脂肪和碳水化合物摄入量与心血管疾病和死亡率的相关性，这一成果由英国格拉斯哥大学Carlos Celis-Morales研究小组经过不懈努力而取得。相关论文发表在2020年3月18日出版的《英国医学杂志》上。

为了探讨大量营养素摄入与全因死亡率和心血管疾病（CVD）的关系，以及对饮食建议的影响，研究组进行了一项基于人群的前瞻性研究。

英国生物库中的195658名参与者至少完成了一份饮食调查问卷，并被纳入分析。中位随访10.6年后，4780名（2.4%）参与者死亡；中位随访9.7年后，948名（0.5%）参与者经历了致命性CVD事件，9776名（5.0%）经历了非致命性CVD事件。

许多常量营养素与上述结局之间存在非线性关联。碳水化合物的摄入量与死亡率呈非线性关系，占总能量摄入的20-50%时不相关，但占总能量摄入的50-70％时为正相关。对于糖类观察到相似模式，但对于淀粉或纤维并非如此。

较高的单不饱和脂肪摄入量、较低的多不饱和脂肪摄入量和较低的饱和脂肪摄入量可有效降低死亡风险。研究组制定了饮食风险矩阵，根据当前摄入量给出饮食建议。

总之，大量营养素摄入与健康结局之间的许多关联呈非线性。因此，饮食建议可根据当前摄入量进行调整。

附：英文原文

Title: Associations of fat and carbohydrate intake with cardiovascular disease and mortality: prospective cohort study of UK Biobank participants

Author: Frederick K Ho, Stuart R Gray, Paul Welsh, Fanny Petermann-Rocha, Hamish Foster, Heather Waddell, Jana Anderson, Donald Lyall, Naveed Sattar, Jason M R Gill, John C Mathers, Jill P Pell, Carlos Celis-Morales

Issue&Volume: 2020/03/18

Abstract: AbstractObjective To investigate the association of macronutrient intake with all cause mortality and cardiovascular disease (CVD), and the implications for dietary advice.Design Prospective population based study.Setting UK Biobank.Participants 195658 of the 502536 participants in UK Biobank completed at least one dietary questionnaire and were included in the analyses. Diet was assessed using Oxford WebQ, a web based 24 hour recall questionnaire, and nutrient intakes were estimated using standard methodology. Cox proportional models with penalised cubic splines were used to study non-linear associations.Main outcome measures All cause mortality and incidence of CVD.Results 4780 (2.4%) participants died over a mean 10.6 (range 9.4-13.9) years of follow-up, and 948 (0.5%) and 9776 (5.0%) experienced fatal and non-fatal CVD events, respectively, over a mean 9.7 (range 8.5-13.0) years of follow-up. Non-linear associations were found for many macronutrients. Carbohydrate intake showed a non-linear association with mortality; no association at 20-50% of total energy intake but a positive association at 50-70% of energy intake (3.14 v 2.75 per 1000 person years, average hazard ratio 1.14, 95% confidence interval 1.03 to 1.28 (60-70% v 50% of energy)). A similar pattern was observed for sugar but not for starch or fibre. A higher intake of monounsaturated fat (2.94 v 3.50 per 1000 person years, average hazard ratio 0.58, 0.51 to 0.66 (20-25% v 5% of energy)) and lower intake of polyunsaturated fat (2.66 v 3.04 per 1000 person years, 0.78, 0.75 to 0.81 (5-7% v 12% of energy)) and saturated fat (2.66 v 3.59 per 1000 person years, 0.67, 0.62 to 0.73 (5-10% v 20% of energy)) were associated with a lower risk of mortality. A dietary risk matrix was developed to illustrate how dietary advice can be given based on current intake.Conclusion Many associations between macronutrient intake and health outcomes are non-linear. Thus dietary advice could be tailored to current intake. Dietary guidelines on macronutrients (eg, carbohydrate) should also take account of differential associations of its components (eg, sugar and starch).

DOI: 10.1136/bmj.m688

Source: https://www.bmj.com/content/368/bmj.m688