绝经后女性的膳食脂肪、碳水化合物与冠状动脉粥样硬化进展
Dietary fats, carbohydrate, and progression of coronary atherosclerosis in postmenopausal women.
作者信息
Mozaffarian Dariush, Rimm Eric B, Herrington David M
机构信息
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Harvard School of Public Health, Boston, Massachusetts, USA.
出版信息
Am J Clin Nutr. 2004 Nov;80(5):1175-84. doi: 10.1093/ajcn/80.5.1175.
BACKGROUND
The influence of diet on atherosclerotic progression is not well established, particularly in postmenopausal women, in whom risk factors for progression may differ from those for men.
OBJECTIVE
The objective was to investigate associations between dietary macronutrients and progression of coronary atherosclerosis among postmenopausal women.
DESIGN
Quantitative coronary angiography was performed at baseline and after a mean follow-up of 3.1 y in 2243 coronary segments in 235 postmenopausal women with established coronary heart disease. Usual dietary intake was assessed at baseline.
RESULTS
The mean (+/-SD) total fat intake was 25 +/- 6% of energy. In multivariate analyses, a higher saturated fat intake was associated with a smaller decline in mean minimal coronary diameter (P = 0.001) and less progression of coronary stenosis (P = 0.002) during follow-up. Compared with a 0.22-mm decline in the lowest quartile of intake, there was a 0.10-mm decline in the second quartile (P = 0.002), a 0.07-mm decline in the third quartile (P = 0.002), and no decline in the fourth quartile (P < 0.001); P for trend = 0.001. This inverse association was more pronounced among women with lower monounsaturated fat (P for interaction = 0.04) and higher carbohydrate (P for interaction = 0.004) intakes and possibly lower total fat intake (P for interaction = 0.09). Carbohydrate intake was positively associated with atherosclerotic progression (P = 0.001), particularly when the glycemic index was high. Polyunsaturated fat intake was positively associated with progression when replacing other fats (P = 0.04) but not when replacing carbohydrate or protein. Monounsaturated and total fat intakes were not associated with progression.
CONCLUSIONS
In postmenopausal women with relatively low total fat intake, a greater saturated fat intake is associated with less progression of coronary atherosclerosis, whereas carbohydrate intake is associated with a greater progression.
背景
饮食对动脉粥样硬化进展的影响尚未完全明确，尤其是在绝经后女性中，其进展的危险因素可能与男性不同。
目的
研究绝经后女性饮食中的常量营养素与冠状动脉粥样硬化进展之间的关联。
设计
对235例已确诊冠心病的绝经后女性的2243个冠状动脉节段进行了基线定量冠状动脉造影，并在平均随访3.1年后再次进行。在基线时评估其日常饮食摄入量。
结果
总脂肪摄入量平均（±标准差）占能量的25±6%。在多变量分析中，较高的饱和脂肪摄入量与随访期间平均最小冠状动脉直径的较小下降（P = 0.001）和冠状动脉狭窄进展较少（P = 0.002）相关。与摄入量最低四分位数时0.22毫米的下降相比，第二四分位数时下降了0.10毫米（P = 0.002），第三四分位数时下降了0.07毫米（P = 0.002），第四四分位数时无下降（P < 0.001）；趋势P = 0.001。这种负相关在单不饱和脂肪摄入量较低（交互作用P = 0.04）、碳水化合物摄入量较高（交互作用P = 0.004）以及总脂肪摄入量可能较低（交互作用P = 0.09）的女性中更为明显。碳水化合物摄入量与动脉粥样硬化进展呈正相关（P = 0.001），尤其是当血糖指数较高时。当多不饱和脂肪替代其他脂肪时与进展呈正相关（P = 0.04），但替代碳水化合物或蛋白质时则不然。单不饱和脂肪和总脂肪摄入量与进展无关。
结论
在总脂肪摄入量相对较低的绝经后女性中，较高的饱和脂肪摄入量与冠状动脉粥样硬化进展较少相关，而碳水化合物摄入量与进展较多相关。
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