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Too much dietary sugar raises CVD mortality 饮食中糖分过多会增加心血管病死亡率  

2014-03-14 13:00:29|  分类: 默认分类 |  标签: |举报 |字号 订阅

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By: MARY ANN MOON, Cardiology News Digital Network


Excess intake of sugar in the diet significantly raises the risk of cardiovascular mortality, independently of other risk factors, according to an analysis of National Health and Nutrition Examination Surveys data published online Feb. 3 in JAMA Internal Medicine.


In an analysis of sugar intake using serial representative samples from the U.S. adult population, people who consumed 17%-21% of their daily calories from sugar – the second-highest category of sugar consumption – showed a nearly 40% higher risk of CVD death than did those who consumed less than 10% of their daily calories from sugar, as is recommended by the World Health Organization. People in the highest category of sugar consumption, who consumed 21% or more of daily calories from sugar, doubled their risk of CVD death, said Quanhe Yang, Ph.D., of the division for heart disease and stroke prevention, Centers for Disease Control and Prevention, Atlanta, and associates.
 
To put these figures into context, most adults in the United States (72%) consumed 10% or more of their daily calories in the form of sugar during the study period. And at least one-tenth of the population consumed 25% or more of their daily calories in that form, nearly tripling their risk of CVD death, the investigators noted.


Dr. Yang and colleagues examined time trends in sugar consumption using data from the National Health and Nutrition Examination Surveys (NHANES) in 1988-1994 (11,733 participants), 1999-2004 (8,786 participants), and 2005-2010 (10,628 participants). They defined "added sugar" as all sugars used in processed or prepared foods such as sugar-sweetened drinks, grain-based desserts, dairy desserts, candy, processed cereals, and yeast breads, but not naturally occurring sugars such as those present in fruits and fruit juices.


Over time, the mean percentage of calories from added sugar in the adult diet rose from 15.7% to 16.8% and then decreased to 14.9%.


The major sources of added sugar in the diet were sugar-sweetened drinks, which accounted for nearly three times as many calories as the next-highest source, grain-based desserts.


Compared with the lowest quintile of sugar consumption, the risk for cardiovascular death increased exponentially with increasing percentage of calories from added sugar, even after the data were adjusted to account for numerous potentially confounding factors such as blood pressure, body mass index, and cholesterol level, the investigators said (JAMA Intern. Med. 2014 Feb. 3 [doi:10.1001/jamainternmed.2013.13563]).


This increase in risk of CVD death was consistent across all but one subgroup of the population by age, sex, race/ethnicity, educational status, physical activity level, and BMI. The exception was among non-Hispanic black adults.


In addition to the WHO, several other organizations have issued recommendations regarding sugar intake, and there is a great deal of variance in their advice. The Institute of Medicine recommends that no more than 25% of daily calories be derived from added sugar, while the American Heart Association suggests that total calories from sugar should be less than 100/day for women and less than 150/day for most men.


The results of this study suggest that participants who consumed 10%-25% of their calories as sugar – a level below that of the IOM recommendations but above that of the WHO and AHA recommendations – still had a 30% higher risk of CVD mortality than did those who consumed fewer calories as sugar. Those who consumed at least 25% of their calories nearly tripled their risk (adjusted hazard ratio, 2.75)


It is not yet known how sugar raises CVD mortality. However, there are several biologically plausible pathways, as sugar is known to raise blood pressure, increase hepatic fat, raise triglyceride levels, adversely affect cholesterol profiles, and increase circulating inflammatory markers, Dr. Yang and associates said.


No financial conflicts of interest were reported.


View on the News


Too much sugar makes us sick, not just fat


This study shows that sugar intake is an independent risk factor for CVD mortality "above and beyond its role as empty calories leading to weight gain and obesity," said Laura A. Schmidt, Ph.D.


The findings underscore the need for national guidelines to help consumers and health care providers set safe limits on individual sugar intake, as well as to regulate the food industry primarily through taxation of sugar-sweetened products. Fifteen other countries already have such programs in place; and the United States has addressed similar issues of regulation in the past with sodium content, trans fats, and other harmful dietary additives.


A key first step would be to remove sugar "from the U.S. Food and Drug Administration’s ‘generally regarded as safe’ list, which allows manufacturers to add unlimited amounts to any food," Dr. Schmidt said.


Laura A. Schmidt, Ph.D., is at the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco. She reported no financial conflicts of interest. These remarks were taken from her editorial accompanying Dr. Yang’s report (JAMA Intern. Med. 2014 Feb. 3 [doi:10.1001/jamainternmed.2013.12991


译文

据2月3日在线发表于《美国医学会杂志?内科学》上的一项对全美健康与营养调查(NHANES)数据的分析,饮食中摄入过多的糖分可显著增加心血管死亡率,与是否存在其他危险因素无关(JAMA Intern. Med. 2014 Feb. 3 [doi:10.1001/jamainternmed.2013.13563])。


亚特兰大疾病预防控制中心心脏病与卒中预防部门的Quanhe Yang医生及其同事利用1988 ~1994年间(11,733名参与者)、1999~2004年间(8,786名参与者)以及2005~2010年间(10,628名参与者)NHANES的数据探究了糖摄入量的时间趋势变化,将“加糖”定义为在食品(比如含糖饮料、谷物甜点、乳制品甜点、糖果、谷类食品以及酵母面包)加工或制备中所使用的所有糖,而非天然含有的糖类,比如水果和果汁中存在的糖。


在这项分析中,每天从糖中摄入的热量占17%~21%(糖摄入量位于第二高)的人心血管死亡风险比日常饮食中源于糖的热量不足10%的人高出将近40%,后者的摄入量为世界卫生组织所推荐。糖摄入量位居第一高的人,即每日从糖中获取的热量在21%或以上,心血管死亡风险加倍。将这些数字结合实际情况进行分析,在研究期间美国大多数成人(72%)每日以糖的形式摄入的热量占10%或以上。至少有1/10的人每日从糖中摄入了25%或更多的热量,由此使其心血管死亡风险增加近2倍(校正后危险比,2.75)。以糖的形式摄入的热量占10%~25%(低于医学研究所建议的水平但高于世界卫生组织和美国心脏协会建议的水平)的受试者心血管死亡风险仍比所占比重较小者高出30%。


随着这几个时期的更替,成人饮食中加糖产生的热量所占的平均百分比从15.7%上升至16.8%,然后又降至14.9%。饮食中加糖的主要来源是含糖饮料,所占比重是第二大来源——谷物甜品的将近3倍。与糖摄入量为最低四分位数相比,心血管死亡风险随着源于加糖的热量百分比增加而大幅上升,即便在对数据进行调整、考虑大量的诸如血压、体重指数以及胆固醇水平这类潜在的混杂因素之后亦如此。除了一组按年龄、性别、种族、教育状况、体力活动和BMI划分的一个亚组人群外,心血管死亡风险的这种增加变化在各个亚组间均呈现出一致性。例外的这个亚组人群是非西班牙裔黑种人成人。


除了世界卫生组织外,还有其他多个组织针对糖摄入量发布了相关建议,其建议存在较大差异。医学研究所建议每日来源于加糖的热量不得超过25%,而美国心脏协会建议女性和大多数男性每日源于糖的总热量应该分别低于100卡路里和150卡路里。


目前尚不清楚糖如何增高心血管死亡风险,可能是通过多个生物学途径实现的,因为众所周知,糖可升高血压,增加肝脏脂肪,提升甘油三酯水平,对胆固醇产生负面影响,并会增加循环中的炎性标志物。


研究者无利益冲突披露。


随刊述评:摄入太多的糖会招致疾病,不仅限于肥胖


Laura A. Schmidt博士指出,本研究表明糖摄入量是心血管死亡的一项独立的危险因素,不仅仅限于导致体重增加和肥胖。上述研究结果强调亟待出台全国性指南,以帮助消费者和医务人员针对个体糖摄入量设定安全的限定范围,通过对含糖食品实行税收政策监管食品行业;美国过去已经解决了对钠盐含量、反式脂肪以及其他有害的饮食添加剂的类似监管问题。关键的第一步可能是“从美国食品药品管理局的“安全食品列表””中去除糖类,这份文件使得生产厂家向任何食物中加糖都没有量的限定(JAMA Intern. Med. 2014 Feb. 3 [doi:10.1001/jamainternmed.2013.12991])。


Laura A Schmidt博士就职于美国加州大学旧金山分校Philip R. Lee卫生政策研究所,她本人无经济利益冲突的报告。

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