Scholl Johannes
Prevention First, 65385 Ruedesheim, Germany.
Cholesterol. 2012;2012:367898. doi: 10.1155/2012/367898. Epub 2012 Feb 28.
whereas smoking prevalence declines, obesity and metabolic syndrome are on the rise. Unfortunately, the traditional low-fat diet for the prevention of cardiovascular disease (CVD) still seems to be the "mainstream knowledge" despite contradicting evidence. But lowering LDL-cholesterol by the wrong diet even may be counterproductive, if sd-LDL is raised and HDL is lowered. New insights into the pathophysiology of insulin resistance and its influence on the effects of dietary changes have led to a better approach: (1) the higher a patient's insulin resistance, the more important is the glycemic load of the diet. (2) Fat quality is much more important than fat quantity. (3) The best principle for a reduced calorie intake is not fat counting, but a high volume diet with low energy density, which means fibre rich vegetables and fruits. (4) And finally, satiation and palatability of a diet is very important: there is no success without the patient's compliance. Thus, the best approach to the dietary prevention of CVD is a Mediterranean style low-carb diet represented in the LOGI pyramid. Dietary guidelines for the prevention of CVD should to be revised accordingly.
心血管疾病（CVD）患者的特征已经发生了变化：吸烟率下降，而肥胖和代谢综合征却在上升。不幸的是，尽管有相互矛盾的证据，但传统的预防心血管疾病的低脂饮食似乎仍然是“主流知识”。但如果小而密低密度脂蛋白（sd-LDL）升高而高密度脂蛋白（HDL）降低，通过错误的饮食降低低密度脂蛋白胆固醇甚至可能适得其反。对胰岛素抵抗的病理生理学及其对饮食变化影响的新见解带来了一种更好的方法：（1）患者的胰岛素抵抗越高，饮食的血糖负荷就越重要。（2）脂肪质量比脂肪数量重要得多。（3）减少热量摄入的最佳原则不是计算脂肪量，而是高容积低能量密度饮食，即富含纤维的蔬菜和水果。（4）最后，饮食的饱腹感和适口性非常重要：没有患者的依从性就不会成功。因此，预防心血管疾病的最佳饮食方法是LOGI金字塔中所代表的地中海式低碳水化合物饮食。预防心血管疾病的饮食指南应相应修订。
