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浙江大学学报(医学版)  2022, Vol. 51 Issue (1): 27-37    DOI: 10.3724/zdxbyxb-2021-0378
专题报道     
代谢综合征患者饮食和运动管理方案最佳证据总结
陈丹丹1,张慧2,邵静3,汤磊雯1,吴静洁1,叶志弘1,3,*()
1.浙江大学医学院附属邵逸夫医院护理部,浙江 杭州 310016
2.贵州省人民医院心血管内科,贵州 贵阳 550002
3.浙江大学医学院护理学研究所,浙江 杭州 310058
Summary of the best evidence of diet and physical activity management in patients with metabolic syndrome
CHEN Dandan1,ZHANG Hui2,SHAO Jing3,TANG Leiwen1,WU Jingjie1,YE Zhihong1,3,*()
1. Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China;
2. Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang 550002, China;
3. Institute of Nursing Research, Zhejiang University School of Medicine, Hangzhou 310058, China
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摘要:

目的:评价并总结代谢综合征患者饮食和运动管理的相关证据,为临床开展代谢综合征患者的饮食和运动管理提供循证依据。方法:系统检索BMJ Best Practice、UpToDate、澳大利亚乔安娜布里格斯研究所(JBI)循证卫生保健中心数据库、美国医疗保健研究与质量局(AHRQ)网站、英国国家医疗保健优化研究所(NICE)网站、苏格兰学院指南网(SIGN)、国际指南协作网(GIN)、中国医脉通指南网、加拿大安大略注册护士协会(RNAO)网站、美国糖尿病协会(ADA)网站、新西兰指南协作组(NZGG)网站、加拿大医学会临床实践指南网站、PubMed、EmBase、Web of Science、CINAHL、Cochrane Library、中国知网、中文科技期刊数据库、万方数据知识服务平台和中国生物医学文献数据库以获取与代谢综合征患者饮食和运动相关的证据,包括指南、证据总结、专家共识、最佳实践信息册、临床决策、推荐实践、系统评价等。检索时限为建库至2021年11月。由2名具有循证医学背景的研究人员对所纳入的文献进行质量评价及证据级别评定。结果:共纳入36篇文献,包括3篇指南、5篇专家共识、1篇临床决策和27篇系统评价。总结了49条与代谢综合征患者饮食和运动相关的证据,包括饮食目标、饮食模式、饮食时间、碳水化合物摄入、脂肪摄入、纤维摄入、盐摄入、果蔬和谷物摄入、咖啡摄入、饮食效果、运动原则、运动强度/形式/时间、运动效果、代谢综合征合并心血管疾病患者的运动处方、饮食和运动联合效果等15个方面。结论:饮食和运动管理方案可以有效改善代谢综合征患者的健康结局,医护人员应结合临床情境、患者偏好有针对性地选择并采用最佳证据。

关键词: 代谢综合征饮食运动循证护理学证据总结    
Abstract:

Objective: To evaluate and summarize the evidence of diet and physical activity management in patients with metabolic syndrome (MS). Methods: BMJ Best Practice, UpToDate, Joanna Briggs Institute (JBI) database, Agency for Healthcare Research and Quality (AHRQ) network, National Institute for Health and Clinical Excellence (NICE) network, Scottish Intercollegiate Guidelines Network (SIGN), Guidelines International Network (GIN), Medlive, Registered Nurses’ Association of Ontario (RNAO) network, American Diabetes Association (ADA) network, New Zealand Guideline Group (NZGG) network, Canadian medical association clinical practice guidelines network, PubMed, EmBase, Web of Science, CINAHL, Cochrane Library, CNKI, China Science and Technology Journal Database, Wanfang Knowledge Data Service Platform and Chinese biomedical database were searched systematically to obtain guidelines, evidence summary, expert consensus, best practice information book, clinical decision-making, recommended practice, and systematic review on diet and physical activity management in patients with MS. The retrieval period is from the establishment of database to November 2021. Two researchers with evidence-based medicine background evaluated the quality and evidence level of the included literature. Results: A total of 36 articles met the criteria, including 3 guidelines, 5 expert consensus, 1 clinical decision and 27 systematic reviews. We summarized 49 pieces of evidence related to diet and physical activity in patients with MS, involving 15 aspects, namely diet goals, diet patterns, diet time, carbohydrate intake, fat intake, fiber intake, salt intake, fruits, vegetables and grains intake, coffee intake, effects of diet, principle of physical activity, intensity, form, time of physical activity, effects of physical activity, physical activity prescription of patients with MS and cardiovascular disease, and the joint effects of diet and physical activity. Conclusions: Diet and physical activity management can effectively improve the health outcomes of patients with MS. Health professionals should choose and apply the best evidence with consideration of the clinical situation and patient preference.

Key words: Metabolic syndrome    Diet    Physical activity    Evidence-based nursing    Evidence summary
收稿日期: 2021-12-09 出版日期: 2022-05-17
CLC:  R589  
基金资助: 浙江省医药卫生科技计划(WKJ-ZJ-1925);国家社会科学基金(20BGL275)
通讯作者: 叶志弘     E-mail: yezh@zju.edu.cn
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引用本文:

陈丹丹,张慧,邵静,汤磊雯,吴静洁,叶志弘. 代谢综合征患者饮食和运动管理方案最佳证据总结[J]. 浙江大学学报(医学版), 2022, 51(1): 27-37.

CHEN Dandan,ZHANG Hui,SHAO Jing,TANG Leiwen,WU Jingjie,YE Zhihong. Summary of the best evidence of diet and physical activity management in patients with metabolic syndrome. J Zhejiang Univ (Med Sci), 2022, 51(1): 27-37.

链接本文:

https://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0378        https://www.zjujournals.com/med/CN/Y2022/V51/I1/27

序号

文献作者

发表年份

证据类型

证据主题

1

中华医学会糖尿病学分会[12]

2021

指南

中国2型糖尿病防治指南

2

姚婧璠等[13]

2014

指南

高血压管理指南

3

Herdy等[14]

2014

指南

心血管疾病的预防和康复指南

4

Krist等[15]

2020

专家共识

行为咨询干预对心血管疾病的作用效果

5

Pérez-Martínez等[16]

2017

专家共识

代谢综合征患者的生活方式推荐

6

Redon等[17]

2008

专家共识

高血压患者的代谢综合征

7

Alberti等[18]

2006

专家共识

代谢综合征的新定义

8

Davis等[19]

2006

专家共识

代谢综合征的脂质治疗策略

9

Meigs[20]

2021

临床决策

代谢综合征(胰岛素抵抗综合征或X综合征)的定义、患病率、危险因素,以及可能的临床结果和治疗方案

10

Alizaei等[21]

2021

系统评价

锻炼对代谢综合征患者的抗炎作用

11

Wood等[22]

2021

系统评价

有氧运动训练对代谢综合征患者脂质的影响

12

Peiris等[23]

2021

系统评价

无人监管的锻炼项目对代谢综合征的作用

13

Ramli等[24]

2021

系统评价

咖啡对代谢综合征参数的影响

14

Rahimi等[25]

2022

系统评价

生活方式干预对超重和肥胖代谢综合征患者炎性标志物和腰围的影响

15

Hadi等[26]

2021

系统评价

补充益生菌对代谢综合征患者人体测量学以及其他代谢参数的影响

16

Mohammadifard等[27]

2021

系统评价

食用大豆对代谢综合征患者代谢参数的影响

17

Parameshwar等[28]

2021

系统评价

身体活动对代谢综合征患者瘦素抵抗的影响

18

许瀚等[29]

2020

系统评价

运动干预对代谢综合征患者心血管危险因素的影响

19

Tenorio-Jiménez等[30]

2020

系统评价

益生菌对代谢综合征的影响

20

Serrablo-Torrejon等[31]

2020

系统评价

高强度间歇训练对代谢综合征的影响

21

Pérez等[32]

2019

系统评价

代谢综合征患者的干预措施

22

Joseph等[33]

2019

系统评价

结构性运动计划对代谢综合征及其组分的影响

23

van Namen等[34]

2019

系统评价

有监督的生活方式干预对代谢综合征风险因素的作用

24

Lemes等[35]

2018

系统评价

有氧训练对代谢综合征患者血压、腰围及高密度脂蛋白的影响

25

Wewege等[36]

2018

系统评价

锻炼对代谢综合征患者心血管风险的影响

26

Ostman等[37]

2017

系统评价

运动训练对代谢综合征患者临床预后的影响

27

Steckhan等[38]

2016

系统评价

不同的饮食方式对代谢综合征患者炎性标志物的作用

28

董蓉蓉等[39]

2016

系统评价

运动对代谢综合征患者血脂水平的作用

29

Cramer等[40]

2016

系统评价

瑜伽对代谢参数的影响

30

Zhong等[41]

2015

系统评价

茶或茶提取物对代谢综合征患者体重的影响

31

Lin等[42]

2014

系统评价

生活方式项目对代谢风险因素的影响

32

Pattyn等[43]

2013

系统评价

锻炼对代谢综合征患者代谢参数的影响

33

Yamaoka等[44]

2012

系统评价

生活方式对代谢综合征的影响

34

Lopez-Huertas [45]

2012

系统评价

ω-3脂肪酸对代谢综合征患者的影响

35

Dunkley等[46]

2012

系统评价

生活方式干预和药物干预对降低代谢综合征患者糖尿病和心血管疾病风险的影响

36

Le?o等[47]

2011

系统评价

营养干预对代谢指标的影响

表 1  纳入文献的一般特征

序号

文献作者

各领域标准化百分比

≥60%领域数

≥30%领域数

推荐级别

范围和目的

参与人员

开发的严格性

表达的清晰性

适用性

编撰的独立性

1

中华医学会糖尿病学分会[12]

100%

33.3%

58.3%

100%

50.0%

75%

3

6

B

2

姚婧璠等[13]

100%

66.7%

35.4%

100%

33.3%

75%

4

6

B

3

Herdy等[14]

100%

50.0%

37.5%

100%

50.0%

100%

3

6

B

表 2  纳入指南的质量评价结果

序号

文献作者

循证问题清晰

明确

纳入标准恰当

检索策略恰当

论文来源恰当

文献质量标准恰当

独立完成文献质量评价

提取资料采用措施减少误差

综合/合并研究的方法准确

评估可能的发表偏倚

提出推荐意见

对未来研究方向提出建议

10

Alizaei等[21]

11

Wood等[22]

12

Peiris等[23]

13

Ramli等[24]

不清楚

不清楚

14

Rahimi等[25]

15

Hadi等[26]

16

Mohammadifard等[27]

不清楚

不清楚

不清楚

17

Parameshwar等[28]

不清楚

不清楚

18

许瀚等[29]

不清楚

19

Tenorio-Jiménez等[30]

不清楚

不清楚

20

Serrablo-Torrejon等[31]

21

Pérez等[32]

不清楚

22

Joseph等[33]

不清楚

不清楚

23

van Namen等[34]

不清楚

24

Lemes等[35]

不清楚

25

Wewege等[36]

不清楚

26

Ostman等[37]

不清楚

不清楚

27

Steckhan等[38]

不清楚

28

董蓉蓉等[39]

不清楚

29

Cramer等[40]

30

Zhong等[41]

不清楚

31

Lin等[42]

不清楚

32

Pattyn等[43]

不清楚

33

Yamaoka等[44]

不清楚

不清楚

34

Lopez-Huertas[45]

不清楚

不清楚

不清楚

35

Dunkley等[46]

不清楚

36

Le?o等[47]

不清楚

不清楚

不清楚

不清楚

表 3  纳入系统评价的质量评价结果

类别

证据内容

证据等级

推荐级别

1饮食目标

1.1对于超重和肥胖者,饮食目标为体重减轻5%[52]

Ⅰa

A

1.2第一年体重减轻5%~10%[18]

Ⅴb

A

2饮食模式

2.1推荐地中海饮食模式[53]

Ⅳa

A

2.2推荐终止高血压膳食(DASH)模式[48]

Ⅰc

A

2.3推荐新北欧饮食模式[54]

Ⅰc

B

2.4推荐素食饮食模式[55]

Ⅳb

B

3饮食时间

3.1推荐下午3点前吃当天的正餐[56]

Ⅰc

A

4碳水化合物摄入

4.1减少添加糖、含糖饮料的摄入[14]

Ⅴb

A

4.2 推荐低碳水化合物饮食(23%±10%的能量来自碳水化合物)[38]

Ⅰa

A

5脂肪摄入

5.1膳食胆固醇摄入低 于200?mg/d,减少反式脂肪摄入[1]

Ⅴb

A

5.2总脂肪和饱和脂肪分别低于总能量的30%和10%[19]

Ⅴb

A

5.3每天摄入ω-3脂肪酸大于1g且至少3个月[45]

Ⅰa

A

5.4每天食用20~40?g的橄榄油来替代其他脂肪[16]

Ⅴb

A

6纤维摄入

6.1 高纤维膳食:每天不少于30?g[49]

Ⅰc

A

7盐摄入

7.1减少盐摄入量[18]

Ⅴb

A

8果蔬和谷物摄入

8.1增加水果、蔬菜和全谷物的摄入[17]

Ⅴb

A

9咖啡摄入

9.1摄入包含180~376?mg绿原酸的绿咖啡(以胶囊形式服用)或510.6?mg绿原酸的液体无咖啡因咖啡[24]

Ⅰa

B

10饮食效果

10.1长期规律的饮食干预可以有效降低代谢综合征的发生率以及改善代谢参数[44]

Ⅰa

A

10.2终止高血压膳食(DASH)疗法可以降低患者的血压,也对空腹血糖、体重、三酰甘油、高密度脂蛋白有积极影响[48]

Ⅰc

A

10.3低碳水化合物饮食能有效减轻体重,降低胰岛素水平[38]

Ⅰa

A

10.4 低脂饮食能有效降低患者的C反应蛋白水平[38]

Ⅰa

A

10.5 茶或茶提取物能有效降低患者的体重和身体质量指数[41]

Ⅰa

A

10.6 益生菌能有效降低患者的总胆固醇水平,但对体重、身体质量指数、腰围、空腹血糖、胰岛素抵抗稳态模型、胰岛素、三酰甘油、低密度脂蛋白及高密度脂蛋白无改善作用[26]

Ⅰa

B

10.7 食用大豆制品(大豆油除外)能有效降低患者的空腹血糖、胰岛素以及胰岛素抵抗稳态模型,但不能有效改善血压、腰围、身体质量指数及体重[27]

Ⅰa

B

11运动原则

11.1须结合患者健康状况和合并症情况制定个体化的身体活动方案[57]

Ⅴb

A

12 运动强度/形式/时间

12.1 身体活动每周不少于4?h[19]

Ⅴb

B

12.2推荐中等强度的身体活动[58]

Ⅰc

B

12.3推荐每天30~60?min的身体活动,包括有氧运动、与工作相关的活动以及肌肉增强训练[59]

Ⅴb

A

12.4每周至少5?d(最好7?d),每次至少30~60?min(最好60?min)中等强度的身体活动(如健步走)[150]

Ⅴb

A

12.5推荐每周至少2次,每次至少40?min的有氧训练[43]

Ⅰb

A

12.6 推荐30?min中等强度的有氧运动,每周4~6次,外加每周2次力量训练[15]

Ⅴb

A

12.7推荐中等强度的有氧运动,以达到最大心率(压力测试)的80%~90%为目标;同时重复进行阻力运动,以锻炼不同肌肉群[14]

Ⅴb

A

12.8推荐中高强度的有氧运动,每周运动至少3次,连续运动至少12周[36]

Ⅰa

A

12.9 高强度间歇训练至少12周,每周3次[31]

Ⅰa

A

13运动效果

13.1 身体活动对患者的瘦素抵抗无改善[28]

Ⅰa

B

13.2额外增加身体活动能增强代谢参数的改善效果[17]

Ⅴb

A

13.3 运动可以有效降低患者的腰围、三酰甘油、收缩压、舒张压、空腹血糖水平,升高其高密度脂蛋白水平[39];锻炼改善了患者的炎症标志物,如肿瘤坏死因子、C反应蛋白、白介素-8和白介素-10,但未改变白介素-6和白介素-18的水平[21]

Ⅰa

A

13.4有氧运动能有效改善患者的腰围、血压、空腹血糖、高密度脂蛋白、三酰甘油、舒张压、心肺适应性. 抗阻训练对代谢指标的改善无显著意义[2235-36]

Ⅰa

A

13.5有氧训练能有效改善患者的身体质量指数、体重、腰围、血压、空腹血糖、三酰甘油、低密度脂蛋白水平及峰值摄氧量[37]

Ⅰa

A

13.6有氧和抗阻训练结合的运动方式能有效改善腰围、峰值摄氧量、收缩压及高密度脂蛋白水平[37]

Ⅰa

A

13.7单纯有氧运动与抗阻训练或二者联合运动对代谢综合征患者的收缩压均有显著影响,但有氧运动较抗阻训练或抗阻训练结合低强度有氧运动更具优势,改善效果更全面[29]

Ⅰa

A

13.8 高强度间歇训练可以有效改善血糖、血压和腰围,但对三酰甘油的影响不显著[31]

Ⅰa

A

13.9瑜伽对患者的腰围和收缩压有显著影响,对三酰甘油、舒张压、高密度脂蛋白和空腹血糖无影响[40]

Ⅰa

B

13.10有监督的运动项目可以改善腰围、血压和高密度脂蛋白水平,且平均体重的减轻程度随着运动项目持续时间的增加而加重[33]

Ⅰa

B

13.11无人监督的锻炼项目能有效减少腰围、血压以及增加身体活动水平,但不能有效改善空腹血糖水平(除非周期大于3个月)、代谢综合征发生率及胆固醇水平[23]

Ⅰa

B

14 合并心血管疾病患者的运动处方

14.1 对于已确定患有心血管疾病的患者,通过详细的体力活动史和(或)运动试验来评估其风险,以指导运动;鼓励每天进行30~60?min中等强度的有氧运动(如快步行走),并辅以增加日常生活方式活动(如步数计跟踪、工作时散步休息、园艺、家务);鼓励每周进行2?d阻力训练;为高危患者(如近期急性冠状动脉综合征或血管重建术)提供医疗监督计划[1]

Ⅴb

A

15 饮食和运动联合效果

15.1正常热量饮食、正常热量饮食与锻炼相结合、低热量饮食、低热量饮食与锻炼相结合的四种饮食模式中,低热量饮食与锻炼相结合对代谢指标的改善作用更显著[47]

Ⅰa

A

15.2饮食和身体活动能有效改善腰围、体重、身体质量指数、血脂、收缩压、体脂[3246]、C反应蛋白、白介素-6和脂联素水平[2542]

Ⅰa

A

15.3有监管的生活方式干预(主要包括饮食和运动)能有效改善腰围、血压、三酰甘油、空腹血糖等指标,降低代谢综合征的发生率[34]

Ⅰa

B

表 4  代谢综合征患者饮食和运动管理方案的最佳证据总结
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