INDIVIDUAL-RESPONSES TO A CHOLESTEROL-LOWERING DIET IN 50 MEN WITH MODERATE HYPERCHOLESTEROLEMIA
INDIVIDUAL-RESPONSES TO A CHOLESTEROL-LOWERING DIET IN 50 MEN WITH MODERATE HYPERCHOLESTEROLEMIA
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DOI：
10.1001/archinte.154.3.317
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发表时间：
1994-02-14
影响因子：
--
通讯作者：
GRUNDY, SM
中科院分区：
文献类型：
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作者：
DENKE, MA;GRUNDY, SM
背景：饮食调整是治疗高胆固醇血症的第一步。然而，国家胆固醇教育计划第一步饮食在门诊高胆固醇血症患者中的疗效一直存在争议。50名自由活动时低密度脂蛋白（LDL）胆固醇水平为4.14至5.69 mmol/L的血脂正常男性（160至220 mg/dL）参加了一项为期两个阶段的门诊饮食咨询研究，该研究使用了1个月的高脂肪，高饱和脂肪酸阶段（Hi-Sat）和4个月的低脂肪、低饱和脂肪酸阶段（Step 1饮食）。在每个饮食阶段的最后2周内，测量5次脂质、脂蛋白水平和血浆甘油三酯脂肪酸，并取每位患者的平均值。通过7天的食物记录评估饮食摄入量。在Hi-Sat期间，LDL周转率的研究，以确定的分数分解率LDL.Results：总胆固醇和LDL胆固醇水平的平均降低达到饮食分别为0.54 mmol/L（21 mg/dL）和0.39 mmol/L（15 mg/dL）。这些反应等同于从代谢病房调查预测。虽然饮食反应是正态分布的，但反应存在明显的个体差异。LDL反应性四分位数的平均值（+/- SD）为+0.41 +/- 0.21 mmol/L（+16 +/- 8 mg/dL）、-0.16 +/- 0.13 mmol/L（-6 +/- 5 mg/dL）、-0.57 +/- 0.16 mmol/L（-22 +/- 6 mg/dL）和-1.16 +/- 0.26 mmol/L（-45 +/- 10 mg/dL）。这些差异的反应部分解释了饮食依从性，基线分数分解代谢率的LDL，和血浆甘油三酯棕榈酸level.Conclusions的变化：步骤1饮食是有效的，许多高胆固醇血症的男性，降低LDL胆固醇水平，并与适当的咨询，门诊病人可以实现预测的结果住院代谢饮食研究。尽管如此，个体的反应性是高度可变的，并且这种可变性受到依从性和生物因素的影响。由于许多男性达到低密度脂蛋白胆固醇水平低到足以消除药物治疗的需要，在一级预防冠心病，饮食治疗应仍然是最初的方法来治疗高胆固醇血症。
Background: Dietary modification is the recommended first step in the treatment of hypercholesterolemia. However, the efficacy of the National Cholesterol Education Program Step 1 Diet in outpatients with hypercholesterolemia has been debated.Methods: Fifty normotriglyceridemic men whose ad libitum low-density lipoprotein (LDL) cholesterol levels were 4.14 to 5.69 mmol/L (160 to 220 mg/dL) participated in a two-period outpatient diet counseling study that used a 1-month high-fat, high-saturated fatty acid period (Hi-Sat) and a 4-month low-fat, low-saturated fatty acid period (Step 1 Diet). Lipid, lipoprotein levels, and plasma triglyceride fatty acids were measured five times during the last 2 weeks of each dietary period and averaged for each patient. Dietary intake was assessed by 7-day food records. During the Hi-Sat period, an LDL turnover study was done to determine the fractional catabolic rate of LDL.Results: The mean reduction in total and LDL cholesterol levels achieved by diet was 0.54 mmol/L (21 mg/dL) and 0.39 mmol/L (15 mg/dL), respectively. These responses equaled those predicted from metabolic ward investigations. While dietary responsiveness was normally distributed, there was marked individual variation in response. The mean (+/- SD) for quartiles of LDL responsiveness were +0.41 +/- 0.21 mmol/L (+16 +/- 8 mg/dL), -0.16 +/- 0.13 mmol/L(-6 +/- 5 mg/dL), -0.57 +/- 0.16 mmol/L (-22 +/- 6 mg/dL),and -1.16 +/- 0.26 mmol/L (-45 +/- 10 mg/dL). These differences in response were partially explained by dietary adherence, baseline fractional catabolic rates of LDL, and the change in plasma triglyceride palmitate level.Conclusions: The Step 1 Diet is effective in lowering LDL cholesterol levels for many hypercholesterolemic men, and with appropriate counseling, outpatients can achieve results predicted by inpatient metabolic diet studies. Nonetheless, the responsiveness for individuals is highly variable, and this variability is influenced by both compliance and biologic factors. Since many men achieved LDL cholesterol levels low enough to remove the need for drug therapy in primary prevention for coronary heart disease, dietary therapy should remain the initial approach to the treatment of hypercholesterolemia.