Department of Atherosclerosis Research Children's Hospital Oakland Research Institute Oakland, CA, USA.
Am J Clin Nutr. 2010 Mar;91(3):502-9. doi: 10.3945/ajcn.2008.26285. Epub 2010 Jan 20.
A focus of dietary recommendations for cardiovascular disease (CVD) prevention and treatment has been a reduction in saturated fat intake, primarily as a means of lowering LDL-cholesterol concentrations. However, the evidence that supports a reduction in saturated fat intake must be evaluated in the context of replacement by other macronutrients. Clinical trials that replaced saturated fat with polyunsaturated fat have generally shown a reduction in CVD events, although several studies showed no effects. An independent association of saturated fat intake with CVD risk has not been consistently shown in prospective epidemiologic studies, although some have provided evidence of an increased risk in young individuals and in women. Replacement of saturated fat by polyunsaturated or monounsaturated fat lowers both LDL and HDL cholesterol. However, replacement with a higher carbohydrate intake, particularly refined carbohydrate, can exacerbate the atherogenic dyslipidemia associated with insulin resistance and obesity that includes increased triglycerides, small LDL particles, and reduced HDL cholesterol. In summary, although substitution of dietary polyunsaturated fat for saturated fat has been shown to lower CVD risk, there are few epidemiologic or clinical trial data to support a benefit of replacing saturated fat with carbohydrate. Furthermore, particularly given the differential effects of dietary saturated fats and carbohydrates on concentrations of larger and smaller LDL particles, respectively, dietary efforts to improve the increasing burden of CVD risk associated with atherogenic dyslipidemia should primarily emphasize the limitation of refined carbohydrate intakes and a reduction in excess adiposity.
饮食建议一直是预防和治疗心血管疾病 (CVD) 的重点，主要是通过降低 LDL-胆固醇浓度来减少饱和脂肪的摄入。然而，支持减少饱和脂肪摄入的证据必须在其他宏量营养素替代的背景下进行评估。用多不饱和脂肪替代饱和脂肪的临床试验通常显示 CVD 事件减少，尽管有几项研究没有显示出效果。前瞻性流行病学研究并没有一致表明饱和脂肪摄入与 CVD 风险之间存在独立关联，尽管一些研究表明在年轻个体和女性中存在风险增加。用多不饱和或单不饱和脂肪替代饱和脂肪可以降低 LDL 和 HDL 胆固醇。然而，用更高的碳水化合物摄入（特别是精制碳水化合物）替代会加剧与胰岛素抵抗和肥胖相关的动脉粥样硬化性血脂异常，包括增加甘油三酯、小 LDL 颗粒和降低 HDL 胆固醇。总之，虽然用饮食中的多不饱和脂肪替代饱和脂肪已被证明可以降低 CVD 风险，但很少有流行病学或临床试验数据支持用碳水化合物替代饱和脂肪的益处。此外，特别是鉴于饮食中饱和脂肪和碳水化合物对较大和较小 LDL 颗粒浓度的不同影响，饮食方面应该主要强调限制精制碳水化合物的摄入量和减少多余的脂肪。
