Johnson Sarah A, Kirkpatrick Carol F, Miller Nicole H, Carson Jo Ann S, Handu Deepa, Moloney Lisa
J Acad Nutr Diet. 2023 Dec;123(12):1808-1830. doi: 10.1016/j.jand.2023.07.017. Epub 2023 Jul 22.
Cardiovascular disease (CVD) is the leading cause of death in the United States and globally and is largely attributable to atherosclerosis. Evidence indicates that multiple dietary components contribute to the complex causes of CVD and associated events and mortality. Public health authorities and scientific organizations have recommended reduced saturated fatty acid (SFA) intake for decades to promote cardiovascular health, which is linked to favorable impacts on established and emerging atherosclerotic CVD risk factors. Recently, a debate has emerged about whether SFA intake should be reduced for CVD prevention, which has contributed to confusion among health care professionals, including registered dietitian nutritionists (RDNs), and the general public, and necessitates the critical evaluation of the evidence. The objective of this evidence-based nutrition practice guideline is to provide health care and public health professionals, particularly RDNs, with evidence-based recommendations on how to address SFA intake in adults within an individualized healthy dietary pattern. Moderate evidence supports the reduction of SFA intake for CVD event reduction, low- to moderate-certainty evidence supports prioritization of replacement of SFAs with polyunsaturated fatty acids, and low-certainty evidence supports focusing on reducing the total amount of SFA rather than specific food sources of SFA. Guideline implementation should include consideration of individual preferences; principles of inclusion, diversity, equity, and access; and potential nutritional deficiencies that may occur with reduced SFA intake. Future research is needed to address gaps that were identified and provide high-quality evidence to support stronger future recommendations based on the relationship between SFA and CVD.
心血管疾病(CVD)是美国乃至全球的首要死因,主要归因于动脉粥样硬化。有证据表明,多种饮食成分导致了CVD的复杂病因以及相关事件和死亡率。数十年来,公共卫生当局和科学组织一直建议减少饱和脂肪酸(SFA)的摄入量,以促进心血管健康,这与对已有的和新出现的动脉粥样硬化性CVD风险因素产生有利影响有关。最近,关于是否应减少SFA摄入量以预防CVD出现了一场争论,这导致包括注册营养师(RDN)在内的医疗保健专业人员和普通公众感到困惑,因此有必要对证据进行批判性评估。本基于证据的营养实践指南的目的是为医疗保健和公共卫生专业人员,特别是RDN,提供基于证据的建议,说明如何在个性化的健康饮食模式中解决成年人的SFA摄入量问题。中等证据支持减少SFA摄入量以降低CVD事件发生率,低至中等确定性证据支持优先用多不饱和脂肪酸替代SFA,低确定性证据支持关注减少SFA的总量而非特定的SFA食物来源。指南的实施应包括考虑个人偏好;包容、多样性、公平和可及性原则;以及减少SFA摄入量可能出现的潜在营养缺乏。需要开展未来研究以填补已发现的空白,并提供高质量证据,以支持基于SFA与CVD之间关系的更强有力的未来建议。