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新英格兰医学杂志、AHA和FDA相继表态支持限盐：Lancet文章“低盐有害”说法寿终正寝

2016-06-13 文韬 中国循环杂志

低盐饮食伪命题
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Lancet近期一项研究“低盐有害”的文章遭到几方面的围追堵截。Lancet的文章称，如果没有高血压，食钠较少的话，心血管病的风险反而增加。

Lancet近期一项研究“低盐有害”的文章遭到几方面的围追堵截。Lancet的文章称，如果没有高血压，食钠较少的话，心血管病的风险反而增加。
 
美国心脏协会（AHA）首先表态，认为该研究的发现根本站不住脚。
 
之后，《新英格兰医学杂志》发表“回音壁（SOUNDING BOARD）”文章，应用经典的Hill判断因果关系标准证实，低盐增加心血管风险是伪命题。

 
述评指出，在报告钠摄入与心血管转归呈J或U形相关的研究中，低钠组伴糖尿病、高血压、既存心血管病或其他慢性病的受试者比例高于高钠组。
 
这就表明，这些人可能由于进食较少等原因而减少钠摄入，可能导致了低钠摄入，这种低钠摄入和心血管事件增多之间的关系不是因果关系。
 
新英格兰医学杂志的这篇文章认为，Lancet文章使用的测量方法出了问题。用点尿钠测定进食盐的方法不准，因为每天的进食钠的水平是有变化的。有强有力的证据表明，盐与高血压呈线性关系。而证明限盐可预防心血管病证据的文章中，使用的是精确测量食盐方法。

这篇文章一针见血的指出，应用不合理的方法的观察性研究即使观察的样本很大，也会得出错误结论，最终让公众失去挽救生命的机会。
 
这与AHA的观点是一致的，低钠饮食与心血管疾病风险仅仅是一种相关关系，并非因果关系。根据尿钠测定的低钠饮食者心血管风险高，是因为其他因素所致。
 
最近，FDA颁布了一项食品工业指南草案，以减少加工及方便食品中的钠盐含量。基本上给限盐定了支持的基调。


美国医学研究所专家指出，每天摄入不足2300 mg钠盐可以显著降低美国居民血压，最终预防大量的早发疾病和死亡。

CDC负责人Thomas R. Frieden指出，据估计，钠盐摄入量每减少400 mg/天就可预防32000例心梗/年和20000例卒/年，钠盐摄入量减少1200 mg/天可能减少1100万的高血压患者。10年之后，这些减少能够预防约50万例死亡，并可节约近1000亿美元的医疗健康费用。

FDA文件的颁布得到了立即得到美国心脏病学院（ACC）与AHA的赞扬。

Hill标准见下图：


来源：

1、Mente A, O'Donnell M, Rangarajan S,et at. Associations of urinary sodium excretion with cardiovascular events inindividuals with and without hypertension: a pooled analysis of data from fourstudies. Lancet. 2016 May 20. pii: S0140-6736(16)30467-6.
2、http://newsroom.heart.org/news/american-heart-association-strongly-refutes-study-findings-on-sodium-consumption
3、FDA issues draft guidance to food industry onvoluntary sodium reduction. Healio. June 1, 2016
4、Dietary Sodium and Cardiovascular Disease Risk — Measurement Matters.
Cogswell ME, et al. June 1, 2016DOI:10.1056/NEJMsb1607161

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1828514, encodeId=fb661828514ef, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Fri Sep 30 05:20:00 CST 2016, time=2016-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1748663, encodeId=e6f11e48663b1, content=<a href='/topic/show?id=52d15861349' target=_blank style='color:#2F92EE;'>#新英格兰#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58613, encryptionId=52d15861349, topicName=新英格兰)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=db3e36178621, createdName=shalley78, createdTime=Fri Aug 12 12:20:00 CST 2016, time=2016-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1267307, encodeId=b3a0126e307cb, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Wed Jun 15 06:20:00 CST 2016, time=2016-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1480107, encodeId=2bf6148010ea5, content=<a href='/topic/show?id=311b58614a5' target=_blank style='color:#2F92EE;'>#新英格兰医学杂志#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58614, encryptionId=311b58614a5, topicName=新英格兰医学杂志)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fec7610558, createdName=ms9476844295372110, createdTime=Wed Jun 15 06:20:00 CST 2016, time=2016-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=89783, encodeId=0b6a89e83fb, content=钠与高血压的关系可能更复杂，部分人持续低盐饮食饮水会导致血压过低，根据个人体质食盐适量才科学，不能一刀切过于强调低盐饮食, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dbff1731570, createdName=WEIXIN741a20ef, createdTime=Mon Jun 13 17:09:00 CST 2016, time=2016-06-13, status=1, ipAttribution=)]
    2016-09-30 howi

    #Lancet#

    0

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    2016-08-12 shalley78

    #新英格兰#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1828514, encodeId=fb661828514ef, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Fri Sep 30 05:20:00 CST 2016, time=2016-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1748663, encodeId=e6f11e48663b1, content=<a href='/topic/show?id=52d15861349' target=_blank style='color:#2F92EE;'>#新英格兰#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58613, encryptionId=52d15861349, topicName=新英格兰)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=db3e36178621, createdName=shalley78, createdTime=Fri Aug 12 12:20:00 CST 2016, time=2016-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1267307, encodeId=b3a0126e307cb, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Wed Jun 15 06:20:00 CST 2016, time=2016-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1480107, encodeId=2bf6148010ea5, content=<a href='/topic/show?id=311b58614a5' target=_blank style='color:#2F92EE;'>#新英格兰医学杂志#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58614, encryptionId=311b58614a5, topicName=新英格兰医学杂志)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fec7610558, createdName=ms9476844295372110, createdTime=Wed Jun 15 06:20:00 CST 2016, time=2016-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=89783, encodeId=0b6a89e83fb, content=钠与高血压的关系可能更复杂，部分人持续低盐饮食饮水会导致血压过低，根据个人体质食盐适量才科学，不能一刀切过于强调低盐饮食, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dbff1731570, createdName=WEIXIN741a20ef, createdTime=Mon Jun 13 17:09:00 CST 2016, time=2016-06-13, status=1, ipAttribution=)]
    2016-06-15 zhaohui6731

    #AHA#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1828514, encodeId=fb661828514ef, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Fri Sep 30 05:20:00 CST 2016, time=2016-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1748663, encodeId=e6f11e48663b1, content=<a href='/topic/show?id=52d15861349' target=_blank style='color:#2F92EE;'>#新英格兰#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58613, encryptionId=52d15861349, topicName=新英格兰)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=db3e36178621, createdName=shalley78, createdTime=Fri Aug 12 12:20:00 CST 2016, time=2016-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1267307, encodeId=b3a0126e307cb, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Wed Jun 15 06:20:00 CST 2016, time=2016-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1480107, encodeId=2bf6148010ea5, content=<a href='/topic/show?id=311b58614a5' target=_blank style='color:#2F92EE;'>#新英格兰医学杂志#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58614, encryptionId=311b58614a5, topicName=新英格兰医学杂志)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fec7610558, createdName=ms9476844295372110, createdTime=Wed Jun 15 06:20:00 CST 2016, time=2016-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=89783, encodeId=0b6a89e83fb, content=钠与高血压的关系可能更复杂，部分人持续低盐饮食饮水会导致血压过低，根据个人体质食盐适量才科学，不能一刀切过于强调低盐饮食, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dbff1731570, createdName=WEIXIN741a20ef, createdTime=Mon Jun 13 17:09:00 CST 2016, time=2016-06-13, status=1, ipAttribution=)]
    2016-06-15 ms9476844295372110

    #新英格兰医学杂志#

    0

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    2016-06-13 WEIXIN741a20ef

    钠与高血压的关系可能更复杂，部分人持续低盐饮食饮水会导致血压过低，根据个人体质食盐适量才科学，不能一刀切过于强调低盐饮食

    0

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Baidu
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Baidu
map