红肉与健康关系的证据有多强?(观点)
  • NutriRECS在制定红肉和加工肉推荐时,采取的证据等级评价工具为GRADE;
  • GRADE主要用于药物治疗的临床试验;在膳食,生活方式和环境暴露等领域开展大型长期随即临床研究是不现实的,因此GRADE不适用于这些领域;
  • 采用新的评价营养研究证据的工具(NutriGRADE),红肉、加工肉和2型糖尿病的正相关关系证据等级为“高质量”,与死亡率的关系为”中等质量”;
  • 未来膳食指南推荐应继续以膳食模式为主,关注拿什么去替换红肉和加工肉。
主编推荐语
flying dutchman
针对前不久Annals of Internal Medicine上发表的红肉和加工肉膳食指南推荐(查看文章),Diabetes Care近期发表了一篇观点文章,指出了该指南几处错误的地方,如用GRADE评价证据等级不妥,对女性健康倡议试验的错误解读,过分考虑人们对食物的偏好及未考虑环境影响。同时,作者提出,在制定膳食指南时应继续以膳食模式为主,强调用最低程度加工的植物性食物(如水果蔬菜、全谷物、坚果和豆类)去替换红肉和加工肉。
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Diabetes Care [IF:16.019]

Red and Processed Meats and Health Risks: How Strong Is the Evidence?

红肉、加工肉和健康风险:证据有多强?

10.2337/dci19-0063

2020-01-20, Article

Abstract & Authors:展开

Abstract:收起
Prevailing dietary guidelines have widely recommended diets relatively low in red and processed meats and high in minimally processed plant foods for the prevention of chronic diseases. However, an ad hoc research group called the Nutritional Recommendations (NutriRECS) consortium recently issued “new dietary guidelines” encouraging individuals to continue their current meat consumption habits due to “low certainty” of the evidence, difficulty of altering meat eaters’ habits and preferences, and the lack of need to consider environmental impacts of red meat consumption. These recommendations are not justified, in large part because of the flawed methodologies used to review and grade nutritional evidence. The evidence evaluation was largely based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria, which are primarily designed to grade the strength of evidence for clinical interventions especially pharmacotherapy. However, the infeasibility for conducting large, long-term randomized clinical trials on most dietary, lifestyle, and environmental exposures makes the criteria inappropriate in these areas. A separate research group proposed a modified and validated system for rating the meta-evidence on nutritional studies (NutriGRADE) to address several limitations of the GRADE criteria. Applying NutriGRADE, the evidence on the positive association between red and processed meats and type 2 diabetes was rated to be of “high quality,” while the evidence on the association between red and processed meats and mortality was rated to be of “moderate quality.” Another important limitation is that inadequate attention was paid to what might be replacing red meat, be it plant-based proteins, refined carbohydrates, or other foods. In summary, the red/processed meat recommendations by NutriRECS suffer from important methodological limitations and involve misinterpretations of nutritional evidence. To improve human and planetary health, dietary guidelines should continue to emphasize dietary patterns low in red and processed meats and high in minimally processed plant foods such as fruits and vegetables, whole grains, nuts, and legumes.

First Authors:
Frank Qian

Correspondence Authors:
Frank B Hu

All Authors:
Frank Qian,Matthew C Riddle,Judith Wylie-Rosett,Frank B Hu

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