Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials

Composition, structure and absorption of milk lipids: a source of energy, fat-soluble nutrients and bioactive molecules

Milkfat is a remarkable source of energy, fat-soluble nutrients and bioactive lipids for mammals. The composition and content of lipids in milkfat vary widely among mammalian species. Milkfat is not only a source of bioactive lipid components, it also serves as an important delivery medium for nutrients, including the fat-soluble vitamins. Bioactive lipids in milk include triacylglycerides, diacylglycerides, saturated and polyunsaturated fatty acids, and phospholipids. Beneficial activities of milk lipids include anticancer, antimicrobial, anti-inflammatory, and immunosuppression properties. The major mammalian milk that is consumed by humans as a food commodity is that from bovine whose milkfat composition is distinct due to their diet and the presence of a rumen. As a result of these factors bovine milkfat is lower in polyunsaturated fatty acids and higher in saturated fatty acids than human milk, and the consequences of these differences are still being researched. The physical properties of bovine milkfat that result from its composition including its plasticity, make it a highly desirable commodity (butter) and food ingredient. Among the 12 major milk fatty acids, only three (lauric, myristic, and palmitic) have been associated with raising total cholesterol levels in plasma, but their individual effects are variable-both towards raising low-density lipoproteins and raising the level of beneficial high-density lipoproteins. The cholesterol-modifying response of individuals to consuming saturated fats is also variable, and therefore the composition, functions and biological properties of milkfat will need to be re-evaluated as the food marketplace moves increasingly towards more personalized diets.

Cereal grains and legumes in the prevention of coronary heart disease and stroke: a review of the literature

A number of reviewers have examined studies investigating the relationship between coronary heart disease and stroke prior to 2000. Since then, several key studies have been published. Five studies have examined the relationship between wholegrain consumption, coronary heart disease (CHD) and cardiovascular (CVD) disease and found protection for either or both diseases. The researchers concluded that a relationship between wholegrain intake and CHD is seen with at least a 20% and perhaps a 40% reduction in risk for those who eat wholegrain food habitually vs those who eat them rarely. Notwithstanding the fact that fibre is an important component of wholegrains, many studies have not shown an independent effect of fibre alone on CHD events. Thus in terms of CHD prevention, fibre is best obtained from wholegrain sources. Wholegrain products have strong antioxidant activity and contain phytoestrogens, but there is insufficient evidence to determine whether this is beneficial in CHD prevention. Soluble fibre clearly lowers cholesterol to a small but significant degree and one would expect that this would reduce CHD events. There have been a small number of epidemiological studies showing soy consumption is associated with lower rates of heart disease. Countering the positive evidence for wholegrain and legume intake has been the Nurses Health Study in 2000 that showed women who were overweight or obese consuming a high glycaemic load (GL) diet doubled their relative risk of CHD compared with those consuming a low GL diet. Although the literature relating GL with CHD events is somewhat mixed, the relationship with risk factors such as HDL cholesterol, triglyceride and C reactive protein is relatively clear. Thus, carbohydrate-rich foods should be wholegrain and, if they are not, then the lowest glycaemic index (GI) product should be used. Promotion of carbohydrate foods should be focused on wholegrain cereals because these have proven to be associated with health benefits. There is insufficient evidence about whether the addition of other components of wholegrains such as polyphenolics or minerals (such as magnesium or zinc) would improve the health benefits of refined grain foods and this needs investigation. Whether adding bran to refined carbohydrate foods can improve the situation is also not clear, and it was found that added bran lowered heart disease risk in men by 30%. This persisted after full adjustment (including GL) suggesting, at least in men, that fibre may be more important than GI. Thus there are two messages: The intake of wholegrain foods clearly protects against heart disease and stroke but the exact mechanism is not clear. Fibre, magnesium, folate and vitamins B6 and vitamin E may be important. The intake of high GI carbohydrates (from both grain and non-grain sources) in large amounts is associated with an increased risk of heart disease in overweight and obese women even when fibre intake is high but this requires further confirmation in normal-weight women.

RECOMMENDATION

Carbohydrate-rich foods should be wholegrain and if they are not, then the lowest GI product available should be consumed. Glycemic index is largely irrelevant for foods that contain small amounts of carbohydrate per serve (such as most vegetables).

Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia

BACKGROUND

Low-carbohydrate diets have been used to manage obesity and its metabolic consequences.

OBJECTIVE

The objective was to study the effects of moderate carbohydrate restriction on atherogenic dyslipidemia before and after weight loss and in conjunction with a low or high dietary saturated fat intake.

DESIGN

After 1 wk of consuming a basal diet, 178 men with a mean body mass index (in kg/m(2)) of 29.2 +/- 2.0 were randomly assigned to consume diets with carbohydrate contents of 54% (basal diet), 39%, or 26% of energy and with a low saturated fat content (7-9% of energy); a fourth group consumed a diet with 26% of energy as carbohydrate and 15% as saturated fat. After 3 wk, the mean weight loss (5.12 +/- 1.83 kg) was induced in all diet groups by a reduction of approximately 1000 kcal/d for 5 wk followed by 4 wk of weight stabilization.

RESULTS

The 26%-carbohydrate, low-saturated-fat diet reduced triacylglycerol, apolipoprotein B, small LDL mass, and total:HDL cholesterol and increased LDL peak diameter. These changes were significantly different from those with the 54%-carbohydrate diet. After subsequent weight loss, the changes in all these variables were significantly greater and the reduction in LDL cholesterol was significantly greater with the 54%-carbohydrate diet than with the 26%-carbohydrate diet. With the 26%-carbohydrate diet, lipoprotein changes with the higher saturated fat intakes were not significantly different from those with the lower saturated fat intakes, except for LDL cholesterol, which decreased less with the higher saturated fat intake because of an increase in mass of large LDL.

CONCLUSIONS

Moderate carbohydrate restriction and weight loss provide equivalent but nonadditive approaches to improving atherogenic dyslipidemia. Moreover, beneficial lipid changes resulting from a reduced carbohydrate intake were not significant after weight loss.

The conversion efficiency of trans-11 and trans-12 18:1 by Delta9-desaturation differs in rats

The present study evaluated and compared the efficiency of the conversion of t11 18:1 and t12 18:1 to their corresponding dienoic acids (c9,tn 18:2) and assessed whether differences due to gender existed in several tissues of rats. Three groups of 4-wk-old male and female rats were fed for 3 wk a diet supplemented with 0, 0.5, or 1% of a trans-octadecenoic acid isomer mixture (tOIM) containing t11 18:1 and t12 18:1 in equal proportion. t11 18:1 and t12 18:1 were incorporated in a tissue-specific manner, and the accrual was significant with increased dietary intake of these trans fatty acid (tFA) isomers. The t12 18:1 isomer was more readily incorporated into the rat tissues than the t11 18:1 isomer. From t11 and t12 18:1, the respective desaturase products, c9,t11 18:2 and c9,t12 18:2, were formed. The calculated conversion rates varied greatly among the tissues of the rats but they were consistently lower for t12 18:1 than for t11 18:1, suggesting that t12 18:1 is a poorer substrate than t11 18:1 for Delta9-desaturase. For both fatty acids investigated, the calculated conversion rates in decreasing order of conversion efficiency were: testes = kidneys > adipose tissue > ovaries > muscle > liver > heart. Overall, there were distinct differences in the conversion of t11 18:1 and t12 18:1, indicating that these 2 fatty acids are metabolized differently despite their structural similarities. Such metabolic differences in tFA accumulation and metabolism may have potential implication in assessing the safety of these tFA isomers because there is a positive correlation between the intake of tFA and the incidence of various diseases.

Sesame ingestion affects sex hormones, antioxidant status, and blood lipids in postmenopausal women

Sesame ingestion has been shown to improve blood lipids in humans and antioxidative ability in animals. Sesamin, a sesame lignan, was recently reported to be converted by intestinal microflora to enterolactone, a compound with estrogenic activity and also an enterometabolite of flaxseed lignans, which are known to be phytoestrogens. Whether sesame can be a source of phytoestrogens is unknown. This study was designed to investigate the effect of sesame ingestion on blood sex hormones, lipids, tocopherol, and ex vivo LDL oxidation in postmenopausal women. Twenty-six healthy subjects attended, and 24 completed, this randomized, placebo-controlled, crossover study. Half of them consumed 50 g sesame seed powder daily for 5 wk, followed by a 3-wk washout period, then a 5-wk 50-g rice powder placebo period. The other half received the 2 supplements in reverse order. After sesame treatment, plasma total cholesterol (TC), LDL-C, the ratio of LDL-C to HDL-C, thiobarbituric acid reactive substances in oxidized LDL, and serum dehydroepiandrosterone sulfate decreased significantly by 5, 10, 6, 23, and 18%, respectively. The ratio of alpha- and gamma-tocopherol to TC increased significantly by 18 and 73%, respectively. All of these variables differed significantly between the 2 treatments. Serum sex hormone-binding globulin and urinary 2-hydroxyestrone (n = 8) increased significantly by 15 and 72%, respectively, after sesame treatment, and these concentrations tended to differ (P = 0.065 and P = 0.090, respectively) from those after the placebo treatment. These results suggest that sesame ingestion benefits postmenopausal women by improving blood lipids, antioxidant status, and possibly sex hormone status.

Intake of ruminant trans fatty acids and risk of coronary heart disease–An overview

Epidemiological studies have shown a strong direct (positive) association between the intake of trans fatty acids (TFA) and the risk of coronary heart disease (CHD), primarily accounted for by industrially produced TFA (IP-TFA). However, comparisons between ruminant TFA (R-TFA) and IP-TFA and risk of CHD have been based on quintiles of intake, which implies that the associations between the two sources of TFA and the risk of CHD were described across different ranges of intake. Controlled metabolic studies of the effect of intake of total and specific R-TFA on CHD risk factors are warranted. Moreover, further epidemiological studies of intake of R-TFA and risk of CHD in populations with a high intake of R-TFA are warranted.

The response of lipoproteins to dietary fat and cholesterol in lean and obese persons

Individuals differ in the response of their blood lipoproteins to cholesterol-lowering diets. One characteristic clearly associated with susceptibility to diet is leanness; many studies show that total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol concentrations respond more strongly to dietary fat and cholesterol in lean subjects than in obese subjects. This is unlikely to be due to differences in dietary compliance. A metabolic explanation is that obese people have a higher rate of total body cholesterol synthesis. The low-density lipoprotein receptors in their liver cells are partly suppressed by this large stream of endogenous cholesterol coming in from their enterohepatic circulation, and the amount added by dietary cholesterol relative to the endogenous pool would be less than in lean people. Whatever the mechanism, diets low in saturated fat and cholesterol are less effective in the obese. The most effective way for obese people to normalize their blood lipids is to lose weight, which is, unfortunately, hard to do in our society.

Effects of dairy products naturally enriched with cis-9,trans-11 conjugated linoleic acid on the blood lipid profile in healthy middle-aged men

BACKGROUND

Interest in the development of dairy products naturally enriched in conjugated linoleic acid (CLA) exists. However, feeding regimens that enhance the CLA content of milk also increase concentrations of trans-18:1 fatty acids. The implications for human health are not yet known.

OBJECTIVE

This study investigated the effects of consuming dairy products naturally enriched in cis-9,trans-11 CLA (and trans-11 18:1) on the blood lipid profile, the atherogenicity of LDL, and markers of inflammation and insulin resistance in healthy middle-aged men.

DESIGN

Healthy middle-aged men (n = 32) consumed ultra-heat-treated milk, butter, and cheese that provided 0.151 g/d (control) or 1.421 g/d (modified) cis-9,trans-11 CLA for 6 wk. This was followed by a 7-wk washout and a crossover to the other treatment.

RESULTS

Consumption of dairy products enriched with cis-9,trans-11 CLA and trans-11 18:1 did not significantly affect body weight, inflammatory markers, insulin, glucose, triacylglycerols, or total, LDL, and HDL cholesterol but resulted in a small increase in the ratio of LDL to HDL cholesterol. The modified dairy products changed LDL fatty acid composition but had no significant effect on LDL particle size or the susceptibility of LDL to oxidation. Overall, increased consumption of full-fat dairy products and naturally derived trans fatty acids did not cause significant changes in cardiovascular disease risk variables, as may be expected on the basis of current health recommendations.

CONCLUSION

Dairy products naturally enriched with cis-9,trans-11 CLA and trans-11 18:1 do not appear to have a significant effect on the blood lipid profile.

Serum fatty acids as biomarkers of fat intake predict serum cholesterol concentrations in a population-based survey of New Zealand adolescents and adults

BACKGROUND

The results of randomized controlled trials indicate that the amount and type of dietary fat are important predictors of serum cholesterol concentrations. However, the results of observational studies show weak or no association between dietary fat intake and serum cholesterol. Serum fatty acids are valid biomarkers of fat intake and may improve dietary estimates.

OBJECTIVE

The objective was to ascertain whether serum fatty acids are associated with serum cholesterol concentrations in New Zealand adolescents and adults.

DESIGN

The current study was a cross-sectional, national, population-based survey of 2793 New Zealanders aged > or =15 y who participated in the 1997 National Nutrition Survey. The fatty acid composition of serum cholesterol esters, phospholipids, and triacylglycerols was measured.

RESULTS

A 1-SD increase in myristic acid (14:0) in serum cholesterol ester, phospholipids, and triacylglycerol corresponded with increases in serum cholesterol of 0.19, 0.13, and 0.10 mmol/L, respectively, after adjustment of the regression analysis for sex, age, body mass index, ethnicity, and smoking. The mean difference in cholesterol concentrations between persons in the highest and the lowest quintiles of serum cholesteryl-myristate was 0.48 mmol/L (P for trend < 0.001). A 1-SD increase in the proportion of linoleic acid (18:2n-6) in serum cholesterol ester, phospholipids, and triacylglycerol corresponded with decreases in serum cholesterol of 0.07, 0.07, and 0.05 mmol/L, respectively. The difference in mean serum cholesterol between the highest and lowest quintiles of cholesteryl-linoleate was 0.18 mmol/L (P for trend = 0.019).

CONCLUSION

Saturated and polyunsaturated fat intakes, measured by using fatty acid biomarkers, are important predictors of serum cholesterol concentrations in New Zealand.

Effects of stearic acid on plasma lipid and lipoproteins in humans

More than 40 years ago, saturated FA with 12, 14, and 16 carbon atoms (lauric acid, myristic acid, and palmitic acid) were demonstrated to be "hypercholesterolemic saturated FA". It was further concluded that the serum total cholesterol level would hardly be changed by isocaloric replacement of stearic acid (18:0) by oleic acid (cis-18:1n-9) or carbohydrates. These earlier studies did not address the effects of the various FA on the serum lipoprotein profile. Later studies found that the hypercholesterolemic saturated FA increase serum total cholesterol levels by raising concentrations of both the atherogenic LDL and the antiatherogenic HDL. Consequently, the ratio of total to HDL cholesterol will hardly change when carbohydrates replace these saturated FA. Compared with other saturated FA, stearic acid lowers LDL cholesterol. Studies on the effects on HDL cholesterol are less conclusive. In some, the effects on HDL cholesterol were comparable to those of palmitic acid, oleic acid, and linoleic acid, whereas in others a decrease was observed. This may suggest that in this respect the source of stearic acid is of importance, which needs however further study. From all these studies, however, it can be concluded that stearic acid may decrease the ratio of total to HDL cholesterol slightly when compared with palmitic or myristic acid. Without doubt, the effects of stearic acid are more favorable than those of trans monounsaturated FA.

Managing abnormal blood lipids: a collaborative approach

Current data and guidelines recommend treating abnormal blood lipids (ABL) to goal. This is a complex process and requires involvement from various healthcare professionals with a wide range of expertise. The model of a multidisciplinary case management approach for patients with ABL is well documented and described. This collaborative approach encompasses primary and secondary prevention across the lifespan, incorporates nutritional and exercise management as a significant component, defines the importance and indications for pharmacological therapy, and emphasizes the importance of adherence. Use of this collaborative approach for the treatment of ABL ultimately will improve cardiovascular and cerebrovascular morbidity and mortality.

Changes in serum lipids and postprandial glucose and insulin concentrations after consumption of beverages with beta-glucans from oats or barley: a randomised dose-controlled trial

OBJECTIVES

To investigate side by side the effects on serum lipoproteins and postprandial glucose and insulin concentrations of beverages enriched with 5 or 10 g of beta-glucans from oats or barley.

DESIGN AND SETTING

An 8-week single blind, controlled study with five parallel groups carried out at two centres under identical conditions.

SUBJECTS

A total of 100 free-living hypercholesterolaemic subjects were recruited locally and 89 completed the study.

INTERVENTIONS

During a 3-week run-in period all subjects consumed a control beverage. For the following 5-week period four groups received a beverage with 5 or 10 g beta-glucans from oats or barley and one group continued with the control beverage. Blood samples in weeks 0, 2, 3, 7 and 8 were analysed for serum lipids, lipoproteins, glucose and insulin. Postprandial concentrations of glucose and insulin were compared between control and the beverage with 5 g of beta-glucans from oats or barley.

RESULTS

Compared to control, 5 g of beta-glucans from oats significantly lowered total-cholesterol by 7.4% (P<0.01), and postprandial concentrations of glucose (30 min, P=0.005) and insulin (30 min, P=0.025). The beverage with 10 g of beta-glucans from oats did not affect serum lipids significantly in comparison with control. No statistically significant effects compared to control of the beverages with barley beta-glucans were found.

CONCLUSIONS

A daily consumption of 5 g of oat beta-glucans in a beverage improved the lipid and glucose metabolism, while barley beta-glucans did not.

The effect of select nutrients on serum high-density lipoprotein cholesterol and apolipoprotein A-I levels

One of the factors contributing to the increased risk of developing premature atherosclerosis is low plasma concentrations of high-density lipoprotein (HDL) cholesterol (HDLc). Multiple potential mechanisms account for the cardioprotective effects of HDL and its main protein apolipoprotein A-I (apo A-I). The low plasma concentrations of HDL could be the result of increased fractional clearance and reduced expression of apo A-I. To this end, nutrients play an important role in modulating the fractional clearance rate, as well as the rate of apo A-I gene expression. Because medical nutrition therapy constitutes the cornerstone of management of dyslipidemias, it is essential to understand the mechanisms underlying the changes in HDL level in response to alterations in dietary intake. In this review, we will discuss the effect of select nutrients on serum HDLc and apo A-I levels. Specifically, we will review the literature on the effect of carbohydrates, fatty acids, and ketones, as well as some of the nutrient-related metabolites, such as glucosamine and the prostanoids, on apo A-I gene expression. Because there are multiple mechanisms involved in the regulation of serum HDLc levels, changes in gene transcription do not necessarily correlate with clinical observations on serum levels of HDLc.

Effects of butter high in ruminant trans and monounsaturated fatty acids on lipoproteins, incorporation of fatty acids into lipid classes, plasma C-reactive protein, oxidative stress, hemostatic variables, and insulin in healthy young men

BACKGROUND

Evidence suggests that ruminant trans fatty acids (FAs), such as vaccenic acid, do not increase the risk of ischemic heart disease (IHD). However, the effects of ruminant trans FAs on risk markers of IHD have been poorly investigated.

OBJECTIVE

The objective was to investigate the effect of butter with a naturally high content of vaccenic acid and a concomitantly higher content of monounsaturated FAs on classic and novel risk markers of IHD.

DESIGN

In a double-blind, randomized, 5-wk, parallel intervention study, 42 healthy young men were given 115 g fat/d from test butter that was high in vaccenic acid (3.6 g vaccenic acid/d) or a control butter with a low content of vaccenic acid. Blood and urine samples were collected before and after the intervention.

RESULTS

The intake of the vaccenic acid-rich diet resulted in 6% and 9% lower total cholesterol and plasma HDL-cholesterol concentrations, respectively, than did the intake of the control diet (P = 0.05 and 0.002, respectively), whereas the ratio of total to HDL cholesterol did not differ significantly between the groups. The FA composition of lipid classes reflected the FAs' proportion of the test butter. No other differences were observed.

CONCLUSIONS

Butter high in ruminant trans and monounsaturated FAs resulted in significantly lower total and HDL cholesterol than did the control butter with higher amounts of saturated FAs. It may be that the differences were due to the greater content of monounsaturated FAs and the lesser content of saturated FAs in the butter rich in ruminant trans FAs, rather than to the content of vaccenic acid per se.

Comparison of isocaloric very low carbohydrate/high saturated fat and high carbohydrate/low saturated fat diets on body composition and cardiovascular risk

Background

It is speculated that high saturated fat very low carbohydrate diets (VLCARB) have adverse effects on cardiovascular risk but evidence for this in controlled studies is lacking. The objective of this study was to compare, under isocaloric conditions, the effects of a VLCARB to 2 low saturated fat high carbohydrate diets on body composition and cardiovascular risk.

Methods

Eighty three subjects, 48 ± 8 y, total cholesterol 5.9 ± 1.0 mmol/L, BMI 33 ± 3 kg/m² were randomly allocated to one of 3 isocaloric weight loss diets (6 MJ) for 8 weeks and on the same diets in energy balance for 4 weeks: Very Low Fat (VLF) (CHO:Fat:Protein; %SF = 70:10:20; 3%), High Unsaturated Fat (HUF) = (50:30:20; 6%), VLCARB (4:61:35; 20%)

Results

Percent fat mass loss was not different between diets VLCARB -4.5 ± 0.5, VLF-4.0 ± 0.5, HUF -4.4 ± 0.6 kg). Lean mass loss was 32-31% on VLCARB and VLF compared to HUF (21%) (P < 0.05). LDL-C increased significantly only on VLCARB by 7% (p < 0.001 compared with the other diets) but apoB was unchanged on this diet and HDL-C increased relative to the other 2 diets. Triacylglycerol was lowered by 0.73 ± 0.12 mmol/L on VLCARB compared to -0.15 ± 0.07 mmol/L on HUF and -0.06 ± 0.13 mmol/L on VLF (P < 0.001). Plasma homocysteine increased 6.6% only on VLCARB (P = 0.026). VLCARB lowered fasting insulin 33% compared to a 19% fall on HUF and no change on VLF (P < 0.001). The VLCARB meal also provoked significantly lower post prandial glucose and insulin responses than the VLF and HUF meals. All diets decreased fasting glucose, blood pressure and CRP (P < 0.05).

Conclusion

Isocaloric VLCARB results in similar fat loss than diets low in saturated fat, but are more effective in improving triacylglycerols, HDL-C, fasting and post prandial glucose and insulin concentrations. VLCARB may be useful in the short-term management of subjects with insulin resistance and hypertriacylglycerolemia.

Chocolate and prevention of cardiovascular disease: a systematic review

Background

Consumption of chocolate has been often hypothesized to reduce the risk of cardiovascular disease (CVD) due to chocolate's high levels of stearic acid and antioxidant flavonoids. However, debate still lingers regarding the true long term beneficial cardiovascular effects of chocolate overall.

Methods

We reviewed English-language MEDLINE publications from 1966 through January 2005 for experimental, observational, and clinical studies of relations between cocoa, cacao, chocolate, stearic acid, flavonoids (including flavonols, flavanols, catechins, epicatechins, and procynadins) and the risk of cardiovascular disease (coronary heart disease (CHD), stroke). A total of 136 publications were selected based on relevance, and quality of design and methods. An updated meta-analysis of flavonoid intake and CHD mortality was also conducted.

Results

The body of short-term randomized feeding trials suggests cocoa and chocolate may exert beneficial effects on cardiovascular risk via effects on lowering blood pressure, anti-inflammation, anti-platelet function, higher HDL, decreased LDL oxidation. Additionally, a large body of trials of stearic acid suggests it is indeed cholesterol-neutral. However, epidemiologic studies of serum and dietary stearic acid are inconclusive due to many methodologic limitations. Meanwhile, the large body of prospective studies of flavonoids suggests the flavonoid content of chocolate may reduce risk of cardiovascular mortality. Our updated meta-analysis indicates that intake of flavonoids may lower risk of CHD mortality, RR = 0.81 (95% CI: 0.71–0.92) comparing highest and lowest tertiles.

Conclusion

Multiple lines of evidence from laboratory experiments and randomized trials suggest stearic acid may be neutral, while flavonoids are likely protective against CHD mortality. The highest priority now is to conduct larger randomized trials to definitively investigate the impact of chocolate consumption on long-term cardiovascular outcomes.

Minor changes in blood lipids after 6 weeks of high-volume low- intensity physical activity with strict energy balance control

Physical activity has been shown to favorably affect metabolic risk markers, including blood lipids. The impact of high-energy turnover, without influencing the traditionally used markers of exercise training effects, on blood lipids is still unclear. The aim was to study the effect of high-volume low-intensity physical activity on the blood lipid pattern, with a tight control of diet and energy balance. Eight untrained men [42.5 (12.1) years, body mass index 24.2 (2.8) kg m(-2)] were tested in two different 6-week protocols. In the sedentary protocol, the subjects were instructed to limit their everyday physical activity. In the activity protocol, a 2-h physical activity bout was performed 5 days week(-1) (approximately 40% of VO(2max); equivalent of an additional 21 MJ week(-1) in energy expenditure). The diet for both protocols comprised approximately 40 energy percent (E%) fat, approximately 50 E% carbohydrates (CHO). The polyunsaturated fatty acids to saturated fatty acids ratio of the diet was approximately 0.12. There were no changes during each 6-week period or differences between the two protocols in body weight, body composition or aerobic capacity. Low-intensity physical activity did not affect lipid parameters substantially, except for a slightly lower Apo-B/Apo-A1 ratio with the activity protocol (P < 0.05). Total and low-density lipoprotein cholesterol, as well as Apo-B and Apo-A1, were increased during the beginning of each 6-week period (P < 0.05), but returned to basal levels by the sixth week. In conclusion, 6 weeks of high-volume low-intensity physical activity did not affect blood lipids substantially.

Randomized, multi-center trial of two hypo-energetic diets in obese subjects: high- versus low-fat content

OBJECTIVE

To investigate whether a hypo-energetic low-fat diet is superior to a hypo-energetic high-fat diet for the treatment of obesity.

DESIGN

Open-label, 10-week dietary intervention comparing two hypo-energetic (-600 kcal/day) diets with a fat energy percent of 20-25 or 40-45.

SUBJECTS

Obese (BMI >or=30 kg/m(2)) adult subjects (n = 771), from eight European centers.

MEASUREMENTS

Body weight loss, dropout rates, proportion of subjects who lost more than 10% of initial body weight, blood lipid profile, insulin and glucose.

RESULTS

The dietary fat energy percent was 25% in the low-fat group and 40% in the high-fat group (mean difference: 16 (95% confidence interval (CI) 15-17)%). Average weight loss was 6.9 kg in the low-fat group and 6.6 kg in the high-fat group (mean difference: 0.3 (95% CI -0.2 to 0.8) kg). Dropout was 13.6% (n = 53) in the low-fat group and 18.3% (n = 70) in the high-fat group (P=0.001). Among completers, more subjects lost >10% in the low-fat group than in the high-fat group ((20.8%, n = 70) versus (14.7%, n = 46), P = 0.02). Fasting plasma total, low-density lipoprotein- and high-density lipoprotein-cholesterol decreased in both groups, but more so in the low-fat group than in the high-fat group. Fasting plasma insulin and glucose were lowered equally by both diets.

CONCLUSIONS

The low-fat diet produced similar mean weight loss as the high-fat diet, but resulted in more subjects losing >10% of initial body weight and fewer dropouts. Both diets produced favorable changes in fasting blood lipids, insulin and glucose.

Dietary stearic acid and risk of cardiovascular disease: Intake, sources, digestion, and absorption

Individual FA have diverse biological effects, some of which affect the risk of cardiovascular disease (CVD). In the context of food-based dietary guidance designed to reduce CVD risk, fat and FA recommendations focus on reducing saturated FA (SFA) and trans FA (TFA), and ensuring an adequate intake of unsaturated FA. Because stearic acid shares many physical properties with the other long-chain SFA but has different physiological effects, it is being evaluated as a substitute for TFA in food manufacturing. For stearic acid to become the primary replacement for TFA, it is essential that its physical properties and biological effects be well understood.

The dietary alpha-linolenic acid to linoleic acid ratio does not affect the serum lipoprotein profile in humans

Alpha-linolenic acid [ALA, 18:3(n-3)] and linoleic acid [LA, 18:2(n-6)] have comparable effects on serum lipid and lipoprotein concentrations, but their effects on lipoprotein subclass distributions and particle sizes are unknown. It is also not known whether these effects are changed by the ALA:LA ratio in the diet. To address these questions, healthy subjects (n = 54) consumed a control diet providing 7% of energy (En%) as LA and 0.4 En% as ALA during a 4-wk run-in period. For the following 6 wk of intervention, each diet was consumed by 18 subjects: the control diet, a low-LA diet (3 En% LA, 0.4 En% ALA), or a high-ALA diet (7 En% LA, 1.1 En% ALA). The ALA:LA ratio for the control diet was 1:19 and was 1:7 for the other 2 diets. Compared with the control group, LDL cholesterol decreased significantly in the ALA group (-0.32 mmol/L, P = 0.024), as did total cholesterol, apolipoprotein (apo) B, and the total:HDL cholesterol ratio. None of the dietary interventions affected HDL cholesterol, apo A-1, or triacylglycerol concentrations. The decrease in total VLDL particle concentrations in the low-LA group was due mainly to a decrease in medium VLDL (-16 nmol/L, P = 0.018) and in the high-ALA group to a decrease in small VLDL (-14 nmol/L, P = 0.044). We conclude that the ALA:LA ratio does not affect the serum lipoprotein profile. Compared with the control and LA diets, ALA lowered LDL cholesterol concentrations, possibly caused by the decrease in small VLDL.

Influence of stearic acid on postprandial lipemia and hemostatic function

It has been suggested that fats rich in stearic acid may result in exaggerated postprandial lipemia and have adverse effects on hemostatic function. The effects of test meals containing different saturated and monounsaturated FA were compared in healthy subjects in a series of studies to investigate this hypothesis. Stearic acid, when present as cocoa butter, resulted in similar postprandial lipemia and factor VII activation compared with a meal containing high-oleic sunflower oil. Stearic acid when presented as shea butter or as randomized stearate-rich TAG resulted in decreased postprandial lipemia and decreased postprandial activation of factor VII. Stearic acid-rich test meals did not result in impaired fibrinolytic activity compared with either a low-fat meal or a meal high in oleate. The difference in responses between the different stearic acid-rich fats appears to be due to varying solid fat contents of the fats at 37 degrees C.

Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction

Metabolic Syndrome (MetS) represents a constellation of markers that indicates a predisposition to diabetes, cardiovascular disease and other pathologic states. The definition and treatment are a matter of current debate and there is not general agreement on a precise definition or, to some extent, whether the designation provides more information than the individual components. We consider here five indicators that are central to most definitions and we provide evidence from the literature that these are precisely the symptoms that respond to reduction in dietary carbohydrate (CHO). Carbohydrate restriction is one of several strategies for reducing body mass but even in the absence of weight loss or in comparison with low fat alternatives, CHO restriction is effective at ameliorating high fasting glucose and insulin, high plasma triglycerides (TAG), low HDL and high blood pressure. In addition, low fat, high CHO diets have long been known to raise TAG, lower HDL and, in the absence of weight loss, may worsen glycemic control. Thus, whereas there are numerous strategies for weight loss, a patient with high BMI and high TAG is likely to benefit most from a regimen that reduces CHO intake. Reviewing the literature, benefits of CHO restriction are seen in normal or overweight individuals, in normal patients who meet the criteria for MetS or in patients with frank diabetes. Moreover, in low fat studies that ameliorate LDL and total cholesterol, controls may do better on the symptoms of MetS. On this basis, we feel that MetS is a meaningful, useful phenomenon and may, in fact, be operationally defined as the set of markers that responds to CHO restriction. Insofar as this is an accurate characterization it is likely the result of the effect of dietary CHO on insulin metabolism. Glucose is the major insulin secretagogue and insulin resistance has been tied to the hyperinsulinemic state or the effect of such a state on lipid metabolism. The conclusion is probably not surprising but has not been explicitly stated before. The known effects of CHO-induced hypertriglyceridemia, the HDL-lowering effect of low fat, high CHO interventions and the obvious improvement in glucose and insulin from CHO restriction should have made this evident. In addition, recent studies suggest that a subset of MetS, the ratio of TAG/HDL, is a good marker for insulin resistance and risk of CVD, and this indicator is reliably reduced by CHO restriction and exacerbated by high CHO intake. Inability to make this connection in the past has probably been due to the fact that individual responses have been studied in isolation as well as to the emphasis of traditional therapeutic approaches on low fat rather than low CHO. We emphasize that MetS is not a disease but a collection of markers. Individual physicians must decide whether high LDL, or other risk factors are more important than the features of MetS in any individual case but if MetS is to be considered it should be recognized that reducing CHO will bring improvement. Response of symptoms to CHO restriction might thus provide a new experimental criterion for MetS in the face of on-going controversy about a useful definition. As a guide to future research, the idea that control of insulin metabolism by CHO intake is, to a first approximation, the underlying mechanism in MetS is a testable hypothesis.

Effects of dietary fats versus carbohydrates on coronary heart disease: A review of the evidence

Recommendations arising from the traditional diet-coronary heart disease (CHD) paradigm, which focuses on effects of total and saturated fat on serum total and low-density lipoprotein cholesterol, may have failed to reduce CHD risk and inadvertently exacerbated dyslipidemia, insulin resistance, and weight gain, particularly among individuals who are older, female, sedentary, or obese. A suitable dietary paradigm must consider types and qualities of fats and carbohydrates consumed, their effects on a range of intermediary risk factors, and characteristics that may modify individual susceptibility. Based on current evidence, replacement of total, unsaturated, and even possibly saturated fats with refined, high-glycemic index carbohydrates is unlikely to reduce CHD risk and may increase risk in persons predisposed to insulin resistance. In contrast, a diet that is 1) rich in whole grains and other minimally processed carbohydrates; 2) includes moderate amounts of fats (approximately 30%-40% of total energy), particularly unsaturated fats and omega-3 polyunsaturated fats from seafood and plant sources; 3) is lower in refined grains and carbohydrates; and 4) eliminates packaged foods, baked goods, and fast foods containing trans fatty acids, will likely reduce the risk of CHD.

Dose-related effects of lauric acid on antropyloroduodenal motility, gastrointestinal hormone release, appetite, and energy intake in healthy men

We recently reported that intraduodenal infusion of lauric acid (C12) (0.375 kcal/min, 106 mM) stimulates isolated pyloric pressure waves (IPPWs), inhibits antral and duodenal pressure waves (PWs), stimulates release of cholecystokinin (CCK) and glucagon-like peptide-1 (GLP-1), and suppresses energy intake and that these effects are much greater than those seen in response to isocaloric decanoic acid (C10) infusion. Administration of C12 was, however, associated with nausea, confounding interpretation of the results. The aim of this study was to evaluate the effects of different intraduodenal doses of C12 on antropyloroduodenal (APD) motility, plasma CCK and GLP-1 concentrations, appetite, and energy intake. Thirteen healthy males were studied on 4 days in double-blind, randomized fashion. APD pressures, plasma CCK and GLP-1 concentrations, and appetite perceptions were measured during 90-min ID infusion of C12 at 0.1 (14 mM), 0.2 (28 mM), or 0.4 (56 mM) kcal/min or saline (control; rate 4 ml/min). Energy intake was determined at a buffet meal immediately following infusion. C12 dose-dependently stimulated IPPWs, decreased antral and duodenal motility, and stimulated secretion of CCK and GLP-1 (r > 0.4, P < 0.05 for all). C12 (0.4 kcal/min) suppressed energy intake compared with control, C12 (0.1 kcal/min), and C12 (0.2 kcal/min) (P < 0.05). These effects were observed in the absence of nausea. In conclusion, intraduodenal C12 dose-dependently modulated APD motility and gastrointestinal hormone release in healthy male subjects, whereas effects on energy intake were only apparent with the highest dose infused (0.4 kcal/min), possibly because only at this dose was modulation of APD motility and gastrointestinal hormone secretion sufficient for a suppressant effect on energy intake.

Mechanisms by which dietary fatty acids modulate plasma lipids

Dietary fatty acids have a considerable effect on plasma LDL cholesterol (LDL-C) concentrations and therefore on the risk for coronary heart disease. Numerous studies have been conducted in animal models to elucidate the mechanisms by which different types of fatty acids modulate plasma cholesterol concentrations. In addition, multiple clinical trials and epidemiological data have demonstrated the effects of fatty acids in determining the concentrations of circulating LDL. SFAs and trans fatty acids have a detrimental effect on plasma lipids, whereas PUFAs of the (n-6) family and monounsaturated fatty acids decrease plasma LDL-C concentrations. Among the SFAs, stearic acid (18:0) appears to have a neutral effect on LDL-C, while lauric (12:0), myristic (14:0), and palmitic (16:0) acids are considered to be hypercholesterolemic. SFAs increase plasma LDL-C by increasing the formation of LDL in the plasma compartment and by decreasing LDL turnover. Although unsaturated fatty acids increase cholesterol synthesis, they also increase hepatic LDL receptor number and LDL turnover in vivo. Fatty acids are also ligands of important regulatory elements, which can play a role in determining plasma cholesterol. This article presents a summary of the major effects of various types of fatty acids on plasma lipid concentrations and the mechanisms involved.

Small differences in the effects of stearic acid, oleic acid, and linoleic acid on the serum lipoprotein profile of humans

BACKGROUND

Studies have suggested that oleic and stearic acids, as well as oleic and linoleic acids, have comparable effects on the serum lipoprotein profile. If so, then substituting these three 18-carbon fatty acids for each other would result in similar effects on the serum lipoprotein profile.

OBJECTIVE

The aim of this study was to compare simultaneously the effects of stearic, oleic, and linoleic acids on the serum lipoprotein profile of healthy subjects.

DESIGN

Forty-five subjects (27 women and 18 men) consumed in random order 3 experimental diets, each for 5 wk. The diets provided 38% of energy from fat, of which 60% was supplied by the experimental fats. The dietary compositions of the diets were the same, except for 7% of energy, which was provided by stearic, oleic, or linoleic acid. At the end of each intervention period, serum lipid and lipoprotein concentrations were measured. In addition, LDL, HDL, and VLDL particle sizes and particle concentrations of lipoprotein subclasses were analyzed by nuclear magnetic resonance spectroscopy.

RESULTS

No significant diet-induced changes in serum lipids and lipoproteins were found. Mean (+/-SD) serum LDL-cholesterol concentrations were 3.79 +/- 0.91, 3.71 +/- 0.79, and 3.65 +/- 0.91 mmol/L with the high-stearic acid, high-oleic acid, and high-linoleic acid diets, respectively (P = 0.137 for diet effects). Mean (+/-SD) HDL-cholesterol concentrations were 1.45 +/- 0.43, 1.46 +/- 0.45, and 1.46 +/- 0.44 mmol/L (P = 0.866). LDL, HDL, and VLDL particle sizes and lipoprotein subclass distributions also did not differ significantly between the 3 diets.

CONCLUSIONS

With realistic intakes of stearic, oleic, and linoleic acids, differences between their effects on the serum lipoprotein profile are small.

A high-protein diet increases postprandial but not fasting plasma total homocysteine concentrations: a dietary controlled, crossover trial in healthy volunteers

BACKGROUND

A high plasma concentration of total homocysteine (tHcy) is associated with increased risk of cardiovascular disease. A high protein intake and hence a high intake of methionine--the sole dietary precursor of homocysteine--may raise plasma tHcy concentrations.

OBJECTIVES

We studied whether high intake of protein increases plasma concentrations of tHcy in the fasting state and throughout the day.

DESIGN

We conducted a randomized, dietary controlled, crossover trial in 20 healthy men aged 18-44 y. For 8 d, men consumed a controlled low-protein diet enriched with either a protein supplement [high-protein diet (21% of energy as protein)] or an isocaloric amount of short-chain glucose polymers [low-protein diet (9% of energy as protein)]. After a 13-d washout period, treatments were reversed. On days 1 and 8 of each treatment period, blood was sampled before breakfast (fasting) and throughout the day.

RESULTS

Fasting tHcy concentrations did not differ significantly after the 1-wk high-protein and the 1-wk low-protein diets. The high-protein diet resulted in a significantly higher area under the 24-h homocysteine-by-time curves compared with the low-protein diet, both on day 1 (difference: 45.1 h x micromol/L; 95% CI: 35.3, 54.8 h x micromol/L; P < 0.0001) and on day 8 (difference: 24.7 h x micromol/L; 95% CI: 15.0, 34.5 h x micromol/L; P < 0.0001).

CONCLUSIONS

A high-protein diet increases tHcy concentrations throughout the day but does not increase fasting tHcy concentrations. As previously shown, the extent of the tHcy increase is modified by the amino acid composition of the protein diet. The clinical relevance of this finding depends on whether high concentrations of tHcy-particularly postprandially-cause cardiovascular disease.

A rapid method for the quantification of fatty acids in fats and oils with emphasis on trans fatty acids using fourier transform near infrared spectroscopy (FT-NIR)

A rapid method was developed for classifying and quantifying the FA composition of edible oils and fats using Fourier Transform near infrared spectroscopy (FT-NIR). The FT-NIR spectra showed unique fingerprints for saturated FA, cis and trans monounsaturated FA, and all n-6 and n-3 PUFA within TAG to permit qualitative and quantitative comparisons of fats and oils. The quantitative models were based on incorporating accurate GC data of the different fats and oils and FT-NIR spectral information into the calibration model using chemometric analysis. FT-NIR classification models were developed based on chemometric analyses of 55 fats, oils, and fat/oil mixtures that were used in the identification of similar materials. This database was used to prepare three calibration models-one suitable for the analysis of common fats and oils with low levels of trans FA, and the other two for fats and oils with intermediate and high levels of trans FA. The FT-NIR method showed great potential to provide the complete FA composition of unknown fats and oils in minutes. Compared with the official GC method, the FT-NIR method analyzed fats and oils directly in their neat form and required no derivatization of the fats to volatile FAME, followed by time-consuming GC separations and analyses. The FT-NIR method also compared well with the official FTIR method using an attenuated total reflectance (ATR) cell; the latter provided only quantification of specific functional groups, such as the total trans FA content, whereas FT-NIR provided the complete FA profile. The FT-NIR method has the potential to be used for rapid screening and/or monitoring of fat products, trans FA determinations for regulatory labeling purposes, and detection of contaminants. The quantitative FT-NIR results for various edible oils and fats and their mixtures are presented based on the FT-NIR models developed.

Butter naturally enriched in conjugated linoleic acid and vaccenic acid alters tissue fatty acids and improves the plasma lipoprotein profile in cholesterol-fed hamsters

Butter, which is naturally enriched in cis-9, trans-11 conjugated linoleic acid (rumenic acid; RA) and vaccenic acid (VA), has been shown to be an effective anticarcinogen in studies with animal models; however, there has been no examination of the effects of a naturally derived source of VA and RA on atherosclerosis-related biomarkers. The current study was designed to determine the effect of a diet containing VA/RA-enriched butter on plasma lipoproteins and tissue fatty acid profiles in cholesterol-fed hamsters. Male Golden Syrian hamsters were fed diets containing 0.2% cholesterol and 20% added fat as: 1) Control, 20% standard butter (CT); 2) 5% standard butter + 15% VA/RA-enriched butter (EB); 3) 15% standard butter + 5% partially-hydrogenated vegetable oil (VO). After 4 wk, plasma lipoproteins were isolated, cholesterol quantified, and tissue fatty acid profiles determined. Tissue concentrations of VA and RA were increased by consumption of the EB diet compared with both the CT and VO diets, whereas the VO diet increased their concentration compared with the CT diet only. Total and LDL cholesterol concentrations were significantly reduced in hamsters fed EB and VO compared with CT, whereas VLDL cholesterol concentrations were reduced in hamsters fed EB compared with those fed CT and VO. HDL cholesterol concentrations did not differ among treatments. The ratio of potentially atherogenic lipoproteins [VLDL + intermediate density lipoproteins (IDL) + LDL] to antiatherogenic HDL was significantly lower in hamsters fed VA/RA-enriched butter (0.60) than in those fed either control diet (1.70) or the diet containing partially hydrogenated vegetable oil (1.04). Thus, increasing the VA/RA concentration of butter results in a plasma lipoprotein cholesterol profile that is associated with a reduced risk of atherosclerosis.

Lupin kernel fibre-enriched foods beneficially modify serum lipids in men

OBJECTIVE

To examine the effect of a diet containing a novel legume food ingredient, Australian sweet lupin (Lupinus angustifolius) kernel fibre (LKFibre), compared to a control diet without the addition of LKFibre, on serum lipids in men.

DESIGN

Randomized crossover dietary intervention study.

SETTING

Melbourne, Australia--Free-living men.

SUBJECTS

A total of 38 healthy males between the ages of 24 and 64 y completed the intervention.

INTERVENTION

Subjects consumed an LKFibre and a control diet for 1 month each. Both diets had the same background menus with seven additional experimental foods that either contained LKFibre or did not. Depending on energy intake, the LKFibre diet was designed to contain an additional 17 to 30 g/day fibre beyond that of the control diet.

RESULTS

Compared to the control diet, the LKFibre diet reduced total cholesterol (TC) (mean+/-s.e.m.; 4.5+/-1.7%; P=0.001), low-density lipoprotein cholesterol (LDL-C) (5.4+/-2.2%; P=0.001), TC: high-density lipoprotein cholesterol (HDL-C) (3.0+/-2.0%; P=0.006) and LDL-C:HDL-C (3.8+/-2.6%; P=0.003). No effects on HDL-C, triacylglycerols, glucose or insulin were observed.

CONCLUSIONS

Addition of LKFibre to the diet provided favourable changes to some serum lipid measures in men, which, combined with its high palatability, suggest this novel ingredient may be useful in the dietary reduction of coronary heart disease risk.

Glycemic load, glycemic index, and carbohydrate intake in relation to risk of cholecystectomy in women

BACKGROUND & AIMS

High-carbohydrate diets with a high glycemic response may exacerbate the metabolic consequences of the insulin-resistance syndrome. The effect on the incidence of gallstone disease is not clear.

METHODS

We examined the associations between high-carbohydrate diets with a high glycemic response and the risk of cholecystectomy in a cohort of women who were aged from 35 to 61 years in 1984 and had no history of gallstone disease. As part of the Nurses' Health Study, the women reported on questionnaires mailed to them every 2 years both their carbohydrate intake and whether they had undergone cholecystectomy.

RESULTS

During 16 years of follow-up, we ascertained 5771 new cases of cholecystectomy. After adjusting for age and other known or suspected risk factors in a multivariate model, the relative risk for the highest compared with the lowest quintile of dietary carbohydrate was 1.35 (95% CI: 1.17-1.55, P for trend < .0001). The relative risks for the highest compared with the lowest quintile were 1.50 for glycemic load (95% CI: 1.32-1.71, P for trend < .0001) and 1.32 for glycemic index (95% CI: 1.20-1.45, P for trend < .0001). Independent positive associations were also seen for intakes of starch and sucrose.

CONCLUSIONS

Our findings suggest that a higher intake of carbohydrate, dietary glycemic load, and glycemic index may enhance risk of cholecystectomy in women.

Flow-Mediated Dilatation Is Impaired by a High–Saturated Fat Diet but Not by a High-Carbohydrate Diet

Objective— It is unknown whether a low-fat diet, which may elevate triglycerides and lower high-density lipoprotein (HDL) cholesterol, harms the endothelium. Our aim was to determine whether a low-fat, high-carbohydrate (CARB) diet impaired endothelial vasodilation compared with high saturated fat (SFA), monounsaturated fat (MUFA), or polyunsaturated fat (PUFA) diets.

Methods and Results— Forty healthy subjects were randomly crossed over to 4, 3-week isocaloric diets high in PUFA, MUFA, or SFA, containing at least 25 g of the relevant fat or a low-fat, CARB, high–glycemic load diet. Flow-mediated dilatation (FMD), fasting blood lipids, high sensitivity C-reactive protein, plasma intercellular, and vascular adhesion molecules plasma E- and P-selectin were measured after each intervention. SFA impaired FMD compared with all other diets (5.41±2.45% versus 10.80±3.69%; P =0.01). FMD did not change on CARB relative to MUFA or PUFA, despite 23% to 39% rises in triglyceride and 10% to 15% falls in HDL cholesterol. P-selectin was highest after SFA (121±52.7 ng/mL) versus MUFA (98±44.5 ng/mL; P =0.001) and PUFA (96±36.4 ng/mL; P =0.001).

Conclusion— High SFA caused deterioration in FMD compared with high PUFA, MUFA, or CARB diets. Inflammatory responses may also be increased on this diet.

Validation of the dietary risk assessment food frequency questionnaire against the Keys score for saturated fat and cholesterol

OBJECTIVE

The objective of this pilot study was to validate the Dietary Risk Assessment (DRA) food frequency questionnaire against the Keys score obtained from 2 2-day dietary recalls in a sample of subjects.

DESIGN

Cross-sectional study design.

SETTING

Urban university-based family practice.

PARTICIPANTS

The 105 subjects included outpatients, medical students, and staff.

MAIN OUTCOME MEASURE

Correlation between the DRA and Keys score.

ANALYSIS

Pearson correlation analysis.

RESULTS

We found that the correlation between the DRA and Keys score derived from the dietary recalls was .62 (P < .001).

CONCLUSIONS AND IMPLICATIONS

The simplicity of the DRA and its correlation with dietary recall may make this a useful dietary analysis and nutrition education tool for both patients and physicians.

Effect of low and high fat diets on nutrient intakes and selected cardiovascular risk factors in sedentary men and women

OBJECTIVE

The desired level of dietary fat intake is controversial. The effect of decreasing fat intake to 19% and increasing it to 50% from a control diet of 30% on nutritional status and cardiovascular risk factors in healthy individuals was studied.

METHODS

Eleven healthy subjects (5 men and 6 women) were randomized to consume diets with 19% and 50% calories from fat. Each diet lasted 3 weeks, with a one-week washout. The habitual and washout diets were determined to be 30% fat. At the beginning and the end of each diet, fasting blood was collected to determine plasma lipoproteins, and physiological factors were measured.

RESULTS

Total caloric expenditure was similarly balanced to intake on the 30% and 50% fat diets, but intake was significantly lower on the 19% fat diet and led to a loss of 0.6 kg body weight. Consumptions of essential fatty acids, vitamin E and zinc were improved with increased fat intake, but folate intake was compromised on the 30% and 50% fat diets. Compared with the 50% fat diet, subjects consuming the 19% fat diet had significantly lower HDL cholesterol (HDL-C) (54 +/- 3 vs. 63 +/- 3 mg. dL(-1), p < 0.05) and apolipoprotein A1 (ApoA1) (118 +/- 4 vs. 127 +/- 3 mg/dL, p < 0.05). Changing the levels of fat intake did not affect % body fat, heart rate, blood pressure, blood triglycerides, total cholesterol (TC), LDL cholesterol, apolipoprotein B (ApoB), TC/HDL-C and ApoA1/ApoB ratios.

CONCLUSION

A low fat diet (19%) may not provide sufficient calories, essential fatty acids, and some micronutrients (especially vitamin E and zinc) for healthy untrained individuals, and it also lowered ApoA1 and HDL-C. Increasing fat intake to 50% of calories improved nutritional status, and did not negatively affect certain cardiovascular risk factors.

Dietary intake of fatty acids, antioxidants and selected food groups and asthma in adults

OBJECTIVE

Within a prospective study, we explored the associations between dietary intake of fatty acids, antioxidants and relevant food sources of these nutrients on the clinical manifestation of asthma in adulthood.

METHOD

A total of 105 newly physician-diagnosed cases of asthma from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heidelberg cohort were identified during follow-up and matched with 420 controls. Baseline dietary intake was obtained by means of validated food frequency questionnaires. The association of dietary intake variables and asthma risk was explored by unconditional logistic regression models.

RESULTS

A high intake of oleic acid (C18:1 n-9) was positively associated with asthma (P-value for trend 0.035), while no significant associations were found for the other dietary fatty acids. Most prominently, a high margarine intake increased the risk of onset of asthma in adulthood (adjusted odds ratio (OR) 3rd tertile: 1.73 (95% confidence interval (95% CI): 1.05-2.87), P for trend=0.050), the effect being stronger in men (2nd tertile: OR=1.66, 3rd tertile: OR=2.51) than in women (2nd tertile: OR=0.91; 3rd tertile: OR=1.47). The dietary intake of antioxidants and their main food sources had no effect on asthma risk.

CONCLUSIONS

In summary, the present results provide evidence that even in adulthood a high margarine intake increases the risk of clinical onset of asthma. Whether oleic acid may serve as a proxy for margarine-derived trans-fatty acids (C18:1 t9) remains to be clarified.

Carbohydrate intake is correlated with biomarkers for coronary heart disease in a population of overweight premenopausal women

The associations between macronutrient intake and plasma parameters associated with increased risk for coronary heart disease (CHD) were evaluated in 80 overweight premenopausal women. We hypothesized that higher carbohydrate intake would be associated with a more detrimental plasma lipid profile. Dietary data were collected using a validated food frequency questionnaire (FFQ). Plasma total cholesterol (TC), triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were determined from two fasting blood samples. In addition, selected apolipoproteins (apo) and LDL peak size were measured. Values for TC, TG and HDL were not in the range of risk classification; however, the mean values of LDL-C, 2.7 +/- 0.7 mmol/L, were higher than the current recommendations. Carbohydrate intake was positively associated with TG and apo C-III (P < .01) concentrations, and negatively associated with LDL diameter (P < .01). Participants were divided into low (<53% of energy) or high (> or = 53% energy) carbohydrate intake groups. Individuals in the <53% carbohydrate group consumed more cholesterol and total fat, but also had higher intake of polyunsaturated and monounsaturated fatty acids (SFAs). In contrast, subjects in the > or =53% group consumed higher concentrations of glucose and fructose than those in the low-carbohydrate (LC) group. In addition, subjects consuming <53% carbohydrate had lower concentrations of LDL-C and apo B (P < .01) and a larger LDL diameter (P < .05) than the > or =53% group. These results suggest that the lower LDL-C in the LC group may be related to both the amount of carbohydrate and the type of fatty acids consumed by these subjects.

Interactions of dietary fat intake and the hepatic lipase -480C-->T polymorphism in determining hepatic lipase activity: the Hoorn Study

BACKGROUND

Gene-nutrient interactions affecting hepatic lipase (HL) activity may contribute to the interindividual variability of the cardiovascular disease risk associated with dietary fat intake.

OBJECTIVE

We determined the associations of dietary fat intake with postheparin HL activity and the possible modifying effect of the HL -480C-->T polymorphism on these associations.

DESIGN

Subjects were recruited from participants in the 2000-2001 follow-up examination of the Hoorn Study. HL activity was determined in postheparin plasma in a sample of 211 men and 218 women aged 60-87 y. Information about dietary intake of the participants was obtained with a validated food-frequency questionnaire. Linear regression was performed, adjusted for age.

RESULTS

Total dietary fat was positively associated with HL activity (standardized beta: 0.11; 95% CI: 0.02, 0.21), and this association was also seen for saturated fat (0.10; 0.01, 0.20) and monounsaturated fatty acid (0.10; 0.01, 0.19). We observed a significant interaction of the HL polymorphism with the relation between total fat intake and HL activity. The association of total fat with HL activity was stronger in subjects with CT (0.27; 0.11, 0.43) and TT (0.39; -0.22, 1.00) genotypes than in subjects with the CC genotype (0.06; -0.06, 0.18; P for interaction < 0.10). The interaction remained statistically significant in models that included age, sex, carbohydrate and protein intakes, and insulin or body mass index.

CONCLUSIONS

Higher intakes of total and saturated fat were positively associated with higher HL activity. In addition, the observed association of total fat with HL activity was modified by the HL-480C-->T polymorphism, after adjustment for age, sex, carbohydrate and protein intakes, and insulin or body mass index.

Metabolic and health effects of isomeric fatty acids

PURPOSE OF REVIEW

Isomeric fatty acids have the same number of carbon and hydrogen atoms, but may have distinct metabolic and health effects. Two well-known examples of isomeric fatty acids are cis and trans monounsaturated fatty acids, and conjugated isomers of linoleic acid (CLA). The purpose of this review is to summarize recent findings from human studies on the metabolic and health effects of these two classes of isomeric fatty acids.

RECENT FINDINGS

Apart from an unfavorable effect on serum lipoproteins, trans monounsaturated fatty acids from hydrogenated oils may increase plasma markers for a low-grade inflammatory state. From epidemiological studies, however, it is not possible to conclude if effects of ruminant and industrial trans fatty acids on cardiovascular risk are different. In contrast to in-vitro and animal studies, there are no indications that in humans the two most common CLA isomers (cis9,trans11-CLA and trans10,cis12-CLA) affect body composition differently. Longer-term supplementation, however, may slightly decrease body fat mass without apparent effects on plasma markers for glucose and lipid metabolism. Other studies have even reported adverse effects of CLA supplementation on insulin resistance and lipid peroxidation.

SUMMARY

Evidence is increasing that trans monounsaturated fatty acids from hydrogenated oils increase plasma markers of low-grade chronic inflammation. From epidemiological studies, however, it is not clear if effects of ruminant and industrial trans fatty acids on cardiovascular risk are different. Effects of CLA on body composition remain controversial and more research is needed before the widely available CLA supplements should be advocated as an adjunct to control body weight.