Метаболический синдром (МС) – это кластер факторов, ассоциированных с высокими рисками инициации сердечно-сосудистых заболеваний, сахарного диабета 2-го типа, общей и сердечно-сосудистой смертности. Распространенность МС в общей популяции в среднем составляет 10–25%, варьируя в зависимости от региона мира от 3 до 71,7%. Два недавних крупных метаанализа установили обратную связь между риском развития МС и потреблением пищевых волокон. Большие перспективы имеют пищевые волокна для воздействия на отдельные компоненты МС. В обзоре современной литературы представлены когортные исследования и рандомизированные контролируемые исследования, в том числе обобщенные в метаанализах и систематических обзорах, свидетельствующие о влиянии растворимого высоковязкого гельобразующего, неферментируемого пищевого волокна – псиллиума – на массу висцерального жира, достижения метаболического контроля, включая коррекцию нарушений углеводного, липидного, пуринового обмена и регуляцию артериального давления.
Metabolic syndrome (MS) is a cluster of factors associated with high risk of initiation of cardiovascular diseases, of diabetes of the 2nd type, total and cardiovascular mortality. The prevalence of MS in the general population averages 10–25%, varying depending on the region of the world from 3 to 71.7%. Two recent large meta-analysis found an inverse relationship between risk of MS and consumption of dietary fiber. Great prospects have dietary fiber for the maintenance of individual MS components. The review of modern literature presents cohort studies and randomized controlled trials, including generalized meta-analyses and systematic reviews, indicating the impact of soluble high-viscosity gel-forming, non-fermentable dietary fiber-psyllium on the weight of visceral fat, achieving metabolic control, including correction of disorders of carbohydrate, lipid, purine metabolism and regulation of blood pressure.
1. Рекомендации по ведению больных с метаболическим синдромом. Клинические рекомендации Министерства здравоохранения Российской Федерации. Москва; 2013. Доступно по ссылке: docplayer.ru/28505097-Rekomendacii-po-vedeniyu-bolnyh-smetabolicheskim-sindromom.html [Recommendations for managing patients with metabolic syndrome. Clinical recommendations of the Ministry of Health of the Russian Federation. Moscow; 2013. Available from: docplayer.ru/28505097-Rekomendacii-po-vedeniyu-bolnyh-smetabolicheskim-sindromom.htm (In Russ.)].
2. Ju SY, Lee JY, Kim DH. Association of metabolic syndrome and its components with all-cause and cardiovascular mortality in the elderly. A meta-analysis of prospective cohort studies. Medicine (Baltimore). 2017 Nov; 96(45):e8491. doi: 10.1097/MD.0000000000008491
3. Kwasny C, Manuwald U, Kugler J, Rothe U. Systematic review of the epidemiology and natural history of the metabolic vascular syndrome and its coincidence with type 2 diabetes mellitus and cardiovascular diseases in different european countries. Horm Metab Res. 2017 Nov 28. doi: 10.1055/s-0043-122395 [Epub ahead of print].
4. Chen JP, Chen GC, Wang XP, et al. Dietary fiber and metabolic syndrome: A meta-analysis and review of related mechanisms. Nutrients. 2017;10(1). pii: E24. doi: 10.3390/nu10010024
5. Wei B, Liu Y, Lin X, et al. Dietary fiber intake and risk of metabolic syndrome: A meta-analysis of observational studies. Clin Nutr. 2017; pii: S0261-5614(17)31392-4
6. Lambeau KV, McRorie JW. Fiber supplements and clinically proven health benefits: How to recognize and recommend an effective fiber therapy. Review systematic. J Am Assoc Nurse Pract. 2017;29:216-23. doi: 10.1002/2327-6924.12447
7. Bernstein AM, Titgemeier B, Kirkpatrick K, et al. Major cereal grain fibers and psyllium in relation to cardiovascular health. Nutrients. 2013;5:1471-87. doi: 10.3390/nu5051471
8. Poutanen KS, Dussort P, Erkner A, et al. A review of the characteristics of dietary fibers relevant to appetite and energy intake outcomes in human intervention trials. Am J Clin Nutr. 2017;106(3):747-54.
doi: 10.3945/ajcn.117.157172
9. McRorie JW, McKeown NM. Understanding the physics of functional fibers in the gastrointestinal tract: An evidence-based approach to resolving enduring misconceptions about insoluble and soluble fiber.
J Acad Nutr Diet. 2017;117: 251-64. doi: 10.1016/j.jand.2016.
09.021
10. Wanders AJ, van den Borne JJGC, de Graaf C, et al. Effects of dietary fibre on subjective appetite, energy intake and body weight: a systematic review of randomized controlled trials. Obes Rev. 2011;12:724-39. doi: 10.1111/j.1467-789X.2011.00895.x
11. Howarth NC, Saltzman E, Roberts SB. Dietary fiber and weight regulation. Nutr Rev. 2001;59(5):129-39. doi: 10.1111/j.1753-4887.2001. tb07001.x
12. Brum J, Roger M, Gibb D, et al. Satiety effects of psyllium in healthy volunteers. Appetite. 2016;105:27e36.
13. Pal S, Khossousi A, Binns C, et al. The effect of a fibre supplement compared to a healthy diet on body composition, lipids, glucose, insulin and other metabolic syndrome risk factors in overweight and obese individuals Brit J Nutr. 2011;105:90-100. doi: 10.1017/ S0007114510003132
14. Pal S, Ho S, Gahler RJ, Wood S. Effect on body weight and composition in overweight/obese Australian adults over 12 months consumption of two different types of fibre supplementation in a randomized trial. Nutr Metab. 2016;13:82-92. doi: 10.1186/s12986-016-0141-7
15. De Bock M, Derraik JGB, Brennan CM, et al. Psyllium supplementation in adolescents improves fat distribution & lipid profile: A randomized, participant-blinded, placebo-controlled, crossover trial. PLoS One. 2012;7(7):e41735. doi: 10.1371/journal.pone.0041735
16. Abutair AS, Naser IA, Hamed AT. Soluble fibers from psyllium improve glycemic response and body weight among diabetes type 2 patients (randomized control trial). Nutr J. 2016;15:86-93. doi: 10.1186/ s12937-016-0207-4
17. Sola R, Godas G, Ribalta J, et al. Effects of soluble fiber (Plantago ovata husk) on plasma lipids, lipoproteins, and apolipoproteins in men with ischemic heart disease. Am J Clin Nutr. 2007;85:1157-63.
doi: 10.1093/ajcn/85.4.1157
18. De la Iglesia R, Lopez-Legarrea P, Abete I, et al. A new dietary strategy for long-term treatment of the metabolic syndrome is compared with the American Heart Association (AHA) guidelines: the MEtabolic Syndrome REduction in NAvarra (RESMENA) project. Brit J Nutr. 2014;111:643-52. doi: 10.1017/S0007114513002778
19. Ahmed F, Urooj A. In vitro hypoglycemic effects and starch digestibility characteristics of wheat based composite functional flour for diabetics. J Food Sci Technol. 2015;52(7):4530-6. doi: 10.1007/s13197-014-1470-z
20. Bajorek SA, Morello CM. Effects of dietary fiber and low glycemic index diet on glucose control in subjects with type 2 diabetes mellitus. Ann Pharmacother. 2010;44(11):1786-92. doi: 10.1345/aph.1P347
21. Gibb RD, McRorie Jr JW, Russell DA, et al. Psyllium fiber improves glycemic control proportional to loss of glycemic control: a meta-analysis of data in euglycemic subjects, patients at risk of type 2 diabetes mellitus, and patients being treated for type 2 diabetes mellitus. Am J Clin Nutr. 2015;102:1604-14. doi: 10.3945/ajcn.115.106989
22. Pal S, Ho S, Gahler RJ, Wood S. Effect on insulin, glucose and lipids in overweight/obese australian adults of 12 months consumption of two different fibre supplements in a randomised trial. Nutrients. 2017; 9:91-104. doi: 10.3390/nu9020091
23. Cicero AF, Colletti A. Role of phytochemicals in the management of metabolic syndrome. Phytomedicine. 2016;23(11):1134-44. doi: 10.1016/j.phymed.2015.11.009
24. Díez R, García JJ, Diez MJ, et al. Influence of Plantago ovata husk (dietary fiber) on the bioavailability and other pharmacokinetic parameters of metformin in diabetic rabbits. BMC Complem Altern Med. 2017;17:298-306. doi: 10.1186/s12906-017-1809-x
25. Rouhi-Boroujeni H, Rouhi-Boroujeni H, Heidarian E, et al. Herbs with anti-lipid effects and their interactions with statins as a chemical antihyperlipidemia group drugs: A systematic review. ARYA Atheroscler. 2015;11(4):244-51.
26. Zarvandi M, Rakhshandeh H, Abazari M, et al. Safety and efficacy of a polyherbal formulation for the management of dyslipidemia and hyperglycemia in patients with advanced-stage of type-2 diabetes. Biomed Pharmacother. 2017;89:69-75. doi: 10.1016/j.biopha.2017.02.016
27. Moreyra AE, Wilson AC, Koraym A. Effect of combining psyllium fiber with simvastatin in lowering cholesterol Аrch Intern Med. 2005; 165(10):1161-6.
28. Díez R, García JJ, Die MJ. Hypoglycemic and hypolipidemic potential of a high fiber diet in healthy versus diabetic rabbits. BioMed Res Int. 2013;2013:960568. doi: 10.1155/2013/960568
29. Whelton SP, Hyre AD, Pedersen B, et al. Effect of dietary fiber intake on blood pressure: a meta-analysis of randomized, controlled clinical trials. J Hypertens. 2005;23(3):475-81. doi: 10.1097/01.hjh. 0000160199.51158.cf
30. Khan K, Jovanovski E, Ho HVT, et al. The effect of viscous soluble fiber on blood pressure: A systematic review and meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis. 2017.
pii: S0939-4753(17)30222-3.
31. Pal S, Khossousi A, Binns C, et al. The effects of 12-week psyllium fibre supplementation or healthy diet on blood pressure and arterial stiffness in overweight and obese individuals. Brit J Nutr. 2012;107:725-34. doi: 10.1017/S0007114511003497
32. Olson BH, Anderson SM, Becker MP et al. Psyllium-enriched cereals lower blood total cholesterol and LDL cholesterol, but not HDL cholesterol, in hypercholesterolemic adults: results of a meta-analysis.
J Nutr. 1997;127(10):1973–80.
33. Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr 1999;69:30-42.
34. Anderson JW et al. Cholesterol-lowering effects of psyllium intake adjunctive to diet therapy in men and women with hypercholesterolemia: meta-analysis of 8 controlled trials. Am J Clin Nutr. 2000;71(2):472-9.
35. Wei ZH, Wang Y, Chen XY et al. Time- and dose-dependent effect of psyllium on serum lipids in mild-tomoderate hypercholesterolemia: a meta-analysis of controlled clinical trials. Eur J Clin Nutr. 2009;63 (7):821-7.
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1. [Recommendations for managing patients with metabolic syndrome. Clinical recommendations of the Ministry of Health of the Russian Federation. Moscow; 2013. Available from: docplayer.ru/28505097-Rekomendacii-po-vedeniyu-bolnyh-smetabolicheskim-sindromom.htm (In Russ.)].
2. Ju SY, Lee JY, Kim DH. Association of metabolic syndrome and its components with all-cause and cardiovascular mortality in the elderly. A meta-analysis of prospective cohort studies. Medicine (Baltimore). 2017 Nov; 96(45):e8491. doi: 10.1097/MD.0000000000008491
3. Kwasny C, Manuwald U, Kugler J, Rothe U. Systematic review of the epidemiology and natural history of the metabolic vascular syndrome and its coincidence with type 2 diabetes mellitus and cardiovascular diseases in different european countries. Horm Metab Res. 2017 Nov 28. doi: 10.1055/s-0043-122395 [Epub ahead of print].
4. Chen JP, Chen GC, Wang XP, et al. Dietary fiber and metabolic syndrome: A meta-analysis and review of related mechanisms. Nutrients. 2017;10(1). pii: E24. doi: 10.3390/nu10010024
5. Wei B, Liu Y, Lin X, et al. Dietary fiber intake and risk of metabolic syndrome: A meta-analysis of observational studies. Clin Nutr. 2017; pii: S0261-5614(17)31392-4
6. Lambeau KV, McRorie JW. Fiber supplements and clinically proven health benefits: How to recognize and recommend an effective fiber therapy. Review systematic. J Am Assoc Nurse Pract. 2017;29:216-23. doi: 10.1002/2327-6924.12447
7. Bernstein AM, Titgemeier B, Kirkpatrick K, et al. Major cereal grain fibers and psyllium in relation to cardiovascular health. Nutrients. 2013;5:1471-87. doi: 10.3390/nu5051471
8. Poutanen KS, Dussort P, Erkner A, et al. A review of the characteristics of dietary fibers relevant to appetite and energy intake outcomes in human intervention trials. Am J Clin Nutr. 2017;106(3):747-54.
doi: 10.3945/ajcn.117.157172
9. McRorie JW, McKeown NM. Understanding the physics of functional fibers in the gastrointestinal tract: An evidence-based approach to resolving enduring misconceptions about insoluble and soluble fiber.
J Acad Nutr Diet. 2017;117: 251-64. doi: 10.1016/j.jand.2016.
09.021
10. Wanders AJ, van den Borne JJGC, de Graaf C, et al. Effects of dietary fibre on subjective appetite, energy intake and body weight: a systematic review of randomized controlled trials. Obes Rev. 2011;12:724-39. doi: 10.1111/j.1467-789X.2011.00895.x
11. Howarth NC, Saltzman E, Roberts SB. Dietary fiber and weight regulation. Nutr Rev. 2001;59(5):129-39. doi: 10.1111/j.1753-4887.2001. tb07001.x
12. Brum J, Roger M, Gibb D, et al. Satiety effects of psyllium in healthy volunteers. Appetite. 2016;105:27e36.
13. Pal S, Khossousi A, Binns C, et al. The effect of a fibre supplement compared to a healthy diet on body composition, lipids, glucose, insulin and other metabolic syndrome risk factors in overweight and obese individuals Brit J Nutr. 2011;105:90-100. doi: 10.1017/ S0007114510003132
14. Pal S, Ho S, Gahler RJ, Wood S. Effect on body weight and composition in overweight/obese Australian adults over 12 months consumption of two different types of fibre supplementation in a randomized trial. Nutr Metab. 2016;13:82-92. doi: 10.1186/s12986-016-0141-7
15. De Bock M, Derraik JGB, Brennan CM, et al. Psyllium supplementation in adolescents improves fat distribution & lipid profile: A randomized, participant-blinded, placebo-controlled, crossover trial. PLoS One. 2012;7(7):e41735. doi: 10.1371/journal.pone.0041735
16. Abutair AS, Naser IA, Hamed AT. Soluble fibers from psyllium improve glycemic response and body weight among diabetes type 2 patients (randomized control trial). Nutr J. 2016;15:86-93. doi: 10.1186/ s12937-016-0207-4
17. Sola R, Godas G, Ribalta J, et al. Effects of soluble fiber (Plantago ovata husk) on plasma lipids, lipoproteins, and apolipoproteins in men with ischemic heart disease. Am J Clin Nutr. 2007;85:1157-63.
doi: 10.1093/ajcn/85.4.1157
18. De la Iglesia R, Lopez-Legarrea P, Abete I, et al. A new dietary strategy for long-term treatment of the metabolic syndrome is compared with the American Heart Association (AHA) guidelines: the MEtabolic Syndrome REduction in NAvarra (RESMENA) project. Brit J Nutr. 2014;111:643-52. doi: 10.1017/S0007114513002778
19. Ahmed F, Urooj A. In vitro hypoglycemic effects and starch digestibility characteristics of wheat based composite functional flour for diabetics. J Food Sci Technol. 2015;52(7):4530-6. doi: 10.1007/s13197-014-1470-z
20. Bajorek SA, Morello CM. Effects of dietary fiber and low glycemic index diet on glucose control in subjects with type 2 diabetes mellitus. Ann Pharmacother. 2010;44(11):1786-92. doi: 10.1345/aph.1P347
21. Gibb RD, McRorie Jr JW, Russell DA, et al. Psyllium fiber improves glycemic control proportional to loss of glycemic control: a meta-analysis of data in euglycemic subjects, patients at risk of type 2 diabetes mellitus, and patients being treated for type 2 diabetes mellitus. Am J Clin Nutr. 2015;102:1604-14. doi: 10.3945/ajcn.115.106989
22. Pal S, Ho S, Gahler RJ, Wood S. Effect on insulin, glucose and lipids in overweight/obese australian adults of 12 months consumption of two different fibre supplements in a randomised trial. Nutrients. 2017; 9:91-104. doi: 10.3390/nu9020091
23. Cicero AF, Colletti A. Role of phytochemicals in the management of metabolic syndrome. Phytomedicine. 2016;23(11):1134-44. doi: 10.1016/j.phymed.2015.11.009
24. Díez R, García JJ, Diez MJ, et al. Influence of Plantago ovata husk (dietary fiber) on the bioavailability and other pharmacokinetic parameters of metformin in diabetic rabbits. BMC Complem Altern Med. 2017;17:298-306. doi: 10.1186/s12906-017-1809-x
25. Rouhi-Boroujeni H, Rouhi-Boroujeni H, Heidarian E, et al. Herbs with anti-lipid effects and their interactions with statins as a chemical antihyperlipidemia group drugs: A systematic review. ARYA Atheroscler. 2015;11(4):244-51.
26. Zarvandi M, Rakhshandeh H, Abazari M, et al. Safety and efficacy of a polyherbal formulation for the management of dyslipidemia and hyperglycemia in patients with advanced-stage of type-2 diabetes. Biomed Pharmacother. 2017;89:69-75. doi: 10.1016/j.biopha.2017.02.016
27. Moreyra AE, Wilson AC, Koraym A. Effect of combining psyllium fiber with simvastatin in lowering cholesterol Аrch Intern Med. 2005; 165(10):1161-6.
28. Díez R, García JJ, Die MJ. Hypoglycemic and hypolipidemic potential of a high fiber diet in healthy versus diabetic rabbits. BioMed Res Int. 2013;2013:960568. doi: 10.1155/2013/960568
29. Whelton SP, Hyre AD, Pedersen B, et al. Effect of dietary fiber intake on blood pressure: a meta-analysis of randomized, controlled clinical trials. J Hypertens. 2005;23(3):475-81. doi: 10.1097/01.hjh. 0000160199.51158.cf
30. Khan K, Jovanovski E, Ho HVT, et al. The effect of viscous soluble fiber on blood pressure: A systematic review and meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis. 2017.
pii: S0939-4753(17)30222-3.
31. Pal S, Khossousi A, Binns C, et al. The effects of 12-week psyllium fibre supplementation or healthy diet on blood pressure and arterial stiffness in overweight and obese individuals. Brit J Nutr. 2012;107:725-34. doi: 10.1017/S0007114511003497
32. Olson BH, Anderson SM, Becker MP et al. Psyllium-enriched cereals lower blood total cholesterol and LDL cholesterol, but not HDL cholesterol, in hypercholesterolemic adults: results of a meta-analysis.
J Nutr. 1997;127(10):1973–80.
33. Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr 1999;69:30-42.
34. Anderson JW et al. Cholesterol-lowering effects of psyllium intake adjunctive to diet therapy in men and women with hypercholesterolemia: meta-analysis of 8 controlled trials. Am J Clin Nutr. 2000;71(2):472-9.
35. Wei ZH, Wang Y, Chen XY et al. Time- and dose-dependent effect of psyllium on serum lipids in mild-tomoderate hypercholesterolemia: a meta-analysis of controlled clinical trials. Eur J Clin Nutr. 2009;63 (7):821-7.
Авторы
Е.В. Онучина
Иркутская государственная медицинская академия последипломного образования – филиал ФГБОУ ДПО «Российская медицинская
академия непрерывного профессионального образования» Минздрава России, Иркутск, Россия
________________________________________________
Е.В. Онучина
Иркутская государственная медицинская академия последипломного образования – филиал ФГБОУ ДПО «Российская медицинская
академия непрерывного профессионального образования» Минздрава России, Иркутск, Россия