Diyet and Koroner Kalp Hastalığı
Özet
Bol miktarda kanıt, spesifik diyet yağ asitlerinin koroner kalp hastalığında önemli roller oynadığını göstermektedir. Bununla birlikte, spesifik yağ asitleri ile kolesterol alımı ve KKH oranları arasındaki doz-yanıt ilişkileri net olarak tanımlanmamıştır. Doymuş yağ, doymamış yağ ile değiştirildiğinde, doymuş yağ ve kolesterol alımında daha fazla azalma ile KKH sıklıklarında mütevazı azalmalar mümkün olmakla birlikte doymuş yağın karbonhidratla değiştirilmesi durumunda çok az fayda veya hiç fayda görülmemesi olasıdır. Ayrıca, diyetin yağ türü dışındaki yönleri KKH risklerini etkiler ve bunlar, çoğu kan lipidleri üzerindeki etkileriyle ilgisi olmayan çeşitli mekanizmalarla hareket edebilirler. Güçlü kanıtlar, ılımlı alkol alımının ve daha fazla meyve, sebze ve sert kabuklu yemiş alımının KKH riskini azaltacağını göstermektedir. Bu faydaların kısmen daha yüksek potasyum alımına aracılık etmesi muhtemeldir, ancak diğer birçok bileşen de büyük olasılıkla katkıda bulunmaktadır. Bir diyetin karbonhidrat kalitesinin önemli olduğu görünmektedir. Bunu tanımlamanın yolları üzerinde daha fazla çalışmaya ihtiyaç olmakla birlikte çok sayıda kanıt, rafine nişastaların ve ilave şekerin posa bakımından yüksek ve düşük glisemik özellikleri olan tam tahıllarla değiştirilmesinin KKH riskini azaltacağını göstermektedir. Ayrıca, birçok kanıt kırmızı etin balık ve sert kabuklu yemişler gibi alternatif protein kaynaklarıyla değiştirilmesinin koroner kalp hastalığı riskini azaltacağını göstermektedir. Diyetin birçok yönünün etkilerini birleştiren genel diyet kalıplarının analizi, genel diyet kalitesinin kardiyovasküler hastalık riski ile büyük bir ilişkisi olduğunu göstermektedir. Enerji alımı ve harcaması arasındaki dengesizliğin sonucu olan aşırı vücut yağı, KKH için güçlü bir risk faktörü olup, diyetin genel kalitesi kadar önemli görünmektedir.
KKH riskini azaltmak isteyen kişilere sağlıklı beslenme rehberliği sağlamak için daha fazla epidemiyolojik veriye ihtiyaç vardır. Besin veya besin ögelerini, diğer besin veya besin ögeleriyle açıkça karşılaştıran ek ikame analizleri, diyetin etkileri ile daha odaklı ve pratik diyet rehberliği hakkında önemli bilgiler sağlayabilir. Diyetin belirli yönlerini KKH riski ile ilişkilendiren hayvan çalışmalarına ve teorik mekanizmalara dayanan birçok hipotez, insan popülasyonlarında tam olarak araştırılmayı beklemektedir.
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