Еще результаты одного РКИ, правда, предварительные, говорят в пользу ограничения не жира, а калорий тем, кто хочет
не толстеть и долго жить.
Исследование исходило из гипотезы о «здоровой средиземноморской диете». Ее имитировали, добавляя в еду взрослым с диабетом 2 типа оливковое масло или орешки. Контрольная группа получала совет снизить потребление жира. Даже худеть не рекомендовали. Впрочем, можно полагать, что участники всё равно стремились не толстеть. Почти пять лет — и вот: получавшие масло по сравнению с контролем снизили массу тела.
Background
Because of the high density of fat, high-fat diets are perceived as likely to lead to increased bodyweight, hence health-care providers are reluctant to recommend them to overweight or obese individuals. We assessed the long-term effects of ad libitum, high-fat, high-vegetable-fat Mediterranean diets on bodyweight and waist circumference in older people at risk of cardiovascular disease, most of whom were overweight or obese.
Methods
PREDIMED was a 5 year parallel-group, multicentre, randomised, controlled clinical trial done in primary care centres affiliated to 11 hospitals in Spain. 7447 asymptomatic men (aged 55–80 years) and women (aged 60–80 years) who had type 2 diabetes or three or more cardiovascular risk factors were randomly assigned (1:1:1) with a computer-generated number sequence to one of three interventions: Mediterranean diet supplemented with extra-virgin olive oil (n=2543); Mediterranean diet supplemented with nuts (n=2454); or a control diet (advice to reduce dietary fat; n=2450). Energy restriction was not advised, nor was physical activity promoted. In this analysis of the trial, we measured bodyweight and waist circumference at baseline and yearly for 5 years in the intention-to-treat population. The PREDIMED trial is registered with ISRCTN.com, number ISRCTN35739639.
Findings
After a median 4·8 years (IQR 2·8–5·8) of follow-up, participants in all three groups had marginally reduced bodyweight and increased waist circumference. The adjusted difference in 5 year changes in bodyweight in the Mediterranean diet with olive oil group was −0·43 kg (95% CI −0·86 to −0·01; p=0·044) and in the nut group was −0·08 kg (–0·50 to 0·35; p=0·730), compared with the control group. The adjusted difference in 5 year changes in waist circumference was −0·55 cm (–1·16 to −0·06; p=0·048) in the Mediterranean diet with olive oil group and −0·94 cm (–1·60 to −0·27; p=0·006) in the nut group, compared with the control group.
Interpretation
A long-term intervention with an unrestricted-calorie, high-vegetable-fat Mediterranean diet was associated with decreases in bodyweight and less gain in central adiposity compared with a control diet. These results lend support to advice not restricting intake of healthy fats for bodyweight maintenance.
Funding
Spanish Government, CIBERobn, Instituto de Salud Carlos III, Hojiblanca, Patrimonio Comunal Olivarero, California Walnut Commission, Borges SA, and Morella Nuts.
А мораль: хотите худеть — надо не «легкий майонез» выбирать или цигун. Не надо избегать жира. Жрать меньше надо.
Василий Власов
