2022-台灣高血脂初級預防指引- 12. 非藥物治療-酒精攝取建議

2025-12-09 11:08AM

2022台灣血脂治療指引(英文版)下面中文使用google自動翻譯

酒精

酒精攝取與高密度脂蛋白膽固醇（HDL-C）水平升高有關，但酒精攝取與動脈粥狀硬化性心血管疾病（ASCVD）之間的關係尚存爭議。 ^73,74 雖然一些研究表明，少量飲酒與心血管風險和糖尿病風險降低有關，^75-77 但許多其他研究對這一觀點提出了質疑。 ^78-81 近期，一項對來自19個高收入國家（新興風險因素協作組、EPIC-CVD和英國生物銀行）的3個大型數據庫的個體參與者數據進行的綜合分析發現，酒精攝入與卒中、冠狀動脈疾病（CAD）、心力衰竭、致命性高血壓疾病和致命性主動脈瘤的風險呈線性相關，每100克/週酒精攝入量的風險比分別為1.14、1.06、1.09、1.24和1.15。 ⁸² 一項孟德爾隨機化統合分析發現，攜帶乙醇脫氫酶1B（ADH1B）變異等位基因的人群…戒酒率較高、飲酒量較低、酗酒發生率較低的人群，患冠心病（比值比 [OR] 0.90，95% 置信區間 [CI] 0.84-0.96)和腦卒中90% CI 0.72-0.95）的風險顯著降低。 ⁷⁸ 約40-50%的台灣人攜帶乙醛脫氫酶-2 (ALDH2) 功能異常等位基因（ALDH2*2 變異體），飲酒的潛在有害影響可能更為顯著。 ⁸³ ALDH2*2 功能異常等位基因會延緩飲酒後乙醛的代謝，導致「亞洲酒精潮紅症候群」或「酒精不耐受症候群」。 ^84,85 事實上，飲酒與許多急性和慢性疾病有關，並被認為是其中一些疾病負擔的主要危險因子。 ^86,87 基於越來越多的證據表明飲酒的有害影響台灣國家健康署建議，無飲酒習慣者應避免因任何原因開始飲酒。 ⁸⁸ 建議男性每週飲酒量少於100克（14克/天或1杯），女性少於50克（7克/天或0.5杯）（一杯標準飲品約含14克純酒精）。攜帶ALDH2*2功能異常等位基因者強烈建議戒酒。若攜帶ALDH2*2功能異常等位基因者無法避免飲酒，則建議男性每週飲酒量少於64克（9克/天或4杯），女性少於28克（4克/天或2杯）。 ⁸⁹ 應嚴格避免酗酒，酗酒定義為男性2小時內飲用5杯，女性2小時內飲用4杯。

建議：無飲酒習慣者應避免任何原因開始飲酒。 （證據等級 I，證據等級 C）。對於未攜帶 ALDH2*2 功能異常等位基因的男性，每週飲酒量應限制在 100 克以下（14 克/天或 1 杯/天），女性應限制在 50 克以下（7 克/天或 0.5 杯/天）。 （證據等級 I，證據等級 A）。對於攜帶 ALDH2*2 功能異常等位基因的男性，每週飲酒量應限制在 64 克以下（9 克/天或 4 杯/週），女性應限制在 28 克以下（4 克/天或 2 杯/週）。 （證據等級 IIa，證據等級 B）。應嚴格避免酗酒，酗酒定義為男性在 2 小時內飲用 5 杯，女性在 2 小時內飲用 4 杯。 （證據等級 I，證據等級 C）（一杯標準飲品含 14 克純酒精）

Alcohol

Alcohol intake is associated with an increase in HDL-C, but the relation between alcohol consumption and ASCVD is controversial.73,74 Although some studies suggest that low levels of alcohol consumption is associated with a decreased CV risk and diabetes,75e77 many other studies have challenged this view.78e81 More recently, in a combined analysis of individual-participant data from 3 large-scale databases in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank), alcohol consumption was linearly associated with an increased risk of stroke, CAD, heart failure, fatal hypertensive disease, and fatal aortic aneurysm, with hazard ratios per 100 g/week alcohol consumption of 1.14, 1.06, 1.09, 1.24, and 1.15, respectively.82 A Mendelian randomization meta-analysis found that alcohol dehydrogenase 1B (ADH1B) variant allele carriers who had higher abstention, lower alcohol consumption, and lower prevalence of binge drinking had a significantly decreased risk of CAD (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.84e0.96) and ischemic stroke (OR 0.83, 95% CI 0.72e0.95).78 The potential detrimental effect of alcohol drinking could be more pronounced in about 40e50% of Taiwanese who carry the aldehyde dehydrogenase-2 (ALDH2) dysfunctional allele (ALDH2*2 variant).83 The ALDH2*2 dysfunctional allele delays acetaldehyde metabolism following alcohol consumption and leads to “Asian alcohol flushing syndrome” or “alcohol intolerance syndrome”.84,85 Actually, alcohol use has been related to many acute and chronic diseases and is recognized as a leading risk factor for the burden of some of these diseases.86,87 Based on the growing evidence for the detrimental effect of alcohol, the Taiwan Health Promotion Administration suggests individuals without a habit of drinking alcohol should avoid starting drinking for any reason.88 A limited alcohol consumption of <100 g/week (14 g/day or 1 drink/ day) for men and <50 g/week (7 g/day or 0.5 drink/day) for women is recommended (one standard drink Z 14 g pure alcohol). Alcohol abstention is strongly advised for those who carry the ALDH2*2 dysfunctional allele. If alcohol consumption is unavoidable in people carrying the ALDH2*2 dysfunctional allele, more limited alcohol consumption of <64 g/week (9 g/day or 4 drinks/week) for men and <28 g/ week (4 g/day or 2 drinks/week) for women is recommended.89 Binge drinking, defined as
5 drinks for men and
4 drinks for women within 2 h, should be strictly avoided

Recommendation People who do not have a habit of alcohol consumption should avoid starting drinking for any reason. (COR I, LOE C). Alcohol consumption should be limited to <100 g/ week (14 g/day or 1 drink/day) in men and <50 g/ week (7 g/day or 0.5 drink/day) in women without the ALDH2*2 dysfunctional allele. (COR I, LOE A). Alcohol consumption should be limited to <64 g/ week (9 g/day or 4 drinks/week) in men and <28 g/ week (4 g/day or 2 drinks/week) in women with the ALDH2*2 dysfunctional allele. (COR IIa, LOE B). Binge drinking, defined as
5 drinks for men and
4 drinks for women within 2 h, should be strictly avoided. (COR I, LOE C) (One standard drink Z 14 g pure alcohol)