p.25 抽出テキスト

......................................................................................... major impact on TG levels, particularly in individuals with HTG.153,170

The detrimental effects of a high-carbohydrate diet on TGs occur mainly when refined carbohydrate-rich foods are consumed, while they are much less prominent if the diet is based largely on fibre-rich, low-glycaemic index foods. This applies particularly to people with DM or MetS.171,172 Habitual consumption of significant amounts (>10% energy) of dietary fructose contributes to TG elevation, particularly in people with HTG or abdominal obesity. These effects are dose-dependent; with a habitual fructose consumption between 1520% of total energy intake, plasma TG increases by as much as 3040%. Sucrose, a disaccharide containing glucose and fructose, represents an important source of fructose in the diet.159,173,174

7.3 Influence of lifestyle on high-density

lipoprotein cholesterol levels Weight reduction increases HDL-C levels; a 0.01 mmol/L (0.4 mg/ dL) increase is observed for every kilogram decrease in body weight when weight reduction has stabilized. Aerobic physical activity, such as 2530 km of brisk walking per week (or any equivalent activity), may increase HDL-C levels by 0.080.15 mmol/L (3.16 mg/dL).169 Smoking cessation may also contribute to HDL-C elevation, provided that weight gain is prevented.163

7.4 Lifestyle recommendations to

improve the plasma lipid profile LDL-C lowering represents the primary target for reducing CV risk and therefore deserves special emphasis in the evaluation of lifestyle measures. The diet recommended to the general population, and particularly to people at increased CV risk, may also be able to modify plasma TG and HDL-C levels (Table 9). This section focuses on dietary and other lifestyle factors that may be implemented to improve the overall lipoprotein profile.

7.4.1 Body weight and physical activity Since overweight, obesity, and—in particular—abdominal adiposity often contribute to dyslipidaemia, caloric intake should be reduced and energy expenditure increased in those with excessive weight and/or abdominal adiposity. In the case of excess weight, body weight reduction, even if modest (510% of basal body weight), improves lipid abnormalities and favourably affects the other CV risk factors often present in dyslipidaemic individuals.148 While the beneficial effects of weight reduction on metabolic and surrogate markers have been demonstrated, the benefits of weight loss on mortality and CV outcome are less clear.175 Weight reduction can be achieved by decreasing the consumption of energy-dense foods, inducing a caloric deficit of 300500 kcal/day. The intervention should combine diet and exercise; this approach also leads to the greatest improvement in physical performance and quality of life, and mitigates reductions in muscle and bone mass, particularly in older people.176 It is always appropriate to advise people with dyslipidaemia to engage in regular physical exercise of moderate intensity for >_30 min/day, even if they are not overweight.168

7.4.2 Dietary fat Avoiding any consumption of trans fat is a key measure of the dietary prevention of CVD. The trans fatty acids produced in the partial hydrogenation of vegetable oils account for 80% of total intake. Thanks to

Table 9 Food choices to lower low-density lipoprotein cholesterol and improve the overall lipoprotein profile

To be preferred To be used in moderation To be chosen occasionally in limited amounts

Cereals Wholegrains Refined bread, rice, and pasta, bis-

cuits, corn flakes Pastries, muffins, pies, croissants

Vegetables Raw and cooked vegetables Potatoes Vegetables prepared in butter or

cream

Legumes Lentils, beans, fava beans, peas,

chickpeas, soybean

Fruit Fresh or frozen fruit Dried fruit, jelly, jam, canned fruit,

sorbets, ice lollies/popsicles, fruit juice

Sweets and sweeteners Non-caloric sweeteners Sucrose, honey, chocolate, sweets/

candies Cakes, ice creams, fructose, soft

drinks

Meat and fish Lean and oily fish, poultry without skin Lean cuts of beef, lamb, pork, and veal, seafood, shellfish Sausages, salami, bacon, spare ribs, hot dogs, organ meats Dairy food and eggs Skimmed milk and yoghurt Low-fat milk, low-fat cheese and

other milk products, eggs Regular cheese, cream, whole milk

and yoghurt

Cooking fat and dressings Vinegar, mustard, fat-free dressings Olive oil, non-tropical vegetable oils, soft margarines, salad dressing,

mayonnaise, ketchup Trans fats and hard margarines (better to avoid them), palm and

coconut oils, butter, lard, bacon fat

Nuts/seeds All, unsalted (except coconut) Coconut Cooking procedures Grilling, boiling, steaming Stir-frying, roasting Frying Downloaded from academic.oup.com/eurheartj/article/41/1/111/5556353 by guest on 07 October 2026