以食为药，防治一体：代谢综合征的营养干预新思路

随着生活方式的改变，超重、肥胖及其伴随的代谢综合征（如高血糖、高血压、血脂异常、高尿酸等）已成为威胁我国居民健康的主要公共卫生问题。全民营养周提出“以食为药，防治一体”的主题，正是提醒我们：科学的饮食，不仅是健康的基石，更是防治代谢性疾病的有力武器。

代谢综合征：不止是“胖”那么简单

数据显示，我国超过一半的成年人超重或肥胖，而其中38.9%—62.4%的人合并代谢综合征。代谢综合征是指一个人同时存在腹型肥胖、高血压、高血糖、高甘油三酯、低高密度脂蛋白中的至少三项问题。这些因素叠加，显著增加心脑血管疾病、2型糖尿病等慢性病的风险。

好消息是，代谢综合征是可以被“吃”好的。

以食为药：营养干预的核心策略

1. 控制能量，减重为先

减重的核心是保持每日500—750千卡的能量差。《体重管理指导原则（2024版）》推荐限能量、高蛋白、低碳水的膳食模式，有助于减轻体重、改善血糖和血脂。

2. 高膳食纤维：代谢的“清道夫”

膳食纤维在控制血糖、降低血脂、缓解高尿酸方面发挥多重作用：

控糖：每日摄入25—36克膳食纤维（尤其是可溶性纤维），可显著降低糖化血红蛋白和空腹血糖。

降脂：可溶性纤维如燕麦β-葡聚糖、车前子，能有效降低总胆固醇和低密度脂蛋白。

降尿酸：纤维通过调节肠道菌群，产生短链脂肪酸，帮助缓解痛风炎症、减少尿酸生成。

建议多吃全谷物、豆类、蔬菜和水果，保证每日纤维摄入量达到25—35克。

3. 矿物质与维生素：小元素，大作用

镁、锌、硒：改善胰岛素抵抗，帮助控制血糖。

维生素B12、叶酸：改善2型糖尿病患者的血糖控制。

维生素C、E、D：有助于降低尿酸水平，改善血压和脂代谢。

钾、钙：DASH饮食和CHH饮食的核心成分，能显著降低血压。

4. 健康脂肪与植物化合物

n-3脂肪酸（如鱼油）：每日2克可降低甘油三酯25%—30%。

植物甾醇、大豆异黄酮、大蒜素：均有助于降低胆固醇。

姜黄素、多酚：具有抗炎、改善脂肪肝的潜力。

科学搭配：高营养密度是关键

在限能量的前提下，选择高营养密度的天然食材，如绿叶蔬菜、豆制品、全谷物、坚果、鱼类等，可以同时满足多种营养素需求，避免单一营养素强化的局限。

中国人民解放军总医院第四医学中心提出的一种新型营养餐食模式——限能量、高蛋白、高膳食纤维、低饱和脂肪、低钠、富含维生素与矿物质，已在真实世界研究中显示出良好的减重和代谢改善效果。

“以食为药”并非一句口号，而是基于大量科学证据的医学营养治疗策略。面对代谢综合征，我们不必等到生病才去医院，从今天开始，调整饮食结构，选择高营养密度的天然食物，就是在为自己“开处方”。

中国人民解放军总医院第四医学中心正在开展《特定膳食计划逆转超重/肥胖合并血脂等异常的研究：一项前瞻性随机对照临床试验》，本研究为国内首个以营养干预为主要手段对超重肥胖合并血脂异常患者进行逆转的研究，预期会有不错的研究结果。

全民营养周，让我们一起行动：用食物守护健康，用营养防治一体。

（中国人民解放军总医院第四医学中心营养科主任 刘玲英）

参考文献

1.《中国居民营养与慢性病状况报告（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. 国家卫生健康委员会. 体重管理指导原则（2024年版）[J]. 中华健康管理学杂志, 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., Galvão 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., Crişan 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.