Fattore Elena, Bosetti Cristina, Brighenti Furio, Agostoni Carlo, Fattore Giovanni
From the Departments of Environmental Health Sciences (EF) and Epidemiology (CB), IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri," Milan, Italy; the Department of Food Science, Università di Parma, Parma, Italy (FB); the Department of Clinical Sciences and Community Health, University of Milan, IRCCS Ospedale Maggiore Policlinico, Milan, Italy (CA); and the Department of Policy Analysis and Public Management & Centre for Research on Health and Social Care Management, Università Bocconi, Milan, Italy (GF).
Am J Clin Nutr. 2014 Jun;99(6):1331-50. doi: 10.3945/ajcn.113.081190. Epub 2014 Apr 9.
Palm oil (PO) may be an unhealthy fat because of its high saturated fatty acid content.
The objective was to assess the effect of substituting PO for other primary dietary fats on blood lipid-related markers of coronary heart disease (CHD) and cardiovascular disease (CVD).
We performed a systematic review and meta-analysis of dietary intervention trials. Studies were eligible if they included original data comparing PO-rich diets with other fat-rich diets and analyzed at least one of the following CHD/CVD biomarkers: total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, TC/HDL cholesterol, LDL cholesterol/HDL cholesterol, triacylglycerols, apolipoprotein A-I and B, very-low-density lipoprotein cholesterol, and lipoprotein(a).
Fifty-one studies were included. Intervention times ranged from 2 to 16 wk, and different fat substitutions ranged from 4% to 43%. Comparison of PO diets with diets rich in stearic acid, monounsaturated fatty acids (MUFAs), and polyunsaturated fatty acids (PUFAs) showed significantly higher TC, LDL cholesterol, apolipoprotein B, HDL cholesterol, and apolipoprotein A-I, whereas most of the same biomarkers were significantly lower when compared with diets rich in myristic/lauric acid. Comparison of PO-rich diets with diets rich in trans fatty acids showed significantly higher concentrations of HDL cholesterol and apolipoprotein A-I and significantly lower apolipoprotein B, triacylglycerols, and TC/HDL cholesterol. Stratified and meta-regression analyses showed that the higher concentrations of TC and LDL cholesterol, when PO was substituted for MUFAs and PUFAs, were not significant in young people and in subjects with diets with a lower percentage of energy from fat.
Both favorable and unfavorable changes in CHD/CVD risk markers occurred when PO was substituted for the primary dietary fats, whereas only favorable changes occurred when PO was substituted for trans fatty acids. Additional studies are needed to provide guidance for policymaking.
由于棕榈油（PO）含有高饱和脂肪酸，它可能是一种不健康的脂肪。
本研究旨在评估用棕榈油替代其他主要膳食脂肪对冠心病（CHD）和心血管疾病（CVD）血脂相关标志物的影响。
我们对饮食干预试验进行了系统评价和荟萃分析。如果研究包含将富含棕榈油的饮食与其他富含脂肪的饮食进行比较的原始数据，并分析了以下至少一种冠心病/心血管疾病生物标志物，则该研究符合条件：总胆固醇（TC）、低密度脂蛋白（LDL）胆固醇、高密度脂蛋白（HDL）胆固醇、TC/HDL胆固醇、LDL胆固醇/HDL胆固醇、甘油三酯、载脂蛋白A-I和B、极低密度脂蛋白胆固醇和脂蛋白(a)。
纳入了51项研究。干预时间为2至16周，不同的脂肪替代比例为4%至43%。将棕榈油饮食与富含硬脂酸、单不饱和脂肪酸（MUFAs）和多不饱和脂肪酸（PUFAs）的饮食进行比较，结果显示TC、LDL胆固醇、载脂蛋白B、HDL胆固醇和载脂蛋白A-I显著更高，而与富含肉豆蔻酸/月桂酸的饮食相比，大多数相同的生物标志物显著更低。将富含棕榈油的饮食与富含反式脂肪酸的饮食进行比较，结果显示HDL胆固醇和载脂蛋白A-I的浓度显著更高，而载脂蛋白B、甘油三酯和TC/HDL胆固醇显著更低。分层和荟萃回归分析表明，当用棕榈油替代MUFAs和PUFAs时，TC和LDL胆固醇浓度较高在年轻人以及脂肪能量占比较低的受试者中并不显著。
用棕榈油替代主要膳食脂肪时，冠心病/心血管疾病风险标志物出现了有利和不利的变化，而用棕榈油替代反式脂肪酸时仅出现了有利的变化。需要更多研究为政策制定提供指导。
