Here's how 10 popular diets scored for heart health

Thinking about trying a new diet but not sure which way to go? 一项对10种流行饮食模式的循证分析表明，有些饮食模式对心脏健康的促进作用要比其他的好得多.

美国心脏协会周四在其期刊上发表了一份科学声明 Circulation found the Mediterranean, DASH-style, 鱼素和素食的饮食模式与心脏健康的饮食指南非常一致, while the popular paleo and ketogenic diets contradicted them.

"The number of different, popular dietary patterns has proliferated in recent years, 社交媒体上关于他们的错误信息已经达到了临界水平," statement writing committee chair Christopher D. Gardner said in a news release. Gardner是加州斯坦福大学Rehnborg Farquhar医学教授.

“公众——甚至许多医疗保健专业人士——可能对心脏健康饮食感到困惑，这是有道理的, 他们可能会觉得自己没有线上电子游戏飞禽走兽或训练来评估不同的饮食," he said. “我们希望这一声明能成为临床医生和公众了解哪些饮食能促进良好的心脏代谢健康的工具."

The report evaluates how well each of 10 popular diets or eating patterns aligns with nine of 10 features of AHA's dietary guidance for heart-healthy eating: consuming a wide variety of fruits and vegetables; choosing mostly whole grains instead of refined grains; using liquid plant oils rather than tropical oils; eating healthy sources of protein, such as from plants, seafood or lean meats; minimizing added sugars and salt; limiting alcohol; choosing minimally processed foods instead of ultraprocessed foods; and following this guidance wherever food is prepared or consumed. 评分中没有包括的一个特征是维持健康体重所需的能量平衡, because it is influenced by factors other than dietary choices, such as physical activity levels.

根据这些饮食对美国心脏协会指导的遵循程度，以1到100分进行评分.

The statement did not review commercial dietary programs, those that are followed for fewer than 12 weeks, practices such as intermittent fasting or time-restricted eating, or diets used to manage non-cardiovascular health conditions.

这些饮食根据得分分为4个等级，得分范围从31到100. 只有一项饮食计划——DASH(阻止高血压的饮食方法)——获得了满分. This eating pattern is low in salt, added sugar, tropical oil, alcohol and processed foods and high in non-starchy vegetables, fruits, whole grains and legumes. Proteins mostly come from plant sources, such as legumes, beans or nuts, along with fish or seafood, lean poultry and meats and low-fat or fat-free dairy products.

地中海饮食模式的得分略低(89分)，因为与DASH不同, it allows for moderate alcohol consumption and does not address added salt. The pescetarian diet (92), which allows for seafood in addition to plant-based foods, and vegetarian diet (86) also were in the top tier.

"If implemented as intended, 顶级饮食模式最符合美国心脏协会的指导，也可以根据文化习俗进行调整, food preferences and budgets to enable people to always eat this way, for the long term," Gardner said.

Vegan and low-fat diets (78 each) fell into the second tier. While they emphasize fruits, vegetables, whole grains, legumes and nuts, while limiting alcohol and added sugars, 纯素饮食是如此严格，以至于长期遵循或外出就餐可能具有挑战性，并可能增加维生素B-12缺乏症的风险, which can lead to anemia.

There also are concerns that low-fat diets treat all fats equally, whereas the AHA guidance calls for replacing saturated fats with healthier fats. 吃低脂饮食的人也可能过度摄入不太健康的碳水化合物, such as added sugars and refined grains. But these concerns may be overcome with proper nutritional counseling and education.

Very low-fat (72) and low-carb diets (64) fall into the third tier. Both restrict foods that are emphasized in the AHA's dietary guidance. For example, very low-fat diets restrict nuts and healthy plant oils, and low-carb diets restrict consumption of fruits, grains and legumes, which can lead to eating less fiber and higher amounts of saturated fats.

旧石器时代饮食(53分)和低碳水化合物/生酮饮食(31分)属于第四层，也就是最低层. Both, which are used for weight loss, 与心脏健康饮食指南不一致，长期来看，并没有显示出比限制较少的饮食更有效的减肥效果. Both also are high in fat without limiting saturated fats.

The tier 4 diets, Gardner said, "are highly restrictive and difficult for most people to stick with long-term. 虽然可能会有短期的好处和显著的减肥效果，但这是不可持续的. A diet that's effective at helping an individual maintain weight-loss goals, from a practical perspective, needs to be sustainable."

加德纳警告说，关于流行饮食研究的相互矛盾的信息可能会让试图遵循它们的人感到困惑.

“我们经常发现，人们并不完全了解流行的饮食模式，也没有按照预期的那样去做," he said. "When that is the case, 确定“按预期饮食”的效果并将其与“按预期饮食”区分开来是具有挑战性的.“两项看似矛盾的研究结果可能仅仅反映了一项研究中对饮食的坚持程度很高，而另一项研究的坚持程度很低。."

作者指出，需要更多的研究和教育，向人们展示如何以与文化相关的方式遵循饮食模式，以确保其有效性. 还需要努力将历史上被边缘化的群体纳入研究，以减少结构性种族主义对饮食相关疾病的影响, 需要制定政策，消除某些社区限制获得健康食品的不公正做法, according to the report.