結(jié)論速覽

通過實驗數(shù)據(jù)匯總分析，得出結(jié)論：

1. 低碳飲食組在體重、甘油三酯、血壓指標的降低明顯多于低脂飲食組

2. 低碳組在LDL-C和HDL-C膽固醇的指標高于低脂組，但這不代表不健康

3. 兩組在空腹血糖、胰島素、糖化血紅蛋白和C反應(yīng)蛋白的數(shù)值沒有明顯差異

低碳飲食vs低脂飲食，哪個更好？

在之前的案例分享中，我和大家說過我曾經(jīng)是一個“傳統(tǒng)減肥法”的擁簇。什么是“傳統(tǒng)減肥法”呢？低脂肪、低熱量、大量運動是它的重要元素。

而生酮飲食，要求低碳水、中等蛋白、高脂肪的飲食結(jié)構(gòu)。對于它的效果，我想已經(jīng)不用多說~關(guān)注我們的酮學尤其是群里的小伙伴每天都在看到。

那么低脂和低碳這兩種減肥流派，究竟誰的效果更好？高脂的生酮飲食對身體有沒有傷害？

2013年在英國營養(yǎng)學期刊上發(fā)布了一篇研究《極低碳的生酮飲食與低脂飲食對長期減肥的隨機對照試驗的薈萃分析》可以給你一個滿意的答案。這份研究還得到了國家衛(wèi)生組織（CNPQ）撥款的支持（130639 / 2011-7）。

Nassib Bezerra Bueno等四位作者在研究中收集了MEDLINE，CENTRAL，ScienceDirect等多個數(shù)據(jù)機構(gòu)的實驗數(shù)據(jù)，這些實驗都是將成年人隨機分配到“低碳”飲食組和“低脂”飲食組，研究其在12個月內(nèi)及后續(xù)的身體變化。

在研究中，主要的分析指標有：

體重

甘油三酯

膽固醇（高低密度脂蛋白）

血壓（收縮壓和舒張壓）

空腹血糖

胰島素

HbA 1c（糖化血紅蛋白）

C反應(yīng)蛋白（免疫性蛋白）

體重

大家最關(guān)心的當然是體重啦！畢竟無論是低脂或者低碳，大部分人執(zhí)行它的最主要目的還是減重（脂）。

讓我們先來實驗匯總數(shù)據(jù)（以示實驗的真實嚴肅）：

（a）體重，（b）甘油三酯，

（c）HDL-膽固醇（HDL-C），（d）LDL-膽固醇（LDL-C）

LFD：低脂組；VLCKD：低碳組

對13個單獨研究（1415名患者）的匯總數(shù)據(jù)顯示，與分配到低脂的個體相比，分配到低碳組的實驗對象體重降低明顯更多（加權(quán)均數(shù)差- 0·91（95％CI - 1·65， - 0·17）kg，P= 0.02;I2= 0％，P= 0·47）。

結(jié)論：低碳飲食在降低體重上效果更好！

血脂（甘油三酯和膽固醇 )

如生酮飲食一樣，低碳組在實驗中攝取了更多的脂肪。很多酮學都擔心，脂肪吃多了難道不會血脂高嗎？

血脂主要包括甘油三酯和膽固醇兩個指標，讓我們看一下這兩個指標對比結(jié)果。

甘油三酯

如上一節(jié)的圖片所示，對12項單獨研究（1258名患者）的數(shù)據(jù)匯總顯示，分配到低碳組的實驗對象在甘油三酯指標上的下降比低脂組明顯更多（加權(quán)均數(shù)差-0·18（95％CI -0·27，-0.08）mmol / l，P<0.001;I2= 12％，P= 0·33）。

并且，除了一組24個月隨訪的實驗沒有具體數(shù)據(jù)外，所有的實驗均顯示出了這個結(jié)果！

膽固醇

如上圖數(shù)據(jù)所示，對12項單獨研究（1257名患者）的數(shù)據(jù)匯總顯示，低碳組實驗對象的的HDL-C（高密度脂蛋白膽固醇）水平顯著增加（加權(quán)均數(shù)差-0·09（95％CI 0·06,0·12）mmol / l，P<0· 001;I2= 9％，P= 0·36），LDL-C（低密度脂蛋白膽固醇）水平顯著增加（加權(quán)均數(shù)差-0·12（95％CI 0·04,0·2）mmol / l，P= 0· 002;I2= 0％，P= 0·7）。

看來低碳組的膽固醇指標果然是明顯的升高了！這是不是說明高脂肪的飲食對身體有危害呢？

首先，高密度脂蛋白膽固醇（HDL），主要負責運輸膽固醇到肝臟，是我們俗稱“好的膽固醇”，對身體健康沒有任何影響。

我們最常聽到的說法是低密度脂蛋白（LDL）是所謂的壞脂蛋白，且認為LDL和心臟病密切相關(guān)。

但是呢，國外研究發(fā)現(xiàn)，LDL也是分種類的，分成大/小顆粒。

大顆粒低密度脂蛋白：顧名思義，粒子大，研究發(fā)現(xiàn)這類脂蛋白和心臟病沒有關(guān)系。

小顆粒低密度脂蛋白：小粒子，可以自由通過動脈管壁，和心臟病有著一定關(guān)系。

Krauss等研究人員發(fā)現(xiàn)，高脂肪攝入量與低碳水攝入相結(jié)合，提高的是大尺寸LDL-C的水平，而大尺寸LDL-C的對動脈粥樣硬化程度是遠低于小顆粒的LDL-C的！

結(jié)論：低碳飲食不僅可以降低甘油三酯水平，所提升的膽固醇水平對身體基本沒有影響，所以低碳可以降血脂！

血壓

與聳人聽聞的“高血脂”如影隨形的，就是“高血壓”了。那么低碳飲食和低脂飲食在血壓上有什么影響呢？

（a）收縮壓（SBP）和（b）舒張壓（DBP）的絕對變化

血壓包括收縮壓SBP和舒張壓DBP。各組間收縮壓SBP無差異（加權(quán)均數(shù)差VLCKD - 1·47（95％CI - 3·44,0.5）mmHg，P=0.14;I2= 33％，P= 0 ·13）。

然而，低碳組的舒張壓DBP指標比低脂組明顯降低（加權(quán)均數(shù)差- 1·43（95％CI - 2·49， - 0·37）mmHg，P= 0.008;I2= 3％，P= 0·41）。

結(jié)論：低碳飲食對降血壓效果更好！

空腹血糖、胰島素、HbA 1c、C反應(yīng)蛋白

這幾項數(shù)據(jù)在兩組中的差異不大，所以兩種不同的飲食方法并沒有什么區(qū)別。

小結(jié)

通過對實驗數(shù)據(jù)的匯總和統(tǒng)計學分析，學者發(fā)現(xiàn)低碳飲食相比于低脂飲食，在減體重、降血脂和降血壓方面有著更好的效果。

由于攝入了更多的飽和脂肪，低碳組的膽固醇水平有所增高，但增高的膽固醇類型對心腦血管無害。

另一方面，低碳飲食并沒有對胰島素水平有著更明顯的改變，并且作者認為由于低碳飲食對大眾飲食習慣的改變更多，執(zhí)行起來的難度也會更大一些。

只要你有足夠的意志力和決心，放心的減少碳水，多吃脂肪吧！

它的效果和安全性可是有科學實驗的背書哦！

下期見，喵~

參考文獻

Bueno,N, Melo,I, Oliverira,S, Ataide,T(2013) Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. British Journal of Nutrition, Volume 110, Issue 7.14 October 2013 , pp. 1178-1187. https://www.cambridge.org (accessed 9 Augest 2018).

World Health Organization (2012) Obesity and overweight. http://www.who.int/mediacentre/factsheets/fs311/en/ (accessed 10 May 2012).

Ggebakan, O, Kohl, A, Osterhoff, MA, et al. (2011) Effects of weight loss and long-term weight maintenance with diets varying in protein and glycemic index on cardiovascular risk factors: the diet, obesity, and genes (DiOGenes) study: a randomized, controlled trial. Circulation 124, 2829–2838.

Ornish, D (1997) Every Day Cooking With Dean Ornish. New York: Harper Collins.

Sears, B & Lawren, W (1995) Enter the Zone. New York: Harper Collins.

Weight Watchers Publishing Group (1997) Weight Watchers New Complete Cookbook. New York: Macmill.

Accurso, A, Bernstein, R, Dahlqvist, A, et al. (2008) Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal. Nutr Metab (Lond) 5, 9.

Alhassan, S, Kim, S, Bersamin, A, et al. (2008) Dietary adherence and weight loss success among overweight women: results from the A to Z weight loss study. Int J Obes (Lond) 32, 985–991.

Sacks, FM, Bray, GA, Carey, VJ, et al. (2009) Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 360, 859–873.

Krieger, JW, Sitren, HS, Daniels, MJ, et al. (2006) Effects of variation in protein and carbohydrate intake on body mass and composition during energy restriction: a meta-regression. Am J Clin Nutr 83, 260–274.

Hession, M, Rolland, C, Kulkarni, U, et al. (2009) Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities. Obes Rev 10, 36–50.

Nordmann, AJ, Nordmann, A, Briel, M, et al. (2006) Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med 166, 285–293.

Santos, FL, Esteves, SS, da Costa Pereira, A, et al. (2012) Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obes Rev 13, 1048–1066.

Moher, D, Liberati, A, Tetzlaff, J, et al. (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151, 264–269.

Sterne JAC, Egger M & Moher D (2011) Addressing reporting biases. In Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0 [updated March 2011]. http://www.cochrane-handbook.org (accessed 10 March 2012).

Robinson, KA & Dickersin, K (2002) Development of a highly sensitive search strategy for the retrieval of reports of controlled trials using PubMed. Int J Epidemiol 31, 150–153.

World Health Organization Expert Consultation (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363, 157–163.

Higgins JPT & Deeks JJ (2011) Selecting studies and collecting data. In Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0 [updated March 2011]. http://www.cochrane-handbook.org (accessed 22 March 2012).

18Higgins JPT, Altman DG & Sterne JAC (2011) Assessing risk of bias in included studies. In Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0 [updated March 2011]. http://www.cochrane-handbook.org (accessed 21 March 2012).

Deeks JJ, Higgins JPT & Altman DG (2011) Analysing data and undertaking meta-analyses. In Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0 [updated March 2011]. http://www.cochrane-handbook.org (accessed 01 April 2012).

DerSimonian, R & Laird, N (1986) Meta-analysis in clinical trials. Control Clin Trials 7, 177–188.

Higgins JPT, Deeks JJ & Altman DG (2011) Special topics in statistics. In Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0 [updated March 2011]. http://www.cochrane-handbook.org (accessed 01 April 2012).

Harbord, RM & Higgins, JPT (2008) Meta-regression in stata. Stata J 8, 493–519.

Peters, JL, Sutton, AJ, Jones, DR, et al. (2008) Contour-enhanced meta-analysis funnel plots help distinguish publication bias from other causes of asymmetry. J Clin Epidemiol 61, 991–996.

Egger, M, Smith, GD, Schneider, M, et al. (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315, 629–634.

Vetter, ML, Iqbal, N, Volger, S, et al. (2010) Long-term effects of low-carbohydrate versus low-fat diets in obese persons. Ann Int Med 152, 334–335.

Stern, L, Iqbal, N, Seshadri, P, et al. (2004) The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med 140, 778–785.

Foster, GD, Wyatt, HR, Hill, JO, et al. (2010) Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Ann Intern Med 153, 147–157.

Brinkworth, GD, Noakes, M, Buckley, JD, et al. (2009) Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo. Am J Clin Nutr 90, 23–32.

Iqbal, N, Vetter, ML, Moore, RH, et al. (2010) Effects of a low-intensity intervention that prescribed a low-carbohydrate vs. a low-fat diet in obese, diabetic participants. Obesity (Silver Spring) 18, 1733–1738.

Gardner, CD, Kiazand, A, Alhassan, S, et al. (2007) Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A to Z Weight Loss Study: a randomized trial. JAMA 297, 969–977.

Ebbeling, CB, Swain, JF, Feldman, HA, et al. (2012) Effects of dietary composition on energy expenditure during weight-loss maintenance. JAMA 307, 2627–2634.

Westman, EC, Feinman, RD, Mavropoulos, JC, et al. (2007) Low-carbohydrate nutrition and metabolism. Am J Clin Nutr 86, 276–284.

Volek, JS, Sharman, MJ & Forsythe, CE (2005) Modification of lipoproteins by very low-carbohydrate diets. J Nutr 135, 1339–1342.

Krauss, RM, Blanche, PJ, Rawlings, RS, et al. (2006) Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia. Am J Clin Nutr 83, 1025–1031.

Berneis, KK & Krauss, RM (2002) Metabolic origins and clinical significance of LDL heterogeneity. J Lipid Res 43, 1363–1379.

Appel, LJ, Sacks, FM, Carey, VJ, et al. (2005) Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the omniheart randomized trial. JAMA 294, 2455–2464.

Anonymous (2001) Primer on statistical significance and P values. Eff Clin Pract 4, 183–184.

Wadden, TA, Volger, S, Sarwer, DB, et al. (2011) A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med 365, 1969–1979.

Alberti, KG, Zimmet, P, Shaw, J, et al. (2005) The metabolic syndrome – a new worldwide definition. Lancet 366, 1059–1062.

Kass, L, Weekes, J & Carpenter, L (2012) Effect of magnesium supplementation on blood pressure: a meta-analysis. Eur J Clin Nutr 66, 411–418.

Ried, K, Sullivan, TR, Fakler, P, et al. (2012) Effect of cocoa on blood pressure. The Cochrane Database of Systematic Reviews, issue 8 CD008893.

Haufe, S, Engeli, S, Kast, P, et al. (2011) Randomized comparison of reduced fat and reduced carbohydrate hypocaloric diets on intrahepatic fat in overweight and obese human subjects. Hepatology 53, 1504–1514.

Phillips, SA, Jurva, JW, Syed, AQ, et al. (2008) Benefit of low-fat over low-carbohydrate diet on endothelial health in obesity. Hypertension 51, 376–382.

Lagiou, P, Sandin, S, Lof, M, et al. (2012) Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study. BMJ 344, e4026–e4037.

Friedman, AN, Ogden, LG, Foster, GD, et al. (2012) Comparative effects of low-carbohydrate high-protein versus low-fat diets on the kidney. Clin J Am Soc Nephrol 7, 1103–1111.

Greenberg, I, Stampfer, MJ, Schwarzfuchs, D, et al. (2009) Adherence and success in long-term weight loss diets: the dietary intervention randomized controlled trial (DIRECT). J Am Coll Nutr 28, 159–168.

Institute of Medicine (2011) Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academy Press.

Centre for Reviews and Dissemination (2009) Systematic Reviews: CRD's Guidance for Undertaking Reviews in Health Care. York: York Publishing Services.

Shai, I, Schwarzfuchs, D, Henkin, Y, et al. (2008) Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 359, 229–241.

Dansinger, ML, Gleason, JA, Griffith, JL, et al. (2005) Comparison of the atkins, ornish, weight watchers, and zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA 293, 43–53.

Davis, NJ, Tomuta, N, Schetcher, C, et al. (2009) Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycemic control in type 2 diabetes. Diabetes Care 32, 1147–1152.

Dyson, PA, Beatty, S & Matthews, DR (2010) An assessment of low-carbohydrate or low-fat diets for weight loss at 2 year's follow-up. Diabet Med 27, 363–368.

Foster, GD, Wyatt, HR, Hill, JO, et al. (2003) A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 348, 2082–2090.

Lim, SS, Noakes, M, Keogh, JB, et al. (2010) Long-term effects of a low carbohydrate, low fat or high unsaturated fat diet compared to a no-intervention control. Nutr Metab Cardiovasc Dis 20, 599–607.

McAuley, KA, Smith, KJ, Taylor, RW, et al. (2006) Long-term effects of popular dietary approaches on weight loss and features of insulin resistance. Int J Obes (Lond) 30, 342–349.

Truby, H, Baic, S, deLooy, A, et al. (2006) Randomised controlled trial of four commercial weight loss programmes in the UK: initial findings from the BBC “diet trials”. BMJ 332, 1309–1314.返回搜狐，查看更多

責任編輯：