Duggan M
Med Hypotheses. 1979 Feb;5(2):209-19. doi: 10.1016/0306-9877(79)90120-8.
The theory that a high dietary cholesterol and saturated fat intake has an aetiological role in coronary artery disease is inadequate. So are those theories based upon insulin, upon refined carbohydrate and upon dietary sucrose. An alternate hypothesis is presented. Central to it is prolonged hyperinsulin-aemia. This, acting synergistically with the changes in lipide metabolism secondary to the effects of dietary fibre and sucrose, is crucial to atherogenesis. There is abundant evidence for an association of insulin and vascular changes, both in vitro and in epidemiological studies. Laboratory and epidemiological evidence also exists for an effect of fibre and soluble carbohydrate on cholesterol synthesis and excretion, both as itself and as bile acid. A scheme is presented to demonstrate these complex inter-relationships and their role in vascular diseases.
高膳食胆固醇和饱和脂肪摄入量在冠状动脉疾病中起病因学作用的理论并不充分。基于胰岛素、精制碳水化合物和膳食蔗糖的理论同样如此。本文提出了另一种假说。其核心是长期高胰岛素血症。这与膳食纤维和蔗糖作用继发的脂质代谢变化协同作用，对动脉粥样硬化的发生至关重要。在体外研究和流行病学研究中，都有大量证据表明胰岛素与血管变化有关。关于纤维和可溶性碳水化合物对胆固醇合成和排泄（包括其本身以及作为胆汁酸）的影响，也存在实验室和流行病学证据。本文提出了一个示意图来展示这些复杂的相互关系及其在血管疾病中的作用。
