膳食脂肪的类型和数量对健康个体和心血管疾病高危个体的血浆因子 VIIc、纤维蛋白原和 PAI-1 的影响：2 项随机对照试验。

The Type and Amount of Dietary Fat Affect Plasma Factor VIIc, Fibrinogen, and PAI-1 in Healthy Individuals and Individuals at High Cardiovascular Disease Risk: 2 Randomized Controlled Trials.

机构信息

Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA.

Department of Biostatistics, Collaborative Studies Coordinating Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

出版信息

J Nutr. 2020 Aug 1;150(8):2089-2100. doi: 10.1093/jn/nxaa137.

DOI:10.1093/jn/nxaa137

PMID:32492148

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7398773/

Abstract

BACKGROUND

Factor VIIc, fibrinogen, and plasminogen activator inhibitor 1 (PAI-1) are cardiovascular disease (CVD) risk factors and are modulated, in part, by fat type and amount.

OBJECTIVE

We evaluated fat type and amount on the primary outcomes: factor VIIc, fibrinogen, and PAI-1.

METHODS

In the Dietary Effects on Lipoproteins and Thrombogenic Activity (DELTA) Trial, 2 controlled crossover feeding studies evaluated substituting carbohydrate or MUFAs for SFAs. Study 1: healthy participants (n = 103) were provided with (8 wk) an average American diet [AAD; designed to provide 37% of energy (%E) as fat, 16% SFA], a Step 1 diet (30%E fat, 9% SFA), and a diet low in SFA (Low-Sat; 26%E fat, 5% SFA). Study 2: participants (n = 85) at risk for CVD and metabolic syndrome (MetSyn) were provided with (7 wk) an AAD, a step 1 diet, and a high-MUFA diet (designed to provide 37%E fat, 8% SFA, 22% MUFA).

RESULTS

Study 1: compared with AAD, the Step 1 and Low-Sat diets decreased mean factor VIIc by 1.8% and 2.6% (overall P = 0.0001), increased mean fibrinogen by 1.2% and 2.8% (P = 0.0141), and increased mean square root PAI-1 by 0.0% and 6.0% (P = 0.0037), respectively. Study 2: compared with AAD, the Step 1 and high-MUFA diets decreased mean factor VIIc by 4.1% and 3.2% (overall P < 0.0001), increased mean fibrinogen by 3.9% and 1.5% (P = 0.0083), and increased mean square-root PAI-1 by 2.0% and 5.8% (P = 0.1319), respectively.

CONCLUSIONS

Replacing SFA with carbohydrate decreased factor VIIc and increased fibrinogen in healthy and metabolically unhealthy individuals and also increased PAI-1 in healthy subjects. Replacing SFA with MUFA decreased factor VIIc and increased fibrinogen but less than carbohydrate. Our results indicate an uncertain effect of replacing SFA with carbohydrate or MUFA on cardiometabolic risk because of small changes in hemostatic factors and directionally different responses to decreasing SFA. This trial was registered at https://clinicaltrials.gov/ct2/show/NCT00000538?term=NCT00000538&rank=1 as NCT00000538.

摘要

背景

因子 VIIc、纤维蛋白原和纤溶酶原激活物抑制剂 1（PAI-1）是心血管疾病（CVD）的危险因素，其部分受脂肪类型和数量的调节。

目的

我们评估了脂肪类型和数量对主要结局的影响：因子 VIIc、纤维蛋白原和 PAI-1。

方法

在饮食对脂蛋白和血栓形成活性的影响（DELTA）试验中，2 项对照交叉喂养研究评估了用碳水化合物或 MUFA 替代 SFA。研究 1：健康参与者（n=103）接受了（8 周）普通美国饮食[AAD；设计提供 37%的能量（%E）作为脂肪，16%的 SFA]、第一步饮食（30%E 脂肪，9% SFA）和低 SFA 饮食（Low-Sat；26%E 脂肪，5% SFA）。研究 2：有 CVD 和代谢综合征（MetSyn）风险的参与者（n=85）接受了（7 周）AAD、第一步饮食和高 MUFA 饮食（设计提供 37%E 脂肪，8% SFA，22% MUFA）。

结果

研究 1：与 AAD 相比，第一步和 Low-Sat 饮食分别降低了平均因子 VIIc 1.8%和 2.6%（总体 P=0.0001），增加了平均纤维蛋白原 1.2%和 2.8%（P=0.0141），并分别增加了平均平方根 PAI-1 0.0%和 6.0%（P=0.0037）。研究 2：与 AAD 相比，第一步和高 MUFA 饮食分别降低了平均因子 VIIc 4.1%和 3.2%（总体 P<0.0001），增加了平均纤维蛋白原 3.9%和 1.5%（P=0.0083），并分别增加了平均平方根 PAI-1 2.0%和 5.8%（P=0.1319）。

结论

用碳水化合物替代 SFA 可降低健康和代谢不健康个体的因子 VIIc 并增加纤维蛋白原，还可增加健康受试者的 PAI-1。用 MUFA 替代 SFA 可降低因子 VIIc 并增加纤维蛋白原，但效果不如碳水化合物。我们的结果表明，用碳水化合物或 MUFA 替代 SFA 对心血管代谢风险的影响不确定，因为止血因子的变化很小，对 SFA 减少的反应方向也不同。该试验在 https://clinicaltrials.gov/ct2/show/NCT00000538?term=NCT00000538&rank=1 注册为 NCT00000538。