高蛋白饮食对超重/肥胖人群减肥功效的证据基础:临床研究的系统评价和Meta分析

摘要:目的 系统评价高蛋白饮食对超重/肥胖成人减肥效果的临床证据。方法 系统检索医学数据库，筛选高蛋白饮食减肥功效研究的随机对照试验和观察性研究，提取体重、身体质量指数（BMI）及体脂等关键数据进行Meta分析。结果 共纳入28项研究，其中5项是自身前后对比实验，23项为随机对照研究。对比高蛋白饮食治疗前后及与常规蛋白饮食对体重、体脂等指标的影响。①与治疗前基线相比:高蛋白饮食组体重[MD=-7.20,95%C1(-8.33,-6.08),P<0.00001]、BMI[MD=-3.08,95%C1 (-4.12,-2.04),P<0.00001明显降低;体脂量[MD=-5.70,95%CI(-7.16,-4.23),P<0.00001]、体脂率[MD=-4.44,95%CI(-5.65,-3.23),P<0.00001]及内脏脂肪面积[MD=-25.98,95%CI(-36.68,-15.27),P<0.00001]明显降低;腰围[MD=-6.68, 95%CI(-8.01,-5.35),P<0.00001]及腰臀比[MD=-0.09,95%CI(-0.14,-0.04),P=0.0007]明显降低，差异均具有统计学意义。②与常规蛋白饮食相比:高蛋白饮食干预后体重[MD--1.33,95%CI(-2.16,-0.49)P-0.0021、体脂量[MD=-0.93,95%CI (-1.58,-0.28),P-0.005]、腰围[MD=-2.11,95%CI (-3.06,-1.15),P<0.0001]降低更明显,全身瘦体重[MD=-0.60，95%CI(0.11，1.10)，P-0.02]增加更明显，差异均具有统计学意义。结论 基于现有临床研究证明，高蛋白饮食体重管理，在短期内能有效改善超重/肥胖人群体重、体脂等指标。临床实践中，建议权衡代谢获益与潜在风险，优先选择优质蛋白来源并定期监测代谢指标。

关键词:高蛋白饮食;超重/肥胖;体重;体脂;Meta

Abstract: Objective To systematically evaluate the clinical evidence regarding the efficacy of high- protein diets for weight loss in overweight orbbese adults. Methods Medical databases were systematically searched to screen randomized controlled trials and observational studies investigatingthe weight-loss effects of high-protein diets. Meta-analysis was performed using extracted key data including body weight, body mass index (BMI),ind body fat. Results A total of 28 studies were included, comprising S before-after self-controlled trials and 23 randomized controlled trials. Theffects of high-protcin dicts on body wcight, body fat, and related paramcters were compared both pre- and post-intervention, and againstnormal-protein diets.DCompared with bascline: In the high-protein diet group, statistically significant reductions were observed in body wcight [MD-7.20, 95%CI (-8.33, -6.08), P<0.00001], BMI[MD =-3.08, 95%CI (-4.12, -2.04), P<0.00001, body fat mass [MD =-5.70, 95%CI(-7.16, -4.23), P<0.00001], body fat percentage [MD =-4.44, 95%CI (-5.65, -3.23), P<0.00001, visceral fat area [MD =-25.98, 95%CI(-36.68, -15.27), P<0.00001], waist circumference [MD=-6.68, 95%CI (-8.01, -5.35), P<0.00001], and waist-to-hip ratio [MD=-0.09,5%CI (-0.14, -0.04), P=0.0007].2Compared with normal-protein diets: The high-protein diet group exhibited significandly greater reductions inbody weight [MD=-1.33, 95%CI (-2.16, -0.49), P=0.002], body fat mass [MD= -0.93, 95%CI (-1.58, -0.28), P=0.0051, and waistircumference [MD=-2.11, 95%CI (-3.06, -1.15), P<0.0001], as wellas a significanly greater increase in total lean body mass [MD =0.60,5%CI(0.11, 1.10),P0.021.All differences were statistically significant. Conclusions Curent clinical evidence demonstrates that high-protein dietsfor weight management effectively improve body weight, body fat, and related indices in overwcight and obese individuals in the short term. Inlinical practice,it is recommended to balance metabolic benefits against potential risks, prioritize high-quality protcin sources, and regularly monitormetabolic parameters.

Key words:High-protein diet; Overweight/Obesity; Weight; Body fat; Meta