Shrapnel W S, Calvert G D, Nestel P J, Truswell A S
National Heart Foundation, Deakin, ACT.
Med J Aust. 1992 May 4;156(S2):S9-16.
Over the last four decades there has been extensive research into the links between diet and coronary heart disease. The most recent literature is reviewed in this position statement. The clinical and public health aspects of the National Heart Foundation's nutrition policy are based on this review. The key points are as follows: 1. Saturated fatty acids A high intake of saturated fatty acids is strongly associated with elevated serum cholesterol and LDL-cholesterol levels and increased risk of coronary heart disease. 2. The n-6 polyunsaturated fatty acids The n-6 polyunsaturated fatty acids (principally linoleic acid) lower serum cholesterol levels when substituted for saturated fats and probably have an independent cholesterol-lowering effect. 3. The n-3 polyunsaturated fatty acids (fish oils) The n-3 polyunsaturated fatty acids reduce serum triglyceride levels, decrease the tendency to thrombosis and may further reduce coronary risk through other mechanisms. 4. Monounsaturated fatty acids Monounsaturated fatty acids reduce serum cholesterol levels when substituted for saturated fatty acids. It is not clear whether this is an independent effect or simply the result of displacement of saturates. 5. Trans fatty acids Trans fatty acids may increase serum cholesterol levels and can be reckoned to be equivalent to saturated fatty acids. 6. Total fat Total fat intake, independent of fatty acid type, is not strongly associated with coronary heart disease but may contribute to obesity. Associations between total fat intake and coronary heart disease are primarily mediated through the saturated fatty acid component. 7. Dietary cholesterol Dietary cholesterol increases serum cholesterol levels in some people and may increase risk of coronary heart disease. 8. Alcohol A high intake of alcohol increases blood pressure and serum triglyceride levels and increases mortality from cardiovascular disease. Light alcohol consumption reduces the risk of coronary heart disease. 9. Sugar The consumption of sugar is not associated with coronary heart disease. 10. Sodium and potassium High salt intake is related to hypertension especially in the subset of "salt-sensitive" people. Potassium intake may be inversely related to hypertension. 11. Overweight and obesity Abdominal obesity increases the risk of coronary heart disease probably by adversely influencing conventional risk factors. 12. Vegetarianism A high intake of plant foods reduces the risk of coronary heart disease through several mechanisms, including lowering serum cholesterol and blood pressure levels.
在过去的四十年里，人们对饮食与冠心病之间的联系进行了广泛研究。本立场声明对最新文献进行了综述。国家心脏基金会营养政策的临床和公共卫生方面基于此综述。要点如下：1. 饱和脂肪酸 高摄入饱和脂肪酸与血清胆固醇和低密度脂蛋白胆固醇水平升高以及冠心病风险增加密切相关。2. n-6 多不饱和脂肪酸 用 n-6 多不饱和脂肪酸（主要是亚油酸）替代饱和脂肪时可降低血清胆固醇水平，且可能具有独立的降胆固醇作用。3. n-3 多不饱和脂肪酸（鱼油）n-3 多不饱和脂肪酸可降低血清甘油三酯水平，降低血栓形成倾向，并可能通过其他机制进一步降低冠心病风险。4. 单不饱和脂肪酸 用单不饱和脂肪酸替代饱和脂肪酸可降低血清胆固醇水平。尚不清楚这是一种独立作用还是仅仅是饱和脂肪酸被替代的结果。5. 反式脂肪酸 反式脂肪酸可能会升高血清胆固醇水平，可被认为等同于饱和脂肪酸。6. 总脂肪 总脂肪摄入量，与脂肪酸类型无关，与冠心病没有密切关联，但可能导致肥胖。总脂肪摄入量与冠心病之间的关联主要通过饱和脂肪酸成分介导。7. 膳食胆固醇 膳食胆固醇会使一些人的血清胆固醇水平升高，并可能增加冠心病风险。8. 酒精 高酒精摄入量会升高血压和血清甘油三酯水平，并增加心血管疾病死亡率。适量饮酒可降低冠心病风险。9. 糖 糖的摄入与冠心病无关。10. 钠和钾 高盐摄入与高血压有关，尤其是在“盐敏感”人群中。钾的摄入可能与高血压呈负相关。11. 超重和肥胖 腹部肥胖可能通过对传统危险因素产生不利影响而增加冠心病风险。12. 素食主义 高摄入植物性食物通过多种机制降低冠心病风险，包括降低血清胆固醇和血压水平。
