Cardiovascular risk potential of dietary saturated fats: an update and some implications
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1 Cardiovascular risk potential of dietary saturated fats: an update and some implications Gerard Hornstra, PhD Med" Prof. Em. of Experimental Nutrition" Maastricht University" The Netherlands"
2 Cardiovascular mortality is positively associated with saturated fat consumption (Seven countries study)" Cardiovascular mortality per 1000 persons at risk Y = X; r = SAFA" intake" (en%)
3 Diet and cardiovascular disease: observational studies v Dietary saturate consumption is associated with increased CV risk" v Progression of coronary artery disease is related to consumption of saturated fatty acids " v Distinction between various saturates appears impossible because of shared food sources"
4 Some dietary fatty acid recommendations " for adults (AMDR, AI, DRV, en%)" IoM (2005) EFSA (2010) WHO/FAO (2010) Total fat Saturated fatty acids ALAP ALAP < 10 Trans fatty acids ALAP ALAP < 1 n-6 fatty acids n-3 fatty acids EPA+DHA, mg/day)
5 Updating recommendations: risk of tunnel vision The narrowness of viewpoints resulting from earlier opinions, interpretations, and understanding"
6 Heart disease has many causes inflammation" hyperlipemia" thrombosis" heart disease" hypertension" diabetes" Personality and genes"
7 Certain plasma lipoproteins are cardiovascular risk factors " v Established: "LDL-chol v Most likely: "HDL-chol v Likely: " "fasting TGs v Possible: " "Lp[a] " Ratio between total- and HDL-cholesterol is thought the most reliable cardiovascular risk marker"
8 Different fatty acids have different effects on " the plasma cholesterol profile (Mensink 2003)" Change (mmol/l) at replacement " of 1 en% carbohydrate" 0.06" 0.04" 0.02" 0.00" -0.02" -0.04" LDL-Chol" Saturates (mixed)" Mono-unsaturates (oleic)" Poly-unsaturates (linoleic)" Industrial trans" HDL-Chol" Total-/HDL-Chol"
9 Saturated fat intake per se is not significantly associated with CHD risk (Siri-Tarino, 2010) Lower risk with SAFA" Higher risk with SAFA" Relative risk"
10 Cardiovascular risk is reduced when dietary SAFA" is replaced by PUFA (Jakobsen, 2009)" PUFA" Diet-adjusted" Cor. events" MUFA" Carbo" PUFA" MUFA" Diet- and lifestyle-adjusted" Cor. mortality" 0.4" 0.8" 0.6" 1" 1.25" 1.5" 2" Carbo" Relative risk at 5 en% replacement" 0.4" 0.6" 0.8" 1" 1.25" 1.5" 2"
11 Intervention studies confirmed that replacement of dietary SAFA (+ trans) by ω-3 and ω-6 PUFA " reduce cardiovascular risk (Mozaffarian, 2010) " Lower risk with PUFA" Higher risk with PUFA"
12 Effects of dietary fats on cardiovascular risk " v Compared to carbohydrates and unsaturated fatty acids, dietary mixed saturates increase plasma levels of LDLcholesterol" v However, a recent meta-analysis demonstrated that SAFA consumption is not associated with increased cardiovascular risk " v Other meta-analysis of observational and intervention studies demonstrated that replacement of dietary SAFA (and trans) by PUFA (not MUFA or CHO) reduced cardiovascular risk" v In these studies, fatty acid food sources were not taken into account"
13 Major sources of dietary saturated fatty acids" Coconut" lauric (12:0)" myristic (14:0)" Palm kernel" lauric (12:0)" myristic (14:0) " Palm fruit" palmitic (16:0)" Cocoa" stearic (18:0)" palmitic (16:0)" " Dairy" lauric (12:0)" myristic (14:0)" palmitic (16:0)" stearic (18:0)" Fatty meat" palmitic (16:0)" stearic (18:0)" "
14 Western diets contain quite a variety of " saturated fatty acids 50 % of total SAFA" < 10:0 12:0" lauric 14:0" myristic 16:0" palmitic 18:0" stearic other
15 Different fatty acids have different effects on " the plasma cholesterol profile (Mensink 2003)" Predicted change (mmol/l) at replacement of 1 en% CHO" 0.06" 0.04" 0.02" 0.00" -0.02" Lauric (12:0)" Myristic (14:0)" Palmitic (16:0)" Stearic (18:0)" -0.04" LDL-Chol" HDL-Chol" Total-/HDL-Chol"
16 Palm oil diets increase plasma cholesterol fractions as compared to more unsaturated vegetable oils, but their cardiovascular risk scores are hardly different Difference (mm) PO higher PO lower 26 studies " 27 comparisons " 511 subjects TC LDL-C HDL-C L/H p = p = p=0.032 p=0.164, NS
17 Palmitic acid from palm oil tends to cause lower plasma cholesterol levels than lauric- and myristic acids from lauric oils, but its CV risk score is not different Difference (mm) PO higher PO lower 9 studies " 9 comparisons " 215 subjects TC LDL-C HDL-C L/H p =0.080 NS p=0.054 NS
18 Palmitic acid from palm oil causes higher plasma cholesterol levels than stearic acid, but its CV risk score" only tends to be higher PO higher studies " 7 comparisons " 107 subjects Difference (mm) PO lower TC LDL-C HDL-C L/H p =0.006 p=0.012 p=0.016 p=0.065
19 Updating recommendations: focus on nutrients or on foods? v Cardiovascular risk is increased by consumption of SAFA from meat, but reduced by SAFA consumption from dairy. Vegetable SAFA were not associated (de Oliveira Otto, 2012) " v When these findings are confirmed and extended, future dietary advice for the general public should possibly concentrate on foods rather than on nutrients! v This change in focus can be expected to reduce the risk of tunnel vision when updating dietary recommendations"
20 Cardiovascular risk potential of dietary saturated fats: summary v Cardiovascular risk is not increased by the consumption of dietary saturates per se, but can be reduced by substituting PUFA for SAFA" v This justifies dietary recommendations to replace SAFA by PUFA wherever possible" v Food sources may be of influence on dietary SAFA effects and should be taken into account when updating dietary recommendations for the general population"
21 Cardiovascular risk potential of dietary saturated fats: some final remarks v Although foods may be the main focus for future dietary recommendations for the general public, recommendations with respect to optimum compositions of nutrients remain essential for food manufacturers and their suppliers" v Given the limited differences in cardiovascular risk potential between the various SAFA s, availability, sustainability, and functionality of their sources are also legitimate determinants of their dietary applications"
22 Dietary lipids and arterial thrombosis" v In a reliable rat model of arterial thrombosis, dietary saturates appeared pro-thrombotic compared to unsaturated fatty acids" v Myristic acid and linoleic acid were the most active pro- and anti-thrombotic fatty acids, respectively" v So far, vegetable oils (palm oil included) appeared largely neutral with respect to platelet thrombotic functions and measures of blood coagulation and fibrinolysis in man"
23 Major dietary sources (%) of total SAFA and of long-chain saturated fatty acids" Total SAFA Lauric 12:0 Myristic 14:0 Palmitic 16:0 Stearic 18:0 bread & cake cheese milk & products nuts& snacks sweets & candy fats, oils & sauces meat & poultry
24 In different dietary cultures, ratio s between various dietary saturates are quite comparable Netherlands" Japan" Mexico" :0" lauric 14:0" myristic 16:0" palmitic 18:0" stearic
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