The health benefits of shellfish: What should we be promoting? Professor Bruce Griffin Nutrition Division Faculty of Health & Medical Sciences

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1 The health benefits of shellfish: What should we be promoting? Professor Bruce Griffin Nutrition Division Faculty of Health & Medical Sciences

2 What should we be promoting? Define health benefits in terms of risk reduction and disease prevention

3 Coronary Heart Disease Thrombus Plaque Plaque rupture Coronary atherosclerosis Coronary thrombosis

4 Age-adjusted 6-year death rate per 1000 men Relationship between CHD death and blood cholesterol Total deaths CHD deaths Blood cholesterol (mmol/l)

5

6 Obesity, metabolic syndrome & diabetes: Major sources of cardio-metabolic risk Frequency in UK by 2020 Obesity Type 2 diabetes 25-30% >6%

7 Metabolic Syndrome: Major source of increased cardio-metabolic risk Pro-inflammatory & Pro-coaguable states Vascular dysfunction Hypertension Obesity (central adiposity) Insulin Resistance (Hyperinsulinaemia) Glucose intolerance Abnormal blood lipids TG HDL Intolerance to dietary fat Abnormal small, dense LDL

8 What are the Risks and Benefits of Diet?

9 What are the Risks and Benefits of Diet? Risks and Benefits Associated with Shellfish? Quantity - Passive over consumption of food energy (fat and carbohydrate) Quality - Types of fat and carbohydrate Fatty acids (as triglyceride) Dietary cholesterol Saturates Monounsaturates Polyunsaturates Omega-6 Omega-3

10 Cholesterol Risks?

11 Blood Cholesterol Dietary Cholesterol? Coronary Heart Disease Low Density Lipoprotein (LDL)

12 Change in Blood Cholesterol (mmol/l) Effect of dietary cholesterol on blood cholesterol: Depends on baseline intake of dietary cholesterol and how much you add to your diet Baseline intake of cholesterol (mg/day) Δ< 0.2mM ~1 egg or ~150g prawns / day Added Dietary Cholesterol (mg/day)

13 Calculated Effects of Dietary Cholesterol versus Saturated Fat on Blood Cholesterol Change in dietary cholesterol 100 mg/day (~half an egg yolk) Change in saturated fat 1% total energy (~2-3g) Change in blood cholesterol ~0.06 mmol/l (~2mg/dl) ~1-3% change in CHD risk

14 Food Example ~10g saturated fat Blood cholesterol-raising potential Saturated Fat vs Dietary Cholesterol ~5 : 1 ~80mg cholesterol

15 Energy, fat, saturated fat and cholesterol content of selected foods / 100g McChance & Widdowson, 2007 Energy Fat Saturated fat Cholesterol (Kj / Kcal) (g) (g) (mg) Egg (boiled) 612 / Prawns (boiled) 418 / Crab (boiled) 535 / Mussels (boiled) 440 / Oysters Burger (raw) / / Pork sausage 1282 / (raw, 65-70% meat) Energy Fat Saturated fat Cholesterol (Kj / Kcal) (g) (g) (mg) Egg (boiled) 612 / Prawns (boiled) 418 / Crab (boiled) 535 / Mussels (boiled) 440 / Burger 1206 / Pork sausage 1282 / Sausage roll 1596 / N (with (raw, puff 65-70% pastry) meat) Sausage roll 1596 / N (with puff pastry)

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17 Dietary Intervention Study with Cold Water Prawns 225g/day for 4 weeks

18 Composition (/100g) of Prawns and Crabsticks Energy Protein Fat Cholesterol EPA+DHA (Kcals) (g) (g) (mg) (mg) Cold water prawns (in shell) Shelled, & cooked Crab sticks trace trace 225g prawns deliver between mg cholesterol & g long chain omega-3

19 Prawn Study Design Randomisation Randomly Study Controlled design Cross-over Wash-out + Habitual crab sticks diet 4wks + crab sticks Habitual diet Habitual diet Run-in 1wk 4 weeks 4 weeks + prawns + prawns Diet diary D 1 D 2 D 3 Blood S 1 S 2 S 3 S 4 S 5 Samples

20 Total plasma cum cholesterol Chol (mmol/l) Prawns: No effect on Total Plasma Cholesterol ± ± Pre-prawn 1 Post-prawn 2 Pre-control 3 Post-control 4 code

21 Benefits? Long chain omega-3 fatty acids

22 Polyunsaturated Fatty Acids Principal Dietary Sources of Long Chain Omega-3 Fatty Acids

23 Regular fish-consumption linked to reduced risk of CHD 36g fish / day (2.2 servings / week) Delivered 0.9g EPA/DHA (as fresh salmon) ~20% reduction in relative risk CHD death ~10% reduction in relative risk total CHD Whelton SP et al (2004) Am J Cardiol 93,

24 Diet And Reinfarction Trial (DART) Effects of changes in fat, fish and fibre intake on death and myocardial re-infarction: 2033 post-mi men randomised to receive either: Fibre advice 18g cereal fibre daily Fatty fish advice 2 portions ( g) of oily fish per week + MaxEPA (~20%) Fat intake advice 30% energy P:S ratio = 1.0 Burr et al (1989) Lancet: 2;

25 Results of DART Fibre advice 18g cereal fibre daily Higher mortality (NS) Fatty fish advice 2 portions ( g) of oily fish per week 29% & 32% reductions in 2 year all-cause mortality and CHD mortality respectively Fat intake advice 30% energy P:S ratio = 1.0 No effect Attributable to reduction in sudden cardiac deaths

26 Dietary Supplementation with Omega-3 PUFA Post-MI GISSI - Prevention Trial Study groups Patients 3mth post-mi n-3 PUFA (0.9mg EPA:DHA (2:1)/d) vitamin E (300mg -tocopherol/d) n-3 PUFA + vitamin E Control intervention 3.5 years Omega-3 PUFA Control Relative risk* (n=2836) (n=2828) (95% CI) Combined endpoints Death, non-fatal MI, non-fatal stroke 356 (12.3%) 414 (14.6%) 0.85 ( ) Cardiovascular death, non-fatal MI, non-fatal stroke 262 (9.2%) 322 (11.4%) 0.80 ( ) * 4-way ANOVA GISSI-Prevenzione Investigators (1999) Lancet 354,

27 Recommendations for intake of long chain omega-3 fatty acids (AHA) Population People without documented coronary heart disease Recommendation Target intake 0.4g/day: Eat a variety of (preferably fatty) fish at least twice a week Patients with documented coronary heart disease Target intake 0.9g/day: From fatty fish, but EPA+DHA supplements could be considered in consultation with physician Patients who need to lower their triglycerides Target intake 2-4g/day EPA + DHA: provided as supplements under a physician s care

28 Manifestations of Coronary Heart Disease Atherosclerosis Thrombosis Arrhythmias Anti-inflammatory Anti-atherosclerotic Stabilise plaque Anti-thrombotic Stabilise myocardium Anti-arrhythmic Multiple Actions of Long Chain Omega-3 Fatty Acids

29 Fish EPA plus DHA (mg/100g eaten) 2 servings ~ g/d Approximate amounts of EPA & DHA in dry heat cooked fish Bays H (2006) Am J Cardiol 98, 71i-76i

30 Long Chain Omega-3 Fatty Acids in Shellfish EPA + DHA mg/100g Data provided by Shellfish Association of Great Britain; Isherwood et al, (2010) Cell & Mol Biol 56; 50-55

31 What is the Target Population for Omega-3 fatty acids? Consider mechanisms of action of LC omega-3s Decrease arrhythmia by stabilising electrical activity of heart muscle Decrease risk of thrombosis Increase vascular reactivity decrease blood pressure Decrease atherosclerotic progression Lower plasma triglycerides Reduce inflammatory response Reduce cardio-metabolic risk

32 Projected future recommendations for intake of long chain omega-3 fatty acids Population People People without at increased documented coronary cardio-metabolic heart disease risk (Obese, metabolic syndrome) type II diabetes Patients with documented coronary heart disease Recommendation Target intake 0.4g/day: Eat a variety of fatty fish and/or shellfish at least twice a week Target intake 0.9g/day: From fatty fish, but EPA+DHA supplements could be considered in consultation with physician Patients who need to lower their triglycerides Target intake 2-4g/day EPA + DHA: provided as supplements under a physician s care

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34 The health benefits of shellfish: What should we be promoting? Summary The case to support a link between dietary cholesterol, in such foods as shellfish (eg. prawns), and clinically significant increases in blood cholesterol is scientifically unfounded Shellfish provide a sustainable source of dietary long chain omega-3 fatty acids, the cardio-protective effects of which may be comparable to that of oily fish

35 ?

36 Thank You

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