100273

Ovarian aging is a major factor for female subfertility. Multiple antioxidants have been applied in different clinical scenarios, but their effects on fertility in women with ovarian aging are still unclear. To address this, a meta-analysis was performed to evaluate the effectiveness and safety of antioxidants on fertility in women with ovarian aging. A total of 20 randomized clinical trials with 2617 participants were included. The results showed that use of antioxidants not only significantly increased the number of retrieved oocytes and high-quality embryo rates but also reduced the dose of gonadotropin, contributing to higher clinical pregnancy rates. According to the subgroup analysis of different dose settings, better effects were more pronounced with lower doses; in terms of antioxidant types, coenzyme Q10 (CoQ10) tended to be more effective than melatonin, myo-inositol, and vitamins. When compared with placebo or no treatment, CoQ10 showed more advantages, whereas small improvements were observed with other drugs. In addition, based on subgroup analysis of CoQ10, the optimal treatment regimen of CoQ10 for improving pregnancy rate was 30 mg/d for 3 mo before the controlled ovarian stimulation cycle, and women with diminished ovarian reserve clearly benefited from CoQ10 treatment, especially those aged <35 y. Our study suggests that antioxidant consumption is an effective and safe complementary therapy for women with ovarian aging. Appropriate antioxidant treatment should be offered at a low dose according to the patient’s age and ovarian reserve.

This study was registered at PROSPERO as CRD42022359529.

卵巢衰老是导致女性不孕的一个主要因素。多种抗氧化剂已被应用于不同的临床情况,但它们对卵巢衰老女性生育力的影响仍不明确。为此,我们进行了一项荟萃分析,以评估抗氧化剂对卵巢衰老女性生育的有效性和安全性。该研究共纳入了20项随机临床试验(RCT),共有2617人参与。结果表明,使用抗氧化剂不仅能显著增加取回的卵母细胞数量和优质胚胎率,还能减少促性腺激素的剂量,从而提高临床妊娠率。根据亚组分析,就不同剂量设置而言,低剂量效果更明显;就抗氧化剂类型而言,辅酶Q10(CoQ10)往往比褪黑素、肌醇和维生素更有效,因为与安慰剂或不治疗相比,辅酶Q10显示出更大优势,而其他药物则改善甚微。此外,根据辅酶Q10的亚组分析,辅酶Q10提高妊娠率的最佳治疗方案是在控制性卵巢刺激周期前三个月,每天30毫克,卵巢储备功能减退的妇女明显受益于辅酶Q10治疗,尤其是35岁以下的妇女。我们的研究表明,对于卵巢衰老的妇女来说,抗氧化剂是一种有效而安全的辅助疗法。应根据患者的年龄和卵巢储备功能,从低剂量开始提供适当的抗氧化剂治疗。本研究已在 PROSPERO 注册(CRD42022359529)。
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引用次数: 0
We Are What, When, And How We Eat: The Evolutionary Impact of Dietary Shifts on Physical and Cognitive Development, Health, and Disease 我们吃什么、什么时候吃、怎么吃:饮食变化对身体和认知发展、健康和疾病的进化影响。
IF 8 1区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-07-25 DOI: 10.1016/j.advnut.2024.100280

“We are what, when, and how we eat”: the evolution of human dietary habits mirrors the evolution of humans themselves. Key developments in human history, such as the advent of stone tool technology, the shift to a meat-based diet, control of fire, advancements in cooking and fermentation techniques, and the domestication of plants and animals, have significantly influenced human anatomical, physiological, social, cognitive, and behavioral changes. Advancements in scientific methods, such as the analysis of microfossils like starch granules, plant-derived phytoliths, and coprolites, have yielded unprecedented insights into past diets. Nonetheless, the isolation of ancient food matrices remains analytically challenging. Future technological breakthroughs and a more comprehensive integration of paleogenomics, paleoproteomics, paleoglycomics, and paleometabolomics will enable a more nuanced understanding of early human ancestors’ diets, which holds the potential to guide contemporary dietary recommendations and tackle modern health challenges, with far-reaching implications for human well-being, and ecological impact on the planet.

"我们吃什么、什么时候吃、怎么吃":人类饮食习惯的演变反映了人类自身的演变。人类历史上的重要发展,如石器技术的出现、向肉食饮食的转变、对火的控制、烹饪和发酵技术的进步、动植物的驯化等,都对人类的解剖、生理、社会、认知和行为变化产生了重大影响。科学方法的进步,如对淀粉颗粒、植物衍生的植金石和桡骨岩等微化石的分析,为人们了解过去的饮食提供了前所未有的视角。然而,古代食物基质的分离在分析上仍然具有挑战性。未来的技术突破以及古基因组学、古蛋白质组学、古地层组学和古代谢组学的更全面整合将使人们能够更细致地了解人类早期祖先的饮食,从而有可能指导当代饮食建议和应对现代健康挑战,对人类福祉和地球生态影响产生深远影响。
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引用次数: 0
Disrupted prenatal metabolism may explain the etiology of suboptimal neurodevelopment: a focus on phthalates and micronutrients and their relationship to autism spectrum disorder 产前代谢紊乱可解释神经发育不良的病因:聚焦邻苯二甲酸盐和微量营养素及其与自闭症谱系障碍的关系。
IF 8 1区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-07-24 DOI: 10.1016/j.advnut.2024.100279

Pregnancy is a time of high metabolic coordination, as maternal metabolism adapts to support the growing fetus. Many of these changes are coordinated by the placenta, a critical fetal endocrine organ and the site of maternal–fetal crosstalk. Dysregulation in maternal and placental metabolism during pregnancy has been linked to adverse outcomes, including altered neurodevelopment. Autism spectrum disorder (ASD) is a neurodevelopmental disorder linked to metabolic alterations in both children and their mothers. Prenatal environmental exposures have been linked to risk of ASD through dysregulated maternal, placental, and fetal metabolism. In this review, we focus on recent studies investigating the associations between prenatal metabolism in the maternal-placental-fetal unit and the impact of prenatal environmental exposures to phthalates and micronutrients on ASD risk. By identifying the mechanisms through which phthalates and other ubiquitous endocrine disrupting chemicals influence development, and how nutritional interventions can impact those mechanisms, we can identify promising ways to prevent suboptimal neurodevelopment.

孕期是新陈代谢高度协调的时期,因为母体的新陈代谢要适应胎儿的生长发育。胎盘是胎儿的重要内分泌器官,也是母体与胎儿之间相互影响的部位。孕期母体和胎盘代谢失调与不良后果有关,包括神经发育的改变。自闭症谱系障碍(ASD)是一种神经发育障碍,与儿童及其母亲的新陈代谢改变有关。通过母体、胎盘和胎儿代谢失调,产前环境暴露与自闭症风险有关。在这篇综述中,我们将重点讨论最近的一些研究,这些研究调查了母体-胎盘-胎儿单元中产前代谢之间的关联,以及产前环境暴露于邻苯二甲酸盐和微量营养素对 ASD 风险的影响。通过确定邻苯二甲酸盐和其他无处不在的干扰内分泌的化学物质对发育的影响机制,以及营养干预措施如何影响这些机制,我们可以找出预防神经发育不良的有效方法。
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引用次数: 0
Health Effects of Various Edible Vegetable Oil: An Umbrella Review 各种食用植物油对健康的影响:综述。
IF 8 1区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-07-23 DOI: 10.1016/j.advnut.2024.100276

Vegetable oils, derived from diverse sources such as seeds, nuts, and some fruits, play a significant role in dietary health. However, the current evidence on the health effects of different types of vegetable oil consumption remains controversial. This umbrella review aims to synthesize evidence from systematic reviews and meta-analyses to assess the health outcomes associated with various vegetable oils. A comprehensive literature search was performed up to 31 July, 2023 on 12 databases for studies examining the association of different vegetable oils with health outcomes in adults. Data was extracted independently by 2 authors, with evidence strength assessed using the grading of recommendations, assessment, development, and evaluation criteria. A total of 48 studies, including 206 meta-analyses, were included. Moderate to very low certainty evidence showed that monounsaturated and polyunsaturated fatty acids such as canola oil, virgin olive oil, and rice bran oil are beneficial in reducing serum total cholesterol and low-density lipoprotein (LDL) concentrations. Conversely, low to very low certainty evidence suggests that oils high in saturated fats, such as coconut oil and palm oil, increase total cholesterol and LDL concentrations but also raise high-density lipoprotein concentrations. Very low certainty evidence showed the consumption of olive oil, sesame oil, and coconut oil could improve blood sugar control. Low certainty evidence showed olive oil consumption reduced risk of breast, digestive, and other cancers. Moderate to very low certainty evidence suggested that canola oil and sesame oil consumption reduced body weight. The consumption of vegetable oil appears to offer different health benefits, with summary estimates indicating beneficial effects on reducing lipid concentrations, especially with monounsaturated and polyunsaturated rich oils when consumed in recommended amounts. Future research should focus on long-term studies and comprehensive dietary assessments to better understand the health impacts of vegetable oils, providing a basis for informed dietary recommendations.

This study was registered at PROSPERO as CRD42021239210.

植物油的来源多种多样,如种子、坚果和一些水果,它们在膳食健康中发挥着重要作用。然而,目前有关食用不同类型植物油对健康影响的证据仍存在争议。本综述旨在综合来自系统综述和荟萃分析的证据,以评估各种植物油对健康的影响。截至 2023 年 7 月 31 日,我们在 12 个数据库中进行了全面的文献检索,以了解有关不同植物油与成人健康结果相关性的研究。数据由两位作者独立提取,并采用 GRADE 标准评估证据强度。共纳入了 48 项研究,包括 206 项元分析。中度到极低确定性证据显示,菜籽油、初榨橄榄油和米糠油等单不饱和脂肪酸和多不饱和脂肪酸有益于降低血清总胆固醇和低密度脂蛋白水平。相反,低度到极低度确定性证据表明,椰子油和棕榈油等饱和脂肪含量高的油类会增加总胆固醇和低密度脂蛋白水平,但也会提高高密度脂蛋白水平。极低确定性证据显示,食用橄榄油、芝麻油和椰子油可改善血糖控制。低确定性证据显示,食用橄榄油可降低罹患乳腺癌、消化系统癌症和其他癌症的风险。中度至极度不确定的证据表明,食用菜籽油和芝麻油可减轻体重。食用植物油似乎能带来不同的健康益处,汇总估算结果表明,食用推荐量的植物油,尤其是富含单不饱和和多不饱和脂肪酸的植物油,对降低血脂水平有益。未来的研究应侧重于长期研究和全面膳食评估,以更好地了解植物油对健康的影响,为知情的膳食建议提供依据。系统综述注册:prospero crd42021239210。
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引用次数: 0
Nutritional Modulation of Host Defense Peptide Synthesis: A Novel Host-Directed Antimicrobial Therapeutic Strategy? 营养调节宿主防御肽的合成:宿主导向的新型抗菌治疗策略?
IF 8 1区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-07-23 DOI: 10.1016/j.advnut.2024.100277

The escalating threat of antimicrobial resistance underscores the imperative for innovative therapeutic strategies. Host defense peptides (HDPs), integral components of innate immunity, exhibit profound antimicrobial and immunomodulatory properties. Various dietary compounds, such as short-chain fatty acids, vitamins, minerals, sugars, amino acids, phytochemicals, bile acids, probiotics, and prebiotics have been identified to enhance the synthesis of endogenous HDPs without provoking inflammatory response or compromising barrier integrity. Additionally, different classes of these compounds synergize in augmenting HDP synthesis and disease resistance. Moreover, dietary supplementation of several HDP-inducing compounds or their combinations have demonstrated robust protection in rodents, rabbits, pigs, cattle, and chickens from experimental infections. However, the efficacy of these compounds in inducing HDP synthesis varies considerably among distinct compounds. Additionally, the regulation of HDP genes occurs in a gene-specific, cell type–specific, and species-specific manner. In this comprehensive review, we systematically summarized the modulation of HDP synthesis and the mechanism of action attributed to each major class of dietary compounds, including their synergistic combinations, across a spectrum of animal species including humans. We argue that the ability to enhance innate immunity and barrier function without triggering inflammation or microbial resistance positions the nutritional modulation of endogenous HDP synthesis as a promising host-directed approach for mitigating infectious diseases and antimicrobial resistance. These HDP-inducing compounds, particularly in combinations, harbor substantial clinical potential for further exploration in antimicrobial therapies for both human and other animals.

抗菌药耐药性的威胁不断升级,这凸显了创新治疗策略的必要性。宿主防御肽(HDPs)是先天性免疫不可或缺的组成部分,具有深远的抗菌和免疫调节特性。目前已发现短链脂肪酸、维生素、矿物质、糖类、氨基酸、植物化学物质、胆汁酸、益生菌和益生元等各种膳食化合物可增强内源性 HDPs 的合成,而不会引起炎症反应或损害屏障的完整性。此外,这些化合物的不同类别在增强 HDP 合成和抗病能力方面具有协同作用。此外,膳食中补充几种 HDP 诱导化合物或其组合已在动物实验感染中显示出强大的保护作用。然而,这些化合物在诱导 HDP 合成方面的功效在不同化合物之间存在很大差异。此外,HDP 基因的调控是以基因、细胞类型和物种特异性的方式进行的。在这篇综述中,我们系统地总结了包括人类在内的各种动物物种对 HDP 合成的调节作用以及每一类主要膳食化合物(包括它们的协同组合)的作用机制。我们认为,营养调节内源性 HDP 合成能够增强先天免疫力和屏障功能,而不会引发炎症或微生物抗药性,因此是减轻传染病和抗微生物抗药性的一种很有前景的宿主导向方法。这些诱导 HDP 的化合物,尤其是其组合,具有巨大的临床潜力,可在人类和其他动物的抗菌疗法中进一步探索。
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引用次数: 0
Intersections of Climate Change with Food Systems, Nutrition, and Health: An Overview and Evidence Map 气候变化与粮食系统、营养和健康的相互关系:概述和证据图。
IF 8 1区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-07-15 DOI: 10.1016/j.advnut.2024.100274

Scientific research linking climate change to food systems, nutrition, and nutrition-related health (FSNH) has proliferated, showing bidirectional and compounding dependencies that create cascading risks for human and planetary health. Within this proliferation, it is unclear which evidence to prioritize for action and which research gaps, if filled, would catalyze the most impact. We systematically searched for synthesis literature (i.e., reviews) related to FSNH published after 1 January, 2018. We screened and extracted characteristics of these reviews and mapped them in an interactive Evidence and Gap Map (EGM) supplemented by expert consultation. Eight hundred forty-four synthesis reports met inclusion criteria (from 2739 records) and were included in the EGM. The largest clusters of reports were those describing climate impacts on crop and animal-source food production and emissions from such (86%). Comparatively few reports assessed climate change impacts on nutrition-related health or food manufacture, processing, storage, and transportation. Reports focused on strategies of climate adaptation (40%), mitigation (29%), both (19%), or none (12%). Only 1 quarter of reports critically evaluated equity (25%), and fewer reports suggested that changes to equity and equitable practices would alter climate-FSNH dynamics (6%). The expert consultation mirrored the results of the EGM and contextualized findings further. This novel map describes a wide research landscape linking climate change to FSNH. We identified 4 key research gaps: 1) research on whole food systems or postharvest elements; 2) research evaluating relationships between climate change and nutrition-related health outcomes, especially among vulnerable populations; 3) promising methods (and additional data required) that can i) identify inflection points or levers for intervention, ii) incorporate complex dynamics and characterize trade-offs, iii) be understood and applied in context-specific, localized ways for decision making; and 4) research undertaken through interdisciplinary collaborations that enables producing and translating evidence to action, especially those that inherently consider coproduction and fairness.

将气候变化与粮食系统、营养和营养相关健康(FSNH)联系起来的科学研究大量涌现,显示出双向和复合的依赖关系,给人类和地球健康带来一连串的风险。在这种激增的情况下,尚不清楚哪些证据应优先用于行动,哪些研究缺口如果得到填补将产生最大影响。我们系统地检索了 2018 年 1 月 1 日之后发表的与 FSNH 相关的综合文献(即综述)。我们筛选并提取了这些综述的特征,并将其映射到交互式证据和差距图(EGM)中,同时辅以专家咨询。844篇综述报告符合纳入标准(来自2739条记录),并被纳入EGM。最大的报告集群是描述气候对作物和动物源性食品 (ASF) 生产的影响以及由此产生的排放的报告(86%)。评估气候变化对营养相关健康或食品制造、加工、储存和运输影响的报告相对较少。报告侧重于气候适应战略(40%)、减缓战略(29%)、两者兼顾战略(19%)或无战略(12%)。只有四分之一的报告对公平性进行了严格评估(25%),较少报告认为公平性和公平做法的改变会改变气候-FSNH 的动态变化(6%)。专家咨询会反映了 EGM 的结果,并将结论进一步背景化。这张新颖的地图描述了气候变化与家庭健康网之间的广泛研究前景。我们确定了四个关键的研究缺口,包括:1)关于整个食品系统或收获后要素的研究;2)评估气候变化与营养相关健康结果之间关系的研究,尤其是在弱势群体中;3) 有前景的方法(和所需的额外数据),能够 a) 确定干预的拐点或杠杆,b) 纳入复杂的动态变化并描述权衡的特点,c) 以特定的、本地化的方式理解和应用于决策;以及 4) 通过跨学科合作开展的研究,能够产生证据并将证据转化为行动,特别是那些本质上考虑共同生产和公平性的研究。
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引用次数: 0
Ceramides as Emerging Players in Cardiovascular Disease: Focus on Their Pathogenetic Effects and Regulation by Diet 神经酰胺是心血管疾病中的新兴角色:关注它们的致病作用和饮食调节。
IF 8 1区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-07-01 DOI: 10.1016/j.advnut.2024.100252
Riccardo Spaggiari , Sharon Angelini , Alessandra Di Vincenzo , Gerarda Scaglione , Sara Morrone , Veronica Finello , Sofia Fagioli , Fabiola Castaldo , Juana M Sanz , Domenico Sergi , Angelina Passaro

Impaired lipid metabolism is a pivotal driver of cardiovascular disease (CVD). In this regard, the accumulation of ceramides within the circulation as well as in metabolically active tissues and atherosclerotic plaques is a direct consequence of derailed lipid metabolism. Ceramides may be at the nexus between impaired lipid metabolism and CVD. Indeed, although on one hand ceramides have been implicated in the pathogenesis of CVD, on the other specific ceramide subspecies have also been proposed as predictors of major adverse cardiovascular events. This review will provide an updated overview of the role of ceramides in the pathogenesis of CVD, as well as their pathogenetic mechanisms of action. Furthermore, the manuscript will cover the importance of ceramides as biomarkers to predict cardiovascular events and the role of diet, both in terms of nutrients and dietary patterns, in modulating ceramide metabolism and homeostasis.

脂质代谢障碍是心血管疾病(CVD)的关键驱动因素。在这方面,神经酰胺在血液循环以及代谢活跃的组织和动脉粥样硬化斑块中的积累是脂质代谢失调的直接后果。神经酰胺可能是脂质代谢受损与心血管疾病之间的联系纽带。事实上,一方面神经酰胺与心血管疾病的发病机制有关,另一方面特定的神经酰胺亚种也被认为是主要不良心血管事件的预测因子。本综述将概述神经酰胺在心血管疾病发病机制中的作用及其致病机制。此外,手稿还将介绍神经酰胺作为生物标志物在预测心血管事件中的重要性,以及饮食(包括营养素和饮食模式)在调节神经酰胺代谢和平衡中的作用。
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引用次数: 0
Dietary Patterns and Cardiovascular Diseases in Asia: A Systematic Review and Meta-Analysis 亚洲的膳食模式与心血管疾病:系统回顾与元分析
IF 8 1区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-07-01 DOI: 10.1016/j.advnut.2024.100249
Gladys Huiyun Lim , Nithya Neelakantan , Yu Qi Lee , Su Hyun Park , Zhi Heng Kor , Rob M van Dam , Mary Foong-Fong Chong , Airu Chia

With emerging Asian-derived diet quality indices and data-driven dietary patterns available, we aimed to synthesize the various dietary patterns and quantify its association with cardiovascular diseases (CVDs) among Asian populations. We systematically searched PubMed, Embase, Scopus, and Web of Science for observational studies in South, Southeast, and East Asia. Dietary patterns were grouped “high-quality,” which included high intakes of three or more of the following food groups: 1) fruits and vegetables, 2) whole grains, 3) healthy protein sources (legumes and nuts, fish and seafood, low-fat dairy, and lean meat and poultry), and 4) liquid plant oils. High-quality patterns were further subcategorized based on their derivation methods: non-Asian indices, Asian indices, data-driven patterns, and plant-based indices. Dietary patterns were grouped “low-quality,” which included high intakes of two or more of the following: 5) ultraprocessed food, 6) beverages and foods with added sugars, 7) foods high in salt, and 8) alcoholic beverages. Data-driven dietary patterns characterized by animal food sources were labeled “animal-based,” and studies using dietary diversity scores were labeled “diet diversity indices.” Dietary patterns that could not be meaningfully categorized were summarized narratively. Study-specific effect estimates were pooled using a random-effects model. Forty-one studies were included in this review. Higher adherence to high-quality dietary patterns in the top compared with bottom tertile defined by non-Asian indices (RR: 0.78; 95% CI: 0.69, 0.88; GRADE: moderate), Asian indices (RR: 0.84; 95% CI: 0.79, 0.90; GRADE: low), and data-driven patterns (RR: 0.81; 95% CI: 0.74, 0.89; GRADE: moderate) were associated with lower CVD risk. Plant-based, low-quality, animal-based, and diet diversity indices dietary patterns were not associated with CVD. Associations of Asian diet quality indices and CVD risk were weaker than those with non-Asian indices, highlighting the need for current Asian diet quality criteria to be updated to better capture the impact of diet on CVD.

The systematic review and meta-analysis was registered at PROSPERO as CRD42021244318.

随着新兴的亚洲膳食质量指数和数据驱动的膳食模式的出现,我们旨在综合各种膳食模式并量化其与亚洲人群心血管疾病(CVDs)的关联。我们系统地检索了 PubMed、Embase、Scopus 和 Web of Science 中有关南亚、东南亚和东亚的观察性研究。膳食模式被归类为 "高质量",包括摄入以下三类或更多食物:1)水果和蔬菜;2)全谷物;3)健康蛋白质来源(豆类和坚果、鱼类和海鲜、低脂乳制品、瘦肉和家禽);4)液态植物油。高质量的膳食模式根据其推导方法进一步细分为:非亚洲指数、亚洲指数、数据驱动型膳食模式和植物性膳食模式。膳食模式被归类为 "低质量",其中包括以下两种或两种以上的高摄入量:5)超加工食品;6)添加糖的饮料和食品;7)高盐食品;8)酒精饮料。以动物性食物来源为特征的数据驱动膳食模式被称为 "动物性膳食",使用膳食多样性评分的研究被称为 "膳食多样性指数"。无法进行有意义分类的膳食模式则以叙述的方式进行总结。采用随机效应模型对特定研究的效应估计值进行汇总。本综述共纳入 41 项研究。与非亚洲人指数(RR:0.78;95% CI:0.69,0.88;GRADE:中度)、亚洲人指数(RR:0.84;95% CI:0.79,0.90;GRADE:低度)和数据驱动模式(RR:0.81;95% CI:0.74,0.89;GRADE:中度)所定义的最低三分位数相比,最高三分位数中更多人坚持高质量膳食模式与较低的心血管疾病风险相关。植物性膳食、低质量膳食、动物性膳食和膳食多样性指数膳食模式与心血管疾病无关。亚洲人的饮食质量指数与心血管疾病风险的相关性弱于非亚洲人的指数,这表明目前亚洲人的饮食质量标准需要更新,以更好地反映饮食对心血管疾病的影响。
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引用次数: 0
Dietary Patterns in Asia: Current Evidence and Future Directions 亚洲的膳食模式:当前证据与未来方向
IF 8 1区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-07-01 DOI: 10.1016/j.advnut.2024.100250
Lukas Schwingshackl , Georg Hoffmann
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引用次数: 0
A Systematic Review and Bayesian Network Meta-Analysis Comparing In-Person, Remote, and Blended Interventions in Physical Activity, Diet, Education, and Behavioral Modification on Gestational Weight Gain among Overweight or Obese Pregnant Individuals 系统性综述和贝叶斯网络元分析:比较面对面、远程和混合干预对超重或肥胖孕妇妊娠体重增加的影响。
IF 8 1区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-07-01 DOI: 10.1016/j.advnut.2024.100253
Hongli Yu , Mingmao Li , Guoping Qian , Shuqi Yue , Zbigniew Ossowski , Anna Szumilewicz

Background

Despite the well-documented adverse outcomes associated with obesity during pregnancy, this condition remains a promising modifiable risk factor.

Objectives

The aim of this study was to ascertain the most effective treatment modalities for gestational weight gain (GWG) in pregnant women classified as overweight or obese.

Methods

A systematic search was conducted across 4 electronic databases: Embase, EBSCOhost, PubMed, and Web of Science. To assess the quality of evidence, the Confidence In Network Meta-Analysis (CINeMA) approach, grounded in the Grading of Recommendations Assessment, Development, and Evaluation framework, was employed. A Bayesian network meta-analysis was conducted to synthesize the comparative effectiveness of treatment modalities based on GWG outcomes.

Results

The analysis incorporated 60 randomized controlled trials, encompassing 16,615 participants. Modes of intervention administration were classified as remote (R: eHealth [e] and mHealth [m]), in-person (I), and a combination of both (I+R). The interventions comprised 5 categories: education (E), physical activity (PA), dietary (D), behavior modification (B), and combinations thereof. The quality of the evidence, as evaluated by CINeMA, ranged from very low to high. Compared to the control group, the I-D intervention (mean difference [MD]: −1.27; 95% confidence interval [CI]: −2.23, −0.32), I-PADB (MD: −0.60, 95% CI: −1.19, −0.00), and I-B (MD: −0.34, 95% CI: −0.57, −0.10) interventions showed significant efficacy in reducing GWG.

Conclusions

Preliminary findings suggest that the I-D intervention is the most efficacious in managing GWG among pregnant women who are overweight or obese, followed by I-PADB and I-B+R-B(m) treatments. These conclusions are drawn from evidence of limited quality and directness, including insufficient data on PA components used in the interventions. Owing to the absence of robust, direct evidence delineating significant differences among various GWG management strategies, it is tentatively proposed that the I-D intervention is likely the most effective approach.

This study was registered with PROSPERO as CRD42023473627.

背景:尽管孕期肥胖带来的不良后果已得到充分证实,但这种情况仍然是一种很有希望改变的风险因素:本研究旨在确定治疗超重或肥胖孕妇妊娠体重增加(GWG)的最有效方法:方法:在四个电子数据库中进行了系统检索:方法:在四个电子数据库中进行了系统检索:Embase、EBSCOhost、PubMed 和 Web of Science。为了评估证据的质量,采用了基于建议评估、发展和评价分级(GRADE)框架的信心网络荟萃分析(CINeMA)方法。通过贝叶斯网络荟萃分析,综合了基于 GWG 结果的各种治疗方法的比较效果:分析纳入了 60 项 RCT,涉及 16,615 名参与者。干预管理模式分为远程(R:电子健康(e)和移动健康(m))、面对面(I)和两者结合(I+R)。干预措施包括五类:教育(E)、体育锻炼(PA)、饮食(D)、行为矫正(B)以及这些措施的组合。经 CINeMA 评估,证据的质量从很低到很高不等。与对照组相比,I-D 干预(平均差 (MD) =-1.27,95% CI [-2.23,-0.32])、I-PADB(MD =-0.60,95% CI [-1.19,-0.00])和 I-B 干预(MD =-0.34,95% CI [-0.57,-0.10])在降低 GWG 方面显示出显著疗效:初步研究结果表明,I-D 干预疗法对控制超重或肥胖孕妇的 GWG 最有效,其次是 I-PADB 和 I-B+R-B(m)疗法。这些结论是根据质量和直接性有限的证据得出的,包括干预措施中使用的 PA 成分数据不足。由于缺乏有力的直接证据来说明各种 GWG 管理策略之间的显著差异,因此初步认为 I-D 干预可能是最有效的方法。系统综述或荟萃分析的登记处和登记号:国际前瞻性系统综述注册表,CRD42023473627 意义声明:本研究提出了新的方法,利用系统综述和贝叶斯荟萃分析,结合直接和间接证据,评估管理超重和肥胖孕妇妊娠体重增加的有效干预措施。这种方法通过评估各种干预方法的有效性和管理过程,弥补了之前的不足;为这一特殊孕妇群体提供了更全面的分析。
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Advances in Nutrition
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