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脱脂VS全脂,哪种牛奶更健康?

2021-05-08 李久玲;朱皓雪 MedSci原创

与脱脂牛奶相比,全脂牛奶显着提高了HDL胆固醇浓度

牛奶是全球广泛消耗的乳制品之一,全世界有近60亿的人摄入牛奶。近些年,有的广告将脱脂牛奶捧上“神坛”,宣传其为减肥者的不二之选。各种品牌的脱脂牛奶涌入市场,让消费者眼花缭乱。那全脂牛奶是否应该被脱脂牛奶完全取代?饮用脱脂牛奶更有利于身体健康吗?

目前,已有研究者将目光投向脱脂牛奶,其中不少研究结果引起我们的兴趣。Sara Engel等人的一项随机对照研究比较了全脂牛奶(3.5%脂肪)和脱脂牛奶(0.1%脂肪)对健康受试者空腹血脂,胰岛素和血浆葡萄糖的影响,结果显示,与脱脂牛奶相比,全脂牛奶显着提高了HDL胆固醇浓度(P<0.05)。这一结论,也在Juristo Fonollá等人的研究得以证实,该团队指出与摄入脱脂牛奶相比,食用脂质含量较高的牛奶能够改善受试者的营养状况和血管疾病危险指标 。

脱脂牛奶与肥胖和二型糖尿病的关系仍待商榷。一项横断面研究显示,与摄入脱脂和半脱脂牛奶的学龄前儿童相比,摄入全脂牛奶的学龄前儿童BMI水平较低。此外,有观察性研究显示,用脱脂牛奶代替半脱脂牛奶,增加了60-64岁和65-72岁的参与者患二型糖尿病的风险 (RD% [95% CI]:0.5% [0.2, 0.7]; 0.4% [0.1, 0.7]; per 50 g/d, respectively) 。

最近,一项由吉林大学基础医学院遗传学系完成的研究显示,与摄入脱脂牛奶相比,全脂牛奶可降低炎症性肠道疾病的发病风险,特别是克罗恩病。该研究成果在《Journal of Bio-X Research》杂志刊登发表。

 

doi: 10.1097/JBR.0000000000000094

炎症性肠道疾病(IBD) 是常见慢性炎症性肠道疾病,包括克罗恩病(CD)和溃疡性结肠炎(UC)。据估计,美国超过100万居民、欧洲超过250万居民患有IBD,为此承担了巨额的医疗费用。IBD的发生和发展取决于遗传因素和环境因素的共同作用,其中,饮食是影响IBD发生的重要环境因素之一。

与传统的流行病学研究不同,本项研究使用了全基因组关联分析(GWAS)和孟德尔随机化研究(MR)。基于遗传变异能随机分配给后代,MR本质上是一种独立于混杂因素的自然随机对照实验,消除了混杂因素对于结局的影响,为风险因素对结局的影响提供了可靠的遗传学证据。

研究者使用了UK Biobank中的约8.8万名牛奶消费者的临床数据及基因型数据,其中,约2万人是全脂牛奶消费者,约6.8万人是脱脂牛奶消费者。研究者用GWAS比较了全脂牛奶消费者与脱脂牛奶消费者的等位基因频率差异,获得了5个与全脂牛奶摄入偏好相关的单核苷酸多态性(SNPs)。他们用这些SNP表征全脂牛奶摄入偏好。进而,研究者将全脂牛奶摄入偏好作为暴露,炎症性肠道疾病(IBD)作为结局,做了一项两样本MR研究。结果发现全脂牛奶摄入偏好能够降低IBD特别是CD的发病风险。

GWAS结果定位了5个与全脂牛奶摄入相关的基因,分别为FTO,APOE,LINC01833,LINC02607,PSMC3。其中,FTO基因是肥胖症的明星基因,并且在这项研究中与全脂牛奶摄入的相关性也最强。研究者推断,全脂牛奶摄入偏好的形成可能与脂肪代谢的能力相关。

 

全脂牛奶遗传偏好有关5个lead SNPs曼哈顿图

MR研究结果表明全脂牛奶摄入降低总体IBD(β=-1.735, P=0.048)及克罗恩病(CD,β=-2.549, P=0.032)的发病风险,但对溃疡性结肠炎没有影响(P=0.44)。

研究团队认为全脂牛奶降低IBD发病风险的具体机制可能与肠道菌群有关。该推断得到了其他研究者的支持。例如,来自Opstelten JL等人的一项研究比较了牛奶消费者与非消费者CD和UC的发病风险,得出了相同结论,即摄入牛奶能够降低CD风险,对UC没有影响(6)。进一步研究样本的肠道菌群结构可以发现,CD患者与正常人、UC患者相比,小肠和结肠菌群组成明显不同。虽然,该研究没有区分全脂和脱脂牛奶,但Opstelten JL等人认为这种菌群组成的差异可能导致了CD和UC患者从牛奶获得的不同收益。

全脂牛奶中含有短链脂肪酸和多不饱和脂肪酸,有益于维持肠道菌群的平衡,调节免疫其中,短链脂肪酸中的丁酸能降低沙门氏菌的致病性、抑制IL-17的表达并促进Treg细胞生成,从而抑制肠炎发生。补充额外的Omega-3脂肪酸可以增加肠道双歧杆菌、罗斯氏菌和乳酸杆菌的丰度,发挥抗炎作用。

综上,研究发现,出于降低炎症性肠道疾病(特别是克罗恩氏病)的目的,饮用全脂牛奶可能是一个更健康的选择。

该论文的作者们最后表示:“我们的研究参与者是欧洲血统,该研究的结果是否适用于其他种族还需要进一步验证。未来我们希望能有随机对照实验进一步验证我们的结论,以便于更好指导日常乳制品的选择。”

*李久玲,吉林大学基础医学院病理学与病理生理学系19级在读博士研究生,研究方向为代谢疾病的分子遗传机理,带领团队完成了本研究并且完成论文初稿,指导教师为陈鹏教授。

*朱皓雪,吉林大学白求恩第一临床医学院18级本科生,带领一个三人大学生创新创业团队参与本研究,完成了数据分析,参与了论文写作。

参考文献:

1.Engel S, Elhauge M, Tholstrup T. Effect of whole milk compared with skimmed milk on fasting blood lipids in healthy adults: a 3-week randomized crossover study. European journal of clinical nutrition 2018;72(2):249-54. doi: 10.1038/s41430-017-0042-5.

2.Fonollá J, López-Huertas E, Machado FJ, Molina D, Alvarez I, Mármol E, Navas M, Palacín E, García-Valls MJ, Remón B, et al. Milk enriched with "healthy fatty acids" improves cardiovascular risk markers and nutritional status in human volunteers. Nutrition (Burbank, Los Angeles County, Calif) 2009;25(4):408-14. doi: 10.1016/j.nut.2008.10.008.

3.Lahoz-García N, Milla-Tobarra M, García-Hermoso A, Hernández-Luengo M, Pozuelo-Carrascosa DP, Martínez-Vizcaíno V. Associations between Dairy Intake, Body Composition, and Cardiometabolic Risk Factors in Spanish Schoolchildren: The Cuenca Study. Nutrients 2019;11(12). doi: 10.3390/nu11122940.

4.Ibsen DB, Overvad K, Laursen ASD, Halkj?r J, Tj?nneland A, Kilpel?inen TO, Parner ET, Jakobsen MU. Changes in intake of dairy product subgroups and risk of type 2 diabetes: modelling specified food substitutions in the Danish Diet, Cancer and Health cohort. European journal of nutrition 2021. doi: 10.1007/s00394-021-02524-0.

5. Li J, Zhu H, Tian A, Guo Y, Zhao X, Zhang M, Chen L, Wen J, Yang J, Qi B, et al. Whole-milk consumption decreases the risk of inflammatory bowel disease: a two-sample Mendelian randomization analysis. 9000;Latest Articles. doi: 10.1097/jbr.0000000000000094.

6.Opstelten JL, Leenders M, Dik VK, Chan SS, van Schaik FD, Khaw KT, Luben R, Hallmans G, Karling P, Lindgren S, et al. Dairy Products, Dietary Calcium, and Risk of Inflammatory Bowel Disease: Results From a European Prospective Cohort Investigation. Inflammatory bowel diseases 2016;22(6):1403-11. doi: 10.1097/mib.0000000000000798.

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    2021-10-21 ms6000001063757863

    全脂牛奶VS脱脂牛奶

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    2021-05-10 1881ef655dm

    厉害

    0

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    2021-05-09 ms7000000611740824

    学到了

    0

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    2021-05-09 乙娆

    以后喝牛奶可以考虑全脂牛奶

    0

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    2021-05-09 ms7000001250691579

    全脂牛奶增加HDL

    0

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    2021-05-08 ms5000001042107093

    0

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    2021-05-08 杨三

    🤔🤔

    0

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    2021-05-08 ms8000001304335137

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    2021-05-08 莉莉安 Lillian C.

    0

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