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膳食补充对预防癌症和心脏病起效的至关重要证据

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huangxin 发表于 2019-1-4 11:59:31 | 显示全部楼层 |阅读模式
VITAL Signs for Dietary Supplementation to Prevent Cancer and Heart Disease
膳食补充对预防癌症和心脏病起效的至关重要证据
The use of dietary supplement products is common in the United States. The National Health and Nutrition Examination Survey, conducted from 1999 through 2012, showed that more than half the adults in the United States consumed dietary supplements. In the past decade, the numbers of persons who supplemented their diets with fish oil increased by a factor of 10 and with vitamin D by a factor of 4.1 But any long-term health benefits from these products remain in doubt. Hence, the results from the Vitamin D and Omega-3 Trial (VITAL), a randomized, double-blind, placebo-controlled trial (with a two-by-two factorial design) of vitamin D3 (cholecalciferol, at a dose of 2000 IU per day) and marine n−3 fatty acids (also called omega-3 fatty acids, at a dose of 1 g per day) for the primary prevention of cancer and cardiovascular disease are both timely and relevant. Manson et al. now report in two Journal articles2,3 that dietary supplementation with fish oil and vitamin D in this trial did not result in a lower incidence of invasive cancer or a prespecified combination of major cardiovascular events than that with placebo.
使用膳食补充剂产品在美国很常见。1999年至2012年进行的全国健康和营养检查调查显示,美国超过一半的成年人食用膳食补充剂。在过去的十年中,补充鱼油和维生素D的人数分别增加了10倍和4.1倍,但是这些产品对健康的长期益处仍然值得怀疑。因此,维生素D和欧米伽- 3试验的结果(至关重要的),一项随机、双盲、安慰剂对照试验(22因子设计)的维生素D3(维生素D3,剂量为每天2000 IU)和海洋n−3脂肪酸(也叫做ω- 3脂肪酸,每天一剂1 g)的初级预防癌症和心血管疾病都是及时的和相关的。Manson等人现在发表在两篇文章2,3中,在这项试验中,饮食中补充鱼油和维生素D并不会比服用安慰剂降低侵袭性癌症的发病率,也不会降低预先指定的主要心血管事件的联合发生率。
Compelling observational data have long existed that the consumption of fish is associated with protection from cardiovascular disease. However, evidence from trials that n−3 fatty acids may prevent coronary heart disease was not available until the open-label Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI)–Prevenzione Trial in the late 1990s. Largely on the basis of that one trial (and supporting preclinical data), the American Heart Association issued a recommendation regarding the use of n−3 fatty acids for the secondary prevention of coronary heart disease.4 That recommendation has since been updated after many large, randomized trials collectively showed no consistent effect of supplemental n−3 fatty acids to reduce the incidence of cardiovascular events in populations at high risk for coronary heart disease.5 The only remaining use for n−3 fatty acids in the most recent American Heart Association statement is an opinion that the use of n−3 fatty acids is reasonable (not recommended) because it may prevent death from coronary heart disease in patients with a recent myocardial infarction, a statement made largely on the basis of a single meta-analysis.6 Somewhat surprisingly, data from trials testing n−3 fatty acids on the primary prevention of cardiovascular disease in the general population were not available. VITAL has now filled this knowledge gap and convincingly shown that the use of n−3 fatty acids is not effective in preventing the combined end point of myocardial infarction, stroke, or death from cardiovascular causes in unselected patients. These data are generally consistent with those from the recent trial ASCEND (A Study of Cardiovascular Events in Diabetes), which showed that the use of n−3 fatty acids had no effect on the primary prevention of cardiovascular disease in patients with diabetes.7
长期以来,令人信服的观察数据表明,食用鱼类与预防心血管疾病有关。然而,证据从试验n−3脂肪酸可以预防冠心病才可用非盲Gruppo意大利语/ lo工作室德拉Sopravvivenza内尔'Infarto Miocardico(GISSI)-Prevenzione审判在1990年代末。在很大程度上,一个试验的基础上(和支持临床前数据),美国心脏协会发布了一份建议的使用n−3脂肪酸对冠心病的二级预防。4,建议已经被许多大型更新后,集体随机试验显示不一致的补充n−3脂肪酸的影响降低心血管事件的发生率在冠心病的高危人群。剩下5用于n−3脂肪酸在最近的美国心脏协会声明只是一种主观观点,n−3脂肪酸的使用是合理的(不推荐),因为它可以防止死于冠心病患者最近的心肌梗死,很大程度上声明了一个荟萃分析的基础。6有些令人惊讶的是,数据从试验测试n−3脂肪酸对心血管疾病的一级预防一般人群并不可用。至关重要的已经填满这些知识差距,令人信服地表明,n−3脂肪酸的使用不是有效预防心肌梗塞的联合终点,中风,或在未经选择的病人死于心血管原因。这些数据通常是一致的与最近的试验提升(糖尿病的心血管事件的研究),这表明,n−3脂肪酸的使用没有影响心血管疾病的一级预防diabetes.7患者。
Not unlike the results regarding marine n−3 fatty acids, there has been a host of observational data suggesting that lower levels of vitamin D are associated with a higher risk of cancer. Such studies, in turn, highlighted the need for randomized, controlled trials. However, VITAL is not the first randomized trial to test whether vitamin D supplementation could prevent cardiovascular disease or cancer, although to our knowledge it is the largest and longest. The Vitamin D Assessment Study (VIDA) was a 3-year, randomized, placebo-controlled trial in New Zealand that involved 5110 persons who received supplementation with high-dose (100,000 IU) vitamin D monthly. In that trial, there was no effect of vitamin D supplementation on the incidence of major cardiovascular events.9 Similarly in a post hoc analysis from VIDA, the supplemental use of vitamin D had no effect on cancer outcomes.
与结果有关海洋n−3脂肪酸,已经有大量的观测数据表明,低水平的维生素D与更高的患癌症的风险。这样的研究反过来强调了随机对照试验的必要性。然而,VITAL并不是第一个测试补充维生素D是否能预防心血管疾病或癌症的随机试验,尽管据我们所知,它是规模最大、时间最长的试验。维生素D评估研究(VIDA)是在新西兰进行的一项为期3年的随机安慰剂对照试验,5110名患者每月补充高剂量(100,000 IU)的维生素D。在该试验中,补充维生素D对主要心血管事件的发生率没有影响。同样,在VIDA的一项事后分析中,补充使用维生素D对癌症预后没有影响。
作者:3141201037黄鑫
作品来源:https://www.nejm.org/doi/full/10.1056/NEJMe1814933?query=featured_secondary
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