重磅研究揭示：低碳飲食對能量消耗的長期影響

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最新荟萃分析發現，低碳水化合物飲食最初會降低總能量消耗（TEE），但在約2.5週後會有顯著增加。這項研究重新分析了29項受控進食研究，涉及617名參與者，指出長期試驗對了解碳水化合物攝入量與能量消耗之間的關系至關重要。

「降低碳水化合物飲食是否增加總能量消耗？對29項受控進食研究的更新和重新分析的荟萃分析」

Do Lower-Carbohydrate Diets Increase Total Energy Expenditure? An Updated and Reanalyzed Meta-Analysis of 29 Controlled-Feeding Studies

Ludwig DS, Dickinson SL, Henschel B, Ebbeling CB, Allison DB. Do Lower-Carbohydrate Diets Increase Total Energy Expenditure? An Updated and Reanalyzed Meta-Analysis of 29 Controlled-Feeding Studies. J Nutr. 2021 Mar 11;151(3):482-490. doi: 10.1093/jn/nxaa350. PMID: 33274750; PMCID: PMC7948201.

https://pubmed.ncbi.nlm.nih.gov/33274750/

Abstract

The effect of macronutrient composition on total energy expenditure (TEE) remains controversial, with divergent findings among studies. One source of heterogeneity may be study duration, as physiological adaptation to lower carbohydrate intake may require 2 to 3 wk.

We tested the hypothesis that the effects of carbohydrate [expressed as % of energy intake (EI)] on TEE vary with time.

The sample included trials from a previous meta-analysis and new trials identified in a PubMed search through 9 March 2020 comparing lower- and higher-carbohydrate diets, controlled for EI or body weight. Three reviewers independently extracted data and reconciled discrepancies. Effects on TEE were pooled using inverse-variance-weighted meta-analysis, with between-study heterogeneity assessed using the I2 statistic. Meta-regression was used to quantify the influence of study duration, dichotomized at 2.5 wk.

The 29 trials ranged in duration from 1 to 140 d (median: 4 d) and included 617 participants. Difference in carbohydrate between intervention arms ranged from 8% to 77% EI (median: 30%). Compared with reported findings in the prior analysis (I2 = 32.2%), we found greater heterogeneity (I2 = 90.9% in the reanalysis, 81.6% in the updated analysis). Study duration modified the diet effect on TEE (P < 0.001). Among 23 shorter trials, TEE was reduced on lower-carbohydrate diets (-50.0 kcal/d; 95% CI: -77.4, -22.6 kcal/d) with substantial heterogeneity (I2 = 69.8). Among 6 longer trials, TEE was increased on low-carbohydrate diets (135.4 kcal/d; 95% CI: 72.0, 198.7 kcal/d) with low heterogeneity (I2 = 26.4). Expressed per 10% decrease in carbohydrate as %EI, the TEE effects in shorter and longer trials were -14.5 kcal/d and 50.4 kcal/d, respectively. Findings were materially unchanged in sensitivity analyses.

Lower-carbohydrate diets transiently reduce TEE, with a larger increase after ∼2.5 wk. These findings highlight the importance of longer trials to understand chronic macronutrient effects and suggest a mechanism whereby lower-carbohydrate diets may facilitate weight loss.

carbohydrate-insulin model; dietary carbohydrate; dietary fat; energy expenditure; feeding study; low-carbohydrate diet; metabolism; obesity.

摘要

碳水化合物組成對總能量消耗（TEE）的影響仍存在爭議，各項研究結果不一。可能造成異質性的一個原因是研究持續時間，因為對較低碳水化合物攝入的生理適應可能需要2到3週。

我們檢驗了碳水化合物[以能量攝入（EI）的百分比表示]對TEE的影響是否隨時間變化的假設。

樣本包括了先前荟萃分析的試驗和通過2020年3月9日的PubMed搜索確定的新試驗，這些試驗比較了低碳水化合物飲食和高碳水化合物飲食，並進行了EI或體重控制。三名審稿人獨立提取數據並調解了爭議。使用反變異權重荟萃分析將TEE的影響汇总，使用I2統計量評估研究間的異質性。使用荟萃回歸分析來量化研究持續時間的影響，分為2.5週。

這29個試驗的持續時間從1到140天不等（中位數：4天），共包括617名參與者。介入組之間的碳水化合物差異範圍從8%到77%的EI（中位數：30%）。與先前分析中的報告結果相比（I2 = 32.2％），我們發現有更大的異質性（重新分析中的I2 = 90.9％，更新分析中的I2 = 81.6％）。研究持續時間修改了飲食對TEE的影響（P <0.001）。在23個較短的試驗中，低碳水化合物飲食降低了TEE（-50.0千卡/天；95％CI：-77.4，-22.6千卡/天），異質性很大（I2 = 69.8）。在6個較長的試驗中，低碳水化合物飲食增加了TEE（135.4千卡/天；95％CI：72.0，198.7千卡/天），異質性較低（I2 = 26.4）。以每降低10％的碳水化合物百分比EI表示，較短和較長試驗中的TEE效應分別為-14.5千卡/天和50.4千卡/天。敏感性分析中的結果基本保持不變。

低碳水化合物飲食會暫時降低TEE，在約2.5週後會出現較大的增加。這些發現強調了長期試驗以了解慢性營養素效應的重要性，並提出了低碳水化合物飲食可能促進減重的機制。

碳水化合物胰島素模型；膳食碳水化合物；膳食脂肪；能量消耗；餵養研究；低碳水化合物飲食；新陳代謝；肥胖。

圖1

PRISMA流程圖，比較低碳水化合物和高碳水化合物飲食對總能量消耗的影響。PRISMA，系統評價和薈萃分析的首選報告項目。

圖2

在比較低碳水化合物和高碳水化合物飲食的29項試驗中，總能量消耗效果的森林圖。試驗依照干預持續時間以升序排列（即最短時間在最上方）。個別試驗的完整引用可以在補充資料中找到。

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