Laaksonen David E, Nyyssönen Kristiina, Niskanen Leo, Rissanen Tiina H, Salonen Jukka T
Department of Physiology, University of Kuopio, Kuopio, Finland.
Arch Intern Med. 2005 Jan 24;165(2):193-9. doi: 10.1001/archinte.165.2.193.
Substitution of dietary polyunsaturated for saturated fat has long been recommended for the primary prevention of cardiovascular disease (CVD), but only a few prospective cohort studies have provided support for this advice.
We assessed the association of dietary linoleic and total polyunsaturated fatty acid (PUFA) intake with cardiovascular and overall mortality in a population-based cohort of 1551 middle-aged men. Dietary fat composition was estimated with a 4-day food record and serum fatty acid composition.
During the 15-year follow-up, 78 men died of CVD and 225 of any cause. Total fat intake was not related to CVD or overall mortality. Men with an energy-adjusted dietary intake of linoleic acid (relative risk [RR] 0.39; 95% confidence interval [CI], 0.21-0.71) and PUFA (RR, 0.38; 95% CI, 0.20-0.70) in the upper third were less likely to die of CVD than men with intake in the lower third after adjustment for age. Multivariate adjustment weakened the association somewhat. Mortality from CVD was also lower for men with proportions of serum esterified linoleic acid (RR, 0.42; 95% CI, 0.21-0.80) and PUFA (RR, 0.25; 95% CI, 0.12-0.50) in the upper vs lower third, with some attenuation in multivariate analyses. Serum and to a lesser extent dietary linoleic acid and PUFA were also inversely associated with overall mortality.
Dietary polyunsaturated and more specifically linoleic fatty acid intake may have a substantial cardioprotective benefit that is also reflected in overall mortality. Dietary fat quality seems more important than fat quantity in the reduction of cardiovascular mortality in men.
长期以来，一直建议用膳食中的多不饱和脂肪替代饱和脂肪以进行心血管疾病（CVD）的一级预防，但只有少数前瞻性队列研究支持这一建议。
我们在一个由1551名中年男性组成的基于人群的队列中，评估了膳食亚油酸和总多不饱和脂肪酸（PUFA）摄入量与心血管疾病及全因死亡率之间的关联。通过4天的食物记录和血清脂肪酸组成来估计膳食脂肪组成。
在15年的随访期间，78名男性死于心血管疾病，225名男性死于任何原因。总脂肪摄入量与心血管疾病或全因死亡率无关。在根据年龄进行调整后，能量调整膳食亚油酸摄入量处于上三分位的男性（相对风险[RR]为0.39；95%置信区间[CI]为0.21 - 0.71）和PUFA摄入量处于上三分位的男性（RR为0.38；95%CI为0.20 - 0.70）死于心血管疾病的可能性低于摄入量处于下三分位的男性。多变量调整使这种关联有所减弱。血清酯化亚油酸比例处于上三分位的男性（RR为0.42；95%CI为0.21 - 0.80）和PUFA比例处于上三分位的男性（RR为0.25；95%CI为0.12 - 0.50）的心血管疾病死亡率也较低，在多变量分析中有所减弱。血清以及在较小程度上膳食中的亚油酸和PUFA也与全因死亡率呈负相关。
膳食多不饱和脂肪酸，尤其是亚油酸的摄入可能具有显著的心脏保护益处，这也反映在全因死亡率上。在降低男性心血管死亡率方面，膳食脂肪质量似乎比脂肪数量更重要。
