Thursday, December 1, 2011

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1 Thursday, December 1, 2011

2 Housekeeping Items Q&A period will follow the webcast This webcast is good for one (1) hour of CPE credit. An will be sent following today s presentation with a link to download your CPE certificate PDF version of the slides will be made available on our Follow us on #foodinsight

3 Today s Learning Objectives Clearly define and provide examples of omega-6 and omega-3 fatty acids Understand the state of the science for and the usefulness of an omega-6:omega-3 ratio Recognize the importance of leading dietary recommendations for omega-6 fatty acids

Today s Speakers Marianne Smith Edge, MS, RD, LD,

South Dakota President, OmegaQuant, LLC, Sioux

4 Today s Speakers Marianne Smith Edge, MS, RD, LD, FADA Senior Vice President, Food Safety and Nutrition William Harris, PhD Research Professor of Medicine, Sanford School of Medicine, University of South Dakota President, OmegaQuant, LLC, Sioux Falls, SD Senior Scientist, Health Diagnostic Lab, Inc., Richmond, VA

5 IFIC Foundation Food & Health Survey

2011 FOOD & HEALTH SURVEY 2 I N F O R M A T I O N S O U R C E S A N D I N F L U E N C E S Factors Influencing Purchasing Decision Taste continues to be the main driver of purchasing foods and

Taste 87% Price 79% 06-10 Healthfulness 66% 06, 09, 10 Convenience 58% 07, 09 Sustainability 52% How much of an impact do the following have on your decision to buy foods and beverages?

6 2011 FOOD & HEALTH SURVEY 2 I N F O R M A T I O N S O U R C E S A N D I N F L U E N C E S Factors Influencing Purchasing Decision Taste continues to be the main driver of purchasing foods and beverages, but price continues to rise as a significant factor, followed by healthfulness and convenience. Sustainability, added in 2011, is important to about half of Americans. Taste 87% Price 79% Healthfulness 66% 06, 09, 10 Convenience 58% 07, 09 Sustainability 52% How much of an impact do the following have on your decision to buy foods and beverages?* [Scale: 1= No impact at all 5= A great impact ] (n=1000) *Question asked since ** Sustainability added in An Impact (Top 2) / Significant increase/decrease from year indicated INTERNATIONAL FOOD INFORMATION COUNCIL FOUNDATION 6

7 2011 FOOD & HEALTH SURVEY 3 D I E T A R Y C O M P O N E N T S Concern Regarding Type of Fats The majority of Americans are concerned about the type of fats they consume. Extremely concerned 20% Not at all concerned 8% Not very concerned 11% 60% of Americans are concerned about the type of fats consumed Neither concerned nor unconcerned 22% Somewhat concerned 40% How concerned are you about the type of fats you consume?* [Select one] (n=1000) *Question added in INTERNATIONAL FOOD INFORMATION COUNCIL FOUNDATION 7

8 2011 FOOD & HEALTH SURVEY 3 D I E T A R Y C O M P O N E N T S Trying to Limit Fats Among the 71% of Americans trying to limit fat consumption, the majority are focused on saturated fats. 71% of Americans are trying to limit some type(s) of fat Saturated fats Trans fats Polyunsaturated fats Monounsaturated fats 19% 17% 49% 56% Omega 6 fatty acids Omega 3 fatty acids 8% 6% 29% of Americans are not trying to limit any type(s) of fat None of the above 29% Which of the following are you trying to limit?* [Select all that apply] (n=1000) *Question added in INTERNATIONAL FOOD INFORMATION COUNCIL FOUNDATION 8

9 2011 FOOD & HEALTH SURVEY 3 D I E T A R Y C O M P O N E N T S Fats Considered Healthful While nearly one in five Americans say they do not consider any fats to be healthful, at least half consider fish oils and omega-3 fatty acids healthful. Very few name the healthful poly- and monounsaturated fats. Fish oils Omega-3 fatty acids Vegetable oils Omega-6 fatty acids Polyunsaturated fats Monounsaturated fats Tropical oils Hydrogenated oils Animal fats Trans fats Partially hydrogenated oils Saturated fats None of the above 12% 11% 9% 5% 5% 5% 4% 4% 17% 32% 30% 50% 62% Which of the following types of fat or fatty acids do you consider to be healthful?* [Select all that apply] (n=1000) *Question added in INTERNATIONAL FOOD INFORMATION COUNCIL FOUNDATION 9

10 N-6 Fatty Acids: Harmful or Helpful? N6:N3 Ratios: Useful or Not? Research Professor of Medicine Sanford School of Medicine University of South Dakota President OmegaQuant, LLC Sioux Falls, SD Senior Scientist Health Diagnostic Lab, Inc. Richmond, VA

11 Essential Fatty Acid Families H 3 C H 3 C ω-6 family C18:2 ω-6 Linoleic Corn Oil Safflower Oil Sunflower Oil C20:4 ω-6 Meat Eggs COOH COOH Arachidonic C18:3 ω-3 H 3 C H 3 C Flaxseed Oil Canola Oil Soybean Oil ω-3 family COOH -Linolenic COOH C20:5 ω-3 Eicosapentaenoic (EPA) H 3 C COOH C22:6 ω-3 Docosahexaenoic (DHA) Oily Fish Fish Oil

12 Mean PUFA Intake in U.S. NHANES * Nutrient Total % of en PUFA 17.0 g 7.1 % 18:2 n-6 (linoleic) 15.1 g 6.3 % 20:4 n-6 (arachidonic) 130 mg 0.05% 18:3 n-3 (ALA) 1.5 g 0.6 % 20:5 n-3 (EPA) 40 mg 0.017% 22:6 n-3 (DHA) 70 mg % N-6:N-3 Ratio 9.5:1 U.S. Department of Agriculture, Agricultural Research Service Nutrient Intakes from Food: Mean Amounts Consumed per Individual, One Day, * Males and Females aged 2 and above; n=8549

13 2010 Dietary Guidelines for Americans Linoleic acid - 5% to 10% of total kcalories U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, th Edition, Washington, DC: U.S. Government Printing Office, December Appendix 5, p.89.

14 AHA Summary Consumption of at least 5-10% of energy from omega-6 PUFA reduces the risk of CHD relative to lower intakes, and higher intakes may be even more beneficial. We have no clinical evidence of harm. To recommend reductions in omega-6 PUFA intakes from their current levels would be more likely to increase than decrease risk for CHD. Harris WS, Mozaffarian D, Rimm E, Kris-Etherton PM, Rudel LL, Appel LJ, Engler MM, Engler MB, Sacks F. Omega-6 Fatty Acids and Risk for Cardiovascular Disease. A Science Advisory from the AHA Nutrition Committee. Circulation 2009;119:

So What s the Problem? I consider omega-6 fats [i.e., linoleic acid, LA] the really bad fats because they can lead to increased formation of arachidonic acid, the building block of all the bad eicosanoids.

15 So What s the Problem? I consider omega-6 fats [i.e., linoleic acid, LA] the really bad fats because they can lead to increased formation of arachidonic acid, the building block of all the bad eicosanoids. (Barry Sears, The OmegaRx Zone. The miracle of the new high dose fish oil. 2002) Even though the medical establishment for decades has advised you to consume vegetable oils (omega-6 PUFAs) to prevent heart disease, human trials have conclusively demonstrated that vegetable oils DO NOT decrease atherosclerosis or decrease your risk of dying from cardiovascular disease. Most people consume far too many omega-6 fats and relatively few omega-3 fats, which promotes the ongoing inflammation underlying most chronic diseases seen today. (Dr. Joe Mercola at Mercola.com)

16 The Four Pillars of the Anti N-6 Position Higher LA intakes lower EPA/DHA levels Higher LA intakes raise AA levels AA is proinflammatory Higher n-6 intakes = more disease

17 No effect of background omega-6 fatty acid intake on incorporation of omega-3 fatty acids into rat cardiac tissue Low n-6 = 1.8% en as LA High n-6 = 7.7% en as LA Ventricular DHA levels on low (o) and high ( ) n-6 diets across a range of omega-3 intakes Slee et al. J Lipid Res 2010;51:

18 The Four Pillars of the Anti N-6 Position Higher LA intakes lower EPA/DHA levels Higher LA intakes raise AA levels AA is proinflammatory Higher n-6 intakes = more disease

19 % change in plasma PL AA No Effect on Plasma Phospholipid AA Content from Changing LA intakes Increasing Dietary LA (% en) on Changes (%) in AA R 2 =0.06 P= Decreasing Dietary LA (% en) on Changes (%) in AA P=0.46 R 2 = % change in plasma PL AA Tracer studies in humans showed that <0.2% of dietary LA is converted to AA. Hussein et al. JLR 2005;46: Rett BS and Whelan J. Nutr Metab 2011;8:36 Diamonds = NS findings Triangles = Significant findings

20 The Four Pillars of the Anti N-6 Position Higher LA intakes lower EPA/DHA levels Higher LA intakes raise AA levels AA is proinflammatory Higher n-6 intakes = more disease

21 n-3 fatty acids n-6 fatty acids Dihydroxyeicosatrienoic acids inactive seh 5-HETE 4-series Leukotrienes pro-inflammatiory Lipoxin A 4 anti-inflammatory It is overly simplistic to assume that all AA products are proinflammatory 15-LOX and 5-LOX or 5-LOX and 12-LOX COX-2 and 5-LOX Epoxyeicosatrieonic acids 5-LOX anti-inflammatory CYP450 AA Phospholipase COX-1 or -2 Phospholipid Phospholipase EPA DHA COX-1 or 2 2-series Thromboxanes Vasoconstrictive - proaggregatory 2-series Prostaglandins Vasodilatiative and constrictive Pro- and anti-aggregatory Anandamides and monoacyl glycerols (AA, EPA, DHA) Endocannabinoid receptor activation E-series Resolvins 5-series Leukotrienes inactive anti-inflammatory 3-series Prostaglandins Vasodilatative -antiaggregatory 3-series Thromboxanes inactive COX-2 and 5-LOX 5-LOX 5-LOX COX-1 or -2 COX-1 or -2 CYP450 D-series Resolvins anti-inflammatory Neuroprotectin D1 anti-inflammatory 17(R),18(S)-Epoxyeicosaquatraenoic acid Epoxydocosapentaenoic acid anti-inflammatory De Roos et al. Brit J Pharmacol 2009;58:

22 PGE 2 - Case In Point PGE 2 (a major AA-derived eicosanoid) has potent proinflammatory effects, including inducing fever and enhancing pain, but it also has anti-inflammatory properties, such as suppressing lymphocyte proliferation and inhibiting the production of certain interleukins and other cytokines. PGE 2 also inhibits the action of 5-lipoxygenase, which is involved in the synthesis of pro-inflammatory leukotrienes, and stimulates the activity of the antiinflammatory lipoxins. Therefore, PGE 2 has a role in initiating the inflammatory response and in its eventual resolution. From the Lipid Library, American Oil Chemists Society

23 Association between Plasma Inflammatory Markers and Fatty Acids in the Ageing in Chianti Study + = significant positive relationship between marker and FA - = significant negative relationship between marker and FA Pro/Anti-Inflammatory Marker AA EPA DHA IL-6 Pro IL-1ra Pro - - TNF- Pro IL-10 Anti + TGF-β Anti Anti-inflammatory state associated with higher plasma AA Ferrucci L, et al. Relationship of plasma polyunsaturated fatty acids to circulating inflammatory markers. J Clin Endocrinol Metab. 2006;91:

24 The Four Pillars of the Anti N-6 Position Higher LA intakes lower EPA/DHA levels Higher LA intakes raise AA levels AA is proinflammatory Higher n-6 intakes = more disease

25 (Very) High LA Diets Reduce Atherosclerosis in Non-Human Primates PUFA=safflower oil 40% en; >25% en LA Adapted from Wolfe et al. Arterio Thromb 1994

Relative Risk for CHD over 14 years in the Health Professionals Follow-up Study: Interplay of n6 and n3 Fatty Acids Above (High) and below (Low) median intakes: N-6 = 11.2 g EPA+DHA=0.25 g ALA=1.

26 Relative Risk for CHD over 14 years in the Health Professionals Follow-up Study: Interplay of n6 and n3 Fatty Acids Above (High) and below (Low) median intakes: N-6 = 11.2 g EPA+DHA=0.25 g ALA=1.08 g/d * * Our findings provide the strongest evidence to date that n-6 PUFA intake does not appreciably counteract the effects of either intermediateor long-chain n-3 PUFAs on the risk of CHD events. N-6 Fatty Acids Low High Low High N-6 Fatty Acids Low High Low High Low High Model adjusted for age; BMI; smoking; history of hypertension, diabetes, hypercholesterolemia; use of alcohol, aspirin; physical activity; intakes of saturated fat, protein, fiber, trans fats, mono fats, EPA+DHA [for ALA analysis], ALA [for EPA+DHA analysis]; and total energy. * p<0.05 vs Lo-Lo Mozaffarian et al. Circulation 2005;111;

27 Relative Risk for MI over 5-7 years in Healthy Subjects According to Serum Phospholipid Linoleic Acid at Baseline (Adapted from Miettinen, BMJ, 1982)

28 Relations between Plasma Cholesteryl Ester Linoleic Acid Levels and 34-yr CHD Mortality in 50 yr-old men (n=2009) Warensjo et al. Am J Clin Nutr 2008;88:

29 Fatty Acid Intake and Sudden Cardiac Death Nurses Health Study Higher intakes of both n-6 and n-3 fatty acids were associated with lower risk for sudden cardiac death. N-6 PUFA intake enhances, rather than attenuates, the inverse association between n-3 PUFA intake and SCD. These results support the AHA dietary guidelines to increase n-6 and n- 3 PUFA intake for heart health. Chiuve SE, et al. Presented at 2011 AHA meeting (Nov 13, 2011) italic added

30 Effects on CHD risk of consuming PUFA, carbohydrate, or MUFA in place of SFA Mozaffarian et al. PLoS Med 2010;7:

31 Meta-Analysis of Randomized Controlled Trials Testing the Effects of Replacing Saturated Fats with PUFAs Mozaffarian et al. PLoS Med 2010;7:

The Ramsden Critique Randomized Controlled Trials with PUFA Replacing Saturated/Trans Fatty Acids Non-fatal MI + CHD Death Advice to specifically increase n-6 PUFA intake,

32 The Ramsden Critique Randomized Controlled Trials with PUFA Replacing Saturated/Trans Fatty Acids Non-fatal MI + CHD Death Advice to specifically increase n-6 PUFA intake, based on mixed n-3/n-6 RCT data, is unlikely to provide the intended benefits, and may actually increase the risks of CHD and death. Ramsden et al. Brit J Nutr 2010;104:1856

33 Response to Ramsden et al. The total body of evidence continues to support the view that higher consumption of n-6 PUFA lowers the risk of CHD. Metabolic feeding trials demonstrate clear benefits of n-6 PUFA consumption on blood lipid levels, and large prospective observational cohorts demonstrate significant inverse associations between n-6 PUFA or total PUFA consumption and risk of CHD events. The magnitudes of both the expected lower risk from blood lipid changes and the observed lower risk in cohort studies are remarkably consistent with the risk reduction demonstrated by Ramsden et al. in the soybean oil trials and in prior meta-analyses of all PUFA trials. Based on these findings, and together with emerging evidence on cardiovascular benefits of ALA, it would be reasonable to recommend (as the American Heart Association has done) increased consumption of both forms of PUFA, n-6 and n-3, both plant- and fish-derived. Letter to the Editor Harris, Brower and Mozaffarian. Brit J Nutr 2011

34 A Review from France... Data from prospective cohort and interventional studies converge towards a specific protective role of dietary n-6 PUFA intake, in particular linoleic acid, against CVD. N-6 PUFA benefits are even increased when SFA intake is also reduced. In regards to studies examined in this narrative review, recommendation for n-6 PUFA intake above 5%, and ideally around 10% of total energy appears justified. Czernichow S, Thomas D, Bruckert E. Omega-6 fatty acids and cardiovascular health: a review of the evidence for dietary intake recommendations. Brit J Nutr 2010; 104(6):

35 The Four Pillars of the Anti N-6 Position Higher LA intakes lower EPA/DHA levels Higher LA intakes raise AA levels AA is proinflammatory Higher n-6 intakes = more disease

36 Problems with the N6:N3 Ratio No distinction made between ALA and EPA/DHA, or between LA and AA Effectively presumes physiological equivalence within class Infinite number of absolute intakes can produce the same ratio Makes it difficult to formulate a practical dietary guideline Suggests that equal benefit can to be obtained from reducing n-6 intake as from increasing n-3 intake CHD endpoint data indicate that both are beneficial Any predictive value of the ratio is carried in the n-3 FA component Harris WS. The omega-6/omega-3 fatty acid ratio and cardiovascular disease risk: Uses and abuses. Curr Athero Repts 2006;8:

37 Problems with the N6:N3 Ratio No distinction made between ALA and EPA/DHA, or between LA and AA Incorrectly presumes physiological equivalence within class Infinite number of absolute intakes can produce the same ratio Makes it difficult to formulate a practical dietary guideline Suggests that equal benefit can to be obtained from reducing n-6 intake as from increasing n-3 intake CHD endpoint data indicate that both are beneficial Any predictive value of the ratio is carried in the n-3 FA component Harris WS. The omega-6/omega-3 fatty acid ratio and cardiovascular disease risk: Uses and abuses. Curr Athero Repts 2006;8:

38 Five Ways to Lower the n-6:n-3 Ratio n-3 n-6 Ratio Harris WS. The omega-6/omega-3 fatty acid ratio and cardiovascular disease risk: Uses and abuses. Curr Athero Repts 2006;8:

39 An Infinite Number of Ways to Achieve a n-6/n-3 Ratio of 10 N-6 (LA) % en (g/d) 19 (42) 17 (38) 2 (4.4) 1 (2.2) N-6 (AA) % en (g/d) 1 (2.2) 3 (6.7) 0 1 (2.2) N-3 (ALA) % en (g/d) 2 (4.4) (0.44) 0 N-3 (EPA and/or DHA) % en (g/d) 0 2 (4.4) (0.44) N-6:N Harris WS. The omega-6/omega-3 fatty acid ratio and cardiovascular disease risk: Uses and abuses. Curr Athero Repts 2006;8:

40 Problems with the N6:N3 Ratio No distinction made between ALA and EPA/DHA, or between LA and AA Incorrectly presumes physiological equivalence within class Infinite number of absolute intakes can produce the same ratio Similar problem with the now-abandoned P/S ratio Suggests that equal benefit can to be obtained from reducing n-6 intake as from increasing n-3 intake CHD endpoint data indicate that both are beneficial Any predictive value of the ratio is carried in the n-3 FA component Harris WS. The omega-6/omega-3 fatty acid ratio and cardiovascular disease risk: Uses and abuses. Curr Athero Repts 2006;8:

41 Problems with the N6:N3 Ratio No distinction made between ALA and EPA/DHA, or between LA and AA Incorrectly presumes physiological equivalence within class Infinite number of absolute intakes can produce the same ratio Similar problem with the now-abandoned P/S ratio Suggests that equal benefit can to be obtained from reducing n-6 intake as from increasing n-3 intake CHD endpoint data indicate that both are beneficial Any predictive value of the ratio is carried in the n-3 FA component Harris WS. The omega-6/omega-3 fatty acid ratio and cardiovascular disease risk: Uses and abuses. Curr Athero Repts 2006;8:

Relative Risk by Tertile 10-yr Relative Risk for Age-Related Macular Degeneration and Fatty Acid Intake: Nurses Health Study All of the information in the ratio comes from the n3, not the n6, fatty

42 Relative Risk by Tertile 10-yr Relative Risk for Age-Related Macular Degeneration and Fatty Acid Intake: Nurses Health Study All of the information in the ratio comes from the n3, not the n6, fatty acids P=0.007 P=0.4 P=0.008 Adjusted for age; Rx assignment; smoking; alcohol intake; menopausal status; history of diabetes, hypertension, high cholesterol, and use of HRT; eye exam in prev. 2 years; multivitamin use; and dietary saturated, mono- and trans fatty acids. P-values for trend shown. Christen et al. Arch Opthalmol 2011;129:

43 Tissue n-6:n-3 FA Ratios and CVD Examine case-control studies for evidence of relationship between risk for CVD and plasma/tissue Phospholipid FA patterns 18 case-control studies were included Prospective Cohort Nested Case Control Cross sectional Harris WS, et al. Tissue n-3 and n-6 fatty acids and risk for CHD events. Atherosclerosis 2007;193:1-10

44 Phospholipid EFA Proportions 18 CHD Case Control Studies All Essential Fatty Acids Are Depressed in CHD Cases <0.01 Harris WS. Tissue Omega-6/Omega-3 Fatty Acid Ratio and Risk for Coronary Heart Disease. Am J Cardiol 2006;98:19i-26i.

45 Tissue PL n-6:n-3 FA Ratios and CVD N=13 studies Harris WS, et al. Tissue n-3 and n-6 fatty acids and risk for CHD events. Atherosclerosis 2007;193:1-10

46 UK Food Standards Agency Workshop Report: the effects of the dietary n-6:n-3 fatty acid ratio on cardiovascular health On the basis of this review of the experimental evidence and on theoretical grounds, it was concluded that the n-6:n-3 fatty acid ratio is not a useful concept and that it distracts attention away from increasing absolute intakes of longchain n-3 fatty acids which have been shown to have beneficial effects on cardiovascular health. Stanley JC, et al. Brit J Nutr 2007;98:

47 Food and Agriculture Organization CONCLUSIONS AND RECOMMENDATIONS FOR N-6 TO N-3 RATIO Based on the evidence and conceptual limitation, there is no rationale for a specific recommendation for n-6 to n-3 ratio, or LA to ALA ratio, if intakes of n-6 and n-3 fatty acids lie within the recommendation established in this report. Fats and Fatty Acids in Human Nutrition. FAO, United Nations. Food and Nutrition Report 91, 2008.

48 CHD Mortality Relations between Plasma PL FA Composition and CHD Mortality Across Populations Tissue HUFA and CHD Mortality 180 USA Total HUFA N6 and N3 FAs >C18 >2 double bonds 140 Quebec All 100 Quebec Cree Quebec Inuit Japan Greenland y = x R 2 = % n-6 HUFA in Total HUFA Lands WEM. Prog Lipid Res 2008;47: ; and Lipids 2004;38:317

49 CHD Mortality Relations between Plasma PL FA Composition and CHD Mortality Across Populations 200 Tissue HUFA and CHD Mortality USA y = x R² = Total HUFA N6 and N3 FAs >C18 >2 double bonds Quebec All MRFIT quintiles Quebec Cree Spain Quebec Inuit 50 Japan Greenland % n-3 HUFA in Total HUFA When eaten, n3 replace n6; but not vice versa Too much n6 HUFA or too little n3 HUFA? A causal relationship? Adjustment for confounders? Lands WEM. Prog Lipid Res 2008;47: ; and Lipids 2004;38:317

50 Finally. It could be the absence of n-3, not the presence of n-6, that is causing the problem Always ask if the purported effect of or association with the ratio is equally well (or better) explained by the numerator or the denominator; it s usually an n-3, not n-6, problem The most effective way to lower tissue n-6 levels is to increase EPA+DHA intakes, not eat less n-6 Focusing on the RATIO distracts from the most important message: increase EPA+DHA intakes

51 Summary and Conclusion Higher intakes of linoleic acid, the primary n-6 fatty acid in the diet, reduces risk for cardiovascular disease relative to lower intakes The n-6:n-3 ratio is not recommended for use in either dietary prescription or risk assessment

52 THE END

53 Thank You! For more info on dietary fats, please visit the IFIC Foundation

Omega-3 Fatty Acids. Alison L. Bailey MD, FACC Erlanger Heart and Lung Institute/University of Tennessee COM

Omega-3 Fatty Acids. Alison L. Bailey MD, FACC Erlanger Heart and Lung Institute/University of Tennessee COM Omega-3 Fatty Acids Alison L. Bailey MD, FACC Erlanger Heart and Lung Institute/University of Tennessee COM Chattanooga @a_l_bailey Disclosures None Objectives Describe omega-3 fatty acids Review the historic