年轻人肾功能轻度下降与不良结果之间的关系

1

//

Clinical application of intermittent fasting for weight loss: progress and future directions

间歇性禁食减肥的临床应用：进展及未来方向

Intermittent fasting diets have become very popular in the past few years, as they can produce clinically significant weight loss. These diets can be defined, in the simplest of terms, as periods of fasting alternating with periods of eating. The most studied forms of intermittent fasting include: alternate day fasting (0–500 kcal per ‘fast day’ alternating with ad libitum intake on ‘feast days’); the 5:2 diet (two fast days and five feast days per week) and time-restricted eating (only eating within a prescribed window of time each day). Despite the recent surge in the popularity of fasting, only a few studies have examined the health benefits of these diets in humans. The goal of this Review is to summarize these preliminary findings and give insights into the effects of intermittent fasting on body weight and risk factors for cardiometabolic diseases in humans. This Review also assesses the safety of these regimens, and offers some practical advice for how to incorporate intermittent fasting diets into everyday life. Recommendations for future research are also presented.

在过去的几年里，间歇性禁食饮食变得非常流行，因为它们可以产生临床上显著地体重减轻。用最简单的术语来说，这些饮食可以被定义为禁食与进食交替的时期。研究最多的间歇性禁食形式包括：隔日禁食（每个“禁食日”0-500千卡，在“盛宴日”随意摄入）;5：2的饮食（每周禁食两天，盛宴五天）和限时饮食（每天只在规定的时间内进食）。尽管最近禁食的流行程度激增，但只有少数研究调查了这些饮食对人类健康的好处。本综述的目的是总结这些初步发现，并深入了解间歇性禁食对人类体重和心脏代谢疾病危险因素的影响。本综述还评估了这些方案的安全性，并就如何将间歇性禁食饮食纳入日常生活提供了一些实用建议。并对今后的研究提出了建议。

2

//

Associations between modest reductions in kidney function and adverse outcomes in young adults

年轻人肾功能轻度下降与不良结果之间的关系

Objective To study age specific associations of modest reductions in estimated glomerular filtration rate (eGFR) with adverse outcomes.

Setting Linked healthcare administrative datasets in Ontario, Canada.

Main outcome measures eGFRs and hazard ratios of composite adverse outcome (all cause mortality, any cardiovascular event, and kidney failure) stratified by age (18-39 years, 40-49 years, and 50-65 years), and relative to age specific eGFR referents (100-110 mL/min/1.73m2) for ages 18-39 years, 90-100 for 40-49 years, 80-90 for 50-65 years).

Results From 1 January 2008 to 31 March 2021, among 8 703 871 adults (mean age 41.3 (standard deviation 13.6) years; mean index eGFR 104.2 mL/min/1.73m2 (standard deviation 16.1); median follow-up 9.2 years (interquartile range 5.7-11.4)), modestly reduced eGFR measurements specific to age were recorded in 18.0% of those aged 18-39, 18.8% in those aged 40-49, and 17.0% in those aged 50-65. In comparison with age specific referents, adverse outcomes were consistently higher by hazard ratio and incidence for ages 18-39 compared with older groups across all eGFR categories. For modest reductions (eGFR 70-80 mL/min/1.73m2), the hazard ratio for ages 18-39 years was 1.42 (95% confidence interval 1.35 to 1.49), 4.39 per 1000 person years; for ages 40-49 years was 1.13 (1.10 to 1.16), 9.61 per 1000 person years; and for ages 50-65 years was 1.08 (1.07 to 1.09), 23.4 per 1000 person years. Results persisted for each individual outcome and in many sensitivity analyses.

Conclusions Modest eGFR reductions were consistently associated with higher rates of adverse outcomes. Higher relative hazards were most prominent and occurred as early as eGFR <80 mL/min/1.73m2 in younger adults, compared with older groups. These findings suggest a role for more frequent monitoring of kidney function in younger adults to identify individuals at risk to prevent chronic kidney disease and its complications.

目的 研究估计肾小球滤过率（eGFR）适度降低与不良结局的年龄特异性关联。

设置 在加拿大安大略省关联的医疗保健管理数据集。

主要结果 测量按年龄（18-39岁，40-49岁和50-65岁）分层的eGFR和复合不良结局（全因死亡率，任何心血管事件和肾衰竭）的危险比，以及相对于年龄特异性eGFR指标（18-39岁100-110 mL/min/1.73m2）， 40-49岁90-100，50-65岁80-90）。

结果2008年1月1日至2021年3月31日，共调查成人8 703 871人，平均年龄41.3岁（标准差13.6）；平均指数eGFR 104.2 mL/min/1.73m2（标准差16.1）；中位随访9.2年（四分位数范围5.7-11.4）），18-39岁的18.0%、40-49岁的18.8%和50-65岁的17.0%的eGFR测量值随年龄适度降低。与特定年龄的指标相比，在所有eGFR类别中，18-39岁年龄组的不良后果风险比和发生率均高于老年组。对于适度降低（eGFR 70-80 mL/min/1.73m2）， 18-39岁的风险比为1.42（95%可信区间1.35 - 1.49），4.39 / 1000人年；40-49岁为1.13（1.10 - 1.16），9.61 / 1000人年；50-65岁是1.08（1.07 - 1.09），23.4 / 1000人年。每个结果和许多敏感性分析的结果都是一致的。

结论 适度的eGFR降低始终与较高的不良结局发生率相关。与老年组相比，较高的相对危险度最为突出，早在eGFR <80 mL/min/1.73m2时就发生了。这些发现表明，对年轻人进行更频繁的肾功能监测，可以识别出有预防慢性肾脏疾病及其并发症风险的个体。

3

//

Non-sugar sweeteners and cancer: Toxicological and epidemiological evidence

非糖甜味剂和癌症：毒理学和流行病学证据

Several toxicological and epidemiological studies were published during the last five decades on non-sugar sweeteners (NSS) and cancer. Despite the large amount of research, the issue still continues to be of interest. In this review, we provided a comprehensive quantitative review of the toxicological and epidemiological evidence on the possible relation between NSS and cancer. The toxicological section includes the evaluation of genotoxicity and carcinogenicity data for acesulfame K, advantame, aspartame, cyclamates, saccharin, steviol glycosides and sucralose. The epidemiological section includes the results of a systematic search of cohort and case-control studies. The majority of the 22 cohort studies and 46 case-control studies showed no associations. Some risks for bladder, pancreas and hematopoietic cancers found in a few studies were not confirmed in other studies. Based on the review of both the experimental data on genotoxicity or carcinogenicity of the specific NSS evaluated, and the epidemiological studies it can be concluded that there is no evidence of cancer risk associated to NSS consumption.

在过去的五十年中，发表了一些关于非糖甜味剂（NSS）和癌症的毒理学和流行病学研究。尽管进行了大量的研究，但这个问题仍然引起人们的兴趣。在这篇综述中，我们提供了一个全面的定量审查毒理学和流行病学证据的NSS和癌症之间可能的关系。毒理学部分包括对乙酰磺胺K、高倍甜味剂爱德万甜、阿斯巴甜、甜蜜素、糖精、甜菊糖苷和三氯蔗糖的遗传毒性和致癌性数据的评估。流行病学部分包括结果对队列研究和病例对照研究进行系统检索。在22项队列研究和46项病例对照研究中，大多数研究没有显示出相关性。在一些研究中发现的膀胱癌、胰腺癌和造血癌的一些风险在其他研究中没有得到证实。根据对特定NSS遗传毒性或致癌性的实验数据和流行病学研究的回顾，可以得出结论，没有证据表明食用NSS有致癌风险。

*转载自双心视界