Postprandial effects of dietary trans fatty acids on apolipoprotein(a) and cholesteryl ester transfer

trans-Fatty Acids as an Enhancer of Inflammation and Cell Death: Molecular Basis for Their Pathological Actions

trans-Fatty acids (TFAs) are food-derived fatty acids that possess one or more trans double bonds between carbon atoms. Compelling epidemiological and clinical evidence has demonstrated the association of TFA consumption with various diseases, such as cardiovascular diseases, and neurodegenerative diseases. However, the underlying etiology is poorly understood since the mechanisms of action of TFAs remain to be clarified. Previous studies have shown that single treatment with TFAs induce inflammation and cell death, but to a much lesser extent than saturated fatty acids (SFAs) that are well established as a risk factor for diseases linked with inflammation and cell death, which cannot explain the particularly higher association of TFAs with atherosclerosis than SFAs. In our series of studies, we have established the role of TFAs as an enhancer of inflammation and cell death. We found that pretreatment with TFAs strongly promoted apoptosis induced by either extracellular ATP, one of the damage-associated molecular patterns (DAMPs) leaked from damaged cells, or DNA damaging-agents, including doxorubicin and cisplatin, thorough enhancing activation of the stress-responsive mitogen-activated protein (MAP) kinase p38/c-jun N-terminal kinase (JNK) pathways; pretreatment with SFAs or cis isomers of TFAs had only minor or no effect, suggesting the uniqueness of the pro-apoptotic role of TFAs among fatty acids. Our findings will provide an insight into understanding of the pathogenesis mechanisms, and open up a new avenue for developing prevention strategies and therapies for TFA-related diseases.

Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association

Cardiovascular disease (CVD) is the leading global cause of death, accounting for 17.3 million deaths per year. Preventive treatment that reduces CVD by even a small percentage can substantially reduce, nationally and globally, the number of people who develop CVD and the costs of caring for them. This American Heart Association presidential advisory on dietary fats and CVD reviews and discusses the scientific evidence, including the most recent studies, on the effects of dietary saturated fat intake and its replacement by other types of fats and carbohydrates on CVD. In summary, randomized controlled trials that lowered intake of dietary saturated fat and replaced it with polyunsaturated vegetable oil reduced CVD by ≈30%, similar to the reduction achieved by statin treatment. Prospective observational studies in many populations showed that lower intake of saturated fat coupled with higher intake of polyunsaturated and monounsaturated fat is associated with lower rates of CVD and of other major causes of death and all-cause mortality. In contrast, replacement of saturated fat with mostly refined carbohydrates and sugars is not associated with lower rates of CVD and did not reduce CVD in clinical trials. Replacement of saturated with unsaturated fats lowers low-density lipoprotein cholesterol, a cause of atherosclerosis, linking biological evidence with incidence of CVD in populations and in clinical trials. Taking into consideration the totality of the scientific evidence, satisfying rigorous criteria for causality, we conclude strongly that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD. This recommended shift from saturated to unsaturated fats should occur simultaneously in an overall healthful dietary pattern such as DASH (Dietary Approaches to Stop Hypertension) or the Mediterranean diet as emphasized by the 2013 American Heart Association/American College of Cardiology lifestyle guidelines and the 2015 to 2020 Dietary Guidelines for Americans.

Association between Low-Molecular Weight Apolipoprotein(a) Isoforms and Obesity in Italian Women

OBJECTIVE

Low-molecular weight (MW) apolipoprotein(a) [apo(a)] isoforms are closely associated with an increased incidence of atherothrombotic disease, prevalence of which is higher in obese individuals, particularly in women. The hypothesis of this study was to assess whether there are differences in the distribution of apo(a) phenotypes between obese patients and healthy controls.

RESEARCH METHODS AND PROCEDURES

One hundred three obese Italian women (BMI > or = 30.0 kg/m2) were enrolled in the study, and apo(a) phenotyping was performed in all subjects. The prevalence of low-MW apo(a) isoforms, detected in plasma samples of our obese women, was compared with that found in a control group of 84 normal-weight, never-obese (BMI < 25.0 kg/m(2)), age-matched women.

RESULTS

The distribution of apo(a) isoforms in the population of obese women was significantly different from that found in normal-weight female subjects. In particular, the percentage of subjects in the obese group with at least one apo(a) isoform of low MW was significantly higher than that in the control group (51.4% vs. 32.1%, p = 0.0079).

DISCUSSION

Our results seem to suggest the possibility that small-sized apo(a) isoforms may be used together with other traditional risk factors to better assess the overall predisposition to atherothrombotic disease in obese women.

Omega-6 polyunsaturated fatty acids prevent atherosclerosis development in LDLr-KO mice, in spite of displaying a pro-inflammatory profile similar to trans fatty acids

The development of atherosclerosis and the inflammatory response were investigated in LDLr-KO mice on three high-fat diets (40% energy as fat) for 16 weeks: trans (TRANS), saturated (SAFA) or ω-6 polyunsaturated (PUFA) fats. The following parameters were measured: plasma lipids, aortic root total cholesterol (TC), lesion area (Oil Red-O), ABCA1 content and macrophage infiltration (immunohistochemistry), collagen content (Picrosirius-red) and co-localization of ABCA1 and macrophage (confocal microscopy) besides the plasma inflammatory markers (IL-6, TNF-α) and the macrophage inflammatory response to lipopolysaccharide from Escherichia coli (LPS). As expected, plasma TC and TG concentrations were lower on the PUFA diet than on TRANS or SAFA diets. Aortic intima macrophage infiltration, ABCA1 content, and lesion area on PUFA group were lower compared to TRANS and SAFA groups. Macrophages and ABCA1 markers did not co-localize in the atherosclerotic plaque, suggesting that different cell types were responsible for the ABCA1 expression in plaques. Compared to PUFA, TRANS and SAFA presented higher collagen content and necrotic cores in atherosclerotic plaques. In the artery wall, TC was lower on PUFA compared to TRANS group; free cholesterol was lower on PUFA compared to TRANS and SAFA; cholesteryl ester concentration did not vary amongst the groups. Plasma TNF-α concentration on PUFA and TRANS-fed mice was higher compared to SAFA. No difference was observed in IL-6 concentration amongst groups. Regarding the macrophage inflammatory response to LPS, TRANS and PUFA presented higher culture medium concentrations of IL-6 and TNF-α as compared to SAFA. The PUFA group showed the lowest amount of the anti-inflammatory marker IL-10 compared to TRANS and SAFA groups. In conclusion, PUFA intake prevented atherogenesis, even in a pro-inflammatory condition.

The relation between trans fatty acid levels and increased risk of myocardial infarction does not hold at lower levels of trans fatty acids in the Costa Rican food supply

Data on the effects of recent industrial modifications that reduced the trans fatty acid (TFA) content in food supplies are scarce. In this study, incident cases (n = 1797) of a first nonfatal myocardial infarction (MI) were matched with population controls (n = 1797) for age, sex, and area of residence in Costa Rica. Odds ratio (OR) and 95% CI were calculated from conditional logistic regressions before and after a reduction of TFA in Costa Rican foods. Initially, the median quintiles of total adipose tissue TFA were 1.85, 2.47, 2.99, 3.58, and 4.40 g/100 g; total TFA was positively associated with increased MI risk after adjusting for established risk factors (OR by quintiles of total TFA: 1.00, 1.37, 1.91, 1.86, 3.28; P for trend < 0.001). This association was mostly due to 18:2 trans. In contrast, after industrial modification, median quintiles of total adipose tissue TFA were 1.84, 2.26, 2.57, 2.88, and 3.42 g/100 g; the association with MI was no longer significant (OR by quintiles of total TFA: 1.00, 0.78, 1.03, 0.88, and 1.03; P for trend = 0.65). Adipose tissue 18:1 trans fatty acids were not associated with risk of MI before or after the modification. Although to date there are no TFA regulations in Costa Rica, it appears that indirect international influence has led to a TFA reduction in the food supply and, consequently, to a reduction in the risk of nonfatal MI. The public health sector of Costa Rica should regulate food labeling and content to ensure very low levels of TFA intake.

New and Existing Oils and Fats Used in Products with Reduced Trans-Fatty Acid Content

The US Food and Drug Administration's final ruling on trans-fatty acid labeling issued in 2003 has caused a rapid transformation in the fat and oil industries. Novel ingredients and improved technologies are emerging to replace partially hydrogenated fats in foods. We present an overview of the structure and formation of trans fatty acids in foods, and a comprehensive review of the newly formulated products and current procedures practiced by the edible oil industry to reduce or eliminate trans fatty acids in response to the Food and Drug Administration's regulations mandating trans fat labeling of foods.

Trans fatty acids and blood lipids

Intake of trans-unsaturated fatty acids (TFA) has been consistently shown in multiple and rigorous randomized trials to have adverse effects on blood lipids, most notably on the LDL:HDL cholesterol ratio, which is a strong marker of cardiovascular risk. When a mixture of TFA isomers obtained by partial hydrogenation of vegetable oils is used to replace oleic acid, there is a dose-dependent increase in the LDL:HDL ratio. The relationship between amount of TFA as % of energy and the increase in the LDL:HDL ratio appears to be approximately linear, with no evidence of a threshold at low levels of intake, and with slope twice as steep as that observed by replacing oleic with saturated fats. The average impact of TFA induced changes in the LDL:HDL ratio correspond to tens of thousands premature deaths in the US alone. Although dramatic, this effect is substantially smaller than the increase in cardiovascular mortality associated with TFA intake in epidemiological studies, suggesting that other mechanisms are likely to contribute to the toxicity of TFA.

Postprandial lipoprotein(a) is affected differently by specific individual dietary fatty acids in healthy young men

Lipoprotein(a) [Lp(a)] is considered a risk factor for coronary heart disease. Our aim was to investigate the effect of individual fatty acids on postprandial plasma Lp(a) and its association with lipemia and tissue plasminogen activator (t-PA). Five test fats dominated by (approximately 43% g/kg) stearic (S), palmitic (P), oleic, C18:1 trans (T), or linoleic acid were produced by interesterification. Sixteen young healthy men were served the individual test fats incorporated into meals (1g fat/kg body wt) after a 12-h fast in random order on different days, separated by 3-wk washout periods. Blood samples were drawn before and 2, 4, 6, and 8 h after eating. There was a pronounced increase in Lp(a) concentrations after intake of the test meals, and the test fats resulted in a difference in Lp(a) response (P < 0.001; diet x time interaction). However, T fat did not change Lp(a) during the time course studied. T fat resulted in less area under the plasma Lp(a) concentration curve compared to S and P fat (P </= 0.003). Test fat with saturated fatty acids resulted in the highest Lp(a) and lowest plasma triacylglycerol (TAG) response, with the reversed situation for T fat. There was no association between Lp(a) and t-PA. In conclusion, intake of meals high in individual dietary fatty acids increased postprandial plasma Lp(a) differently. There seems to be a complex regulatory role of plasma TAG on nonfasting plasma Lp(a) concentrations.

Effect of dietary fatty acids on the postprandial fatty acid composition of triacylglycerol-rich lipoproteins in healthy male subjects

OBJECTIVE

The aim of the present study was to investigate the effect of trans-18:1 isomers compared to other fatty acids, especially saturates, on the postprandial fatty acid composition of triacylglycerols (TAG) in chylomicrons and VLDL.

DESIGN

A randomised crossover experiment where five interesterified test fats with equal amounts of palmitic acid (P fat), stearic acid (S fat), trans-18:1 isomers (T fat), oleic acid (O fat), or linoleic acid (L fat) were tested.

SUBJECTS

A total of 16 healthy, normolipidaemic males (age 23+/-2 y) were recruited.

INTERVENTIONS

The participants ingested fat-rich test meals (1 g fat per kg body weight) and the fatty acid profiles of chylomicron and VLDL TAG were followed for 8 h.

RESULTS

The postprandial fatty acid composition of chylomicron TAG resembled that of the ingested fats. The fatty acids in chylomicron TAG were randomly distributed among the three positions in accordance with the distributions in test fats. Calculations of postprandial TAG concentrations from fatty acid data revealed increasing amounts up to 4 h but lower response curves (IAUC) for the two saturated fats in accordance with previous published data. The T fat gave results comparable to the O and L fats. The test fatty acids were much less reflected in VLDL TAG and there was no dietary influence on the response curves.

CONCLUSIONS

The fatty acid composition in the test fats as well as the positional distributions of these were maintained in the chylomicrons. No specific clearing of chylomicron TAG was observed in relation to time.

Dietary Hydrogenated Fat Increases High-Density Lipoprotein apoA-I Catabolism and Decreases Low-Density Lipoprotein apoB-100 Catabolism in Hypercholesterolemic Women

OBJECTIVE

To determine mechanisms contributing to decreased high-density lipoprotein cholesterol (HDL-C) and increased low-density lipoprotein cholesterol (LDL-C) concentrations associated with hydrogenated fat intake, kinetic studies of apoA-I, apoB-100, and apoB-48 were conducted using stable isotopes.

METHODS AND RESULTS

Eight postmenopausal hypercholesterolemic women were provided in random order with 3 diets for 5-week periods. Two-thirds of the fat was soybean oil (unsaturated fat), stick margarine (hydrogenated fat), or butter (saturated fat). Total and LDL-C levels were highest after the saturated diet (P<0.05; saturated versus unsaturated) whereas HDL-C levels were lowest after the hydrogenated diet (P<0.05; hydrogenated versus saturated). Plasma apoA-I levels and pool size (PS) were lower, whereas apoA-I fractional catabolic rate (FCR) was higher after the hydrogenated relative to the saturated diet (P<0.05). LDL apoB-100 levels and PS were significantly higher, whereas LDL apoB-100 FCR was lower with the saturated and hydrogenated relative to the unsaturated diet. There was no significant difference among diets in apoA-I or B-100 production rates or apoB-48 kinetic parameters. HDL-C concentrations were negatively associated with apoA-I FCR (r=-0.56, P=0.03) and LDL-C concentrations were negatively correlated with LDL apoB-100 FCR (r=-0.48, P=0.05).

CONCLUSIONS

The mechanism for the adverse lipoprotein profile observed with hydrogenated fat intake is determined in part by increased apoA-I and decreased LDL apoB-100 catabolism.

Dietary fat and postprandial lipids

Impaired clearance of chylomicron remnants is associated with increased risk of atherosclerosis and cardiovascular disease. An intake of 40 to 50 g of fat in a meal results in significant lipemia in healthy adults, with consecutive fat-containing meals enhancing the lipemia. This would suggest that limiting fat intake to approximately 30 g on each eating occasion would minimize postprandial lipemia. Sedentary behavior and obesity independently impair the postprandial metabolism of lipids. Postprandial lipemia causes endothelial dysfunction and results in a transient increase in factor VII activated (FVIIa) concentration. Plasminogen activator inhibitor type-1 activity is associated with fasting plasma triacylglycerol concentration, but is not influenced by postprandial lipemia. Trans-18:1 acid appears to increase cholesterol ester transfer activity acutely compared with oleate. Randomized stearic acid-rich fats result in less postprandial lipemia and a lower postprandial increase in FVIIa, whereas unrandomized cocoa butter results in similar postprandial lipemia and increases in FVIIa compared with oleate. A background diet containing in excess of 3 g/d of long-chain omega-3 fatty acids decreases postprandial lipemia by stimulating lipoprotein lipase expression and decreasing very low-density lipoprotein synthesis, but a diet enriched in alpha-linolenic acid (up to 9.5 g/d) does not show these effects. Future research on diet and postprandial lipids needs to exploit newly gained knowledge on the regulation of adipocyte metabolism by adipokines and nuclear hormone receptors, particularly with regard to fat patterning and reverse cholesterol transport.