Meta-analysis of the Effect of Carbohydrates on Cardiovascular Disease Risk Factors

doi:10.12114/j.issn.1007-9572.2023.0296

Abstract

Abstract:

Background

As the leading cause of death in the world, cardiovascular diseases pose a serious threat to human health. Diet has attracted much attention as an important intervention, but the effect of carbohydrates on cardiovascular disease is unknown.

Objective

To analyze the evidence of the correlation between carbohydrate intake and cardiovascular disease risk.

Methods

Wanfang Data, CNKI, VIP, SinoMed, PubMed, Cochrane Library and Embase were searched by computer for randomized controlled trials on the risk of carbohydrates and cardiovascular disease published from inception to January 2023. Two researchers performed literature screening, data extraction, and quality evaluation separately. RevMan 5.3 was used for data analysis.

Results

A total of 16 randomized trials were included. Carbohydrate could significantly reduce triglyceride level by 0.17 mmol/L (95%CI=-0.24--0.10, P<0.000 01). The level of triglyceride decreased by 0.25 mmol/L (95%CI=-0.33--0.17, P<0.000 01) in carbohydrate diet intervention for less than 6 months, and 0.15 mmol/L (95%CI=-0.29--0.01, P=0.04) in 12-23 months group. Plasma HDL-C level increased by 0.09 mmol/L (95%CI=0.07-0.10, P<0.000 01), and plasma LDL-C level increased by 0.10 mmol/L (95%CI=0.02-0.17, P=0.01) .

Conclusion

The overall effect of low carbohydrate diet on cardiovascular risk factors is more favorable below 6 months and 6-11 months, but it has no significant effect on cardiovascular risk factors after 2 years, and its long-term effect needs further study.

Key words: Cardiovascular diseases, Carbohydrates, Diet, Dyslipidemias, Meta-analysis

摘要：

背景

心血管疾病作为全球首要死亡原因，严重威胁人类的健康。饮食作为重要的干预手段备受关注，但碳水化合物对心血管疾病的影响尚未知。

目的

分析碳水化合物摄入对心血管疾病风险因素影响的证据。

方法

计算机检索万方数据知识服务平台、中国知网、维普信息资源系统、中国生物医学文献数据库、PubMed、Cochrane Library、Embase数据库，获取发表时间为建库至2023年1月的关于碳水化合物与心血管疾病风险的随机对照研究。由两名研究者分别独立提取文献数据，并进行文献质量评价。使用RevMan 5.3软件进行数据分析。

结果

共纳入16项随机对照试验，碳水化合物饮食干预能够降低三酰甘油水平，下降了0.17 mmol/L（95%CI=-0.24~-0.10 mmol/L，P<0.000 01）。持续6个月以下碳水化合物饮食干预使三酰甘油水平下降了0.25 mmol/L（95%CI=-0.33~-0.17 mmol/L，P<0.000 01）；12~23个月组三酰甘油降低0.15 mmol/L（95%CI=-0.29~-0.01 mmol/L，P=0.04）。血浆高密度脂蛋白水平升高0.09 mmol/L（95%CI=0.07~0.10 mmol/L，P<0.000 01），血浆低密度脂蛋白水平升高0.10 mmol/L（95%CI=0.02~0.17 mmol/L，P=0.01）。

结论

低碳水化合物饮食对心血管危险因素的总体影响在6个月以下和6~11个月时更加有利，但2年后对心血管危险因素没有显著影响，其长期影响需要进一步研究证实。

关键词: 心血管疾病, 碳水化合物, 膳食, 血脂异常, Meta分析

CLC Number:

R 54

LI Yiguang,LIU Hejun,ZHAO Jinpeng, et al. Meta-analysis of the Effect of Carbohydrates on Cardiovascular Disease Risk Factors[J]. Chinese General Practice, 2024, 27(34): 4341-4349. DOI: 10.12114/j.issn.1007-9572.2023.0296.
李一光,刘荷君,赵锦鹏等. 碳水化合物对心血管疾病风险因素影响的Meta分析[J]. 中国全科医学, 2024, 27(34): 4341-4349. DOI: 10.12114/j.issn.1007-9572.2023.0296.

Figures/Tables 8

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第一作者	年份（年）	国家	样本量	男/女（例）	年龄（±s，岁）	BMI（±s，kg/m²）	随访持续时间	碳水化合物摄入量
LEAN^[15]	1997	英国	110	0/110	50.6±13.8	32.55±5.3	6个月	35%
BREHM^[16]	2003	美国	42	NA	43.7±7.7	37.65±1.83	6个月	≤20 g
FOSTER^[17]	2003	美国	63	20/43	44.1±8.2	34.2±5.4	1年	肌动蛋白饮食
MO RGAN^[18]	2008	英国	118	30/88	40.85±9.65	31.7±2.55	6个月	肌动蛋白饮食
SACKS^[19]	2009	美国	403	139/264	50.5±9.5	33±4	2年	35%
ELHAYANY^[20]	2010	以色列	124	66/58	56.3±6.2	31.4±3	1年	35%
FOSTER^[21]	2010	美国	307	99/208	45.5±9.7	36.1±3.5	2年	≤20 g
LIM^[22]	2010	澳大利亚	46	NA	47±10	32±6	15个月	4%
LIU^[23]	2013	中国	49	NA	47.9±0.9	26.7±0.3	1年	20 g/d每周增加10 g
BAZZANO^[24]	2014	美国	148	31/131	46.8±10.15	35.4±4.15	6个月	<40 g/d
TAY^[25]	2015	澳大利亚	115	66/49	58±7	34.6±4.3	52周	14%
TAY^[26]	2018	澳大利亚	115	66/49	58±7	34.6±4.3	2年	<50 g/d
ROHLING^[27]	2020	德国	123	NA	52.68±8.68	32.2±2.22	52周	<30.6%
ALZAH RANI^[28]	2021	丹麦	56	40/16	64±7.7	30.1±5.2	36周	前12周30%，后24周（28%±4%）
EBBELING^[29]	2022	美国	99	NA	35.7±13.6	32.2±4.8	20周	20%
GRAM-KAMPMANN^[30]	2022	丹麦	71	31/40	56.65±1.92	33.34±1.65	6个月	≤20%

第一作者	年份（年）	国家	样本量	男/女（例）	年龄（±s，岁）	BMI（±s，kg/m²）	随访持续时间	碳水化合物摄入量
LEAN^[15]	1997	英国	110	0/110	50.6±13.8	32.55±5.3	6个月	35%
BREHM^[16]	2003	美国	42	NA	43.7±7.7	37.65±1.83	6个月	≤20 g
FOSTER^[17]	2003	美国	63	20/43	44.1±8.2	34.2±5.4	1年	肌动蛋白饮食
MO RGAN^[18]	2008	英国	118	30/88	40.85±9.65	31.7±2.55	6个月	肌动蛋白饮食
SACKS^[19]	2009	美国	403	139/264	50.5±9.5	33±4	2年	35%
ELHAYANY^[20]	2010	以色列	124	66/58	56.3±6.2	31.4±3	1年	35%
FOSTER^[21]	2010	美国	307	99/208	45.5±9.7	36.1±3.5	2年	≤20 g
LIM^[22]	2010	澳大利亚	46	NA	47±10	32±6	15个月	4%
LIU^[23]	2013	中国	49	NA	47.9±0.9	26.7±0.3	1年	20 g/d每周增加10 g
BAZZANO^[24]	2014	美国	148	31/131	46.8±10.15	35.4±4.15	6个月	<40 g/d
TAY^[25]	2015	澳大利亚	115	66/49	58±7	34.6±4.3	52周	14%
TAY^[26]	2018	澳大利亚	115	66/49	58±7	34.6±4.3	2年	<50 g/d
ROHLING^[27]	2020	德国	123	NA	52.68±8.68	32.2±2.22	52周	<30.6%
ALZAH RANI^[28]	2021	丹麦	56	40/16	64±7.7	30.1±5.2	36周	前12周30%，后24周（28%±4%）
EBBELING^[29]	2022	美国	99	NA	35.7±13.6	32.2±4.8	20周	20%
GRAM-KAMPMANN^[30]	2022	丹麦	71	31/40	56.65±1.92	33.34±1.65	6个月	≤20%