MEDICAL SCIENCE SURPRISES: SATURATED FAT COMPOSITION NOT ASSOCIATED WITH CORONARY HEART DISEASE RISK?
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1 MEDICAL SCIENCE SURPRISES: SATURATED FAT COMPOSITION NOT ASSOCIATED WITH CORONARY HEART DISEASE RISK? Kalyana Sundram PhD, FASc., FNSM September, 2015 Deputy CEO & Director Science & Environment Malaysian Palm Oil Council
2 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
3 :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
4 "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
5 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
6 Cardiovascular mortality per 1000 persons at risk Cardiovascular mortality is positively associated with saturated fat consumption (Seven countries study) 300 Y = X; r = NUTRI-SEARCH SAFA intake (en%)
7 7
8 Lower risk with SAFA Saturated fat is not significantly associated with cardiovascular risk (Siri-Tarino, 2010) Coronary heart disease Relative risk
9 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
10 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
11 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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13 13
14 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:
15 Fried Fats, Fatty Acid Profile & Oxidative Stability Palm AOM Lard AOM Cotton AOM Soybean AOM Com AOM Sunflower AOM Canola AOM Low Lin canolca (C5) AOM Low lin Soy AOM Natreon Sun AOM The practice of frying foods to increase palatability and increase consumer appreciation is rated among the top 20 innovations in the food industry National Academy of Science, Royal Society, United Kingdom, Sept Natreon Canola AOM % 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Sats Oleic 18:1 Linoleic 18:2 Linolenic 18:3
16 Moderator Dennis Bier, M.D. Professor of Pediatrics, Baylor College of Medicine Participants Margo A. Denke, M.D. Clinical Professor of Medicine, University of Texas Health Science Center, San Antonio Joseph Judd, Ph. D. Former Research Leader, Diet and Human Performance Laboratory, Beltsville Human Nutrition Research Center, USDA Agricultural Research Service Richard O Brien Industry Consultant, Author, Fats and Oils Formulating and Processing for Applications Fran Seligson, Ph. D. Independent consultant and Associate Professor in the Nutrition Department at Penn State Howard Weintraub, M.D. Co-Clinical Director, Lipid Treatment and Research Center, New York University Medical Center, Clinical Associate Professor of Medicine
17 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
18 Low Fat Foods 18
19 Malaysian Prospective Lipid Study: A study on Malaysian Dietary Trends and Effects on Metabolic Profiles and Lipoprotein Particle Sizes 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!
20 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)
21 The Metabolic Syndrome: Current Perspective Adapted from Reaven G. Drugs 1999;58(suppl):19-20 with permission from WolthersKluwer Health. Body Size BMI Central Adiposity Insulin Resistance + Hyperinsulinemia Glucose Metabolism Uric Acid Metabolism Dyslipidemia Hemodynamic Novel Risk Factors ± Glucose intolerance Uric acid Urinary uric acid clearance TG PP lipemia HDL-C PHLA Small, dense LDL SNS activity Na retention Hypertension CRP PAI-1 Fibrinogen Coronary Heart Disease
22 22
23 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.
24 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. 24
25 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, lifestages 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
26 THANK YOU (fr)
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