两种分别富含不饱和脂肪酸或碳水化合物的饮食对高甘油三酯血症的治疗作用：对脂蛋白亚类、脂解酶、脂质转运蛋白、胰岛素和瘦素的影响
Treatment of hypertriglyceridemia by two diets rich either in unsaturated fatty acids or in carbohydrates: effects on lipoprotein subclasses, lipolytic enzymes, lipid transfer proteins, insulin and leptin.
作者信息
Pieke B, von Eckardstein A, Gülbahçe E, Chirazi A, Schulte H, Assmann G, Wahrburg U
机构信息
Institute of Arteriosclerosis Research at the University of Münster, Germany.
出版信息
Int J Obes Relat Metab Disord. 2000 Oct;24(10):1286-96. doi: 10.1038/sj.ijo.0801440.
BACKGROUND
There is lack of agreement on which dietary regimen is most suitable for treatment of hypertriglyceridemia, especially if high triglyceride concentrations are not due to obesity or alcohol abuse. We compared the effects on blood lipids of a diet high in total and unsaturated fat with a low-fat diet in patients with triglyceride concentrations of > 2.3 mmol/l.
METHODS
Nineteen non-obese male outpatients with triglycerides ranging from 2.30 to 9.94 mmol/l received two consecutive diets for 3 weeks each: first a modified high-fat diet (39% total fat, 8% SFA, 15% monounsaturated fatty acids, 1.6% marine n-3 polyunsaturated fatty acids), and then a low-fat diet (total fat 28%, carbohydrates 54%).
RESULTS
The high-fat diet significantly decreased triglycerides (-63%), total cholesterol (-22%), VLDL cholesterol (-54%), LDL cholesterol ( 16%), total apoC-III (-27%), apoC-III in apoB containing lipoproteins (apoC-III LpB; -31%) and in HDL (apoC-III nonLpB; -29%), apoE in serum (-33%) and apoB-containing lipoproteins (nonHDL-E; -42%), LpA-I (-16%), insulin (-36%), and leptin (-26%) and significantly increased the means of HDL cholesterol (+8%), LDL size (+6%), lipoprotein lipase (LPL, +11%), hepatic lipase (+13%), and lecithin: cholesterol acyltransferase (LCAT, +2%). The subsequent low-fat diet increased triglycerides (+63%), VLDL cholesterol (+19%), apoC-III (+23%), apoC-III LpB (+44%) apoC-III nonLpB (+17%), apoE (+29%) and nonHDL-E (+43%), and decreased HDL cholesterol (-12%), LPL (-3%), and LCAT (-3%). Changes in triglycerides correlated with changes in LPL activity and insulin levels.
CONCLUSIONS
In hypertriglyceridemic patients, a modified diet rich in mono- and n-3 polyunsaturated fatty acids is more effective than a carbohydrate-rich low-fat diet in correcting the atherogenic lipoprotein phenotype.
背景
对于哪种饮食方案最适合治疗高甘油三酯血症，目前尚无定论，尤其是当高甘油三酯浓度并非由肥胖或酗酒引起时。我们比较了总脂肪和不饱和脂肪含量高的饮食与低脂饮食对甘油三酯浓度>2.3 mmol/l患者血脂的影响。
方法
19名甘油三酯水平在2.30至9.94 mmol/l之间的非肥胖男性门诊患者，每人连续接受两种饮食，每种饮食为期3周：首先是改良高脂饮食（总脂肪39%，饱和脂肪酸8%，单不饱和脂肪酸15%，海洋n-3多不饱和脂肪酸1.6%），然后是低脂饮食（总脂肪28%，碳水化合物54%）。
结果
高脂饮食显著降低甘油三酯（-63%）、总胆固醇（-22%）、极低密度脂蛋白胆固醇（-54%）、低密度脂蛋白胆固醇（-16%）、总载脂蛋白C-III（-27%）、含载脂蛋白B脂蛋白中的载脂蛋白C-III（载脂蛋白C-III LpB；-31%）和高密度脂蛋白中的载脂蛋白C-III（载脂蛋白C-III非LpB；-29%）、血清中的载脂蛋白E（-33%）和含载脂蛋白B脂蛋白（非高密度脂蛋白-E；-42%）、脂蛋白A-I（-16%）、胰岛素（-36%）和瘦素（-26%），并显著提高高密度脂蛋白胆固醇均值（+8%）低密度脂蛋白大小（+6%）、脂蛋白脂肪酶（LPL，+11%）、肝脂肪酶（+13%）和卵磷脂胆固醇酰基转移酶（LCAT，+2%）。随后的低脂饮食使甘油三酯升高（+63%）、极低密度脂蛋白胆固醇升高（+19%）、载脂蛋白C-III升高（+23%）、载脂蛋白C-III LpB升高（+44%）、载脂蛋白C-III非LpB升高（+17%）、载脂蛋白E升高（+29%）和非高密度脂蛋白-E升高（+43%），并降低高密度脂蛋白胆固醇（-12%）、LPL（-3%）和LCAT（-3%）。甘油三酯的变化与LPL活性和胰岛素水平的变化相关。
结论
在高甘油三酯血症患者中，富含单不饱和脂肪酸和n-3多不饱和脂肪酸的改良饮食在纠正致动脉粥样硬化脂蛋白表型方面比富含碳水化合物的低脂饮食更有效。
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