高密度脂蛋白之影響因素－飲食、體能及荷爾蒙（上篇：飲食）

Abstract

高密度脂蛋白(HDL)為蛋白質含量最高，密度最大，循環在血液中之脂蛋白(lipoprotein)。HDL在反轉膽固醇運輸機制中扮演主要之角色，因為它會與血中游離的膽固醇以及與周邊組織代謝的膽固醇結合，將其運送到肝臟代謝，減少粥狀動脈硬化之危險，所以俗稱為好的脂蛋白。美國在1988及1993年的國家膽固醇教育計畫(National Cholesterol Education Program, NCEP)中，增加了高密度脂蛋白膽固醇(HDL-C)<35mg/dL，列為與糖尿病、高血壓等危險因數同樣重要的主要導致冠狀動脈心臟病危險因數之一。所以需不需要提高HDL-C？如何提高HDL-C？是營養從業人員常被詢問的問題。本篇針對飲食對高密度脂蛋白之影響作一文獻回顧。一般而言，飲食中醣類攝取與HDL-C多呈負相關，而膽固醇及總脂肪攝取量與HDL-C多呈正相關，脂肪的飽和度及雙鍵位置也可能HDL-C有所影響，蛋白質種類及攝取量對HDL-C影響不大。酒精攝取量是飲食中影響高密度脂蛋白濃度最明顯之因素。

High density lipoprotein (HDL) plays the central role in reverse cholesterol transport, which with highest density and abundant protein component of the lipoprotein moieties. Nascent HDL accepts unesterified cholesterol from peripheral tissues, esterified the free cholesterol and moves cholesterol ester to the core of HDL, then carries the cholesterol ester to liver for further metabolism. Therefore, HDL decreases the peripheral cholesterol deposition and reduces the risk for developing atherosclerotic diseases. In 1988 and 1993, both versions of the National Cholesterol Education Program in U.S.A. added HDL-Cholesterol (HDL-C) less than 35 mg/dL as a risk for coronary heart disease along with other risk factors such as diabetes and hypertension. The nutritionists in Taiwan often were asked the questions like "Is it necessary to raise the HDL level?" and "How to raise the HDL level?" by the clients and other medical professionals. The first review of this HDL series will focus on dietary factors on HDL-C concentration. There was a negative correlation between carbohydrate intake and HDL-C. However, fat and cholesterol intakes were positively correlated with HDL-C levels in most epidemiological and clinical studies. The types of fatty acid with various carbon numbers and positions of double bonds affect HDLC differently. Protein intake was not significantly correlated with HDL-C. The universal agreement is that alcohol consumption is the most significant dietary factor for HDL level.