Tilting Carbohydrate Consumption in Favour of Dietary Fats To Manage CHD Risk?

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1 Tilting Carbohydrate Consumption in Favour of Dietary Fats To Manage CHD Risk? Kalyana Sundram PhD, FASc., FNSM August 2015 Deputy CEO & Director Science & Environment Malaysian Palm Oil Council

2 Carotene and Vitamin E Composition Carotene (1000 ppm) Vitamin E (500 ppm) * 30% alpha carotene * 60% beta carotene * 1% lycopene * 9% others Dr. Oz, USA: A Miracle Food! * 70% tocotrienols * 30% tocopherols

3 From the oil palm fruit two highly different oils are obtained Palm oil 18:2 18:1 16:0 18:0 18:1 12/14:0 Palm kernel oil NUTRI-SEARCH

4 :3 18:2 C18:1 18:0 16:0 AAD 34%en 15:12:7 P/S :0 12:0 10:0 Dietary fat composition: by fatty acids t18: 1 6:0+ 8:0 16:1 Fatty Acids, % Coco PKO MilkF CoaBut Tallow Pstear Palm pole Lard Chick Olive hiosun Canola Soyb Corn Saff saturated fats unsaturated fats

5 "there is a direct link between the intake of SAFAs and the increase of blood low density lipoprotein (LDL) cholesterol concentrations" "EFSA, USDA and FAO/WHO recommend reducing SAFA intake and replacing them with poly- and mono- unsaturated fats" SAFA reduction is in line with the recommendations of all major scientific bodies and authorities, and, although disputed by some scientists, it is supported by the most

6 RISK FACTORS FOR CHD Gender Increasing age Genetics: Family history of CHD High TC, LDL-C Low HDL-C Smoking Diabetes Obesity DIET Fat quality Protein quality Fiber Antioxidants Phytochemicals Carbohydrate type Alcohol

7 Cardiovascular mortality is positively associated with saturated fat consumption (Seven countries study) 300 Y = X; r = 0.85 Cardiovascular mortality per 1000 persons at risk NUTRI-SEARCH SAFA intake (en%)

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9 Saturated fat intake per se is not significantly associated with cardiovascular risk (Siri-Tarino, 2010) Coronary heart disease Stroke Lower risk with SAFA Higher risk with SAFA Relative risk 3 6

10 Relative risk of CHD based on quintiles of dietary fatty acid intake (Multivariate analyses) 20 year follow-up data from the Nurses Health Study 12 to 18% en 4.1 to 7.4% en Adverse effects with tfa Beneficial effects with PUFA 1.6 to 2.8% en SFA MUFA PUFA tfa from Oh et al (2005) Am J Epidemiol, 161:

11 Saturated Fatty Acids - Revisited RRs for coronary outcomes in prospective cohort studies of circulating saturated fatty acid composition Chowdhury et al., Ann Intern Med. 2014;160: doi: /M

12 Where is the Peer- Reviewed Scientific Evidence for Palm Oil and Effects on Blood Lipids? Comes from 38 Peer- Reviewed Human Dietary Intervention Trials all over the world

13 Sundram K, Hornstra G, et al. (1992). Replacement of dietary fat with palm oil: effect on human serum lipids, lipoproteins and apolipoproteins. Br J Nutr. 68(3): Initial Palm Oil Control Initial Palm Oil Control mmol/l 3 mmol/l Serum TC VLDL IDL LDL 0 HDL1 HDL2 HDL3 Increase HDL 2 -C significantly when replaced by palm oil.

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16 The Olive Oil health miracle works only for Virgin Olive Oil due to its high content of polyphenols. It does nor work the same for refined olive oil despite its high mono oleic acid. Dr. Francesco Visioli, Spain, an accomplished authority on olive oil

17 PALM PHENOLICS ARE AKIN TO OLIVE PHENOLICS? (see: BMC GENOMICS, 2011, Br. J of Nutr, 2011, Eur.J Nutr 2012 ASIAN INNOVATIONS AWARD, Far Eastern Economic Review, October 2001 THE TECH MUSEUM, STANFORD UNIV. USA, HONOURED THIS INVENTION AS A TECHNOLOGICAL BREAKTHROUGH BENEFITTING HUMANITY THE TECH MUSEUM LAURATES AWARAD, 2002

18 Study ID Palm vs SAFA: TC:HDLC SMD (95% CI) % Weight (I-V) Denke et al. (1992) Ng et al. (1992) Schwab et al. (1994) Sundram et al. (1994) Tholstrup et al. (1994a) Tholstrup et al. (1994b) Zock et al. (1994) Dougherty et al. (1995)b Schwab et al. (1996) Temme et al. (1996) Cater et al. (1997) Sundram et al. (1997) Zhang et al. (1997)c Nestel et al. (1998) Bonanome et al. (1988) Kelly et al. (2001) Sundram et al. (2007) Tholstrup et al. (2011) Voon et al. (2011) I-V Overall (I-squared = 0.0%, p = 0.769) D+L Overall 0.32 (-0.42, 1.07) (-0.79, 0.18) (-0.76, 0.67) (-0.70, 0.64) 0.36 (-0.36, 1.08) 0.37 (-0.44, 1.18) 0.14 (-0.22, 0.50) (-1.19, 0.57) (-0.85, 0.76) 0.16 (-0.34, 0.65) (-0.97, 0.88) (-0.99, 0.09) (-0.91, 0.12) 0.03 (-0.68, 0.75) 0.33 (-0.51, 1.17) 0.04 (-0.73, 0.81) (-0.92, 0.10) 0.03 (-0.46, 0.52) 0.07 (-0.35, 0.48) (-0.17, 0.10) (-0.17, 0.10) Sundram et al. Unpublished 2014; These data are similar to that of Fattore et al. AJCN 2014

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20 Results of Randomized Studies of the Effects of a Diet High in Trans Fatty Acids (Circles) or Saturated Fatty Acids (Squares) on the Ratio of LDL Cholesterol to HDL Cholesterol Ascherio A et al. N Engl J Med 1999;340:

21 HDL-C: Trans versus Palm Oil Significant HDL-C increasing effect of palm oil versus trans Study ID SMD (95% CI) % Weight (I-V) Mensink et al (1990) Sundram et al (1997) Mensink (2008) Sundram et al (2007) Sundram et al (2003) Vega-Lopez (2006) wood et al (1993)a wood et al (1993)b Muller et al (1998) Nestel et (1992) I-V Overall (I-squared = 22.4%, p = 0.237) D+L Overall 0.56 (0.19, 0.92) 0.91 (0.35, 1.47) 0.17 (-0.25, 0.59) 0.46 (-0.05, 0.97) 1.50 (0.50, 2.50) 0.23 (-0.49, 0.95) 0.27 (-0.24, 0.78) 0.14 (-0.36, 0.65) 0.49 (-0.05, 1.03) 0.65 (0.10, 1.19) 0.46 (0.29, 0.62) 0.46 (0.27, 0.65)

22 SMART BALANCE FAMILY OF FOODS Based on 3 Patents by Sundram et al. and the Brand name SMART BALANCE, a US NASDAQ listed company Boulder Foods Inc. paid US$465 million to acquire this business. This now generates annual product sales of US$275 million Palm oil thus became widely accepted in the US market as a trans fat replacer

23 Low Fat Foods 23

24 Malaysian Prospective Lipid Study: A study on Malaysian Dietary Trends and Effects on Metabolic Profiles and Lipoprotein Particle Sizes MPOC Dr. Kalyana Sundram Team UKM Dr. Tilakavati Karupaiah Chuah Khun Aik, Yeak Zu Wei, Woon Jia En, Adeline Leong, Gaiyal UM: Dr. Karu Chinna The key element in this study was the fact that we tracked Malaysians in the Klang Valley with no history of heart disease or diabetes but each individual (n=577) consumed palm oil/palm olein uninterrupted daily for 15 years or more!

25 Study Flow Health Screening at varies location (n=2790) 1116 subjects were invited to take part Medical screening Excluded: 1674 did not fulfill criteria Excluded: 510 did not turn up or not interested Excluded 8 people were on medication 598 subjects were recruited with informed consent signed Anthropometry Weight Height BMI Waist Circumference Body fat Lean mass Blood pressure Blood & Urine Profile Liver function test Renal function test Lipid profile Glucose Insulin HsCRP Plasma + RBC FAC Lipoprotein Particles Metabolomics 3-day diet records IPAQ Fat & cholesterol Qs Excluded 9 people were on weight loss program 12 people were on special diet regime or extreme underreporters (EI:BMR <0.9) Data Analysis (n=577), SPSS ver 18

26 Correlation between Energy Intake and Metabolic Profile- Insulin, HOMA-IR Total Energy Carbohydrate Fat Intake Protein Intake Intake Intake Spearman s rho r Value r Value r Value r Value TC (mmol/l) LDL (mmol/l) TG (mmol/l) 0.141** 0.182** HDL-C (mmol/l) ** ** * * TC:HDL 0.131** 0.160** LDL:HDL 0.106* 0.129* Waist C. (cm) 0.191** 0.225** 0.111* BP Systolic (mmhg) 0.186** 0.230** * BP Diastolic (mmhg) 0.166** 0.206** * BMI 0.129* 0.135* 0.084* 0.089* Glucose Insulin 0.205** 0.174** 0.184** 0.138* HOMA-IR 0.189** 0.159** 0.177** 0.116* ** correlation is significant at the level (2-tailed) *correlation is significant at the 0.05 level (2-tailed)

27 Low Fat High Carb N=116 Low Fat Low Carb N=157 High Fat High Carb N=218 High Fat low Carb N=86 Groups stratified based on Fat and Carb intake Grouping based on cut off 30% en from Fat & 55% en from Carb based on mean energy intake (=1825 kcal) in MLS population

28 Low Fat Low Carb Low Fat High Carb High Fat Low Carb High Fat High Carb ANOVA n=157 n=116 n=86 n=218 P-value TC (mmol/l) 5.13± ± ± ± HDL-C (mmol/l) 1.55±0.36 a 1.45± ± ±0.38 a TG (mmol/l) 1.03±0.48 ab 1.32±0.69 bc 1.07±0.52 c 1.23±0.65 a <0.001 LDL-C (mmol/l) 3.11± ± ± ± TC:HDL-C 3.49±1.02 b 3.88±1.28 b 3.55± ± HOMA-IR 1.34±1.13 a 1.32±0.89 e 1.47± ±1.74a e Similar alphabets on each values indicate siginificant between 2 groups, based on Tukey s post hoc test.

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30 LDL particle size is a crucial determinant of CVD risk. Small LDL particles are the most atherogenic How diet influences LDL size is an active on-going research question, largely still unexplored! 30

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32 Effect of Nutrient Intake on LDL Lipoprotein Particles Low Fat Low Fat High Fat High Fat ANOVA Low Carb High Carb Low Carb High Carb n=157 n=116 n=86 n=218 P-value LDL-P (nmol/l) 1084± ± ± ± Large LDL-P (nmol/l) 507±189 b 438±233 b 461± ± Small LDL-P (nmol/l) 404±275 ab 537±327 b 461± ±339 a <0.001 A high carbohydrate diet triggers significant increases in Small LDL particles (atherogenic) accompanied by a lowering of large (protective) LDL particles.

33 Emerging overall evidence suggest that SAFAs are mostly neutral for health They are neither a major nutrient of concern nor a health promoting priority for increased intake Continued focus on modifying intake of SAFAs as a single nutrient group is misleading Changes in dietary fats simply cannot explain most of the current reductions in blood cholesterol observed in many populations Medication use also can explain only a small part of the observed global trends in blood cholesterol and blood pressure Source: Darius Mozaffarian, The Lancet/diabetes-endocrinology, June 29, 2015 To-date, there is no proven adversity or increased risk for CHD from long term palm oil consumption. 33

34 Saturated Fats & Palm Oil Current Evidence Revisited The assumption that saturated fat at ANY level of intake is deleterious is no longer supported by scientific evidence Variations in human genetics, lifestage and lifestyles lead to variations in responses to diet, including saturated fat Specific saturated fats at appropriate intakes for overall good health and nutrition is the future of diet and health It is time to put the saturated-fat heart disease hypothesis to bed and seek real scientific evidence for heart disease risk! Low Fat, High Carbohydrate Diets contribute to obesity burden and are not the healthy alternative Palm Oil will benefit from this movement

35 The MLS Team! UKM-UM-MPOC Without their tireless dedication this would not have been possible! 35

36 THANK YOU (fr)