以食為藥，防治一體：代謝綜合征的營養干預新思路

隨著生活方式的改變，超重、肥胖及其伴隨的代謝綜合征（如高血糖、高血壓、血脂異常、高尿酸等）已成為威脅我國居民健康的主要公共衛生問題。全民營養周提出“以食為藥，防治一體”的主題，正是提醒我們：科學的飲食，不僅是健康的基石，更是防治代謝性疾病的有力武器。

代謝綜合征：不止是“胖”那么簡單

數據顯示，我國超過一半的成年人超重或肥胖，而其中38.9%—62.4%的人合并代謝綜合征。代謝綜合征是指一個人同時存在腹型肥胖、高血壓、高血糖、高甘油三酯、低高密度脂蛋白中的至少三項問題。這些因素疊加，顯著增加心腦血管疾病、2型糖尿病等慢性病的風險。

好消息是，代謝綜合征是可以被“吃”好的。

以食為藥：營養干預的核心策略

1. 控制能量，減重為先

減重的核心是保持每日500—750千卡的能量差。《體重管理指導原則（2024版）》推薦限能量、高蛋白、低碳水的膳食模式，有助于減輕體重、改善血糖和血脂。

2. 高膳食纖維：代謝的“清道夫”

膳食纖維在控制血糖、降低血脂、緩解高尿酸方面發揮多重作用：

控糖：每日攝入25—36克膳食纖維（尤其是可溶性纖維），可顯著降低糖化血紅蛋白和空腹血糖。

降脂：可溶性纖維如燕麥β-葡聚糖、車前子，能有效降低總膽固醇和低密度脂蛋白。

降尿酸：纖維通過調節腸道菌群，產生短鏈脂肪酸，幫助緩解痛風炎癥、減少尿酸生成。

建議多吃全谷物、豆類、蔬菜和水果，保證每日纖維攝入量達到25—35克。

3. 礦物質與維生素：小元素，大作用

鎂、鋅、硒：改善胰島素抵抗，幫助控制血糖。

維生素B12、葉酸：改善2型糖尿病患者的血糖控制。

維生素C、E、D：有助于降低尿酸水平，改善血壓和脂代謝。

鉀、鈣：DASH飲食和CHH飲食的核心成分，能顯著降低血壓。

4. 健康脂肪與植物化合物

n-3脂肪酸（如魚油）：每日2克可降低甘油三酯25%—30%。

植物甾醇、大豆異黃酮、大蒜素：均有助于降低膽固醇。

姜黃素、多酚：具有抗炎、改善脂肪肝的潛力。

科學搭配：高營養密度是關鍵

在限能量的前提下，選擇高營養密度的天然食材，如綠葉蔬菜、豆制品、全谷物、堅果、魚類等，可以同時滿足多種營養素需求，避免單一營養素強化的局限。

中國人民解放軍總醫院第四醫學中心提出的一種新型營養餐食模式——限能量、高蛋白、高膳食纖維、低飽和脂肪、低鈉、富含維生素與礦物質，已在真實世界研究中顯示出良好的減重和代謝改善效果。

“以食為藥”并非一句口號，而是基于大量科學證據的醫學營養治療策略。面對代謝綜合征，我們不必等到生病才去醫院，從今天開始，調整飲食結構，選擇高營養密度的天然食物，就是在為自己“開處方”。

中國人民解放軍總醫院第四醫學中心正在開展《特定膳食計劃逆轉超重/肥胖合并血脂等異常的研究：一項前瞻性隨機對照臨床試驗》，本研究為國內首個以營養干預為主要手段對超重肥胖合并血脂異常患者進行逆轉的研究，預期會有不錯的研究結果。

全民營養周，讓我們一起行動：用食物守護健康，用營養防治一體。

（中國人民解放軍總醫院第四醫學中心營養科主任 劉玲英）

參考文獻

1.《中國居民營養與慢性病狀況報告（2020年）》. Accessed November 12, 2024.https://www.gov.cn/xinwen/2020-12/24/content_5572983.htm

2.Pan XF, Wang L, Pan A. Epidemiology and Determinants of Obesity in China. Vol 9.; 2021. www.thelancet.com/diabetes-endocrinology

3.Cawley J, Biener A, Meyerhoefer C, et al. Direct Medical Costs of Obesity in the United States and the Most Populous States. Vol 27.; 2021.

4.Rhee, M.; Lee, J.; Lee, E.Y.; Yoon, K.H.; Lee, S.H. Lipid Variability Induces Endothelial Dysfunction by Increasing Inflammation and Oxidative Stress. Endocrinol. Metab. 2024, 39, 511–520.

5.Fahed, G.; Aoun, L.; Zerdan, M.B.; Allam, S.; Zerdan, M.B.; Bouferraa, Y.; Assi, H.I. Metabolic Syndrome: Updates on Pathophysiology and Management in 2021. Int. J. Mol. Sci. 2022, 23, 786.

6. Noubiap, J.J., Nansseu, J.R., Nyaga, U.F. et al. Worldwide trends in metabolic syndrome from 2000 to 2023: a systematic review and modelling analysis. Nat Commun 17, 573 (2026).https://doi.org/10.1038/s41467-025-67268-5

7. Mata A, Jasul G Jr. Prevalence of Metabolic Syndrome and its Individual Features Across Different (Normal, Overweight, Pre-Obese and Obese) Body Mass Index (BMI) Categories in a Tertiary Hospital in the Philippines. J ASEAN Fed Endocr Soc. 2017;32(2):117-122. doi: 10.15605/jafes.032.02.04. Epub 2017 Oct 2. PMID: 33442094; PMCID: PMC7784121.

8. Stevens W, Peneva D, Li JZ, Liu LZ, Liu G, Gao R, et al. Estimating the future burden of cardiovascular disease and the value of lipid and blood pressure control therapies in China. BMC Health Serv Res. (2016) 16:175. 10.1186/s12913-016-1420-8

9. Xia, Q., et al., Prevalence, awareness, treatment, and control of dyslipidemia in Chinese adults: a systematic review and meta-analysis. Front Cardiovasc Med, 2023. 10: p. 1186330.

10. Zhou YC, Liu JM, Zhao ZP, Zhou MG, Ng M. The national and provincial prevalence and non-fatal burdens of diabetes in China from 2005 to 2023 with projections of prevalence to 2050. Mil Med Res. 2025 Jun 2;12(1):28. doi: 10.1186/s40779-025-00615-1. PMID: 40457495; PMCID: PMC12128495.

11. Xue Cao, Xin Wang, Yixin Tian, et al, Trends and sociodemographic patterns in hypertension prevalence and treatment in China,Med,Volume 6, Issue 11,2025,100808,https://doi.org/10.1016/j.medj.2025.100808.

12. Brum J, Ramsey D, McRorie J, Bauer B, Kopecky SL. Meta-analysis of usefulness of psyllium fiber as adjuvant antilipid therapy to enhance cholesterol lowering efficacy of statins. Am J Cardiol. 2018;122(7):1169-1174.

13. Clinical and metabolic features of the randomised controlled Diabetes Remission Clinical Trial (DiRECT) cohort[J].Diabetologia: Clinical and Experimental Diabetes and Metabolism = Organ of the European Association for the Study of Diabetes (EASD), 2018.

14. Leslie W S , Ali E , Harris L ,et al.Antihypertensive medication needs and blood pressure control with weight loss in the Diabetes Remission Clinical Trial (DiRECT)[J].Diabetologia, 2021(6):1-12.DOI:10.1007/s00125-021-05471-x.

15. Wang S, Yang Z, Tian L et al. Remission to normal blood pressure in older adults with hypertension who did not receive antihypertensive medication: analysis of data from two longitudinal cohorts, eClinicalMedicine, 2024; 73

16. Kim JY. Optimal Diet Strategies for Weight Loss and Weight Loss Maintenance. J Obes Metab Syndr. 2021 Mar 30;30(1):20-31. doi: 10.7570/jomes20065. PMID: 33107442; PMCID: PMC8017325.

17. 國家衛生健康委員會. 體重管理指導原則（2024年版）[J]. 中華健康管理學雜志, 2025, 19(1): 1-8.

18. Evert AB, Dennison M, Gardner CD, et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus report[J]. Diabetes Care, 2019, 42(5): 731-754. DOI:10.2337/dci19-0014.

19.Wei Chen, Hua Jiang, et al. Chinese guidelines for medical nutrition therapy for patients with diabetes (2022 edition)[J]. Asia Pacific Journal of Clinical Nutrition, 2024, 33(2): 118-152. DOI: 10.6133/apjcn.202406_33(2).0001.

20. Yajuan Xie, Luoning Gou, Miaomiao Peng, et al. Effects of soluble fiber supplementation on glycemic control in adults with type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials, Clinical Nutrition, Volume 40, Issue 4, 2021, 1800-1810,https://doi.org/10.1016/j.clnu.2020.10.032.

21.Kim DJ, Yun SH, Lee JB, et al. Effects of magnesium supplementation on type 2 diabetes mellitus glycemic control: a systematic review and meta-analysis of randomized controlled trials. Nutrients. 2018;10(5):E606. doi:10.3390/nu10050606

22.Liu X, Zhang X, Sun Z, et al. Zinc supplementation for type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. J Trace Elem Med Biol. 2018;50:62-68. doi:10.1016/j.jtemb.2018.05.005

23.A, Swayamjeet Satapathy , et al. "Folic acid and vitamin B12 supplementation in subjects with type 2 diabetes mellitus: A multi-arm randomized controlled clinical trial." Complementary Therapies in Medicine 53(2020).

24.Sudchada, Patcharaporn , et al. "Effect of folic acid supplementation on plasma total homocysteine levels and glycemic control in patients with type 2 diabetes: A systematic review and meta-analysis." Diabetes Res Clin Pract 98.1(2012).

25.Huang, Ying-Chen, Gerald F. Combs Jr, Tung-Lung Wu, Huawei Zeng, and Wen-Hsing Cheng. "Selenium status and type 2 diabetes risk." Archives of biochemistry and biophysics (2022): 109400.

26. Daley SF, Vadakekut ES. The DASH Diet: A Guide to Managing Hypertension Through Nutrition. [Updated 2025 Dec 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from:https://www.ncbi.nlm.nih.gov/books/NBK482514/

27. Wang Y, Feng L, Zeng G,, et al.DECIDE-Diet Study Group. Effects of Cuisine-Based Chinese Heart-Healthy Diet in Lowering Blood Pressure Among Adults in China: Multicenter, Single-Blind, Randomized, Parallel Controlled Feeding Trial. Circulation. 2022 Jul 26;146(4):303-315. doi: 10.1161/CIRCULATIONAHA.122.059045.

28. Harris WS. n-3 Fatty acids and serum lipoproteins: human studies. Am J Clin Nutr. 1997; 65 (5 Suppl): 1645S–1654S.

29. McRorie JW, Jr., McKeown NM. Understanding the physics of functional fibers in the gastrointestinal tract: an evidence-based approach to resolving enduring misconceptions about insoluble and soluble fiber. J Acad Nutr Diet. 2017;117(2):251-264.

30. Jovanovski E, Yashpal S, Komishon A, et al. Effect of psyllium (Plantago ovata) fiber on LDL cholesterol and alternative lipid targets, non-HDL cholesterol and apolipoprotein B: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2018;108(5):922-932.

31. Wink J, Giacoppe G, King J. Effect of very-low-dose niacin on high-density lipoprotein in patients undergoing long-term statin therapy. Am Heart J. 2002;143(3):514-518.

32. Rumberger JA, Napolitano J, Azumano I, Kamiya T, Evans M. Pantethine, a derivative of vitamin B(5) used as a nutritional supplement, favorably alters low-density lipoprotein cholesterol metabolism in low- to moderate-cardiovascular risk North American subjects: a triple-blinded placebo and diet-controlled investigation. Nutr Res. 2011;31(8):608-615.

33. Ras RT, Geleijnse JM, Trautwein EA. LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis of randomised controlled studies. Br J Nutr. 2014;112(2):214-219.

34. Tokede OA, Onabanjo TA, Yansane A, Gaziano JM, Djousse L. Soya products and serum lipids: a meta-analysis of randomised controlled trials. Br J Nutr. 2015;114(6):831-843.

35. Ried K, Toben C, Fakler P. Effect of garlic on serum lipids: an updated meta-analysis. Nutr Rev. 2013;71(5):282-299.

36. Watson, S., & Tabackman, L. (2024, January 26).10 Foods to Include in a Healthy Liver Diet. Healthline.https://www.healthline.com/nutrition/liver-diet.

37. Rai S.K., Fung T.T., Lu N., Keller S.F., Curhan G.C., Choi H.K. The Dietary Approaches to Stop Hypertension (DASH) diet, Western diet, and risk of gout in men: Prospective cohort study. BMJ. 2017;357:j1794. doi: 10.1136/bmj.j1794.

38. Meng S., Cui Z., Li M., Li T., Wu F., Kang T., Meng H. Associations Between Dietary Animal and Plant Protein Intake and Cardiometabolic Risk Factors—A Cross-Sectional Study in China Health and Nutrition Survey. Nutrients. 2021;13:336. doi: 10.3390/nu13020336.

39. Wu J., Zhou Y., Hu H., Yang D., Yang F. Effects of β-carotene on glucose metabolism dysfunction in humans and type 2 diabetic rats. Acta Mater. Medica. 2022;1 doi: 10.15212/AMM-2021-0009.

40. Zhang L., Shi X., Yu J., Zhang P., Ma P., Sun Y. Dietary Vitamin E Intake Was Inversely Associated with Hyperuricemia in US Adults: NHANES 2009–2014. Ann. Nutr. Metab. 2020;76:354–360. doi: 10.1159/000509628.

41. Brzezińska O., Styrzyński F., Makowska J., Walczak K. Role of Vitamin C in Prophylaxis and Treatment of Gout—A Literature Review. Nutrients. 2021;13:701. doi: 10.3390/nu13020701.

42. Han Y., Han K., Zhang Y., Zeng X. Serum 25-hydroxyvitamin D might be negatively associated with hyperuricemia in U.S. adults: An analysis of the National Health and Nutrition Examination Survey 2007–2014. J. Endocrinol. Investig. 2022;45:719–729. doi: 10.1007/s40618-021-01637-x.

43. Juraschek S.P., Miller E.R., Gelber A.C. Effect of oral vitamin C supplementation on serum uric acid: A meta-analysis of randomized controlled trials. Arthritis Rheum. 2011;63:1295–1306. doi: 10.1002/acr.20519.

44. Vieira A., Galv?o I., Macia L., Sernaglia M., Vinolo M.A., Garcia C., Tavares L.P., Amaral F.A., Sousa L., Martins F., et al. Dietary fiber and the short-chain fatty acid acetate promote resolution of neutrophilic inflammation in a model of gout in mice. J. Leukoc. Biol. 2017;101:275–284. doi: 10.1189/jlb.3A1015-453RRR.

45. Klisic A., Kocic G., Kavaric N., Jovanovic M., Stanisic V., Ninic A. Body mass index is independently associated with xanthine oxidase activity in overweight/obese population. Eat. Weight. Disord.-Stud. Anorex. Bulim. Obes. 2020;25:9–15. doi: 10.1007/s40519-018-0490-5.

46. Cleophas M.C.P., Cri?an T.O., Lemmers H., Toenhake-Dijkstra H., Fossati G., Jansen T.L., Dinarello C.A., Netea M.G., Joosten L.A.B. Suppression of monosodium urate crystal-induced cytokine production by butyrate is mediated by the inhibition of class I histone deacetylases. Ann. Rheum. Dis. 2016;75:593–600. doi: 10.1136/annrheumdis-2014-206258.

47. Ware, John E. , M. Kosinski , and S. D. Keller . "A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. " Medical Care 34.3(1996):220-233.