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背景目前尚未确定饮食减体重干预能否使颈动脉粥样硬化退缩。方法和结果2年饮食干预随机对照试验-颈动脉[Dietary Intervention Randomized Controlled Trial-Carotid(DIRECT-Carotid)]研究,将参试者随机纳入低脂肪、地中海或低碳水化合物饮食组,B超观察颈动脉内膜层厚度变化,3D超声测量颈动脉血管壁体积(carotid vessel wall volume,VWV)。140名参试者(年龄51岁;BMI 30 kg/m2;88%为男性)做了影像评价,颈动脉VWV基线较高与内膜层厚度增加、年龄、男性、基线体重、血压和胰岛素水平相关(P值均<0.05)。经2年饮食干预,我们观察到颈动脉VWV平均退缩5%[(-58.1 mm3;95%CI(-81.0,-35.1);P<0.001],地中海、低脂肪、低碳水化合物饮食组无差异(分别为-60.69 mm3、-37.69 mm3、-84.33 mm3,P=0.28)。血管内膜层厚度平均变化为-1.1%(P=0.18)。发现,与低脂肪组比较,低碳水化合物组载脂蛋白B100和载脂蛋白A1比率要低(P=0.001)。与增进[平均增加,+89.6 mm3;95%CI(+66.6,+112.6)]的参试者比较,颈动脉VWV退缩参试者[平均减少,-128.0 mm3;95%CI(-148.1,-107.9)]的体重减轻要多(-5.3 kg vs.-3.2 kg,P=0.03)、收缩压(-6.8 mm Hg vs.-1.1 mm Hg,P=0.009)和总同型半胱氨酸(-0.06μmol/L vs.+1.44μmol/L,P=0.04)下降的幅度要大,载脂蛋白A1上升要高(+0.05 g/Lvs.-0.00 g/L,P=0.06)。多元回归模型显示,仅降低收缩压保持着作为与随后颈动脉VWV(β=0.23,P=0.01)和内膜层厚度(β=0.28,P=0.008)较大退缩的可修正预示因子。结论 2年减体重饮食可明显减少颈动脉VWV。低脂肪、地中海或低碳水化合物饮食策略作用相似,可使体重减轻、血压下降。
Background It has not been established whether dietary weight loss can attenuate carotid atherosclerosis. METHODS AND RESULTS Two-year dietary intervention randomized controlled trial, the Carotid Arterial Intervention Randomized Controlled Trial-Carotid (DIRECT-Carotid) study, randomized participants to low-fat, Mediterranean or low-carbohydrate diets, B Arterial intima thickness changes were measured by 3D echocardiography. The carotid vessel wall volume (VWV) was measured. Images of 140 participants (age 51 years; BMI 30 kg / m2; 88% men) were evaluated with elevated baseline carotid VWV and thickness of the intima, age, males, baseline body weight, blood pressure, and insulin levels Correlation (P <0.05). After two years of dietary intervention, we observed an average 5% reduction in VWV in carotid arteries (-58.1 mm3; 95% CI (-81.0, -35.1); P <0.001] and no difference in Mediterranean, low-fat, low- carbohydrate diets (-60.69 mm3, -37.69 mm3, -84.33 mm3, respectively, P = 0.28), and the mean change in intima-layer thickness was -1.1% (P = 0.18) .It was found that the low carbohydrate group The ratio of lipoprotein B100 to apolipoprotein A1 was lower (P = 0.001) .Compared with those with increasing [mean increase, + 89.6 mm3; 95% CI (+66.6, +121.6)], carotid VWV withdrawal test (-5.3 kg vs.-3.2 kg, P = 0.03), systolic blood pressure (-6.8 mm Hg vs. -12), and weight loss (-128.0 mm 3; 95% CI 1.1 mm Hg, P = 0.009) and total homocysteine (-0.06 μmol / L vs. + 1.44 μmol / L, P = 0.04) and apolipoprotein A1 (+0.05 g Multivariate regression model showed that reducing systolic pressure alone was associated with a significant decrease in VWV (β = 0.23, P = 0.01) and intima-media thickness (β = 0.28, P = 0.008) .Conclusion Two-year diet reduced body weight significantly decreased carotid VWV. Sea or low-carbohydrate diet strategy similar to the role, can make weight loss, drop in blood pressure.