生酮饮食与心血管健康：平衡代谢益处与脂质相关风险
Ketogenic diets and cardiovascular health balancing metabolic benefits against lipid-related risk.
摘要(中文译文)
生酮饮食（KD）对心血管的影响仍存在争议。在本综述中，KD指旨在通过显著限制碳水化合物摄入以诱导营养性酮症的成人饮食干预，同时承认生酮饮食疗法（KDT）是涵盖多种方案变体的更广泛的上位术语。我们系统检索了PubMed、Embase、Web of Science和Cochrane Library自建库至2026年3月的文献，并额外检索了灰色文献来源（ClinicalTrials.gov、WHO国际临床试验注册平台、medRxiv、会议论文集和参考文献列表）。纳入的研究包括成人KD干预（通常碳水化合物供能<10%或<50 g/天）的随机对照试验（RCT）、前瞻性队列研究和观察性研究。主要结局为血脂变化；次要结局包括血糖、人体测量学指标和血压；探索性结局为死亡率和动脉粥样硬化。采用随机效应荟萃分析生成合并估计值。本方案未进行前瞻性注册。共纳入24项研究（20项RCT、2项前瞻性队列、1项非随机临床试验和1项试点干预；>47,000名参与者）。与对照饮食相比，KD升高了低密度脂蛋白胆固醇（LDL-C）（平均差[MD] +12.2 mg/dL，95% CI 7.5至16.9；I2 = 67.7%）和总胆固醇，而高密度脂蛋白胆固醇（HDL-C）轻度升高。甘油三酯总体下降（MD -16.1 mg/dL，95% CI -20.3至-11.8；I2 = 17.1%）。KD还改善了空腹血糖、糖化血红蛋白、体重、体重指数和收缩压。队列证据提示全因死亡率较低，但心血管死亡率未见明显降低。动脉粥样硬化的影像学证据有限且结果不一。KD与肥胖程度、血糖控制和血压的改善相关，但也与LDL-C和总胆固醇升高相关。临床心血管终点的证据仍然有限、结果不一，且大多证据确定性低，支持个体化风险-获益评估，而非普遍采用KD。
Abstract
The cardiovascular impact of ketogenic diets (KD) remains debated. In this review, KD refers to adult dietary interventions intended to induce nutritional ketosis through marked carbohydrate restriction, while acknowledging that ketogenic diet therapy (KDT) is a broader umbrella term encompassing several protocol variants. We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library from inception to March 2026, and we additionally searched gray literature sources (ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform, medRxiv, conference proceedings, and reference lists). Eligible studies included randomized controlled trials (RCTs), prospective cohorts, and observational studies of adult KD interventions (generally < 10% of energy from carbohydrate or < 50 g/day). Primary outcomes were lipid changes; secondary outcomes included glycemia, anthropometrics, and blood pressure; exploratory outcomes were mortality and atherosclerosis. Random-effects meta-analyses generated pooled estimates. The protocol was not prospectively registered. Twenty-four studies (20 RCTs, 2 prospective cohorts, 1 non-randomized clinical trial, and 1 pilot intervention; >47,000 participants) were included. Compared with control diets, KD increased low-density lipoprotein cholesterol (LDL-C) (mean difference [MD] + 12.2 mg/dL, 95% CI 7.5 to 16.9; I2 = 67.7%) and total cholesterol, while high-density lipoprotein cholesterol (HDL-C) rose modestly. Triglycerides decreased overall (MD -16.1 mg/dL, 95% CI -20.3 to -11.8; I2 = 17.1%). KD also improved fasting glucose, glycated hemoglobin, body weight, body mass index, and systolic blood pressure. Cohort evidence suggested lower all-cause mortality but no clear reduction in cardiovascular mortality. Imaging evidence for atherosclerosis was limited and mixed. KD was associated with improvements in adiposity, glycemic control, and blood pressure, but also with higher LDL-C and total cholesterol. Evidence for clinical cardiovascular endpoints remains limited, mixed, and mostly low certainty, supporting individualized risk-benefit assessment rather than universal adoption of KD.
如何引用
AMA
Hanxiu Liu, Wei Wu, Ni He, Xiqiang Wang, Shuo Pan, Ling Zhu, et al. Ketogenic diets and cardiovascular health balancing metabolic benefits against lipid-related risk.. BMC cardiovascular disorders. 2026; doi:10.1186/s12872-026-06189-7.
APA
Hanxiu Liu, Wei Wu, Ni He, Xiqiang Wang, Shuo Pan, Ling Zhu, et al (2026). Ketogenic diets and cardiovascular health balancing metabolic benefits against lipid-related risk.. BMC cardiovascular disorders. https://doi.org/10.1186/s12872-026-06189-7
GB/T 7714
Hanxiu Liu, Wei Wu, Ni He, Xiqiang Wang, Shuo Pan, Ling Zhu, et al. Ketogenic diets and cardiovascular health balancing metabolic benefits against lipid-related risk.[J]. BMC cardiovascular disorders, 2026 doi:10.1186/s12872-026-06189-7.
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