终止高血压膳食疗法对儿童青少年血压影响的meta分析

A meta-analysis on the effects of dietary approaches to stop hypertension （DASH） diet on blood pressure of children and adolescents

目的：通过meta分析探讨终止高血压膳食疗法（DASH饮食）对儿童青少年血压的影响。方法收集国内外应用DASH饮食开展的随机对照临床试验（RCT）文献，收集年限不限，按照纳入与排除标准筛选文献，评价质量并提取有效数据，通过meta分析的方法计算合并加权均数差（WMD，95%CI）评估DASH饮食对儿童青少年血压影响。结果8篇RCT文献被纳入meta分析，纳入研究的试验组样本量838例，对照组样本量1222例。文献质量评估8篇均为高质量。DASH饮食高低摄入量比较，对收缩压（WMD=-2.29 mmHg，95%CI：-3.20～-1.38）（1 mmHg=0.133 kPa）和舒张压（WMD=-2.18 mmHg，95%CI：-3.00～-1.35）均有降压作用；DASH 饮食前后比较，对收缩压（WMD=-5.83 mmHg，95%CI：-9.55～-2.11）和舒张压（WMD=-2.78 mmHg，95%CI：-4.74～-0.83）亦有降压作用；DASH饮食与常规饮食血压变化差值比较，DASH饮食对收缩压（WMD=-4.98 mmHg，95%CI：-7.37～-2.59）和舒张压（WMD=-1.47 mmHg，95%CI：-2.53～-0.41）的降压作用优于常规饮食；DASH 饮食对儿童青少年的收缩压降压作用优于舒张压（WMD=-3.25 mmHg，95%CI：-5.46～-1.05）。结论 DASH饮食对儿童青少年血压有一定降压疗效，且对收缩压的降压作用大于舒张压。

Objective To estimate the effects of the dietary approaches to stop hypertension （DASH） diet on blood pressure （BP） of children and adolescents by using meta-analysis. Methods The articles of the randomized controlled clinical trials （RCT） on the DASH diet were collected and selected according to inclusion and exclusion criteria. Meta-analysis was performed to calculate the weighted mean difference （WMD） and 95% confidence interval （CI） to assess the blood pressure change associated with DASH diet in children and adolescents. Results Eight RCT papers involving experimental group for 838 and the control group for 1 222 were included. All the papers had high methodological quality. According to comparative analysis between the lowest tertiles of DASH Score and highest tertiles of DASH Score, the DASH-style pattern led to lower systolic BP（SBP） （WMD=-2.29 mmHg, 95%CI：-3.20--1.38） （1 mmHg=0.133 kPa）and diastolic BP（DBP） （WMD=-2.18 mmHg, 95%CI：-3.00--1.35） levels. Comparing with pre-DASH diet, the DASH diet was more effective in lowing SBP （WMD=-5.83 mmHg, 95%CI：-9.55--2.11）and DBP（WMD=-2.78 mmHg, 95%CI：-4.74--0.83）. Comparing with the routine care （RC）, the DASH diet was proved more effective than RC in lowing SBP（WMD=-4.98 mmHg, 95%CI：-7.37--2.59） and DBP（WMD=-1.47 mmHg, 95%CI：-2.53--0.41） in children and adolescents. The DASH diet was more effective in lowing SBP（WMD=-3.25 mmHg, 95%CI：-5.46--1.05）than DBP in children and adolescents. Conclusion This research suggested that DASH diet had a positive clinical efficacy on blood pressure in children and adolescents, and caused a greater decrease in SBP than in DBP.