Dietary total fat, fatty acids intake, and risk of cardiovascular disease: a dose-response meta-analysis of cohort studies

Hypercholesterolemia and cardiovascular disease: What to do before initiating pharmacological therapy

The availability of efficient lipid-lowering drugs has substantially reduced the incidence and mortality for cardiovascular disease (CVD). Despite that, CVD still represents a major cause of death and disability; efforts are thus required to prevent this disease, since reducing the established CV risk factors may slow or prevent the onset of cardiovascular events. Current guidelines recommend a healthier lifestyle for all CV risk categories, as it may have a beneficial impact on several risk factors; in individuals with a low-to-moderate hypercholesterolemia, which are not eligible for a pharmacological approach and are not far from the cholesterol target recommended for their risk category, functional foods or nutraceuticals may be considered as supplement to reduce their CV risk status. Of note, counseling and lifestyle intervention in people at moderate CV risk represents a major issue for both preventing a further risk increase and reducing the need for drugs. Studies on general populations have clearly indicated that lifestyle interventions translate into a clinical benefit, with reduction of the incidence of myocardial infarction and the risk of developing type 2 diabetes.

Association of dietary fatty acids and the incidence risk of cardiovascular disease in adults: the Tehran Lipid and Glucose Prospective Study

Background

Considering the inconsistent available findings regarding the cardioprotective effect of dietary fatty acid composition, we prospectively examined the feasible association between the dietary fatty acids and the cardiovascular disease (CVD) incidence in framework of the population-based Tehran Lipid and Glucose Study.

Methods

A total of 2369 participants (19–70 years, 43.5% men) without CVD at baseline (2006–2008) were included and followed-up for 6.7 years. Fatty acids’ dietary intake was estimated using a 168-item semi-quantitative food frequency questionnaire. The CVD incidence risk across tertiles of dietary fatty acids was predicted via Cox proportional hazards regression models.

Results

The average age and body mass index of the included population were 38.5 ± 13.3 years and 26.6 ± 4.8 kg/m² at baseline. Over 6.7 years of follow-up, 79 cases of CVD were detected. The risk of CVD was lower in upper tertile of monounsaturated fatty acids, oleic acid, and docosahexaenoic acid + eicosapentaenoic acid among the tertiles. No significant associations were found between total fat, saturated and polyunsaturated fatty acids’ intake, and CVD.

Conclusions

Our results suggest that the dietary fatty acid composition might affect the incidence risk of CVD within the Iranian population.

Postpartum Weight Retention and Its Determinants in Lebanon and Qatar: Results of the Mother and Infant Nutrition Assessment (MINA) Cohort

Excessive Postpartum Weight Retention (PWR) is postulated to increase the risk of adverse health outcomes for mothers and offspring. Using data from the Mother and Infant Nutritional Assessment (MINA) cohort in Lebanon and Qatar, this study aimed to examine PWR and its determinants at 6 months after delivery. Pregnant women (n = 183) were recruited during their first trimester and were followed up through pregnancy and after delivery. During this period, face-to-face interviews as well as extraction from medical charts were conducted to collect data regarding the socioeconomic, anthropometric and dietary intake of participants. The mean PWR (kg) among participants was 3.1 ± 5.6 at delivery, and 3.3 ± 5.3 and 2.7 ± 4.7 at 4 and 6 months after delivery, respectively. Results of the multiple logistic regression analyses showed that a Qatari nationality and excessive GWG were associated with higher odds of a high PWR (above median) while an insufficient GWG had lower odds. After adjustment for energy, participants with a high PWR reported a greater intake of proteins, Trans fat, cholesterol, sodium and lower intakes of mono and polyunsaturated fat as compared to those with a low PWR (below median). These findings suggested priority areas for interventions to prevent excessive PWR amongst women of childbearing age in Lebanon and Qatar.

Ruminant and industrial trans-fatty acids consumption and cardiometabolic risk markers: A systematic review

The development of cardiometabolic diseases is related to conditions such as obesity, abdominal fat, insulin resistance, diabetes mellitus, elevated blood pressure and changes in lipid profile. The whole of Trans Fatty Acid (TFA) intake is associated with the increase of cardiometabolic risk factors. There are two main sources of TFA, the ruminant TFA (rTFA) which are produced by biohydrogenation in animal's rumen, and the industrial TFA (iTFA), produced by hydrogenation of vegetable oils, the individual effect of each group is still controversial. The aim of this study was to analyze the effect of industrially and ruminants TFA intake on cardiometabolic risk in adults. It was carried out a systematic search of the literature in October 2019 and two independent authors selected and extracted data from articles. After the selection process, nine clinical trials were included, and summary tables were constructed to present data for all outcomes. The results showed that both sources of TFA can increase cardiometabolic risk parameters, especially lipid profile. At levels up to 1.5%-7% of energy, the effect of rTFA seems to be greater than iTFA and it seems to be greater in women. However, rTFA seems to be less harmful than iTFA for High Density Lipoprotein cholesterol, although for total cholesterol and Low density Lipoprotein cholesterol it may be worse. In summary, both sources of TFA can increase cardiometabolic risk parameters, especially lipid profile. However, the dose of TFA and the whole composition of the food must be considered.

Adherence to Dietary Recommendations, Nutrient Intake Adequacy and Diet Quality among Pediatric Cystic Fibrosis Patients: Results from the GreeCF Study

Nutrition is an important component of cystic fibrosis (CF) therapy, with a high-fat diet being the cornerstone of treatment. However, adherence to the dietary recommendations for CF appears suboptimal and burdensome for most children and adolescents with CF, leading to malnutrition, inadequate growth, compromised lung function and increased risk for respiratory infections. A cross-sectional approach was deployed to examine the degree of adherence to the nutrition recommendations and diet quality among children with CF. A total of 76 children were recruited from Aghia Sophia’s Children Hospital, in Athens, Greece. In their majority, participants attained their ideal body weight, met the recommendations for energy and fat intake, exceeding the goal for saturated fatty acids consumption. Carbohydrate and fiber intake were suboptimal and most participants exhibited low or mediocre adherence to the Mediterranean diet prototype. It appears that despite the optimal adherence to the energy and fat recommendations, there is still room for improvement concerning diet quality and fiber intake.

Biotechnology tools and applications for development of oilseed crops with healthy vegetable oils

Vegetable oils, consisting principally of triacylglycerols (TAG), are major sources of calories and essential fatty acids in the human diet. The fatty acid composition of TAG is a primary determinant of the nutritional quality and health-promoting properties of vegetable oils. TAG fatty acid composition also affects the functionality and properties of vegetable oils in food applications and in food processing and preparation. Vegetable oils with improved nutritional and functional properties have been developed for oilseed crops by selection and breeding of fatty acid biosynthetic mutants. These efforts have been effective at generating vegetable oils with altered relative amounts of saturated and unsaturated fatty acids in seed TAG, but are constrained by insufficient genetic diversity for producing oils with "healthy" fatty acids that are not typically found in major oilseeds. The development and application of biotechnological tools have instead enabled the generation of oilseeds that produce novel fatty acid compositions with improved nutritional value by the introduction of genes from alternative sources, including plants, bacteria, and fungi. These tools have also allowed the generation of desired oil compositions that have proven difficult to obtain by breeding without compromised performance in selected oilseed crops. Here, we review biotechnological tools for increasing crop genetic diversity and their application for commercial or proof-of-principal development of oilseeds with expanded utility for food and feed applications and higher value nutritional and nutraceutical markets.

The correlation between dietary fat quality indices and lipid profile with Atherogenic index of plasma in obese and non-obese volunteers: a cross-sectional descriptive-analytic case-control study

BACKGROUND AND AIM

Abnormalities in lipid metabolism are commonly observed in patients who were obese. Alongside dyslipidemia, one of the markers in predicting the risk of cardiovascular disease is the Atherogenic Index of Plasma (AIP), which is related to dietary intake. Healthy fat quality indices might affect on AIP. The purpose of this study is to find the possible relationship between dietary fat quality, and AIP and comparison of these indices among obese and non-obese volunteers.

METHODS

This study was a cross-sectional descriptive-analytic case-control study with 157 normal and overweight and obese volunteers (n = 71 normal, Age: 38.90 ± 10.976 vs n = 86 overweight/obese, Age: 38.60 ± 9.394) in the age range of 18-65 years. Food intake was measured using FFQ, anthropometric indices (weight, height, body mass index and waist to hip ratio), body composition (visceral fat level, total body water, body fat mass), and lipid profile were measured.

RESULTS

Based on the present results, comparable biochemical parameters including TC (P = 0.580), TG (P = 0.362), LDL (P = 0.687) and HDL (P = 0.151) among overweight/obese volunteers as compared to normal ones were noticed. Effects of dietary fat quality, including Atherogenicity (AI) and Thrombogenicity (TI) hypo/hypercholesterolemic ratio (h/H), the Cholesterol-Saturated Fat Index (CSI) showed significantly higher AI (P = 0.012) in the overweight/obese group as compared to the normal group. Whereas, h/H (P = 0.034) and ω-6/ω-3 ratio (P = 0.004) were significantly higher in normal-weight volunteers. There was a positive correlation between AI, TI, CSI, SFA, MUFA, PUFA and ω-6/ω-3 ratio with AIP and negative correlation between h/H with AIP in both groups. Despite the significances of these correlations no strong relation was observed by doing multiple regression among normal and overweight/obese groups (R2 = 0.210, R2 = 0.387).

CONCLUSIONS

In summary, the present work proposes a direct relationship between dietary fat quality, increased BMI, and lipid abnormalities with AIP. Nevertheless, further large-scale studies are required to sustain a clear conclusion in this wish.

Emulsion Droplet Crystallinity Attenuates Short-Term Satiety in Healthy Adult Males: A Randomized, Double-Blinded, Crossover, Acute Meal Study

BACKGROUND

The influence of triacylglycerol (TAG) physical properties on satiety remains poorly understood.

OBJECTIVES

The objective was to investigate if and how TAG digestion and absorption, modulated only by differences in TAG crystallinity, would differentially affect short-term satiety in healthy men.

METHODS

We tempered 500 mL 10% palm stearin oil-in-water emulsions such that the lipid droplets were either undercooled liquid (LE) or partially crystalline solid (SE). Fifteen healthy men (mean ± SD age: 27.5 ± 5.7 y; BMI: 24.1 ± 2.5 kg/m2; fasting TAG: 0.9 ± 0.3 mmol/L) consumed each beverage at two 6-h study visits separated by ≥6 d after an overnight fast, along with 1500 mg acetaminophen suspended in water. The participants characterized the emulsion sensory properties, completed satiety visual analog scale ratings, and had serial blood samples collected for 6-h analysis of plasma peptide YY (PYY), glucagon-like peptide-1 (GLP-1), ghrelin, leptin, glucose-dependent insulinotropic polypeptide (GIP), insulin, and acetaminophen (for assessing gastric emptying). Repeated-measures ANOVAs and 2-tailed paired t tests were used to analyze the changes from baseline and incremental area under the curve (iAUC) values, respectively.

RESULTS

With consumption of LE compared with SE, there was a 358% higher fullness (P = 0.015) and a 103% lower average appetite (P = 0.041) score, along with higher iAUC values for PYY (P = 0.011) and GLP-1 (P = 0.028) (103% and 66% higher, respectively), but not for ghrelin (P = 0.39), based on change from baseline values. Acetaminophen response trended toward significance (P = 0.08) and was 15% higher with LE. SE was rated as 44% thicker (P = 0.034) and 24% creamier (P = 0.05) than LE.

CONCLUSIONS

The suppression of TAG digestion by the presence of partially crystalline lipid droplets blunted the appetite-suppressing effects of an oil-in-water emulsion.This trial was registered at clinicaltrials.gov as NCT03990246.

Public health guidelines should recommend reducing saturated fat consumption as much as possible: NO

The proposition that dietary SFAs should be restricted to the maximal extent possible (e.g., to achieve approximately half of current consumption) is based primarily on observational and clinical trial data that are interpreted as indicating a benefit of such limitation on cardiovascular disease (CVD) risk. Further support is believed to derive from the capacity of SFAs to raise LDL cholesterol, and the evidence that LDL-cholesterol lowering reduces CVD incidence. Despite their apparent merit, these arguments are flawed. In fact, although it is possible that dietary intake of SFAs has a causal role in CVD, the evidence to support this contention is inconclusive. Moreover, other considerations argue against a guideline focused primarily on limiting SFA intake, including the heterogeneity of individual SFAs, the likelihood of clinically meaningful interindividual variation in response to SFA reduction, the potential for unintended health consequences of population-wide promotion of severe restriction, and the critical differences in health impacts among individual SFA-containing foods.

Saturated Fats and Health: A Reassessment and Proposal for Food-Based Recommendations: JACC State-of-the-Art Review

The recommendation to limit dietary saturated fatty acid (SFA) intake has persisted despite mounting evidence to the contrary. Most recent meta-analyses of randomized trials and observational studies found no beneficial effects of reducing SFA intake on cardiovascular disease (CVD) and total mortality, and instead found protective effects against stroke. Although SFAs increase low-density lipoprotein (LDL) cholesterol, in most individuals, this is not due to increasing levels of small, dense LDL particles, but rather larger LDL particles, which are much less strongly related to CVD risk. It is also apparent that the health effects of foods cannot be predicted by their content in any nutrient group without considering the overall macronutrient distribution. Whole-fat dairy, unprocessed meat, and dark chocolate are SFA-rich foods with a complex matrix that are not associated with increased risk of CVD. The totality of available evidence does not support further limiting the intake of such foods.

Oleogels in Food: A Review of Current and Potential Applications

Legislative limitations of the use of trans and saturated fatty acids, the rising concerns among consumers about the negative effects of some fats on human health, and environmental and health considerations regarding the increased use of palm fat in food and biodiesel production drove to innovations in reformulating fat-containing food products. Oleogelation is one of the most in-trend methods for reducing or replacing the unhealthy and controversial fats in food products. Different edible oleogels are being formulated by various techniques and used in spreads, bakeries, confectioneries, and dairy and meat products. This review exclusively focuses on up-to-date applications of oleogels in food and mechanisms of gelation, and discusses the properties of new products. Research has produced acceptable reformulated food products with similar technological and rheological properties as the reference products or even products with improved techno-functionality; however, there is still a high need to improve oleogelation methods, as well as the technological process of oleogel-based foods products. Despite other strategies that aim to reduce or replace the occurrence of trans and saturated fats in food, oleogelation presents a great potential for industrial application in the future due to nutritional and environmental considerations.

Dietary saturated fat and heart disease: a narrative review

The American Heart Association (AHA) recently published a meta-analysis that confirmed their 60-year-old recommendation to limit saturated fat (SFA, saturated fatty acid) and replace it with polyunsaturated fat to reduce the risk of heart disease based on the strength of 4 Core Trials. To assess the evidence for this recommendation, meta-analyses on the effect of SFA consumption on heart disease outcomes were reviewed. Nineteen meta-analyses addressing this topic were identified: 9 observational studies and 10 randomized controlled trials. Meta-analyses of observational studies found no association between SFA intake and heart disease, while meta-analyses of randomized controlled trials were inconsistent but tended to show a lack of an association. The inconsistency seems to have been mediated by the differing clinical trials included. For example, the AHA meta-analysis only included 4 trials (the Core Trials), and those trials contained design and methodological flaws and did not meet all the predefined inclusion criteria. The AHA stance regarding the strength of the evidence for the recommendation to limit SFAs for heart disease prevention may be overstated and in need of reevaluation.

Gene Expression and Fatty Acid Profiling in Longissimus thoracis Muscle, Subcutaneous Fat, and Liver of Light Lambs in Response to Concentrate or Alfalfa Grazing

A better understanding of gene expression and metabolic pathways in response to a feeding system is critical for identifying key physiological processes and genes associated with polyunsaturated fatty acid (PUFA) content in lamb meat. The main objective of this study was to investigate transcriptional changes in L. thoracis (LT) muscle, liver, and subcutaneous fat (SF) of lambs that grazed alfalfa (ALF) and concentrate-fed (CON) slaughtered at 23 kg and using the Affymetrix Ovine Gene 1.1 ST whole-genome array. The study also evaluated the relationship between meat traits in LT muscle, including color, pigments and lipid oxidation during 7 days of display, α-tocopherol content, intramuscular fat (IMF) content and the fatty acid (FA) profile. Lambs that grazed on alfalfa had a greater α-tocopherol concentration in plasma than CON lambs (P < 0.05). The treatment did not affect the IMF content, meat color or pigments (P > 0.05). Grazing increased the α-tocopherol content (P < 0.001) and decreased lipid oxidation on day 7 of display (P < 0.05) in LT muscle. The ALF group contained a greater amount of conjugated linoleic acid (CLA), C18:3 n−3, C20:5 n−3, C22:5 n−3, and C22:6 n−3 than did the CON group (P < 0.05). We identified 41, 96 and four genes differentially expressed in LT muscle, liver, and subcutaneous fat, respectively. The most enriched biological processes in LT muscle were skeletal muscle tissue development, being the genes related to catabolic and lipid processes downregulated, except for CPT1B, which was upregulated in the ALF lambs. Animals grazing alfalfa had lower expression of desaturase enzymes in the liver (FADS1 and FADS2), which regulate unsaturation of fatty acids and are directly involved in the metabolism of n−3 PUFA series. The results found in the current study showed that ingesting diets richer in n−3 PUFA might have negative effects on the de novo synthesis of n−3 PUFA by downregulating the FADS1 and FADS2 expression. However, feeding diets poorer in n−3 PUFA can promote fatty acid desaturation, which makes these two genes attractive candidates for altering the content of PUFAs in meat.

Evaluating causal associations between chronotype and fatty acids and between fatty acids and type 2 diabetes: A Mendelian randomization study

BACKGROUND AND AIMS

Preference for activity in the morning or evening (chronotype) may impact type 2 diabetes (T2D) risk factors. Our objective was to use Mendelian randomization (MR) to evaluate whether there are causal links between chronotype and one potential T2D risk factor, total fatty acids (TOTFA), and between TOTFA and T2D.

METHODS AND RESULTS

We estimated the causal effect of: 1) morning chronotype on TOTFA; and 2) higher TOTFA on T2D. We found that: a) morning compared to evening chronotype was associated with lower TOTFA levels (inverse-weighted variance (IVW) estimate -0.21; 95% CI -0.38, -0.03; raw P = 0.02; FDR-corrected P 0.04) and b) elevated TOTFA levels were protective against T2D (IVW estimate -0.23; 95% CI -0.41, -0.05; raw P = 0.01; FDR-corrected P = 0.03). Based on this finding, we further hypothesized that healthy fats would show a similar pattern and performed MR of a) morning chronotype on omega-3 (Omega-3), monounsaturated (MUFA), and polyunsaturated (PUFA) fatty acids; and b) MR of each of these fat types on T2D. We observed the same mediating-type pattern for chronotype, MUFA, and T2D as we had for chronotype, TOTFA, and T2D, and morning chronotype was associated with lower Omega-3.

CONCLUSION

Our findings provide suggestive, new information about relationships among chronotype, TOTFA, and T2D and about chronotype as a factor influencing Omega-3, MUFA, and TOTFA levels. In addition, we validated previous knowledge about MUFA and T2D. Morning chronotypes may predispose towards lower levels of TOTFA and some healthy fats, whereas higher levels of TOTFA and MUFA may protect against T2D.

Dietary Fat Intake and Metabolic Syndrome in Older Adults

BACKGROUND

Metabolic Syndrome (MetS) is associated with higher rates of cardiovascular disease (CVD), type 2 diabetes mellitus, and cancer worldwide.

OBJECTIVE

To assess fat intake in older adults with or without MetS.

DESIGN

Cross-sectional nutritional survey in older adults living in the Balearic Islands (n = 477, 48% women, 55-80 years old) with no previous CVD.

METHODS

Assessment of fat (total fat, MUFA, PUFA, SFA, TFA, linoleic acid, α-linolenic acid, marine and non-marine ω-3 FA, animal fat and vegetable fat, cholesterol) and macronutrient intake using a validated food frequency questionnaire, and its comparison with recommendations of the US Institute of Medicine (IOM) and the Spanish Society of Community Nutrition (SENC).

RESULTS

Participants with MetS showed higher BMI, lower physical activity, higher total fat and MUFA intake, and lower intake of energy, carbohydrates, and fiber than participants without MetS. Men and women with MetS were below the Acceptable Macronutrient Distribution Range (AMDR) proposed by IOM for carbohydrates and above the AMDR for total fat and MUFAs, and women were below the AMDR proposed for α-linolenic acid (ALA) compared with participants without MetS.

CONCLUSIONS

Subjects with MetS were less likely to meet IOM and SENC recommendations for fat and macronutrient intakes as compared to non-MetS subjects.