生酮饮食对超重/肥胖病人影响效果的Meta分析

Meta-analysis of the effect of a ketogenic diet on overweight/obese patients

目的系统评价国内外采用生酮饮食减脂的效果,从而为超重/肥胖病人的饮食管理提供一些证据。方法通过检索PubMed、EMbase、CochraneLibrary、万方、维普、中国生物医学文献数据库等数据库,收集国内外对超重/肥胖病人使用生酮饮食进行减脂的随机对照试验(RCT),检索时间为从建库至2020年6月,试验组给予生酮饮食,对照组给予低热量饮食、低脂饮食或常规饮食等,采用RevMan 5.3软件进行Meta分析。结果最终纳入10篇RCT,共478例受试者。Meta分析结果显示:与对照组相比,生酮饮食能够明显降低体质量[MD=−4.61 kg,95%CI(−4.89,−4.33)kg,P<0.00001]、降低脂肪质量[MD=−4.61 kg,95%CI(−4.88,−4.34)kg,P<0.00001]、降低腰围[MD=−7.25 cm,95%CI(−8.96,−5.55)cm,P<0.00001]、降低体质量指数(BMI)[MD=−2.00 kg/m^(2),95%CI(−2.95,−1.41)kg/m^(2),P<0.00001],均差异有统计学意义,在非脂肪质量的改变方面[MD=−0.73 kg,95%CI(−2.61,1.15)kg,P=0.45],差异无统计学意义。结论生酮饮食组与对照组相比,在降低体质量、脂肪质量、腰围、BMI方面疗效更好,且不影响非脂肪质量改变。

Objective To systematically review the efficacy of a ketogenic diet for fat reduction at home and abroad,so as to provide some evidence for the dietary management of overweight/obese patients.Methods Randomized controlled trials(RCTs)of overweight/obese patients using a ketogenic diet for fat reduction were collected at home and abroad by searching PubMed,EMbase,Cochrane Library,Wanfang,VIP,the Chinese Biomedical Literature Database and other databases.The retrieval time was from the establishment of the database to June 2020.The experimental group was given a ketogenic diet,and the control group was given a low-calorie diet,a low-fat diet or a regular diet.RevMan 5.3 software was used for meta-analysis.Results Ten RCTs with a total of 478 subjects were includ-ed.Meta-analysis results showed that compared with the control group,the ketogenic diet significantly reduced body mass[MD=−4.61 kg,95%CI(−4.89,−4.33)kg,P<0.00001],reduced fat mass[MD=−4.61 kg,95%CI(−4.88,−4.34)kg,P<0.00001],decreased waist cir-cumference[MD=−7.25 cm,95%CI(−8.96,−5.55)cm,P<0.00001],decreased body mass index(BMI)[MD=−2.00 kg/m^(2),95%CI(−2.95,−1.41)kg/m^(2),P<0.00001].There were no significant differences in the change of nonfat mass[MD=−0.73 kg,95%CI(−2.61,1.15)kg,P=0.45].Conclusion Compared with the control group,the ketogenic diet group was more effective in reducing body mass,fat mass,waist circumference,and BMI and did not affect the change in nonfat mass.