K Hollenberg Norman
Department of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
J Cardiovasc Pharmacol. 2006;47 Suppl 2:S99-102; discussion S119-21. doi: 10.1097/00005344-200606001-00002.
Diet patterns are widely recognized as contributors to hypertension. Widely studied potential contributors include intake of sodium, potassium, magnesium, calcium, soluble fiber, omega-3 fatty acids, alcohol, protein, and calories. We add to that list the effect of dietary flavanols present in certain cocoas, which have sufficient activity on vascular nitric oxide to influence blood pressure control. Kuna Indians who live on islands near Panama have little age-related rise in blood pressure or hypertension. On migration to Panama City, blood pressure rises with age, and the frequency of essential hypertension matches urban levels elsewhere. We have identified a specific food that probably makes an important contribution to cardiovascular status. Island-dwelling Kuna drink more than 5 cups of flavanol-rich cocoa per day and incorporate that cocoa into many recipes. Mainland Kuna ingest little cocoa, and what they take is commercially available and flavanol-poor. The flavanol-rich cocoa activates nitric oxide synthase in vitro and in intact humans in the doses that the Kuna employ. Vasodilator responses to flavonoid-rich cocoa are prevented or reversed by the arginine analog, N-nitro-L-arginine methyl ester. Island-dwelling Kuna have a 3-fold larger urinary nitrate:nitrite than do Mainland dwellers. As endothelial dysfunction is central to current thinking on cardiovascular pathophysiology, a food that enhances endothelial function could have broad implications. The list of candidate conditions that might be influenced is impressive, ranging from atherosclerosis and diabetes mellitus to hypertension and preeclampsia, to vascular dementias and end-stage renal disease. The next decade will be interesting.
饮食模式被广泛认为是导致高血压的因素。广泛研究的潜在因素包括钠、钾、镁、钙、可溶性纤维、ω-3脂肪酸、酒精、蛋白质和热量的摄入。我们在此清单中增加了某些可可中所含膳食黄烷醇的作用，这些黄烷醇对血管一氧化氮具有足够的活性，从而影响血压控制。生活在巴拿马附近岛屿上的库纳印第安人几乎没有与年龄相关的血压升高或高血压情况。迁移到巴拿马城后，血压随年龄增长而升高，原发性高血压的发生率与其他地方的城市水平相当。我们已经确定了一种可能对心血管状况有重要贡献的特定食物。居住在岛上的库纳人每天饮用超过5杯富含黄烷醇的可可，并将其纳入许多食谱中。大陆上的库纳人很少摄入可可，他们所食用的是市售的且黄烷醇含量低的可可。富含黄烷醇的可可在库纳人使用的剂量下，在体外和完整人体中均可激活一氧化氮合酶。精氨酸类似物N-硝基-L-精氨酸甲酯可阻止或逆转对富含类黄酮可可的血管舒张反应。居住在岛上的库纳人的尿硝酸盐：亚硝酸盐比大陆居民大三倍。由于内皮功能障碍是当前心血管病理生理学研究的核心，一种能增强内皮功能的食物可能具有广泛的影响。可能受到影响的候选病症清单令人印象深刻，从动脉粥样硬化、糖尿病到高血压和先兆子痫，再到血管性痴呆和终末期肾病。未来十年将会很有趣。
