在以上綜述中，三位大師明確質疑血清膽固醇測量（空腹），以及所有以此為指標的研究的相關性，原文：Diet is not just about fasting cholesterol; it is mainly about the postprandial effects of cholesterol, saturated fats, oxidative stress and inflammation. A misplaced focus on fasting lipids obscures three key issues. Dietary cholesterol increases the susceptibility of low-density lipoprotein to oxidation, increases postprandial lipemia and potentiates the adverse effects of dietary saturated fat. Dietary cholesterol, including egg yolks, is harmful to the arteries..
In human subjects, a high intake of dietary cholesterol increased fasting low-density lipoprotein (LDL) levels by approximately 10% (17) in a dose-dependent manner (18). A 10% increase in fasting cholesterol levels may not seem like much, but in the first study to show that diet and cholestyramine reduced coronary risk, a 12% reduction of fasting LDL levels reduced coronary risk by 19% (19). Even the relatively permissive Step 1 American Heart Association diet (300 mg/day of cholesterol and 30% of calories from fat) reduced fasting LDL levels by approximately 10%, compared with a typical western diet (14).
Furthermore, diet is not all about fasting lipids; it is mainly about the three-quarters of the day that we are in the nonfasting state (20). Fasting lipids can be thought of as a baseline; they show what the endothelium was exposed to for the last few hours of the night. Then we get up and eat breakfast. For the next several hours, the endothelium is exposed to sugars, fats, cholesterol and free radicals from that meal, on top of the baseline. Then we have lunch followed by supper and by the time we retire to bed, we have been in a nonfasting state for approximately 18 h of the day. This is determined without even considering snacks between meals.
A focus on fasting LDL and dietary cholesterol levels per se has obscured three important issues. The first is that dietary cholesterol increased susceptibility of LDL to oxidation by 37% (21) in one study and by 39% in another (22).
下麵這張圖來自2013年12月William*****urg心血管大會：
