循環器外来患者における血漿不飽和脂肪酸値と独自の魚チェックシートによる栄養指導の有用性に関する検討

Usefulness of Nutrition Counseling Using an Original Fish Check Sheet on Plasma Unsaturated Fatty Acid Levels in Cardiovascular Outpatients

要旨　循環器外来患者における，不飽和脂肪酸値〔ジホモγリノレン酸(DGLA)，アラキドン酸(AAA)，エイコサペンタエン酸(EPA)，ドコサヘキサエン酸(DHA)〕と生化学検査値(HbA1c，LDL，HDL，hsCRP)との関係，および魚チェックシートを使用した食事内容と不飽和脂肪酸値との関係を検討することを目的とした．165例(平均年齢66±11歳，男性120例，女性45例)に採血検査を行い，さらにEPA値が低値である患者には栄養指導後の食事内容をスコア化した．栄養指導前のEPA/AA比と生化学検査値との間に相関関係は認めなかった．栄養指導後はEPAの有意な増加およびEPA/AA比の有意な上昇を認めた(前64.6±35.0μg/ml，後102.5±46.4μg/ml，前0.40±0.22，後0.66±0.28；両者ともp＜0.001)．魚チェックシートのスコアとEPA値は有意な正の相関関係を認め(R＝0.49，p＝0.05)，脂質管理の指導に有用と思われた．

　This study aimed at investigating the relationship between plasma unsaturated fatty acid levels ［dihomo-gamma-linolenic acid(DGLA), arachidonic acid(AA), eicosapentaenoic acid(EPA), docosahexaenoic acid(DHA)］ and biochemical data(hemoglobin A1c, LDL-cholesterol, HDL-cholesterol, high sensitivity C-reactive protein), and to examine the relationship between meal content using the Fish Check Sheet and plasma unsaturated fatty acid levels in cardiovascular outpatients. Blood was collected and analyzed for lipid and biochemical parameters in a total of 165 patients(120 men and 45 women, mean age 66±11 years). In patients with low EPA levels(n＝17), nutrition counseling was conducted and the patients were instructed to record fish consumption on the Fish Check Sheet that we designed. After counseling, the meal content as recorded on the Fish Check Sheet was scored. No correlation was observed between biochemical data and the EPA/AA ratio before counseling. Plasma EPA level and EPA/AA ratio were significantly increased after counseling(64.6±35.0 μg/ml vs. 102.5±46.4 μg/ml, 0.40±0.22 vs. 0.66±0.28; both p＜0.001). Furthermore, a significant positive correlation was found between the Fish Check Sheet score and EPA level(R＝0.49, p＝0.05). These results suggest that the Fish Check Sheet is useful for providing guidance on lipid management.