Knopp Robert H, Fish Brian, Dowdy Alice, Retzlaff Barbara, Walden Carolyn, Rusanu Irina, Paramsothy Pathmaja
Northwest Lipid Research Clinic, Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington School of Medicine, 325 9th Avenue, Box 359720, Seattle, WA 98104, USA.
Curr Atheroscler Rep. 2006 Nov;8(6):492-500. doi: 10.1007/s11883-006-0025-9.
A low-fat diet is recommended for hyperlipidemia. However, low-density lipoprotein (LDL) responses depend on the type of hyperlipidemia (ie, simple hypercholesterolemia or combined hyperlipidemia). In combined hyperlipidemia, which is typical of patients with metabolic syndrome, LDL levels are only one third as responsive to fat and cholesterol as simple hypercholesterolemia. The diminished dietary sensitivity of combined hyperlipidemia is explained by diminished intestinal absorption of cholesterol, a feature of metabolic syndrome. In turn, combined hyperlipidemia is caused by heightened lipid secretion by the liver. A moderate-fat, moderate-carbohydrate diet employing allowable fats has the promise of reducing endogenous lipoprotein production in combined hyperlipidemia. Triglyceride, LDL, and small-dense LDL should be lower, and high-density lipoprotein, apoprotein A-I, and buoyant LDL should be higher. A test of this dietary strategy on lipoproteins and downstream benefits on inflammatory mediators, oxidative stress, and vascular reactivity is now underway.
高脂血症患者建议采用低脂饮食。然而，低密度脂蛋白（LDL）的反应取决于高脂血症的类型（即单纯高胆固醇血症或混合性高脂血症）。在代谢综合征患者典型的混合性高脂血症中，LDL水平对脂肪和胆固醇的反应仅为单纯高胆固醇血症的三分之一。代谢综合征的一个特征是胆固醇肠道吸收减少，这解释了混合性高脂血症饮食敏感性降低的原因。反过来，混合性高脂血症是由肝脏脂质分泌增加引起的。采用允许食用的脂肪的中等脂肪、中等碳水化合物饮食有望减少混合性高脂血症中内源性脂蛋白的产生。甘油三酯、LDL和小而密LDL应该降低，而高密度脂蛋白、载脂蛋白A-I和漂浮LDL应该升高。目前正在对这种饮食策略对脂蛋白的影响以及对炎症介质、氧化应激和血管反应性的下游益处进行测试。
