Margolis S, Dobs A S
Johns Hopkins School of Medicine, Baltimore, Maryland 21205.
J Am Coll Nutr. 1989;8 Suppl:33S-45S. doi: 10.1080/07315724.1989.10737968.
Prevention of vascular disease and acute pancreatitis is the goal of hyperlipidemia treatment. The risk of coronary heart disease (CHD) increases with increasing plasma cholesterol levels because low-density lipoprotein (LDL), the major carrier of cholesterol in the plasma, is atherogenic. High-density lipoprotein (HDL), especially the HDL2 subfraction, protects against CHD. Hypertriglyceridemia, although not an independent risk factor for CHD, is generally accompanied by low HDL cholesterol (HDLch), which may predispose to CHD. Reducing plasma LDL and raising HDL levels are thus goals in preventing CHD. Serum LDL levels may be lowered by reducing saturated fat and cholesterol intake; weight loss may decrease LDL but is more effective in lowering plasma triglycerides and raising HDLch. The percent of total calories from polyunsaturated, monounsaturated, and saturated fats should be less than 10%, up to 10-15%, and less than 10%, respectively. High cholesterol intake increases the flux of cholesterol, which may be harmful to arterial walls, but beyond a certain point does not increase plasma cholesterol levels. Some diets change the composition rather than the level of LDL and apoproteins. Weight reduction and maintenance are the most effective dietary measures to lower plasma triglycerides; omega-3 fatty acids (fish oils) have shown promise in reducing triglyceride but not cholesterol levels. Substitution of starch for sugar lowered triglyceride levels toward normal in hypertriglyceridemia patients. Fasting triglyceride levels rise in all individuals fed high-carbohydrate diets, but the high levels persist in hypertriglyceridemia patients. Weight loss, cessation of cigarette smoking, increased physical activity, good control of diabetes, and moderate alcohol use all raise HDLch levels. Vitamin E deficiency causes neurological sequelae in children with severe malabsorption problems due to abetalipoproteinemia or cholestatic liver disease.
预防血管疾病和急性胰腺炎是高脂血症治疗的目标。冠心病（CHD）的风险随着血浆胆固醇水平的升高而增加，因为血浆中胆固醇的主要载体低密度脂蛋白（LDL）具有致动脉粥样硬化作用。高密度脂蛋白（HDL），尤其是HDL2亚组分，可预防冠心病。高甘油三酯血症虽然不是冠心病的独立危险因素，但通常伴有低高密度脂蛋白胆固醇（HDLch），这可能易患冠心病。因此，降低血浆LDL和提高HDL水平是预防冠心病的目标。通过减少饱和脂肪和胆固醇的摄入可降低血清LDL水平；体重减轻可能会降低LDL，但在降低血浆甘油三酯和提高HDLch方面更有效。多不饱和脂肪、单不饱和脂肪和饱和脂肪占总热量的百分比应分别小于10%、高达10 - 15%和小于10%。高胆固醇摄入会增加胆固醇通量，这可能对动脉壁有害，但超过一定程度后不会增加血浆胆固醇水平。一些饮食会改变LDL和载脂蛋白的组成而非水平。减轻体重并维持体重是降低血浆甘油三酯最有效的饮食措施；ω-3脂肪酸（鱼油）在降低甘油三酯水平而非胆固醇水平方面显示出前景。用淀粉替代糖可使高甘油三酯血症患者的甘油三酯水平降至正常。所有食用高碳水化合物饮食的个体空腹甘油三酯水平都会升高，但高甘油三酯血症患者的高水平会持续存在。体重减轻、戒烟、增加体力活动、良好控制糖尿病以及适度饮酒均可提高HDLch水平。维生素E缺乏会导致患有因无β脂蛋白血症或胆汁淤积性肝病引起的严重吸收不良问题的儿童出现神经后遗症。
