BMJ：跌眼镜！降低胆固醇反而增加死亡率！

2016-04-17 MedSci MedSci原创

数十年来，医学界一直提倡以植物油或鱼油代替动物脂肪，降低患心血管疾病风险，牛油、肥肉、芝士均被视为不健康食物。类似这样的新闻：坏胆固醇成国人死亡首因，8种食物降低坏胆固醇，到处都是！一般认为植物油中富含亚油酸（linoleic acid），用来代替饱和脂肪酸（以动物油为代表），可以降低心血管疾病，如冠心病。不过，美国国家卫生研究院（NIH）周三发表研究报告指，不饱和脂肪的确有效降低血液中的胆固

数十年来，医学界一直提倡以植物油或鱼油代替动物脂肪，降低患心血管疾病风险，牛油、肥肉、芝士均被视为不健康食物。类似这样的新闻：坏胆固醇成国人死亡首因，8种食物降低坏胆固醇，到处都是！一般认为植物油中富含亚油酸（linoleic acid），用来代替饱和脂肪酸（以动物油为代表），可以降低心血管疾病，如冠心病。

不过，美国国家卫生研究院（NIH）周三发表研究报告指，不饱和脂肪的确有效降低血液中的胆固醇，但胆固醇减幅愈大，死亡风险反而愈高。报告结果完全颠覆过去的观念。

该项由拉姆斯登（Christopher Ramsden）领导的研究 Minnesota Coronary Experiment (MCE)，刊于世界权威医学期刊——《英国医学期刊》（BMJ）。研究分析明尼苏达州的精神病院及护理院45年前的数据。约9400人被随机分成两组，其中一组的餐单以植物油代替饱和脂肪，另一组的餐单则含有高量动物脂肪。

一如所料，食用植物油组人群，血液胆固醇含量明显下降（平均从基线值-13.8%v-1.0%; P<0.001）。生存分析结果显示，两组并无任何区别，同时各种预设的亚组分析，也未观察到差异。令人惊讶的是，通过COX回归分析，校正协变量后发现，血液中胆固醇每下降30 mg/dL (0.78 mmol/L)，人群的死亡风险增加22%（HR: 1.22, 95%:CI：1.14 to 1.32; P<0.001），也没有发现降胆固醇对冠心病，心肌梗死有任何益处。进一步通过系统综述和meta分析，也得出类似结论，降低胆固醇的治疗，并不能给心血管疾病带来获益。

澳洲昆士兰大学讲师费尔曼（Lennert Veerman）评论指，研究显示，以不饱和脂肪取代饱和脂肪的效用，比我们想像的低；但需要作更多研究，以证实是否所有类型的奥米加6（Omega-6）不饱和脂肪，都有同样的研究结果。在有进一步结果之前，应该继续提倡进食更多鱼类、蔬果及全谷类食物。

这项研究发表后，立即引起全球学者的广泛讨论，但总的观点包括：

（1）植物油富含不饱和脂肪酸，其作用可能被夸大.

（2）动物油中饱和脂肪酸同样十分重要，人们应该从不同来源的食物中获取脂肪酸，包括坚果，植物，鱼，以及肉类。

（3）饱和脂肪酸是否有害，不饱和脂肪酸是否有益，还需要进一步研究。

（4）减肥与降胆固醇是两回事，降胆固醇也许不重要，但是减肥依然十分重要。

与胆固醇相关的拓展阅读：

有关胆固醇更多资讯

原始出处：

Ramsden CE, Zamora D, Majchrzak-Hong S, Faurot KR, Broste SK, Frantz RP, Davis JM, Ringel A, Suchindran CM, Hibbeln JR.Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73).BMJ. 2016 Apr 12;353:i1246. doi: 10.1136/bmj.i1246.

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#插入话题

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[GetPortalCommentsPageByObjectIdResponse(id=141007, encodeId=304814100eb6, content=文章真心很好，感谢作者, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Thu Oct 06 13:57:58 CST 2016, time=2016-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1847960, encodeId=bbee184e960c3, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Mon Sep 05 17:05:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=82696, encodeId=908e8269620, content=入选人群怎么样？对于有心血管危险因素的，降胆固醇确定有益无疑。, beContent=null, objectType=article, channel=null, level=null, likeNumber=194, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9ebb1716792, createdName=黑心天使, createdTime=Mon Apr 25 11:18:00 CST 2016, time=2016-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=80058, encodeId=a179800580d, content=物极必反~, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xwU6047w4GQZHmaJMe3cGxCqPS0x43a9R04dN3HrAn5diaR2N4pEwoibqiaiaA3m6ia3g3XbZXadIomlRa5WAvjSUHb/0, createdBy=93aa1715091, createdName=为啥子, createdTime=Thu Apr 21 20:05:00 CST 2016, time=2016-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79613, encodeId=9cf1e961338, content=平衡，是永远的话题。任何东西过多过少都不好，平衡才是健康的前提。胆固醇还是体内一些激素合成的前体，长期低水平肯定不利于健康。所以，饮食要平衡，动物脂肪同样要摄取，但是不要过量。, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6ee81714827, createdName=yanan1954, createdTime=Tue Apr 19 17:58:00 CST 2016, time=2016-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1560385, encodeId=98921560385d6, content=<a href='/topic/show?id=4ff1e294238' target=_blank style='color:#2F92EE;'>#眼镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72942, encryptionId=4ff1e294238, topicName=眼镜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=508115130308, createdName=zhangfenasdf, createdTime=Tue Apr 19 13:05:00 CST 2016, time=2016-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1566394, encodeId=379c156639449, content=<a href='/topic/show?id=4ff1e294238' target=_blank style='color:#2F92EE;'>#眼镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72942, encryptionId=4ff1e294238, topicName=眼镜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=508115130308, createdName=zhangfenasdf, createdTime=Tue Apr 19 13:05:00 CST 2016, time=2016-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79497, encodeId=12a8e94973e, content=文章不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=146, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Tue Apr 19 01:22:00 CST 2016, time=2016-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79498, encodeId=b2e7e949887, content=学习了…, beContent=null, objectType=article, channel=null, level=null, likeNumber=187, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Tue Apr 19 01:22:00 CST 2016, time=2016-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79326, encodeId=b950e932663, content=肥胖是不好的！！！, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=078f1661649, createdName=wei834766788, createdTime=Mon Apr 18 11:38:00 CST 2016, time=2016-04-18, status=1, ipAttribution=)]
2016-10-06 1e10c84am36(暂无匿称)

文章真心很好，感谢作者

124 0
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2016-09-05 gaoxiaoe

#BMJ#

66 0
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2016-04-25 黑心天使

入选人群怎么样？对于有心血管危险因素的，降胆固醇确定有益无疑。

194 0
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2016-04-21 为啥子

物极必反~

127 0
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2016-04-19 yanan1954

平衡，是永远的话题。任何东西过多过少都不好，平衡才是健康的前提。胆固醇还是体内一些激素合成的前体，长期低水平肯定不利于健康。所以，饮食要平衡，动物脂肪同样要摄取，但是不要过量。

129 0
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2016-04-19 zhangfenasdf

#眼镜#

73 0
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2016-04-19 zhangfenasdf

#眼镜#

64 0
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2016-04-19 李继凯

文章不错

146 0
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2016-04-19 李继凯

学习了…

187 0
[GetPortalCommentsPageByObjectIdResponse(id=141007, encodeId=304814100eb6, content=文章真心很好，感谢作者, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Thu Oct 06 13:57:58 CST 2016, time=2016-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1847960, encodeId=bbee184e960c3, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Mon Sep 05 17:05:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=82696, encodeId=908e8269620, content=入选人群怎么样？对于有心血管危险因素的，降胆固醇确定有益无疑。, beContent=null, objectType=article, channel=null, level=null, likeNumber=194, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9ebb1716792, createdName=黑心天使, createdTime=Mon Apr 25 11:18:00 CST 2016, time=2016-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=80058, encodeId=a179800580d, content=物极必反~, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xwU6047w4GQZHmaJMe3cGxCqPS0x43a9R04dN3HrAn5diaR2N4pEwoibqiaiaA3m6ia3g3XbZXadIomlRa5WAvjSUHb/0, createdBy=93aa1715091, createdName=为啥子, createdTime=Thu Apr 21 20:05:00 CST 2016, time=2016-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79613, encodeId=9cf1e961338, content=平衡，是永远的话题。任何东西过多过少都不好，平衡才是健康的前提。胆固醇还是体内一些激素合成的前体，长期低水平肯定不利于健康。所以，饮食要平衡，动物脂肪同样要摄取，但是不要过量。, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6ee81714827, createdName=yanan1954, createdTime=Tue Apr 19 17:58:00 CST 2016, time=2016-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1560385, encodeId=98921560385d6, content=<a href='/topic/show?id=4ff1e294238' target=_blank style='color:#2F92EE;'>#眼镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72942, encryptionId=4ff1e294238, topicName=眼镜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=508115130308, createdName=zhangfenasdf, createdTime=Tue Apr 19 13:05:00 CST 2016, time=2016-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1566394, encodeId=379c156639449, content=<a href='/topic/show?id=4ff1e294238' target=_blank style='color:#2F92EE;'>#眼镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72942, encryptionId=4ff1e294238, topicName=眼镜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=508115130308, createdName=zhangfenasdf, createdTime=Tue Apr 19 13:05:00 CST 2016, time=2016-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79497, encodeId=12a8e94973e, content=文章不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=146, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Tue Apr 19 01:22:00 CST 2016, time=2016-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79498, encodeId=b2e7e949887, content=学习了…, beContent=null, objectType=article, channel=null, level=null, likeNumber=187, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Tue Apr 19 01:22:00 CST 2016, time=2016-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79326, encodeId=b950e932663, content=肥胖是不好的！！！, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=078f1661649, createdName=wei834766788, createdTime=Mon Apr 18 11:38:00 CST 2016, time=2016-04-18, status=1, ipAttribution=)]
2016-04-18 wei834766788

肥胖是不好的！！！

132 0

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