生活方式和饮食控制对HDL-C的影响
HDL and Coronary Heart Disease
Effects of Lifestyle and Dietary Modification on HDL-C Levels
Lifestyle Changes
Weight loss
Smoking cessation
Exercise
Weight and HDL-C
Inverse correlation between body weight and HDL-C is consistently observed in both men and women.
For every 3 kg (7 lb) of weight loss, HDL-C levels increase 1 mg/dL.
Dattilo AM, Kris-Etherton PM. Am J Clin Nutr 1992;56:320–328
Weight Loss Increases HDL-C Level
131 overweight sedentary men were randomized to 1-year intervention of exercise, diet, or no instructions.
Lipids were tracked.
Subjects Wt change LDL-C HDL-C (kg) (mg/dL) (mg/dL)
Control (n = 42) + 0.2 144 40
Exercise (n = 47) - 4.0 138 44*
Diet (n = 42) - 7.2 137 47*
*P < 0.01 vs control subjects
Wood PD et al. N Engl J Med 1988;319:1173–1179
Smoking Cessation Increases HDL-C Level
In study by Moffatt, smokers had HDL-C levels 15–20% lower than nonsmokers (P < 0.05).1
PROCAM showed less of an effect of smoking on HDL-C (7% lower than nonsmokers).2
HDL-C levels returned to normal within 30–60 days after smoking cessation.1
In eight women who smoked > 1 packs per day for 5 years, HDL-C levels increased from 51 to 64 mg/dL after quitting for 60 days.1
1. Moffatt RJ. Atherosclerosis 1988;74:85–89
2. Cullen P et al. Eur Heart J 1998;19:1632–1641
Effects of Chronic Exercise on HDL-C Level
Regular exercise increases HDL-C level.
Kokkinos et al reported a clear dose-response relationship between aerobic exercise (running) and HDL-C levels in healthy men:
HDL-C (mg/dL)
Nonrunner 5 mi/wk 9 mi/wk 12 mi/wk 17 mi/wk 31 mi/wk
(n = 685) (n = 335) (n = 512) (n = 376) (n = 602) (n = 396)
47.3 48.7 50.6* 52.5*? 53.0*? 56.3*?
*P < 0.001 vs nonrunners; ?P < 0.01 vs nonrunners and 5 mi/wk; ?P < 0.01 vs all other groups
Kokkinos PF et al. Arch Intern Med 1995;155:415–420
Dietary Influences
Total fat intake, independent of type
Trans–fatty acids
Alcohol
Caloric restriction
Total Fat Intake
HDL-C levels were significantly associated with dietary fat intake in prepubertal lean boys from several countries.
Be=Benin; Fi=Finland; Ge=Germany; Gr=Greece; Hu=Hungary; It=Italy; Ke=Kenya; Ne=Netherlands; Ph=Philippines; Pol=Poland; Por=Portugal; Ta=Tanzania; US=United States.
West CE et al. Am J Epidemiol 1990;131:271–282
Low-Fat Diets and HDL-C
Low-fat diets with equivalent saturated-fat content lower HDL-C levels (mg/dL) without significantly lowering LDL-C.
Diet (% energy from fat) Mean LDL-C Mean HDL-C
Safflower oil (n = 11)
9% 128 37
20% 128 41
30% 124 46
Olive oil (n = 11)
9% 129 43
20% 136 46
30% 128 48
Morgan SA et al. J Am Diet Assoc 1993;93:644–648
Very-Low-Fat Diets: What Are the Benefits? Epidemiologic Data
Populations that consume low-fat diets have lower CHD rates, LDL-C, and HDL-C than populations with high-fat diets.
It is unknown how much of this association is due to the fat content of the diet, the saturated fat content, or other environmental and lifestyle factors due to industrialization.
Very-Low-Fat Diets: What Are the Benefits? Clinical Trial Data
Angiographic benefit was observed in the Lifestyle Heart Trial (n = 48) with very-low-fat diet + smoking cessation, exercise, weight loss, and meditation.1
No differences in CHD events were seen in 264 men post-MI randomized to 40 g/d fat vs usual diet (110 g/d).2
Changes in fat composition (not quantity) led to significant reductions in CHD events in the Lyon Diet Heart Study.3
1. Ornish D et al. Lancet 1990;336:129–133
2. Ball KP et al. Lancet 1965;ii:501–504
3. de Lorgeril M et al. Lancet 1994;343:1454–1459
Trans–Fatty Acids Have Only a Slight Lowering Effect on HDL-C
Degree of effect is small and is best illustrated in studies where high trans-fatty intake diets were used.
When feeding 20% calories from soybean stick margarine vs soybean oil, HDL-C was lowered by only 1 mg/dL.
Diet LDL-C HDL-C
(mg/dL) (mg/dL)
Oil 154 43
Stick 168 42
Lichtenstein AH et al. N Engl J Med 1999;340:1933–1940
Alcohol Increases HDL-C Level
Alcohol increases HDL-C level in a dose-dependent manner.
Half bottle of wine per day (39 g alcohol) for 6 weeks significantly increased mean HDL-C level by 7 mg/dL in 12 healthy subjects.1
Wine intake did not significantly affect Total-C, Total-TG, or LDL-C.1
One beer per day (13.5 g alcohol) for 6 weeks significantly increased mean HDL-C level by 2 mg/dL in 20 healthy subjects.2
Beer intake did not significantly affect LDL-C, VLDL-C, TG, or apolipoproteins.
1. Thornton J et al. Lancet 1983;ii:819–822
2. McConnell MV et al. Am J Cardiol 1997;80:1226–1228
Caloric Restriction Acutely Lowers HDL-C Level
Trials of very-low-calorie diets show that HDL-C levels decrease by 2–12 mg/dL during acute caloric restriction.
After 12 wks, HDL-C returned to pretreatment range, and this trend was still apparent after 1 year.
Therefore, benefits of weight-loss programs should not be assessed during acute caloric restriction.
R?ssner S et al. Atherosclerosis 1987;64:125–130
Summary Effects of Lifestyle Modifications on HDL-C Levels
Weight reduction
For every 3 kg (7 lb) of weight loss, HDL-C levels increase 1 mg/dL.
Smoking cessation
HDL-C levels in smokers are 7–20% lower than those in nonsmokers.
HDL-C levels return to normal within 30–60 days after smoking cessation.
Exercise
Aerobic exercise (eg, running) increases HDL-C in dose-dependent manner.
Summary (Continued) Effects of Dietary Modifications on HDL-C Levels
Total fat intake
Low-fat diets lower HDL-C in all patients.
Alcohol
Alcohol increases HDL-C in a dose-dependent manner.
Caloric restriction
Caloric restriction acutely lowers HDL-C.