2013年2月25日 星期一

【速譯文】地中海飲食幫你降低心臟病風險 (翻完了)

本來呢,我對「吃什麼讓你更健康」這類的新聞一向沒有興趣(我只相信讚美我愛的食物的研究),不過誰叫今天我的晚餐剛好是

綠蘆筍,橄欖油,鹽花
白花菜筆管麵(白花椰菜,橄欖油,大蒜,鯷魚)
綠醬煮白肉魚(Hake(台灣應該翻成x鱈),橄欖油,大蒜,parsley)

飲料是costco買的美味Puilly Fume

剛吃完飯順便讀了今天NYT這篇報導,自我感覺非常良好,於是想翻出來給更多人參考---嗯嗯,待我吃完甜點之後---希望在我得心臟病前來得及翻完。

如果對研究本身比較沒興趣的,也可以先看看同一天 Mark Bittman 根據這則報導寫出的感想文章 " When Diet Meets Delicious"  , MB在這篇文章中基本上附和了這個研究的結果,但他進一步的說,重點其實不在地中海不地中海,也未必是特定一種成份,例如他不覺得只靠喝葡萄酒就能讓人如何如何,因為實驗裡一週七杯的量實在太少了…他甚至覺得紅肉本身的問題搞不好並非來自紅肉本身,而是現代工業或農牧業畜養牛羊的方式。重點是一整個強調非工業化、不過度加工,不含垃圾食品,而且來源愈天然愈好的均衡飲食,以現代(美國)的生活形態,你要嘛是非常有錢並且住在曼哈頓或舊金山,不然就只能自已烹煮食物了。




February 25, 2013

Mediterranean Diet Is Shown to Ward Off Heart Risks

About 30 percent of heart attacks, strokes and deaths from heart disease can be prevented in people at high risk if they switch to a Mediterranean diet rich in olive oil, nuts, beans, fish, fruits and vegetables, and even drink wine with meals, a large and rigorous new study has found.

一個嚴謹且規模宏大的最新研究顯示,藉著採取富含橄欖油、核果、豆類、魚、蔬果並以葡萄酒佐餐的所謂「地中海式飲食」,心血管疾病高危險群者將能有效減低心臟病、腦溢血甚至死亡的風險達百分之三十。
The findings, published on The New England Journal of Medicine’s Web site on Monday, were based on the first major clinical trial to measure the diet’s effect on heart risks. The magnitude of the diet’s benefits startled experts. The study ended early, after almost five years, because the results were so clear it was considered unethical to continue.

本週一發佈於新英格蘭醫學期刊網站的上述結果,來自第一個關於飲食對心臟風險的影響的臨床試驗。飲食的選擇對受試者的助益之大深深震憾著專家學者。這份研究甚至因此較預計時程提早結束,因為效果的差別實在太一翻兩瞪眼,繼續做下去實在太缺德惹。(譯註:意思就是說,控制組太衰小)
The diet helped those following it even though they did not lose weight and most of them were already taking statins, or blood pressure or diabetes drugs to lower their heart disease risk.

即使體重並沒有減輕,而且其中多數人還同時接受著心血管疾病的藥物控制, 採用「地中海飲食的」受試者身上依然看到明顯的成效。

“Really impressive,” said Rachel Johnson, a professor of nutrition at the University of Vermont and a spokeswoman for the American Heart Association. “And the really important thing — the coolest thing — is that they used very meaningful endpoints. They did not look at risk factors like cholesterol or hypertension or weight. They looked at heart attacks and strokes and death. At the end of the day, that is what really matters.”

"太炫了",佛蒙特大學營養學教授同時也是美國心臟學會的發言人RJ教授說"真正重要、且最酷的的地方在於,他們採取一種最有意義的結果論。不是去探討諸如膽固醇、hypertension(?)或者體重之類的指標性因素,而是直接去看有多少人得心臟病、中風或是掛點---說到底,這才是最重要的嘛!"

Until now, evidence that the Mediterranean diet reduced the risk of heart disease was weak, based mostly on studies showing that people from Mediterranean countries seemed to have lower rates of heart disease — a pattern that could have been attributed to factors other than diet.

在此之前,有關地中海飲食能降低心臟疾病發生率的証據一直顯得相當薄弱。他們主要是根據地中海地區居民擁有相對較低的心臟疾病發生率所做出的推測,但是那並不能排除飲食習慣以外其他因素所造成的影響。

And some experts had been skeptical that the effect of diet could be detected, if it existed at all, because so many people are already taking powerful drugs to reduce heart disease risk, while other experts hesitated to recommend the diet to people who already had weight problems, since oils and nuts have a lot of calories.

許多專家甚至懷疑,就算飲食真的有影響,其效應也很難被區別出來加以驗証,因為許多人同時也會攝取各種各樣預防心臟疾病的藥物。另外一群專家則對推廣「地中海飲食」持保留的態度,因為許多患者都已經有過重的毛病,偏偏地中海飲食中的骨幹,(橄欖)油與果仁,都是高熱量的食物。

Heart disease experts said the study was a triumph because it showed that a diet was powerful in reducing heart disease risk, and it did so using the most rigorous methods. Scientists randomly assigned 7,447 people in Spain who were overweight, were smokers, or had diabetes or other risk factors for heart disease to follow the Mediterranean diet or a low-fat one.

心臟疾病專家們稱這個研究結果是一大勝利,因為他不僅顯示飲食對降低心臟病的風險的確具有強效,而且研究方法至為嚴謹。科學家們在7,447名過重、吸煙或者有糖尿病的西班牙受試者中,隨機地分組,讓他們分別採取地中海式的飲食或者低卡飲食。

Low-fat diets have not been shown in any rigorous way to be helpful, and they are also very hard for patients to maintain — a reality borne out in the new study, said Dr. Steven E. Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic Foundation.

Cleveland Clinic Foundation 心臟醫學系主任 Dr Steven E. Nissen說:「這個新研究帶給我們的一個現實是,低卡飲食不僅無法被嚴格証明有用,他們還很難持續。」

“Now along comes this group and does a gigantic study in Spain that says you can eat a nicely balanced diet with fruits and vegetables and olive oil and lower heart disease by 30 percent,” he said. “And you can actually enjoy life.”

「現在好了,這個西班牙團隊的龐大研究的結果告訴我們,你可以藉由美味均衡的飲食---包含蔬菜、水果與橄欖油---降低30%的心臟病風險,而且還能真正享受人生!」他說。

The study, by Dr. Ramon Estruch, a professor of medicine at the University of Barcelona, and his colleagues, was long in the planning. The investigators traveled the world, seeking advice on how best to answer the question of whether a diet alone could make a big difference in heart disease risk. They visited the Harvard School of Public Health several times to consult Dr. Frank M. Sacks, a professor of cardiovascular disease prevention there.

巴塞隆納大學醫學教授 Dr. Ramon Estruch 與同仁歷經了長期擘劃才完成這個研究。研究人員曾前往世界各處拜訪該領域專家,企圖尋求一個能夠回答「飲食本身是否能對罹患心臟疾病的風險帶來顯著影響」這問題的最佳辦法。其中,他們數度前往哈佛大學公共衛生學院,請教該院心臟病預防醫學專家 Frank M. Sacks 教授。

In the end, they decided to randomly assign subjects at high risk of heart disease to three groups. One would be given a low-fat diet and counseled on how to follow it. The other two groups would be counseled to follow a Mediterranean diet. At first the Mediterranean dieters got more intense support. They met regularly with dietitians while members of the low-fat group just got an initial visit to train them in how to adhere to the diet, followed by a leaflet each year on the diet. Then the researchers decided to add more intensive counseling for them, too, but they still had difficulty staying with the diet.

最後他們決定隨機地將被歸類為心臟疾病高危險群的受試者分成三組。第一組採取低卡飲食,並且獲得有關此飲食方法的諮詢輔導。另外兩組則是在研究者指導下採取地中海式的飲食。一開始時,地中海飲食組獲得較密集的輔導,他們會定期與飲食專家談話,而低卡飲食組則只在一開始的時候接受這方面的訓練,他們被給予如何堅持這種飲食習慣的建議,以及每年一份有關知識的書面資料。後來研究者決定給予「低卡組」更多協助,可是讓他們堅持下去仍有相當的困難。

One group assigned to a Mediterranean diet was given extra-virgin olive oil each week and was instructed to use at least 4 four tablespoons a day. The other group got a combination of walnuts, almonds and hazelnuts and was instructed to eat about an ounce of the mix each day. An ounce of walnuts, for example, is about a quarter cup — a generous handful. The mainstays of the diet consisted of at least three servings a day of fruits and at least two servings of vegetables. Participants were to eat fish at least three times a week and legumes, which include beans, peas and lentils, at least three times a week. They were to eat white meat instead of red, and, for those accustomed to drinking, to have at least seven glasses of wine a week with meals.

在兩個地中海組中,其中一組的成員們被要求每天吃至少四湯匙的特級處女橄欖油。另一組成員則被要求每天吃大約一盎司的綜合果仁(胡桃,杏仁,榛果),也就是大約四分之一杯或者說一大把。兩組共通的主要食物則是每天至少三分的水果,二份疏菜,受試者每週還得吃至少三次的魚,三次的豆類(青豆和扁豆等)。他們得以白肉取代紅肉,有飲酒習慣者還被要求一週喝至少七杯葡萄酒(譯註:雪莉酒不曉得算不算在內)佐餐。(譯註:難怪另一組撐不下去啊)

They were encouraged to avoid commercially made cookies, cakes and pastries and to limit their consumption of dairy products and processed meats.

研究者也建議他們盡可能避開非自家製的餅干、蛋糕以及甜點,並且節制乳製品以及加工肉品的食用。(譯註: Jamon Iberico也算嗎…)

To assess compliance with the Mediterranean diet, researchers measured levels of a marker in urine of olive oil consumption — hydroxytyrosol — and a blood marker of nut consumption — alpha-linolenic acid.

研究人員另外也藉由測量尿液中兩種分別來自橄欖油與果仁的指標性成份,來評估受測者身上的"地中海度"。(譯註:顯然這句只是意譯)

The participants stayed with the Mediterranean diet, the investigators reported. But those assigned to a low-fat diet did not lower their fat intake very much. So the study wound up comparing the usual modern diet, with its regular consumption of red meat, sodas and commercial baked goods, with a diet that shunned all that.

研究報告指出,地中海飲食組的成員能維持這種飲食習慣,反之低卡組的受測者所攝取的熱量並沒有顯著降低。於是這研究到頭來演變成所謂的現代飲食,也就是一般人所攝取的紅肉、碳酸飲料、市面販售的烘焙食品,與一種避免上述成份的飲食習慣間的比較。

Dr. Estruch said he thought the effect of the Mediterranean diet was due to the entire package, not just the olive oil or nuts. He did not expect, though, to see such a big effect so soon. “This is actually really surprising to us,” he said.

 Estruch 博士認為效果來自配套,而不是諸如橄欖油或者果仁之類的單一成份。不過當初他並不預期見效會如此之快。「說真的,我們感到非常驚訝」他說。

The researchers were careful to say in their paper that while the diet clearly reduced heart disease for those at high risk for it, more research was needed to establish its benefits for people at low risk. But Dr. Estruch said he expected it would also help people at both high and low risk, and suggested that the best way to use it for protection would be to start in childhood.滿

在文章中,研究者也不忘謹慎提醒人們,即使地中海飲食對高危群有一定的效果,但對於低危險群人們的作用,則還有待進一步探討。但 Estruch 個人預期這樣的飲食習慣無論高或低危險群都會有作用,而且最有效的方法是從小開始。
Not everyone is convinced, though. Dr. Caldwell Blakeman Esselstyn Jr., the author of the best seller “Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure,” who promotes a vegan diet and does not allow olive oil, dismissed the study.

當然,並不是所有人都信服這個結果。暢銷書「預防並扭轉心臟疾病:一種經科學証實的革命性療法」的作者,同時亦是素食鼓吹者的 Caldwell Blakeman Esselstyn Jr 博士(或大夫)就對這研究嗤之以鼻。
His views and those of another promoter of a very-low-fat diet, Dr. Dean Ornish, president of the nonprofit Preventive Medicine Research Institute, have influenced many to try to become vegan. Former President Bill Clinton, interviewed on CNN, said Dr. Esselstyn’s and Dr. Ornish’s writings helped convince him that he could reverse his heart disease in that way.

許多人在他 (Esselstyn) 以及其他超級低卡飲食的提倡者,例如 Dr. Dean Ornish (president of the nonprofit Preventive Medicine Research Institute)的觀點影響下,已選擇成為素食主義者。前總統科林頓就曾在CNN 的訪談裡表示,兩位大夫的文章說服自己藉由這種方法改善自己心臟方面的毛病。
Dr. Esselstyn said those in the Mediterranean diet study still had heart attacks and strokes. So, he said, all the study showed was that “the Mediterranean diet and the horrible control diet were able to create disease in people who otherwise did not have it.”

Esselstyn 大夫說這個地中海飲食研究的受測者裡仍然有人死會於心臟病或中風,「所以這研究告訴我們的不過就是:無論地中海飲食或都那個悲慘的控制組都會在本來沒病的人們身上造成心臟病。」(譯註: 是我理解錯還是他在開玩笑? 怕書銷量鋭減嗎?)
Others hailed the study. 至於其他人則是力挺這個研究。
“This group is to be congratulated for carrying out a study that is nearly impossible to do well,” said Dr. Robert H. Eckel, a professor of medicine at the University of Colorado and a past president of the American Heart Association. 

科羅拉多大學醫學教授,也是美國心臟學會前任主席 Robert H. Eckel 就說:「這個團隊值得大加恭賀,他們完成了一個幾乎不可能做好的研究!」
As for the researchers, they have changed their own diets and are following a Mediterranean one, Dr. Estruch said.
“We have all learned,” he said.

至於那些研究者本身呢,Estruch 博士說他們全都變成地中海飲食的實踐者(譯註:我一直不懂,這些不是西班牙人嗎?)

他說:「我們都受教了。」

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翻完了,晚餐吃的 Four Burgers  漢堡果然有效。




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