Effects of higher- versus lower-protein diets on health outcomes: a systematic review and meta-analysis

被引:204
作者
Santesso, N. [1 ]
Akl, E. A. [1 ,2 ]
Bianchi, M. [3 ]
Mente, A. [1 ]
Mustafa, R. [1 ]
Heels-Ansdell, D. [1 ]
Schuenemann, H. J. [1 ,2 ,4 ]
机构
[1] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON L8S 4K1, Canada
[2] SUNY Buffalo, Dept Med, Buffalo, NY 14260 USA
[3] Barilla SpA, Parma, Italy
[4] McMaster Univ, Dept Med, Hamilton, ON L8S 4K1, Canada
关键词
protein diet; GRADE; systematic review; weight loss; meta-analysis; randomised trial; LOW-FAT DIET; LOW-CARBOHYDRATE DIET; WEIGHT-LOSS DIETS; BODY-WEIGHT; OVERWEIGHT; SATIETY; OBESITY; ATKINS; DAIRY; MOOD;
D O I
10.1038/ejcn.2012.37
中图分类号
R15 [营养卫生、食品卫生]; TS201 [基础科学];
学科分类号
100403 ;
摘要
BACKGROUND/OBJECTIVES: Numerous randomised controlled trials (RCTs) published in first tier medical journals have evaluated the health effects of diets high in protein. We conducted a rigorous systematic review of RCTs comparing higher-and lower-protein diets. METHODS: We searched several electronic databases up to July 2011 for studies focusing on patient-important outcomes (for example, cardiovascular disease) and secondary outcomes such as risk factors for chronic disease (for example, adiposity). RESULTS: We identified 111 articles reporting on 74 trials. Pooled effect sizes using standardised mean differences (SMDs) were small to moderate and favoured higher-protein diets for weight loss (SMD - 0.36, 95% confidence interval (CI) - 0.56 to - 0.17), body mass index (- 0.37, CI - 0.56 to 0.19), waist circumference (- 0.43, CI - 0.69 to - 0.16), blood pressure (systolic: - 0.21, CI - 0.32 to - 0.09 and diastolic: - 0.18, CI - 0.29 to - 0.06), high-density lipoproteins (HDL 0.25, CI 0.07 to 0.44), fasting insulin (- 0.20, CI - 0.39 to - 0.01) and triglycerides (- 0.51, CI - 0.78 to - 0.24). Sensitivity analysis of studies with lower risk of bias abolished the effect on HDL and fasting insulin, and reduced the effect on triglycerides. We observed nonsignificant effects on total cholesterol, low-density lipoproteins, C-reactive protein, HbA1c, fasting blood glucose, and surrogates for bone and kidney health. Adverse gastrointestinal events were more common with high-protein diets. Multivariable meta-regression analysis showed no significant dose response with higher protein intake. CONCLUSIONS: Higher-protein diets probably improve adiposity, blood pressure and triglyceride levels, but these effects are small and need to be weighed against the potential for harms.
引用
收藏
页码:780 / 788
页数:9
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