Saturated Fats: What is the Link to Cardiovascular Disease?

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1 Saturated Fats: What is the Link to Cardiovascular Disease? Benoît Lamarche, PhD Chair of Nutrition School of Nutrition INAF, Université Laval Québec, Canada CNS 2015 Winnipeg

2 Disclosures Funding (last 5 years) CIHR, NSERC, FRQ-NT, FRQ-S Dairy Farmers of Canada/Agriculture Agri-Food Canada Canola Council of Canada/Agriculture Agri-Food Canada Atrium Innovations Danone Institute Merck Frosst Other (advisory, honoraria, last 5 years) Dairy Farmers of Canada Unilever Danone Canada Canadian Nutrition Society Centre Européen pour la Nutrition & la Santé (CENS)

3 Current dietary guidelines, fat/sfa Advisory committee Year Total fat SFA Canadian Dietary reference intakes (DRI) Dietary Guidelines for Americans (DGAC/USDA) % of total calories 20-35% of total calories As low as possible < 10% of kcal AHA/ACC Lifestyle Management Guideline none < 7% of kcal European Food Safety Agency (EFSA) World Health Organization (WHO) ANSES, France % of total calories 15-35% of total calories 35-40% of total calories As low as possible < 10% of kcal <12% (<8%) J Am Coll Cardiol 63: EFSA Journal 8: Ann Nutr Metab 55:

4 Seven Countries Study CHD Deaths (/100,000) US Montegiorgio Rome Crevalcore Slavonie Corfou Zrenjanin Dalmatie Velnika Krsna Japan Crete SFA (% Kcal) Finland East Finland West Holland Adapted from Keys. Am J Epidemiol. 1986

5 Change in plasma lipids: CHO (1% energy) replaced by SFA, cismufa, cispufa, trans Mensink, R. P et al. Am J Clin Nutr 2003;77: Chol/HDL-C LDL-C HDL-C mmol/l SFA PUFA MUFA Trans

6 Sources of SFA, US Population age > 2 yrs NHANES

7 2010: SFA vs CHD risk? 7

8 Meta-analysis- Prospective cohort studies on SFA vs CVD Siri-Tarino et al Am J Clin Nutr 2010 Protection

9 Meta-analysis- Prospective cohort studies on SFA vs CVD Siri-Tarino et al Am J Clin Nutr 2010

10 PUFA, MUFA, CHO vs. SFA and CVD Meta-analysis of 11 cohort studies, men and women Δ Risk 20% 10% 0% -10% -20% -30% MI Death SFA:PUFA SFA:MUFA SFA:CHO Jakobsen et al, AJCN 2009

11 Meta-analysis of RCTs evaluating effects of increasing PUFA consumption in place of SFA and CHD events Mozaffarian D et al, PLoS 2010; 7:e % Protection Increase Risk, MI CHD Death

12 Meta-analysis of RCTs evaluating effects of increasing PUFA consumption in place of SFA and CHD events Mozaffarian D et al, PLoS 2010; 7:e % Protection Increase

13 32 observational studies (N=530,525), diet records 17 observational studies (N=25,721), biomarkers 27 RCTs (N=103,052) fatty acid supplementation. 13 Chowdhury et al Ann Intern Med 2014;160:

14 Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk A Systematic Review and Meta-analysis 14 Chowdhury et al Ann Intern Med 2014;160:

15 Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk A Systematic Review and Meta-analysis 15 Chowdhury et al Ann Intern Med 2014;160:

16 FOOD-SPECIFIC SFA AND CVD De Oliviera Otto et al Am J Clin Nutr 2012;96: Mixed 5% increase in E -17% Source of SFA Plant Butter Meat Dairy Total -38% -17% -38% -29% +48% Hazard Ratio for CVD Reduced Increased N=5209 Follow-up 10 yrs

17 FOOD-SPECIFIC SFA AND CVD De Oliviera Otto et al Am J Clin Nutr 2012;96:

18 Change in plasma lipids: CHO (1% energy) replaced by SFA, cismufa, cispufa, trans Mensink, R. P et al. Am J Clin Nutr 2003;77: Chol/HDL-C LDL-C HDL-C mmol/l SFA PUFA MUFA Trans

19 Low vs high (SFA) diet and LDLsize Dreon et al AJCN 1998;67:827-36

20 Should we have a target for SFA? Academy of Nutrition and Dietetics: says NO If SFA > PUFA for CVD risk CHO > SFA for CVD risk Then CHO > PUFA for CVD risk Recommendation: substitute CHO for PUFA

21 SFA: A hot topic (hard to keep up )

22 Should we have a target for SFA? Advisory committee Year Total fat SFA Canadian Dietary reference intakes (DRI) Dietary Guidelines for Americans (DGAC/USDA) % of total calories 20-35% of total calories As low as possible < 10% of kcal AHA/ACC Lifestyle Management Guideline none < 7% of kcal European Food Safety Agency (EFSA) World Health Organization (WHO) ANSES, France % of total calories 15-35% of total calories 35-40% of total calories As low as possible < 10% of kcal <12% (<8%)

23 Sources of SFA, US Population age > 2 yrs NHANES % 7%

24 Conclusions Convincing evidence: SFA increases LDL-C? Not always SFA from dairy may have neutral effects SFA increases the risk of clinical outcomes? Not always May depend on source of SFA Dairy fat (SFA) is not associated with increased risk of clinical outcomes (CVD, hypertension, T2D)

25 Conclusions FUTURE? Importance to identify the source of dietary SFA with regards to risk management Consider the impact of SFA (from all sources) on other cardiometabolic risk factors Disentangle the public health recommendations to population targets Adapt the message on SFA (population vs. health professionals, vs. public health) APNM 2014;39:1 3