Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States; Department of Nutritional Sciences, The Pennsylvania State University, PA, United States.
Department of Nutritional Sciences, The Pennsylvania State University, PA, United States; Research, Nutrition, and Innovation, Athletic Greens International, Carson City, NV, United States.
Am J Clin Nutr. 2024 Sep;120(3):619-629. doi: 10.1016/j.ajcnut.2024.06.019. Epub 2024 Jul 2.
An inverse relationship between saturated fatty acid (SFA) intake and Lp(a) concentration has been observed; however, there has been no quantification of this effect.
The objective was to determine whether SFA consumption alters Lp(a) concentrations among adults without atherosclerotic cardiovascular disease (ASCVD).
A systematic review and meta-analysis of randomized controlled trials contrasting a lower SFA diet(s) with a higher SFA diet(s) among adults without ASCVD was conducted. PubMed, Cochrane Central Register of Clinical Trials, clinicaltrials.gov, and Web of Science databases and registers were searched through October 2023. The standardized mean difference (SMD) in Lp(a) between diets lower and higher in SFA [percentage of energy (%E)] was determined using random-effects meta-analysis. Analyses were also conducted to examine the effect of replacing SFA with carbohydrates (CHO), monounsaturated (MUFAs), polyunsaturated (PUFAs), or trans fatty acids (TFAs).
In total, 6255 publications were identified in the systematic search. Twenty-six publications reporting 27 randomized controlled trials, including 1325 participants and 49 diet comparisons, were included. The mean difference in SFA between lower and higher SFA diets was 7.6%E (3.7%-17.8%E). After lower SFA diets, Lp(a) concentration was higher (SMD: 0.14; 95% confidence interval [CI]: 0.03, 0.24) than after higher SFA diets. Subgroup analyses showed higher Lp(a) following diets where SFA was replaced by CHO (trials = 8; n = 539; SMD: 0.21; 95% CI: 0.02, 0.40) or TFAs (trials = 8; n = 300; SMD: 0.32; 95% CI: 0.17, 0.48). No differences in Lp(a) were observed when MUFA (trials = 16; n = 641; SMD: 0.04; 95% CI: -0.08, 0.16) or PUFA (trials = 8; n = 415; SMD: 0.09; 95% CI: -0.04, 0.22) replaced SFA.
Lower SFA diets modestly increase Lp(a) compared to higher SFA diets among individuals without ASCVD. This effect appeared to be driven by replacement of SFA with CHO or TFA. Research investigating the atherogenicity of diet-induced Lp(a) changes is needed to inform dietary management of lipid/lipoprotein disorders. This trial was registered with PROSPERO as CRD42020154169.
已经观察到饱和脂肪酸（SFA）摄入量与 Lp(a)浓度之间呈负相关；然而，尚未对这种影响进行量化。
旨在确定 SFA 消耗是否会改变无动脉粥样硬化性心血管疾病（ASCVD）成年人的 Lp(a)浓度。
对无 ASCVD 成年人中 SFA 含量较低的饮食与 SFA 含量较高的饮食进行了系统评价和荟萃分析。通过 2023 年 10 月对 PubMed、Cochrane 临床试验中心注册库、clinicaltrials.gov 和 Web of Science 数据库和注册中心进行了搜索。使用随机效应荟萃分析确定 SFA 含量较低和较高饮食之间 Lp(a)的标准化均数差（SMD）[能量百分比（%E）]。还进行了分析以检查用碳水化合物（CHO）、单不饱和脂肪酸（MUFA）、多不饱和脂肪酸（PUFA）或反式脂肪酸（TFA）替代 SFA 的效果。
系统搜索共确定了 6255 篇出版物。纳入了 26 篇报告了 27 项随机对照试验的出版物，包括 1325 名参与者和 49 项饮食比较。较低 SFA 饮食与较高 SFA 饮食之间的 SFA 平均差异为 7.6%E（3.7%-17.8%E）。在较低 SFA 饮食后，Lp(a)浓度更高（SMD：0.14；95%置信区间[CI]：0.03，0.24）。亚组分析显示，用 CHO（试验=8；n=539；SMD：0.21；95%CI：0.02，0.40）或 TFA（试验=8；n=300；SMD：0.32；95%CI：0.17，0.48）替代 SFA 后，Lp(a)更高。用 MUFA（试验=16；n=641；SMD：0.04；95%CI：-0.08，0.16）或 PUFA（试验=8；n=415；SMD：0.09；95%CI：-0.04，0.22）替代 SFA 时，Lp(a) 无差异。
与较高 SFA 饮食相比，无 ASCVD 成年人的低 SFA 饮食会适度增加 Lp(a)。这种影响似乎是由 SFA 被 CHO 或 TFA 替代引起的。需要研究饮食诱导的 Lp(a)变化的致动脉粥样硬化性，以告知脂质/脂蛋白紊乱的饮食管理。本试验已在 PROSPERO 中注册，注册号为 CRD42020154169。
