生物与医学2017cell.com
膳食碳水化合物损害健康寿命并促进死亡率
Dietary Carbohydrates Impair Healthspan and Promote Mortality
进阶 · 约 40 分钟读完前置知识：流行病学基础、统计推断、宏量营养素
导读
论文分析膳食碳水化合物摄入与健康寿命及死亡率的关联，报告较高碳水摄入与不良健康结局相关。但评论指出，研究中最低碳水组仍从碳水获取约46%能量，且未区分精制碳水与全谷物等来源，因此不能据此支持极低碳或生酮饮食。
HN 关注点：这项研究是否真的支持低碳/生酮饮食，以及营养流行病学在碳水质量、随访时长和因果推断上的缺陷。
HN 评论精选
这几条评论里：质疑 2 补充 1 亲历 1
补充研究最低碳水组仍占46%能量，作者明确不支持极低碳饮食。
注意，这可能不是你想的那样（低碳、极低碳甚至生酮饮食有益健康寿命）。研究中最低五分位从碳水摄入46.4% kcal（2000 kcal总摄入约230克碳水），按今天健康博客的标准远不算低碳。作者在讨论部分明确说：低碳水摄入（如<50%能量）与健康结局无关联，并不能支持极低碳水饮食；一定量碳水是满足体力活动短期能量需求所必需的，中等摄入（如50–55%能量）可能比极高或极低碳水更合适。
fasteo查看英文原文
Note that this is probably not what you are thinking (low-carb, very-low carb or even keto diets are good for your healthspan). The lowest quintile in this study were consuming 46,4% of kcal from carbs (that's about 230 gram of carbs for a 2000 kcal total intake). Not even close to low carb by today's standard in the health blogosphere. The authors make this explicit in the discussion section: >>> However, the absence of association between low carbohydrate intake (eg, <50% of energy) and health outcomes does not provide support for very low carbohydrate diets. Importantly, a certain amount of carbohydrate is necessary to meet short-term energy demands during physical activity and so moderate intakes (eg, 50–55% of energy) are likely to be more appropriate than either very high or very low carbohydrate intakes.
质疑研究有缺陷，健康人群吃大量非精制碳水。
这项研究有很大缺陷（附哈佛营养源链接）。基于这些“发现”改变饮食要小心。地球上最健康的人群吃大量碳水，但不是精制糖。
cageface查看英文原文
This study is highly flawed: https://www.hsph.harvard.edu/nutritionsource/2017/09/08/pure-study-makes-headlines-but-the-conclusions-are-misleading/ Be careful making any changes to your diet based on these "findings". The healthiest populations on the planet eat plenty of carbs, but not refined sugars.
质疑研究未区分碳水来源且随访仅7.4年，不能证明长期寿命影响。
看到它上HN头条不意外，因为很多人是生酮饮食粉丝。对找到适合自己方法的人我很高兴，但如果你在找这项研究来证实生酮，我会非常警惕：1. 研究没有分析哪种具体碳水来源（糖/精制碳水 vs 全谷物）导致观察到的有害效应，尤其收入和财富显著影响饮食质量。这很重要——把整个宏量营养素标为“坏”无助于理解全貌，最有营养和最没营养的食物都可能是碳水。2. 这项研究及多数高脂/生酮研究时间不够长（这项7.4年），无法说明真正的“寿命”影响；少数世代研究几乎都显示“高碳水”或更具体“植物性”有益长寿，高脂是否益寿还没真正看到例子。3. 许多尝试生酮的人会告诉你……
shlant查看英文原文
I'm not surprised to see this at the top of HN considering how many people seem to be fans of the Keto Diet. I am very excited for people who find something that works for them, but I would be very wary of a study like this if you are looking for confirmation for multiple reasons: 1. The study "did not analyze which specific source of carbohydrates (e.g., sugar/refined carbs versus whole-grain products) may contribute to the detrimental effects of carbs observed, especially since income and wealth do impact the quality of dietary choices significantly." This is HUGE. Any study or person that attempts to label an entire macronutrient as "bad" or "evil" is not helping anyone understand the whole picture. The most nutritious foods in the world are carbs. Many of the least nutritious foods are also carbs. Not distinguishing the two gets us nowhere. 2. With this study and most high fat/keto diet studies as well, the timeline is not long enough to tell us about true "lifespan" impact. This one is over 7.4 years. I know it's more difficult to do 10, 20, 30 year studies, but until something can be correlated over those timespans, I would not bet everything on that diet for longevity. There are a handful of generational studies, and almost all have shown that "high carb" or more specifically "plant based" ARE good for longevity. Not saying high fat aren't good for longevity as well, but we have yet to really see examples yet. 3. As many who have tried Keto specifically will tell you (as some have mentioned in the comments), it is very difficult to maintain a ketogenic state. You have to be very disciplined, and this is made harder when you are a social person. This is a big problem when talking about diet and longevity. If it's not fairly easy to maintain, then it's not a feasible diet for longevity where the average person is concerned. 4. As someone else mentioned, the percentage of carbs that the studies participants were eating were not even close to the level required for a Keto Diet
亲历应观察健康长寿者的生活方式，家常菜含脂肪和碳水，不必恐惧。
我读过很多常常相互矛盾的饮食建议，意识到一件很重要的事：人类很容易接受自己喜欢的东西对自己有害（见脂肪、性等），所以听人们说什么有害是愚蠢的。相反我采取更简单的方法：观察健康长寿者的生活方式。我观察到吃“好的、老式”家常菜很重要。我祖母活到90多岁，吃脂肪和碳水；Julia Child活到90多岁，吃脂肪和碳水；Edna Lewis活到90多岁，吃脂肪和碳水。我可以继续列举。照他们做，你机会一样好。
cup-of-tea查看英文原文
I've read a lot of, often conflicting, dietry guidance. I have realised one very important thing: humans will very easily accept that something they enjoy is bad for them (see fat, sex etc.) So listening to what people say is bad for them is stupid. Instead I have taken a simpler approach: I observe the lifestyles of people who are healthy and live a long time. I have observed that eating simply "good, old-fashioned" home cooked food is important. My grandmother lived into her 90s. Ate fat and carbs. Julia Child lived into her 90s. Ate fat and carbs. Edna Lewis lived into her 90s. Ate fat and carbs. I could go on. Just do what they did and you'll have as good a chance as any.
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- 2017Hacker News 讨论帖158 分 · 114 评
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