地中海饮食可改善心血管高危人群的高密度脂蛋白功能：一项随机对照试验。
Mediterranean Diet Improves High-Density Lipoprotein Function in High-Cardiovascular-Risk Individuals: A Randomized Controlled Trial.
机构信息
From Cardiovascular Risk and Nutrition Research Group (A.H., O.C., R.d.l.T, M. Fitó) and Cardiovascular Epidemiology and Genetics Research Group (R. Elosua), REGICOR Study Group, and Human Pharmacology and Neurosciences Research Group (R.d.l.T.), Hospital del Mar Medical Research Institute, Barcelona, Spain; PhD Program in Food Sciences and Nutrition (A.H.) and Department of Nutrition and Bromatology, Faculty of Pharmacy (M.C.L.-S.), Universitat de Barcelona, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain (A.H., O.C., X.P., R. Estruch, J.S.-S., D.C., F.A., L.S.-M., M. Fiol, M.O.-C., E.R., M.A.M.-G., R.d.l.T., M.C.L.-S., M. Fitó); Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain (X.P.); Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Hospital Clinic, University of Barcelona, Spain (R. Estruch, E.R.); Human Nutrition Department, Hospital Universitari Sant Joan, Institut d'Investigació Sanitaria Pere Virgili, Universitat Rovira i Virgili, Reus, Spain (J.S.-S.); Department of Preventive Medicine, Universidad de Valencia, Spain (D.C.); Department of Cardiology, Hospital Universitario de Álava, Vitoria, Spain (F.A.); Department of Clinical Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain (L.S.-M.); Hospital Son Espases, and Institute of Health Sciences (IUNICS), Palma de Mallorca, Spain (M. Fiol); Department of Family Medicine, Distrito Sanitario Atención Primaria Sevilla, Centro de Salud Las Palmeritas, Spain (M.O.-C.); and Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain (M.A.M.-G.).
出版信息
Circulation. 2017 Feb 14;135(7):633-643. doi: 10.1161/CIRCULATIONAHA.116.023712.
BACKGROUND
The biological functions of high-density lipoproteins (HDLs) contribute to explaining the cardioprotective role of the lipoprotein beyond quantitative HDL cholesterol levels. A few small-scale interventions with a single antioxidant have improved some HDL functions. However, to date, no long-term, large-scale, randomized controlled trial has been conducted to assess the effects of an antioxidant-rich dietary pattern (such as a traditional Mediterranean diet [TMD]) on HDL function in humans.
METHODS
This study was performed in a random subsample of volunteers from the PREDIMED Study (Prevención con Dieta Mediterránea; n=296) after a 1-year intervention. We compared the effects of 2 TMDs, one enriched with virgin olive oil (TMD-VOO; n=100) and the other enriched with nuts (TMD-Nuts; n=100), with respect to a low-fat control diet (n=96). We assessed the effects of both TMDs on the role of HDL particles on reverse cholesterol transport (cholesterol efflux capacity, HDL ability to esterify cholesterol, and cholesteryl ester transfer protein activity), HDL antioxidant properties (paraoxonase-1 arylesterase activity and total HDL antioxidant capacity on low-density lipoproteins), and HDL vasodilatory capacity (HDL ability to induce the release of nitric oxide in endothelial cells). We also studied the effects of a TMD on several HDL quality-related characteristics (HDL particle oxidation, resistance against oxidative modification, main lipid and protein composition, and size distribution).
RESULTS
Both TMDs increased cholesterol efflux capacity relative to baseline (=0.018 and =0.013 for TMD-VOO and TMD-Nuts, respectively). The TMD-VOO intervention decreased cholesteryl ester transfer protein activity (relative to baseline, =0.028) and increased HDL ability to esterify cholesterol, paraoxonase-1 arylesterase activity, and HDL vasodilatory capacity (relative to control, =0.039, =0.012, and =0.026, respectively). Adherence to a TMD induced these beneficial changes by improving HDL oxidative status and composition. The 3 diets increased the percentage of large HDL particles (relative to baseline, <0.001).
CONCLUSIONS
The TMD, especially when enriched with virgin olive oil, improved HDL atheroprotective functions in humans.
CLINICAL TRIAL REGISTRATION
URL: http://www.controlled-trials.com. Unique identifier: ISRCTN35739639.
背景
高密度脂蛋白（HDL）的生物学功能有助于解释脂蛋白除了定量 HDL 胆固醇水平之外的心脏保护作用。一些使用单一抗氧化剂的小规模干预已经改善了一些 HDL 功能。然而，迄今为止，尚无长期、大规模、随机对照试验评估富含抗氧化剂的饮食模式（如传统的地中海饮食[TMD]）对人类 HDL 功能的影响。
方法
本研究在 PREDIMED 研究（地中海饮食预防[Prevención con Dieta Mediterránea]）的志愿者随机子样本中进行，在 1 年干预后。我们比较了两种 TMD 的效果，一种富含初榨橄榄油（TMD-VOO；n=100），另一种富含坚果（TMD-Nuts；n=100），与低脂对照饮食（n=96）。我们评估了两种 TMD 对 HDL 颗粒在胆固醇逆向转运中的作用的影响（胆固醇外排能力、HDL 酯化胆固醇的能力和胆固醇酯转移蛋白活性）、HDL 抗氧化特性（对氧磷酶 1 芳基酯酶活性和总 HDL 对低密度脂蛋白的抗氧化能力）和 HDL 血管扩张能力（HDL 诱导内皮细胞释放一氧化氮的能力）。我们还研究了 TMD 对几种与 HDL 质量相关的特征的影响（HDL 颗粒氧化、对氧化修饰的抵抗力、主要脂质和蛋白质组成以及大小分布）。
结果
两种 TMD 均增加了胆固醇外排能力（与基线相比，TMD-VOO 为 0.018，TMD-Nuts 为 0.013）。TMD-VOO 干预降低了胆固醇酯转移蛋白活性（与基线相比，=0.028）并增加了 HDL 酯化胆固醇的能力、对氧磷酶 1 芳基酯酶活性和 HDL 血管扩张能力（与对照组相比，=0.039，=0.012，=0.026）。遵循 TMD 通过改善 HDL 氧化状态和组成诱导这些有益变化。这三种饮食增加了大 HDL 颗粒的百分比（与基线相比，<0.001）。
结论
TMD，尤其是富含初榨橄榄油的 TMD，改善了人类的 HDL 抗动脉粥样硬化功能。
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