Hu Frank B, Willett Walter C
Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA.
JAMA. 2002 Nov 27;288(20):2569-78. doi: 10.1001/jama.288.20.2569.
Coronary heart disease (CHD) remains the leading cause of mortality in industrialized countries and is rapidly becoming a primary cause of death worldwide. Thus, identification of the dietary changes that most effectively prevent CHD is critical.
To review metabolic, epidemiologic, and clinical trial evidence regarding diet and CHD prevention.
We searched MEDLINE through May 2002 for epidemiologic and clinical investigations of major dietary factors (fat, cholesterol, omega-3 fatty acids, trans-fatty acids, carbohydrates, glycemic index, fiber, folate, specific foods, and dietary patterns) and CHD. We selected 147 original investigations and reviews of metabolic studies, epidemiologic studies, and dietary intervention trials of diet and CHD.
Data were examined for relevance and quality and extracted by 1 of the authors.
Compelling evidence from metabolic studies, prospective cohort studies, and clinical trials in the past several decades indicates that at least 3 dietary strategies are effective in preventing CHD: substitute nonhydrogenated unsaturated fats for saturated and trans-fats; increase consumption of omega-3 fatty acids from fish, fish oil supplements, or plant sources; and consume a diet high in fruits, vegetables, nuts, and whole grains and low in refined grain products. However, simply lowering the percentage of energy from total fat in the diet is unlikely to improve lipid profile or reduce CHD incidence. Many issues remain unsettled, including the optimal amounts of monounsaturated and polyunsaturated fats, the optimal balance between omega-3 and omega-6 polyunsaturated fats, the amount and sources of protein, and the effects of individual phytochemicals, antioxidant vitamins, and minerals.
Substantial evidence indicates that diets using nonhydrogenated unsaturated fats as the predominant form of dietary fat, whole grains as the main form of carbohydrates, an abundance of fruits and vegetables, and adequate omega-3 fatty acids can offer significant protection against CHD. Such diets, together with regular physical activity, avoidance of smoking, and maintenance of a healthy body weight, may prevent the majority of cardiovascular disease in Western populations.
冠心病（CHD）仍是工业化国家的主要死因，并且在全球范围内正迅速成为主要死因。因此，确定最有效地预防冠心病的饮食变化至关重要。
回顾关于饮食与冠心病预防的代谢、流行病学及临床试验证据。
我们检索了截至2002年5月的MEDLINE数据库，查找主要饮食因素（脂肪、胆固醇、ω-3脂肪酸、反式脂肪酸、碳水化合物、血糖指数、纤维、叶酸、特定食物及饮食模式）与冠心病的流行病学及临床研究。我们选择了147项关于饮食与冠心病的代谢研究、流行病学研究及饮食干预试验的原始研究和综述。
由一位作者检查数据的相关性和质量并进行提取。
过去几十年来自代谢研究、前瞻性队列研究及临床试验的有力证据表明，至少3种饮食策略对预防冠心病有效：用非氢化不饱和脂肪替代饱和脂肪和反式脂肪；增加鱼类、鱼油补充剂或植物来源的ω-3脂肪酸的摄入量；食用富含水果、蔬菜、坚果和全谷物且精制谷物产品含量低的饮食。然而，单纯降低饮食中总脂肪的能量百分比不太可能改善血脂状况或降低冠心病发病率。许多问题仍未解决，包括单不饱和脂肪和多不饱和脂肪的最佳量、ω-3与ω-6多不饱和脂肪的最佳平衡、蛋白质的量和来源，以及个别植物化学物质、抗氧化维生素和矿物质的作用。
大量证据表明，以非氢化不饱和脂肪作为主要膳食脂肪形式、全谷物作为碳水化合物主要形式、富含水果和蔬菜以及有足够ω-3脂肪酸的饮食可提供显著的冠心病预防作用。这样的饮食，再加上定期体育活动、戒烟和维持健康体重，可能预防西方人群中的大多数心血管疾病。
