EFFECT OF DIETARY FATTY-ACIDS ON SERUM-LIPIDS AND LIPOPROTEINS - A METAANALYSIS OF 27 TRIALS
EFFECT OF DIETARY FATTY-ACIDS ON SERUM-LIPIDS AND LIPOPROTEINS - A METAANALYSIS OF 27 TRIALS
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DOI：
10.1161/01.atv.12.8.911
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发表时间：
1992-08-01
期刊：
影响因子：
--
通讯作者：
KATAN, MB
中科院分区：
文献类型：
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作者：
MENSINK, RP;KATAN, MB
为了计算碳水化合物和脂肪酸摄入量的变化对血脂和脂蛋白水平的影响，我们回顾了1970年至1991年间发表的27项符合特定纳入标准的对照试验。这些研究产生了65个数据点，这些数据点通过多元回归分析进行分析，使用饱和（sat），单不饱和（mono）和多不饱和（polyo）脂肪酸与碳水化合物（carb）的等热量交换作为自变量。对于高密度脂蛋白（HDL），我们发现以下公式：Δ-HDL胆固醇（mmol/l）= 0.012 x（碳水化合物-->饱和）+0.009 x（碳水化合物-->单）+0.007 x（碳水化合物-->多）或以毫克/分升计，0.47 x（碳水化合物-->饱和）+0.34 x（碳水化合物-->单）+0.28 x（碳水化合物-->多）。括号中的表达式表示被饱和、顺式单不饱和或多不饱和脂肪酸取代的碳水化合物的每日能量摄入百分比。所有的脂肪酸取代碳水化合物时，高密度脂蛋白胆固醇升高，但效果随着脂肪酸不饱和度的增加而减弱。对于低密度脂蛋白（LDL），方程为Δ-LDL胆固醇（mmol/l）=0.033x（碳水化合物-->饱和）- 0.006x（碳水化合物-->单）- 0.014x（碳水化合物-->多），或以毫克/分升计，1.28x（碳水化合物-->饱和）- 0.24x（碳水化合物-->单）- 0.55x（碳水化合物-->多）。多不饱和化合物的系数与零有显著差异，但单不饱和化合物的系数与零无显著差异。对于甘油三酯，方程为Δ-甘油三酯（mmol/l）= -0.025x（carb->sat）-0.022x（carb->mono）-0.028x（carb->poly），或以毫克/分升计，-2.22x（carb->sat）-1.99x（carb->mono）-2.47x（carb->poly）。因此，脂肪替代碳水化合物降低血清甘油三酯的性质无关的脂肪。用不饱和脂肪酸替代饱和脂肪酸会提高HDL与LDL的胆固醇比率，而用碳水化合物替代则没有影响。因此，在等热量、代谢病房条件下，如果用不饱和脂肪酸代替饱和脂肪酸，而不减少总脂肪摄入，则冠心病的脂蛋白风险特征最有利。将我们的数据外推到自由生活的人群中，需要更多地了解饮食对体重的影响;如果高油饮食促进肥胖，那么它们对血脂的有利影响就会消失。
To calculate the effect of changes in carbohydrate and fatty acid intake on serum lipid and lipoprotein levels, we reviewed 27 controlled trials published between 1970 and 1991 that met specific inclusion criteria. These studies yielded 65 data points, which were analyzed by multiple regression analysis using isocaloric exchanges of saturated (sat), monounsaturated (mono), and polyunsaturated (poly) fatty acids versus carbohydrates (carb) as the independent variables. For high density lipoprotein (HDL) we found the following equation: DELTA-HDL cholesterol (mmol/l)=0.012x(carb-->sat) + 0.009x(carb-->mono) + 0.007x(carb-->poly) or, in milligrams per deciliter, 0.47x(carb-->sat) + 0.34x(carb-->mono) + 0.28x(carb-->poly). Expressions in parentheses denote the percentage of daily energy intake from carbohydrates that is replaced by saturated, cis-monounsaturated, or polyunsaturated fatty acids. All fatty acids elevated HDL cholesterol when substituted for carbohydrates, but the effect diminished with increasing unsaturation of the fatty acids. For low density lipoprotein (LDL) the equation was DELTA-LDL cholesterol (mmol/l)=0.033x(carb-->sat) - 0.006x(carb->-mono) - 0.014x(carb-->poly) or, in milligrams per deciliter, 1.28x(carb-->sat) - 0.24x(carb-->mono) - 0.55x(carb-->poly). The coefficient for polyunsaturates was significantly different from zero, but that for monounsaturates was not. For triglycerides the equation was DELTA-triglycerides (mmol/1) = -0.025x(carb-->sat) - 0.022x(carb-->mono) -0.028x(carb-->poly) or, in milligrams per deciliter, -2.22x(carb-->sat) - 1.99x(carb-->mono) -2.47x(carb-->poly). Thus, replacement of carbohydrates by fat lowered serum triglycerides independent of the nature of the fat. Replacement of saturated by unsaturated fatty acids raised the HDL to LDL cholesterol ratio, whereas replacement by carbohydrates had no effect. Thus, under isocaloric, metabolic-ward conditions the most favorable lipoprotein risk profile for coronary heart disease was achieved if saturated fatty acids were replaced by unsaturated fatty acids, with no decrease in total fat intake. Extrapolation of our data to free-living populations requires more insight into effects of diet on body weight; if high-oil diets promote obesity, then their favorable effects on serum lipids will be lost.