Monounsaturated fatty acid-enriched diet decreases plasma plasminogen activator inhibitor type 1

The relationship between Dietary approaches to stop hypertension diet adherence and inflammatory factors and insulin resistance in overweight and obese women: A cross-sectional study

BACKGROUND

Although there is abundant evidence for an association between dietary pattern, weight, and other related factors, such as homeostatic model assessment for insulin resistance (HOMA-IR) and inflammatory markers; there is limited information pertaining to levels of plasminogen activator inhibitor-1 (PAI-1) and Monocyte Chemoattractant Protein -1 (MCP-1). Therefore, this study sought to examine the association between adherence to the dietary approaches to stop hypertension (DASH) diet and levels of inflammatory factors PAI-1, MCP-1, and HOMA-IR.

METHODS

This cross-sectional study was performed on 305 obese and overweight women. The typical food intake of individuals was assessed using the 147 items semi-quantitative food frequency questionnaire (FFQ). Body components were measured for all participants. Insulin resistance was estimated by homeostasis model assessment (HOMA), and biochemical parameters were examined.

RESULTS

No significant relationship was observed between the DASH diet and MCP-1 (P-trend = 0.70), PAI-1 (P-trend = 0.92), or HOMA-IR (P-trend = 0.08) in the crude model. However, there was a significant inverse relationship between the DASH diet and HOMA-IR (P-trend = 0.03) after adjusting for age, BMI, and physical activity.

CONCLUSION

This study showed that higher adherence to DASH pattern is inversely correlated with HOMA-IR in overweight and obese women.

Iberian Cured-Ham Consumption Improves Endothelial Function in Healthy Subjects

OBJECTIVES

Previous studies have shown that dietary components such as oleic acid or polyphenols exert beneficial effects on endothelium. We aimed to assess the impact of regular consumption of Iberian cured-ham (ICH) on endothelial function.

DESIGN

An open-label, randomized controlled parallel study.

SETTING

Volunteers recruited through advertisements at a hospital in Madrid, Spain.

PARTICIPANTS

102 Caucasian adults (76.8% females) aged 25-55 years, and free from cardiometabolic disease.

INTERVENTION

Participants were randomized to an ICH-enriched ad libitum diet or an ad libitum diet without ICH for 6 weeks. Subjects in ICH group were randomly provided with either acorn- or mixed-fed ICH, and followed up for an additional 6-week period under their usual diet.

MEASUREMENTS

Clinical parameters, biomarkers of endothelial function and oxidative stress, microvascular vasodilatory response to hyperemia and arterial stiffness were measured before and after the intervention.

RESULTS

After 6 weeks, a larger decrease in PAI-1 was observed in subjects consuming ICH compared to the Control group (-6.2±17.7 vs. 0.3±1.4 ng/ml; p=0.020). Similarly, microvascular vasodilatory response to hyperemia showed a significant increase (112.4±391.7 vs. -56.0±327.9%; p=0.007). However, neither oxidative stress, hemodynamic nor clinical parameters differed significantly over the study. Additionally, after stopping ICH consumption, improvements in PAI-1 remained for 6 additional weeks with respect to baseline (p=0.006).

CONCLUSION

The present study demonstrates, for the first time, that regular consumption of ICH improves endothelial function in healthy adults. Strategies aimed to preserve or improve the endothelial function may have implications in vascular aging beyond the prevention of the atherothrombotic disease.

Effect of diacylglycerol acyltransferase 2 overexpression in 3T3-L1 is associated to an increase in mono-unsaturated fatty acid accumulation

BACKGROUND

Fatty acid (FA) composition is the most important parameter affecting the flavor and nutritional value of the meat. The final and the only committed step in the biosynthesis of triglycerides is catalyzed by diacylglycerol acyltransferase 2 (DGAT2). The role of DGAT2 in lipid accumulation has been demonstrated in adipocytes, However, little is known about the effect of DGAT2 on the FA composition of these cells.

METHODS

To investigate the role of DGAT2 in regulating lipid accumulation, FA composition and the expression of adipogenic genes, we cloned the open reading frame of the porcine DGAT2 gene and established 3T3-L1 cells that overexpressed DGAT2. Cells were then cultured in differentiation medium (DM) without FA, with a mixture of FAs (FA-DM), or containing a (13)C stable isotope-labeled FA mixture (IFA-DM). The FA composition of adipocytes was analyzed by gas chromatography-mass spectrometry and gas chromatography-isotope ratio mass spectrometry. Quantitative PCR and western blotting were employed to detect expression of adipogenic genes in 3T3-L1 adipocytes cultured with FA-DM for 12 d.

RESULTS

The triacylglyceride (TAG) content was significantly higher in 3T3-L1 adipocytes overexpressing DGAT2 than in control cells. When cultured in DM or FA-DM for 12 d, cells overexpressing DGAT2 showed a higher proportion of unsaturated FAs (C16:1 and C18:1). However, when cells overexpressing DGAT2 were cultured with FA-DM for 30 min, the FA composition was almost identical to that of controls. Further, the proportion of stable isotope-labeled FAs were similar in 3T3-L1 adipocytes overexpressing DGAT2 and control cells cultured in IFA-DM for 12 d. These results collectively indicate that the higher proportion of mono-unsaturated FAs, C16:1 and C18:1, may originate from de novo FA synthesis but not from the uptake of specific FAs from the medium. This hypothesis is further supported by evidence that both mRNA and protein expression of genes involved in FA synthesis (ACACA, FASN, SCD1, and A-FABP) were significantly higher in cells overexpressing DGAT2 than in control cells.

CONCLUSIONS

In conclusion, our study revealed that TAG accumulation, the proportion of MUFAs, and the expression of adipogenic genes were higher in 3T3-L1 cells overexpressing DGAT2 than in control cells.

Plasminogen activator inhibitor-1 (PAI-1) in children and adolescents with type 1 diabetes mellitus: relation to diabetic micro-vascular complications and carotid intima media thickness

BACKGROUND

Plasminogen activator inhibitor-1 (PAI-1) is a fast-acting inhibitor of fibrinolysis that has been linked to increase risk of thrombosis. We determined PAI-1 levels in 80 children and adolescents with type 1 diabetes (T1DM) compared with 40 healthy controls as a potential marker for micro-vascular complications and assessed the relation to carotid intima media thickness (CIMT) as a synergistic risk factor for development of atherosclerosis.

METHODS

Patients were divided into 2 groups according to micro-vascular complications. Hemoglobin A1c (HbA1c), urinary albumin excretion, fasting serum lipid profile and PAI-1 levels were measured. CIMT of the common carotid artery was assessed using high resolution ultrasonography.

RESULTS

PAI-1 levels were significantly elevated in the group with diabetes compared with control group (p<0.001). PAI-1 levels were also increased in patients with micro-vascular complications compared with those without (p<0.001). CIMT was significantly higher in patients, particularly those with micro-vascular complications than patients without complications or controls (p<0.001). Positive correlations were found between PAI-1 levels and random blood glucose, HbA1c, triglycerides, total cholesterol and CIMT (p<0.05).

CONCLUSIONS

Increased plasma PAI-1 may be involved in the state of hypofibrinolysis in patients with T1DM leading to the occurrence of micro-vascular complications and increased risk of atherosclerosis.

Long-term effects on haemostatic variables of three ad libitum diets differing in type and amount of fat and carbohydrate: a 6-month randomised study in obese individuals

Diet is important in the prevention of CVD, and it has been suggested that a diet high in MUFA is more cardioprotective than a low-fat diet. We hypothesised that the thrombotic risk profile is improved most favourably by a high-MUFA diet compared with a low-fat diet. This was tested in a parallel randomised intervention trial on overweight individuals (aged 28·2 (sd 4·6) years) randomly assigned to a diet providing a moderate amount of fat (35–45 % of energy; >20 % of fat as MUFA) (MUFA diet; n 39), to a low-fat (LF; 20–30 % of energy) diet (n 43), or to a control diet (35 % of energy as fat; n 24) for 6 months after a weight loss of about 10 %. Protein constituted 10–20 % of energy in all three diets. All foods were provided free of charge from a purpose-built supermarket. Fasting blood samples were collected before and after intervention and analysed for factor VII coagulant activity (FVII:c), fibrinogen, prothrombin fragment 1+2 (F1+2), D-dimer and plasminogen activator inhibitor (PAI). The fibrinogen concentration was significantly lowered by the LF diet, but not by the MUFA diet. Changes in fibrinogen differed significantly between diet groups. BMI and PAI concentration increased and D-dimer concentrations were reduced irrespective of the diets. No changes were observed for FVII:c and F1+2. Our findings suggest that in overweight subjects after weight loss the thrombotic risk profile is improved most favourably by the LF diet compared with the MUFA diet based on the reduction in fibrinogen concentrations.

Olive oil and the haemostatic system

Interest in the Mediterranean diet (MD) has grown worldwide due to its link with greater longevity and lower cardiovascular disease rate, cancer and age cognitive decline. Despite the high complexity of its nutrients composition, olive oil emerges as its principal food, since it provides the higher percent of energy and a lot of bioactive compounds. In this review we will discuss the benefits of diets enriched in virgin olive oil, whose effects are probably due not only to its oleic acid content but also to its other potentially health-promoting components. Traditionally, the benefits of MD were linked to its effect on lipoprotein metabolism but today we realise that there exists a whole sheaf of other benefits, including the components of haemostasis: platelet function, thrombogenesis and fibrinolysis. A diet enriched in virgin olive oil can reduce the sensitivity of platelets to aggregation, decreasing von Willebrand and tromboxane B2 plasma levels. Moreover a particular interest has arisen about its capacity to decrease fasting Factor VII plasma levels and to avoid or modulate its postprandial activation. Also Tissue Factor expression in mononuclear cells could be reduced with the chronic intake of virgin olive oil and finally, studies performed in different experimental situation have shown that it could also increase fibrinolytic activity, reducing plasma concentration of Plasma Activator Inhibitor type-1.

The influence of olive oil on human health: not a question of fat alone

Olive oil is the most representative food in the traditional Mediterranean diet and its most important source of MUFA. The healthy benefits of MUFA-rich diets on plasma cholesterol levels, were the first to generate interest in this dietary model. In addition to the benefits conferred by its lipids, olive oil has other biological effects, some of them also related to MUFA. However, most recent studies have shown that there are a number of properties that depend on, or are potentiated by, the consumption of olive oil, such as virgin olive oil, that is rich in microcomponents. This foodstuff, thanks to its double set of benefits, thus tends to produce a better lipid profile and a less prothrombotic environment, promoting antioxidant and anti-inflammatory effects, with a greater endothelial protective capacity. In view of these effects, it would appear that when olive oil is the basic source of dietary alimentary fat it has a major antiatherogenic capacity, which is not shared to the same extent by other oils that are rich in oleic acid but lack its characteristic micronutrients.

Diet and haemostatic processes

Diet plays an important role in the primary and secondary prevention of cardiovascular disease. The growing perception that abnormal haemostatic processes of coagulation, platelet aggregation and fibrinolysis contribute to cardiovascular disease aetiology motivated this review on the relationships of diet, specific foods and nutrients with haemostatic function. Functional endpoints that reflect the function and status of some of these processes and which can be measured in dietary trials are identified. The effects of energy intake and expenditure, alcohol, total fat and specific fatty acids, non-starch polysaccharides (dietary fibre), antioxidant nutrients and some foods on a variety of haemostatic markers are reviewed. The results indicate that the prudent low-fat, high-fibre diet and maintenance of ideal body weight recommended to protect against and treat hyperlipidaemia and coronary heart disease will also benefit haemostatic profiles. It is concluded that more research on specific effects is needed for improved recommendations on a population level for prevention of cardiovascular disease.

The -675 4G/5G polymorphism at the Plasminogen Activator Inhibitor 1 (PAI-1) gene modulates plasma Plasminogen Activator Inhibitor 1 concentrations in response to dietary fat consumption

The objective of the study was to determine whether Plasminogen Activator Inhibitor Type 1 (PAI-1) -675 4G/5G polymorphism is associated with the response of functional plasma PAI-1 concentrations to changes in the amount and quality of dietary fat in healthy subjects. PAI-1 is the major inhibitor of fibrinolysis, and a lower level of fibrinolytic activity could be implicated in an increased risk of IHD. Fifty-nine healthy Spanish volunteers (ten 4G/4G homozygotes, twenty-eight heterozygotes 4G/5G and twenty-one 5G/5G homozygotes) consumed three diets for periods of 4 weeks each: a SFA-rich diet (38 % fat, 20 % SFA), followed by a carbohydrate-rich diet (30 % fat, 55 % carbohydrate) and a MUFA-rich diet (38 % fat, 22 % MUFA) according to a randomized crossover design. At the end of each dietary period plasma lipid and functional plasma PAI-1 concentrations were determined. Subjects carrying the 4G allele (4G/4G and 4G/5G) showed a significant decrease in PAI-1 concentrations after the MUFA diet, compared with the SFA-rich and carbohydrate-rich diets (genotype x diet interaction: P = 0.028). 5G/5G homozygotes had the lowest plasma PAI-1 concentrations compared with 4G/4G and 4G/5G subjects (genotype: P = 0.002), without any changes as a result of the amount and the quality of the dietary fat. In summary, no differences in plasma PAI-1 concentration response were found after changes in dietary fat intake in 5G/5G homozygotes, although these subjects displayed the lowest concentrations of PAI-1. On the other hand, carriers of the 4G allele are more likely to hyper-respond to the presence of MUFA in the diet because of a greater decrease in PAI-1 concentrations.

Paraoxonase 1 response to a high-fat diet: gender differences in the factors involved

Diets consumed in industrialized countries are rich in fat and increase the incidence of atherosclerosis, a process reported to be influenced by gender. Considering the anti-atherogenic role attributed to serum Paraoxonase 1 (PON1) activity, and given the pro-atherogenic effects described for saturated fatty acids (SFA), as opposed to the beneficial ones conferred to monounsaturated fatty acids (MUFA), the aim of this study was to investigate the response of male and female rat serum PON1 activity and its related factors to a high-fat (HF), hypercaloric diet (fat representing 55.2% of the energy) containing similar amounts of SFA and MUFA. The HF diet feeding did not alter total body weight, but increased adiposity. Nevertheless, and in spite of the increased adiposity, the HF diet did not entail a more pro-inflammatory serum adipokine or lipid profile or increased lipid peroxidation. Paraoxonase activity was reduced in both male and female HF fed rats, due to a reduction of PON1 mRNA levels in males and to a reduced stability and/or number of HDL particles responsible for PON1 transport in females. Both the maintenance of body weight and the MUFA content in the diet would be among the factors responsible for the attenuation of the negative effects usually related to excessive fat intake and for the reduction in PON activity, whose antioxidant activity would be less necessary in this situation.

Intake of phenol-rich virgin olive oil improves the postprandial prothrombotic profile in hypercholesterolemic patients

BACKGROUND

Oxidative stress associated with postprandial lipemia contributes to endothelial dysfunction, which shifts hemostasis to a more thrombogenic state.

OBJECTIVE

We investigated whether a high concentration of phenols in olive oil can partly reverse this phenomenon.

DESIGN

Twenty-one hypercholesterolemic volunteers received 2 breakfasts rich in olive oils with different phenolic contents (80 or 400 ppm) according to a randomized, sequential crossover design. Plasma concentrations of lipid fractions, factor VII antigen (FVIIag), activated factor VII (FVIIa), and plasminogen activator inhibitor-1 (PAI-1) activity were measured at baseline and postprandially.

RESULTS

Concentrations of FVIIa increased less (P = 0.018) and plasma PAI-1 activity decreased more (P = 0.021) 2 h after the high-phenol meal than after the low-phenol meal. FVIIa concentrations 120 min after intake of the olive oil with a high phenol content correlated positively with fasting plasma triacylglycerols (P = 0.001), area under the curve (AUC) of triacylglycerols (P = 0.001), and AUC of nonesterified fatty acids (P = 0.024) and negatively with hydroxytyrosol plasma concentrations at 60 min (P = 0.039) and fasting HDL-cholesterol concentrations (P = 0.005). PAI-1 positively correlated with homeostasis model assessment of insulin resistance (P = 0.005) and fasting triacylglycerols (P = 0.025) and inversely with adiponectin (P = 0.026). In a multivariate analysis, the AUCs of nonesterified fatty acids (R(2) = 0.467; beta: 0.787; SE: 0.02; P < 0.001) and adiponectin (R(2) = 0.232; beta: -1.594; SE: 0.629; P < 0.05) were the strongest predictors of plasma FVIIa and PAI-1, respectively.

CONCLUSIONS

A virgin olive oil with a high content of phenolic compounds changes the postprandial hemostatic profile to a less thrombogenic state.

1-Tetradecanol complex reduces progression of Porphyromonas gingivalis-induced experimental periodontitis in rabbits

BACKGROUND

It has been recently shown that monounsaturated fatty acids inhibit endothelial activation and reduce tissue responsiveness to cytokines. The present study has been planned to investigate topical application of a novel monounsaturated fatty acid complex (1-tetradecanol complex) for prevention of Porphyromonas gingivalis-induced periodontitis in rabbits.

METHODS

Experimental periodontitis was induced in New Zealand white rabbits with silk sutures tied around the mandibular second premolars bilaterally, followed by the topical application of 10(9) colony forming units (CFU) of P. gingivalis. 1-Tetradecanol complex (1-TDC) was topically applied at 1- and 10-mg/ml concentrations in five animals in each group, whereas control animals received olive oil vehicle (five animals) three times per week for 6 weeks. Negative controls included ligature alone (14 animals) or ligature + P. gingivalis (non-treatment; 15 animals). Rabbits were sacrificed after 6 weeks, and mandibular block sections were obtained; tissues were decalcified and embedded in paraffin. Thin sections (5 microm) were stained with hematoxylin and eosin or tartrate-resistant acid phosphatase. Macroscopic and histologic evaluation of samples was followed by the characterization of cellular inflammatory infiltrate and quantitative histomorphometric measurements.

RESULTS

Treatment with both concentrations of 1-TDC and vehicle resulted in significant prevention of macroscopic periodontal inflammation and bone loss (75%; P <0.05) compared to the non-treatment (ligature + P. gingivalis) group, where significant periodontal tissue destruction characterized by attachment and bone loss was detected. However, there was no statistically significant difference between the vehicle and both 1-TDC groups. Histologically, 1-TDC inhibited inflammatory cell infiltration and prevented osteoclastogenesis, whereas treatment with vehicle did not show the same effect as in the 1-TDC groups; the difference between vehicle and the higher concentration of 1-TDC (10 mg/ml) was statistically significant.

CONCLUSION

Topical application of an esterified monounsaturated fatty acid complex (1-TDC) was found promising in preventing bone loss, inflammatory cell infiltration, and connective tissue destruction in the rabbit periodontitis model.

Effect of breakfast fat content on glucose tolerance and risk factors of atherosclerosis and thrombosis

Twenty-four middle-aged healthy men were given a low-fat high-carbohydrate (5.5 g fat; L), or a moderately-fatty, (25.7 g fat; M) breakfast of similar energy contents for 28 d. Other meals were under less control. An oral glucose tolerance test (OGTT) was given at 09.00 hours on day 1 before treatment allocation and at 13.30 hours on day 29. There were no significant treatment differences in fasting serum values, either on day 1 or at the termination of treatments on day 29. The following was observed on day 29: (1) the M breakfast led to higher OGTT C-peptide responses and higher areas under the curves (AUC) of OGTT serum glucose and insulin responses compared with the OGTT responses to the L breakfast (P< 0.05); (2) treatment M failed to prevent OGTT glycosuria, eliminated with treatment L; (3) serum non-esterified fatty acid (NEFA) AUC was 59% lower with treatment L than with treatment M, between 09.00 and 13.20 hours (P<0.0001), and lower with treatment L than with treatment M during the OGTT (P= 0.005); (4) serum triacylglycerol (TAG) concentrations were similar for both treatments, especially during the morning, but their origins were different during the afternoon OGTT when the Svedberg flotation unit 20–400 lipid fraction was higher with treatment L than with treatment M (P= 0.016); plasma apolipoprotein B-48 level with treatment M was not significantly greater than that with treatment L (P= 0.086); (5) plasma tissue plasminogen-activator activity increased after breakfast with treatment L (P= 0.0008), but not with treatment M (P= 0.80). Waist:hip circumference was positively correlated with serum insulin and glucose AUC and with fasting LDL-cholesterol. Waist:hip circumference and serum TAG and insulin AUC were correlated with factors of thrombus formation; and the OGTT NEFA and glucose AUC were correlated. A small difference in fat intake at breakfast has a large influence on circulating diurnal NEFA concentration, which it is concluded influences adversely glucose tolerance up to 6 h later.

The Mediterranean and CHO diets decrease VCAM-1 and E-selectin expression induced by modified low-density lipoprotein in HUVECs

BACKGROUND AND AIM

The oxidative modifications of low-density lipoprotein (LDL) are crucial for the atherosclerosis process. The aim of this study was to determine if the minimally modified LDL, obtained after the ingestion of three different diets, produce differential effects on the vascular cell adhesion molecule-1 (VCAM-1) and E-selectin expression in human umbilical endothelial cells (HUVECs).

METHODS AND RESULTS

Twenty healthy young males were exposed to three dietary periods. Each period lasted four weeks. During the first period, all subjects consumed a saturated fat (SFA) enriched diet (38% fat, 20% SFA). The second and third dietary periods were administered following a randomized crossover design: a low fat high carbohydrates diet (CHO diet) and a Mediterranean diet. LDL particles, isolated during each dietary period, were oxidized by exposure to UV light and incubated for 48 h with HUVEC. Thereafter, 100 U/mL of TNF-alpha was added and incubation continued for 6 h. Cellular ELISA determined adhesion molecules expression. Lag time, propagation rate and total amounts of formed conjugated dienes were calculated in LDL incubated with 10mumol/L Cu(2+). When compared to the SFA diet, LDL isolated from the Mediterranean and CHO diets induced a lower expression of VCAM-1 and E-selectin in HUVECS (P<0.007). There were no differences between both lipid lowering diets. However, lag time of LDL from the Mediterranean diet was higher than with the CHO diet (P<0.042). This parameter was inversely correlated with E-selectin expression (r=-0.497; P<0.04).

CONCLUSION

Our results suggest that both the Mediterranean and CHO diets may decrease the pro-inflammatory environment induced by modified LDL in endothelial cells.

Olive oil and haemostasis: a review on its healthy effects

Interest in the Mediterranean diet (MD) has grown worldwide. Despite the high complexity of its nutrients composition, olive oil emerges as its principal food, since it provides the higher percentage of energy and a lot of bioactive compounds.

Objective

In this review, we will discuss the benefits of diets enriched in virgin olive oil, whose effects are probably due not only to its oleic acid content but also to its other potentially health-promoting components.

Methods

Traditionally, the benefits of MD were linked to its effect on lipoprotein metabolism, but today we realise that there exists a whole sheaf of other benefits, including the components of haemostasis: platelet function, thrombogenesis and fibrinolysis.

Results

A diet enriched in virgin olive oil can reduce the sensitivity of platelets to aggregation, decreasing von Willebrand and thromboxane B2 plasma levels. Moreover, a particular interest has aroused about its capacity to decrease fasting factor VII plasma levels and to avoid or modulate its postprandial activation. In addition, tissue factor expression in mononuclear cells could be reduced with the chronic intake of virgin olive oil, and finally, studies performed in different experimental situation have shown that it could also increase fibrinolytic activity, reducing plasma concentration of plasma activator inhibitor type-1 (PAI-1).

Conclusion

The MD is an alimentary model with a high content of monounsaturated fats that is capable of inducing a wide range of biological effects on the cardiovascular system. The application of modern focuses of study will dilucidate in the future the biological and clinical interest of these findings.

Hemostasis and aging

Many changes in the vasculature, hemostasis and endothelium, including alterations of platelets, coagulation and fibrinolytic factors, occur during aging. While the increasing hypercoagulability observed with aging may account for the higher incidence of thrombotic cardiovascular disorders in the elderly, the lack of genetic protective factors against thrombosis in healthy centenarians suggests that little is yet known about the age-associated changes of hemostasis. The complex inter-relationships between inherited and acquired factors influencing the hemostatic system during aging are discussed in this review.

Thematic review series: Patient-Oriented Research. Nutritional determinants of insulin resistance

Interpreting the literature relating to the nutritional determinants of insulin resistance is complicated by the wide range of methods used to determine insulin sensitivity. Excess adiposity is unquestionably the most important determinant of insulin resistance, although the effect may be tempered by a relatively high proportion of lean body mass. Weight loss is associated with improved insulin sensitivity. Thus, diet-related factors that promote excessive energy intake may be regarded as promoters of insulin resistance. In the context of energy balance, diets characterized by high intakes of saturated fat and low intakes of dietary fiber are associated with reduced insulin sensitivity. Total fat intakes greater than the usually consumed range appear to promote insulin resistance, although the relative proportions of total fat and carbohydrate within the usual range appear unimportant. Monounsaturated fatty acids with a cis configuration and fiber-rich carbohydrate foods appear to be appropriate substitutes for saturated fatty acids and rapidly digested glycemic carbohydrates. In animal studies, n-3 unsaturated fatty acids have been shown to enhance insulin sensitivity and fructose and sucrose to increase insulin resistance. However, human data are limited. Large prospective studies currently being conducted should confirm the most appropriate macronutrient composition of diets for preventing and treating insulin resistance as well as establishing whether a range of candidate genes explains the variation in response to dietary change.

A Diet Rich in High-Oleic-Acid Sunflower Oil Favorably Alters Low-Density Lipoprotein Cholesterol, Triglycerides, and Factor VII Coagulant Activity

OBJECTIVE

To compare concentrations of factor VII coagulant activity (factor VIIc), fibrinogen, plasminogen activator inhibitor-1, and blood lipids on a saturated fat-rich diet with one rich in monounsaturated fat.

DESIGN

Subjects were randomly allocated to two groups. The study design was an ABB/BAA extra-period crossover. One group consumed a diet rich in saturated fatty acid (SFA) with fat making up 20.8% of total energy, for 5 weeks and then one rich in monounsaturated fatty acid (MUFA), with fat making up 20.3% of total energy for 10 weeks. The other group consumed the MUFA diet for 5 weeks followed by the SFA diet for 10 weeks.

SUBJECTS/SETTING

Men and women aged 35 to 69 years who were nonsmokers with no chronic illness and not on any medication were recruited to participate. Eighteen subjects were recruited and 15 (5 men, 10 women) completed the community-based study.

INTERVENTION

Blood was sampled at the beginning and end point of each 5-week diet period for analysis of coagulation and fibrinolysis factors and blood lipids. Subjects kept 3-day food diaries twice during each of the three diet periods and were weighed on each visit for blood collection. Analysis of plasma fatty acids was used to indicate dietary compliance.

MAIN OUTCOME MEASURES

Differences in fasting factor VIIc, fibrinogen, plasminogen activator inhibitor-1, insulin, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, apolipoproteins A-1 and B, and plasma oleic acid levels while receiving the SFA diet vs MUFA diet.

STATISTICAL ANALYSIS

A general linear model allowing for the ABB/BAA extra-period crossover, was used for each of the outcome measures.

RESULTS

Factor VIIc was lower on the MUFA diet ( P <.05) but fibrinogen and insulin concentrations and plasminogen activator inhibitor-1 activity did not differ between diets. Low-density lipoprotein cholesterol ( P <.001) and triglyceride ( P <.01) levels were lower on the MUFA diet compared with the SFA diet. A significant increase in both plasma phospholipid and neutral lipid oleic acid (P <.0001) occurred on the MUFA diet.

CONCLUSIONS

Substitution of foods rich in saturated fat with foods rich in high-oleic-acid sunflower oil and margarine has favorable outcomes on blood lipids and factor VIIc. This oil presents another useful source of MUFA for diets aimed at prevention of heart disease.

Dietary fatty acids and the haemostatic system

Studies of the effects of dietary fatty acids on the haemostatic system, and their potential relevance for the thrombotic component of coronary heart disease (CHD), have a pedigree as long as those linking dietary fat, plasma lipoprotein metabolism and atheroma. Achievements have not been as impressive, however, partly owing to the relatively slow evolution of our understanding of the complicated physiology, biochemistry and pathology of haemostasis and fibrinolysis, which remains incomplete. Progress was also retarded up to 1980 by a general reluctance to acknowledge the pathogenic importance of thrombosis for myocardial infarction. Interest in dietary fat and the haemostatic mechanism re-emerged with reports of associations of haemostatic variables with plasma triacylglycerol levels and risk of CHD. This review summarises the history, focuses on evidence for dietary C18-unsaturated fatty acids as important determinants of factor VII (FVII) activation and plasminogen activator inhibitor type 1 (PAI-1) levels, and discusses possible underlying mechanisms involving ATP binding cassette (ABC) transporters and peroxisome proliferator-activated receptors. The potential relevance of these effects for CHD is discussed. In the presence of unstable atheromatous plaques, increased levels of activated FVII and PAI-1 induced by diets rich in mixtures of saturated and unsaturated fats may raise the risk of occlusive thrombosis in the event of plaque rupture.

Substitution of high monounsaturated fatty acid avocado for mixed dietary fats during an energy-restricted diet: effects on weight loss, serum lipids, fibrinogen, and vascular function

OBJECTIVE

First, we wanted to dispel the myth that avocados are fattening and therefore should be avoided in energy-restricted diets. Second, we examined the effects of avocados, a rich source of monounsaturated fatty acids, as part of an energy-restricted diet on weight loss, serum lipids, fibrinogen, and vascular function in overweight and obese subjects.

METHODS

Sixty-one free-living volunteers (13 men and 48 women), with body mass index of 32 +/- 3.9 kg/m(2) (mean +/- standard deviation) participated in this randomized, controlled, parallel study. Subjects were paired and randomly assigned to one of two groups. The experimental group consumed 200 g/d of avocado (30.6 g of fat), which substituted for 30 g of other mixed dietary fats such as margarine or oil, and the control group excluded avocado from their energy-restricted diet for 6 wk. Seven-day isoenergetic menus were planned according to mean energy requirements of both sexes to provide total energy intakes consisting of 30% fat, 55% carbohydrates, and 15% protein. Anthropometric measurements, physical activity, blood pressure, and arterial compliance were measured with standard methods at the beginning and end of the intervention. Fasting blood samples were drawn at the beginning and end of the intervention.

RESULTS

Fifty-five subjects completed the study. The compliance rate to avocado intake in the experimental group was 94.6%. The percentage of plasma oleic acid increased significantly with the consumption of avocado in the experimental group, whereas a decrease was seen in the percentage of myristic acid from baseline to the end of the intervention in both groups but was significant only in the experimental group. Anthropometric measurements (body mass, body mass index, and percentage of body fat) decreased significantly in both groups during the study (P < 0.001), and the change was similar in both groups. Serum lipid concentrations (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triacylglycerols), fibrinogen, blood pressure, and arterial compliance did not change significantly within or between groups.

CONCLUSION

The consumption of 200 g/d of avocado within an energy-restricted diet does not compromise weight loss when substituted for 30 g of mixed dietary fat. Serum lipid concentrations, plasma fibrinogen, arterial compliance, and systolic and diastolic blood pressures were not affected by weight loss or avocado intake.

Postprandial activation of hemostatic factors: role of dietary fatty acids

Intake of dietary fat is an important determinant of the plasma concentration of triacylglycerol-rich lipoproteins, and the degree of alimentary lipemia is reported to have effects on hemostatic status including platelet function. Although association between the amount of dietary fat intake, lipemic response and certain cardiovascular disease (CVD) risk factors (VIIa and PAI-1) has been reported, the significance of the fatty acid composition of ingested fat for the postprandial lipid concentrations and the hemostatic factors is still unclear. Accumulating evidence suggests a relationship between dietary fatty acids and emerging hemostatic CVD risk factors, although much of this evidence is incomplete or conflicting. In order to improve our knowledge in this area, sufficient sample size in future studies are required to take into account of the genetic variation (gene polymorphisms for VII, PAI-1), sex, physical activity, stage of life factors, and sufficient duration to account for adaptation for definitive conclusions.

Dietary fatty acids, hemostasis, and cardiovascular disease risk

The cause of many myocardial infarctions is occlusive thrombosis, or a blood clot that stops blood flow in a coronary artery. Hemostasis involves a complex system of factors, which normally form and degrade blood clots, that work within a delicate balance. Emerging evidence suggests that some hemostatic factors, including factor VII, fibrinogen, and plasminogen activator inhibitor-1, are associated with increased risk for cardiovascular disease (CVD). Accumulating evidence suggests a relationship between dietary fatty acids and emerging hemostatic CVD risk factors, although much of this evidence is incomplete or conflicting. Dietary supplementation with marine n-3 fatty acids prolongs bleeding time and may decrease risk for thrombosis. Factor VII coagulant activity modestly decreases with reductions in saturated fatty acid (SFA) intake and thereby may contribute to the beneficial effects of low SFA diets. Large triglyceride-rich particles formed during postprandial lipemia can support the assembly and function of coagulation complexes and seem to play a role in the activation of factor VII, and thus may partially explain increased CVD risk associated with increased postprandial triglyceridemia. As our understanding of the role of dietary fatty acids and hemostasis evolves, it is likely that we will be able to make specific dietary recommendations to further decrease CVD risk. At this juncture, however, increasing marine n-3 fatty acids and decreasing certain SFAs are leading strategies to reduce hemostatic CVD risk factors. An array of dietary strategies that target multiple CVD risk factors could have a greater impact on CVD than a single risk factor intervention strategy.

Diet and cardiovascular disease in the UK: are the messages getting across?

Cardiovascular disease (CVD) is a leading cause of premature death in the UK and a major cause of ill health and disability. Whilst death rates from CVD have been falling since the late 1970s in the UK, levels of morbidity (such as angina) do not seem to be falling and may even be rising in some age-groups, especially as the population ages. There is broad consensus that lifestyle factors, including physical activity and diet, are fundamental determinants of heart disease risk. Current recommendations to reduce cardiovascular risk include maintaining a healthy body weight, eating five or more portions of fruit and vegetables each day, reducing intake of fat (particularly saturated fatty acids), reducing salt intake and eating one portion of oily fish per week. Although some improvements have been made in recent years (e.g. a reduction in total fat intake), national studies suggest that more effective campaigns are required to increase awareness of the benefits of these dietary changes. The present paper will discuss how the dietary messages relating to CVD are best communicated to the general public and will identify some of the main barriers to their implementation.

Impact of margarine enriched with plant sterols on blood lipids, platelet function, and fibrinogen level in young men

The effects of margarines enriched with omega-6 polyunsaturated fatty acids (PUFA), as well as those containing plant sterols or stanols, on reduction of plasma low-density lipoprotein-cholesterol (LDL-C) have been extensively studied. However, their impact on fibrinogen (Fb) concentration and blood platelet function is much less known. Our research involved 42 healthy male students (average age, 23.7 +/- 1.6) who during the research period were subjected to a controlled regime of nutrition and physical activity. After a period of diet stabilization involving 30 g butter daily in 2 servings, the subjects were randomly divided into 2 groups. In the first group, the butter was replaced by the same quantity of PUFA margarine, while the second group received margarine with added plant sterols instead of butter. The subjects consuming margarine with sterols showed a significant (11%) decrease in LDL-C (P<.001). Margarine rich in PUFA caused a 6% reduction in LDL-C (P<.01), with a simultaneous 3% reduction in high-density lipoprotein-cholesterol (HDL-C) (P<.001). Both types of margarine increased the concentration of Fb (P<.001), without exceeding the normal medium value of 2.8 g/L. After the consumption of margarine with sterols, the adhesion and aggregation time of blood platelets was significantly prolonged after collagen-epinephrine activation. Margarine with sterols, through its antiplatelet activity and the significant reduction of LDL-C, can play a vital role in the nonpharmacologic prevention of circulatory diseases.

A reduction in dietary saturated fat decreases body fat content in overweight, hypercholesterolemic males

BACKGROUND AND AIM

The effect of the quality of dietary fat on body composition is unknown. Our objective was to determine whether body composition is modified by the isocaloric substitution of a diet rich in saturated fat by a diet high in monounsaturated fat (Mediterranean diet) or a carbohydrate-rich diet in overweight subjects with hypercholesterolemia.

METHODS AND RESULTS

The study involved 34 hypercholesterolemic males aged 18-63 years with a body mass index (BMI) of 28.2 (2.6), all of whom consumed a diet rich in saturated fat (SAT) for 28 days. They were then randomly divided into two groups of 17 subjects and underwent two dietary periods of 28 days each in a crossover design: a Mediterranean diet high in monounsaturated fat (MONO) and a carbohydrate-rich diet (CHO). The order of the diets was different for the two group. The CHO diet contained 57% CHO and 28% total fat (< 10% saturated fat, 12% monounsaturated fat and 6% polyunsaturated fat); the Mediterranean diet contained 47% CHO and 38% fat (< 10% saturated fat, 22% monounsaturated fat--75% of which was provided by olive oil- and 6% polyunsaturated fat). The variables measured at the end of each dietary intervention period were: 1) body composition by means of bioelectrical impedance; 2) plasma lipoproteins using enzymatic techniques; and 3) fatty acids in cholesterol esters by means of gas chromatography. BMI and the waist/hip ratio remained the same during the three dietary periods. A decrease in fat was observed when changing from a saturated fat diet (23.3 (6.3) kg) to a Mediterranean diet (20.8 (7.2) kg) (p < 0.05), or a carbohydrate-rich diet (20.6 (6.7) kg) (p < 0.05). Lean mass increased when changing from a SAT diet (58.4 (7.0) kg) to a CHO diet (60.2 (7.0) kg) (p < 0.05).

CONCLUSION

The isocaloric substitution of a saturated fat-rich diet by a Mediterranean or carbohydrate-rich diet decreases total body fat in hypercholesterolemic males.

Nutritional assessment, health markers and lipoprotein profile in postmenopausal women belonging to a closed community

OBJECTIVE

To assess the dietary characteristics of a closed community and their relationship with several health markers and lipid and lipoprotein values in postmenopausal women.

DESIGN

Energy and nutrient intake, serum lipids, lipoproteins, antioxidants, peroxides and low-density lipoprotein (LDL) peroxides in addition to several health markers were measured in a closed, postmenopausal female community consuming a diet without meat, meat products and alcoholic beverages.

SETTING

Departamento de Nutrición and Sección Departamental de Química Analítica and Escuela de Especialización de Análisis Clínicos, Universidad Complutense de Madrid, Spain and Lerma, Burgos, Spain.

RESULTS

Cereals, vegetables, legumes and fruit, together with milk and eggs, constituted the most important ingredients of the diet consumed. Dietary carbohydrates contributed 42%en and lipids 46.4%en. The SFA/MUFA/PUFA ratio was 1/2/1 and the n-3/n-6 ratio 0.05 (SFA=saturated fatty acids, MUFA=monounsaturated fatty acids, PUFA=polyunsaturated fatty acids). The study community diet was monotonous and made for possible deficiencies of iron, magnesium, zinc, vitamin B(6) and vitamin D, in variable proportions. Routine biochemical and haematological normality markers indicate that only one woman presented hyperglycaemia and hyperuricaemia. Two women had haemoglobin levels <12 g/dl, but their mean corpuscular volume or mean corpuscular haemoglobin was normal. The prevalence of high cholesterol values (>6.21 mmol/l) was 42.8%, while that of high LDL-cholesterol levels (>3.88 mmol/l) was 35.7%, but none of the women displayed levels of high-density lipoprotein (HDL)-cholesterol <1.16 mmol/l, triglycerides >1.2 mmol/l or an LDL-cholesterol/HDL-cholesterol ratio>3. Only one woman had apolipoprotein (Apo) B levels >1.5 g/l, while most of the women presented Apo B values <1.2 g/l and an ApoA-1/ApoB ratio &<1.1. Plasma and LDL-peroxide levels, together with the tocopherol and carotene intakes, suggest a good antioxidant status in this population.

CONCLUSIONS

The diet of the study group seems compatible with a healthy life-profile and permits a more-than-acceptable degree of cardiovascular disease protection. However, the consumption of certain nutrients should be improved.

Long-term monounsaturated fatty acid diets reduce platelet aggregation in healthy young subjects

The aim of the present study was to compare the response of a range of atherogenic and thrombogenic risk markers to two dietary levels of saturated fatty acid (SFA) substitution with monounsaturated fatty acids (MUFA) in students living in a university hall of residence. Although the benefits of such diets have been reported for plasma lipoproteins in high-risk groups, more needs to be known about effects of more modest SFA-MUFA substitutions over the long term and in young healthy adults. In a parallel design over 16 weeks, fifty-one healthy young subjects were randomised to one of two diets: (1) a moderate-MUFA diet in which 16 g dietary SFA/100 g total fatty acids were substituted with MUFA (n 25); (2) a high-MUFA diet in which 33 g dietary SFA/100 g total fatty acids were substituted with MUFA (n 26). All subjects followed an 8-week run-in diet (reference diet), with a fatty acid composition close to the UK average values. There were no differences in plasma lipid responses between the two diets over 16 weeks of the study with similar reductions in total cholesterol (P<0.001) and LDL-cholesterol (P<0.01) in both groups; a small but significant reduction in HDL-cholesterol was also observed in both groups (P<0.01). Platelet responses to ADP (P<0.01) and arachidonic acid (P<0.05) differed with time on the two diets; at 16 weeks, platelet aggregatory response to ADP was significantly lower on the high-MUFA than the moderate-MUFA (P<0.01) diet; ADP responses were also significantly lower within this group at 8 (P<0.05) and 16 (P<0.01) weeks compared with baseline. There were no differences in fasting factor VII activity (factors VIIc and VIIag), fibrinogen concentration or tissue-type plasminogen activator activity between the diets. There were no differences in postprandial factor VIIc responses to a standard meal (area under the curve) between the diets after 16 weeks, but postprandial factor VIIc response was lower than on the high-MUFA diet compared with baseline (P<0.01). In conclusion, a high-MUFA diet sustains potentially beneficial effects on platelet aggregation and postprandial activation of factor VII. Moderate or high substitution of MUFA for SFA achieves similar reductions in fasting blood lipids in young healthy subjects.

High intakes of trans monounsaturated fatty acids taken for 2 weeks do not influence procoagulant and fibrinolytic risk markers for CHD in young healthy men

Dietary trans fatty acids are associated with increased risk of CHD. We hypothesized that the changes in plasma lipids associated with a high intake of trans fatty acids would cause adverse effects on procoagulant and fibrinolytic activities. A randomized crossover controlled feeding study was conducted in twenty-nine men. A trans-rich diet supplying 10 % energy as trans- 18:1 was compared with diets in which the trans fatty acids were replaced either with carbohydrate or oleate; each diet was taken for 2 weeks in random order. Fasting fibrinogen and d-dimer concentrations and factor VII coagulant, plasminogen activator inhibitor type 1 and tissue plasminogen activator did not differ between diets. Postprandially, tissue plasminogen activator activity increased and plasminogen activator inhibitor type 1 activity decreased on all diets. Factor VIIc increased postprandially by 15 and 17 % on the trans and oleate diets respectively, compared with an 11 % increase on the carbohydrate diet; the mean difference between oleate and carbohydrate diets was 6 (95 % CI 0.2, 11.9) %. The LDL-cholesterol:HDL-cholesterol and apolipoprotein B : apolipoprotein A-I ratios increased by 13 (95 % CI 5.7, 21.8) and 10 (95 % CI 3.1, 17.2) % respectively on the trans diet compared with the oleate diet and by 6 (95 % CI 0.1,12.7) and 7 (95 % CI 0, 13.5) % respectively compared with the carbohydrate diet. Plasma HDL2-cholesterol concentration was 18 (95 % CI 0.7, 35.9) % lower on the trans diet compared with the oleate diet. The results confirm adverse effects of trans fatty acids on HDL-cholesterol concentrations, but suggest that trans fatty acids do not have any specific effects on known haemostatic risk markers for cardiovascular disease in healthy young men in the short-term.

A preliminary fast may potentiate response to a subsequent low-salt, low-fat vegan diet in the management of hypertension - fasting as a strategy for breaking metabolic vicious cycles

Although a salted diet appears to be a sine qua non for the development of essential hypertension, low-salt diets often have a modest or even negligible impact on the blood pressure of hypertensives; this suggests that salt, perhaps often acting in concert with other aspects of a modern, rich diet, may set in place certain metabolic vicious cycles that sustain blood pressure elevation even when dietary salt is eliminated. Therapeutic fasting is known to lower elevated blood pressure - presumably in large part because it minimizes insulin secretion - and may have the potential to break some of these vicious cycles. Goldhamer has recently reported that a regimen comprised of a water-only fast of moderate duration, followed by a transition to a low-fat, low-salt, whole-food vegan diet, achieves dramatic reductions in the blood pressure of hypertensives, such that the large majority of patients can be restored to normotensive status, in the absence of any drug therapy. Although long-term follow-up of these subjects has been sporadic, the available data suggest that these large reductions is blood pressure can be conserved in patients who remain compliant with the follow-up diet - in other words, a 'cure' for hypertension may be feasible. If a protein-sparing modified fast can be shown to be virtually as effective as a total fast for achieving these benefits, it may be possible to implement this regimen safely on an outpatient basis. The ability of therapeutic fasts to break metabolic vicious cycles may also contribute to the efficacy of fasting in the treatment of type 2 diabetes and autoimmune disorders. As a general principle, if a metabolic disorder is susceptible to prevention - but not reversal - by a specific diet, and therapeutic fasting has a temporary favorable impact on this disorder, then a more definitive therapy may consist of a therapeutic fast, followed up by the protective diet as a maintenance regimen.

Protective effect of dietary monounsaturated fat on arteriosclerosis: beyond cholesterol

The consumption of diets enriched in monounsaturated fat has been related to a lower rate of coronary heart disease. It is well known that this dietary model decreases LDL-cholesterol plasma levels when replacing a saturated fat enriched diet. For this reason, a high monounsaturated fat diet is now being advocated to prevent cardiovascular disease, especially in Mediterranean countries. However, some expert panels-the Joint Task Force of European and other Societies on Coronary Prevention and the International Task Force for Prevention of Coronary Heart Disease-recommend replacing dietary saturated fat by complex carbohydrates, limiting the intake of total fat to <30% of the energy and monounsaturated fat to no more than 10-15% of total calories, reaching a similar effect on LDL-cholesterol plasma levels to a high monounsaturated fat diet. The most appropriate nutritional model to prevent arteriosclerosis should be supported by research into other biological effects of both diets. Therefore, it is interesting to review the non-lipid effect of monounsaturated fat, starting with its influence on other cardiovascular risk factors, such as carbohydrate metabolism and blood pressure. Moreover, substantial evidence of the effect of dietary monounsaturated fat on a wide range of healthy benefits beyond cholesterol, which have been investigated in recent years, such as lipoprotein oxidation, coagulation, fibrinolysis and endothelium, will be discussed. Furthermore, many observational epidemiological studies suggest that a high intake of monounsaturated fat is associated with reduced coronary risk and this will be analyzed in accordance with the clinical evidence to discuss the best dietary model to prevent coronary artery disease.

The impact of angiotensin II receptor blockade and the DASH diet on markers of endogenous fibrinolysis

Hypertension is associated with impaired fibrinolysis. Both angiotensin receptor blockers (ARB) and the DASH (Dietary Approaches to Stop Hypertension) diet effectively lower blood pressure in hypertensive patients. Some evidence suggests that treatment with ARBs could increase fibrinolysis, however, data is conflicting. The impact of the DASH diet on fibrinolytic parameters is not known. Fifty-five hypertensive participants (35 African-American, 20 white) were randomly assigned to receive 8 weeks of either a control diet or the DASH diet. The diets did not differ in sodium content (approximately 3 g/day). Within each diet, individuals were randomly assigned to receive losartan or placebo for 4 weeks in double-blind, cross-over fashion. Tissue plasminogen activator (t-PA) antigen, t-PA activity, plasminogen activator inhibitor-1 (PAI-1) activity and plasma renin activity (PRA) were measured at the end of a 2-week run-in period on the control diet and after each treatment period. The DASH diet did not affect markers of fibrinolysis. Losartan significantly lowered t-PA antigen levels (-1.8 ng/mL, P = 0.045), but had no effect on t-PA or PAI-1 activities. This effect was more pronounced in whites (-4.1 ng/mL (P = 0.003)) compared with African-Americans (-0.3 ng/mL (P = 0.7), P-interaction = 0.03). Results were not materially affected by adjustment for basline values or changes in blood pressure. This study demonstrates that losartan reduces t-PA antigen levels in white, but not African-American hypertensive individuals. In contrast, the DASH diet had no significant effect on markers of fibrinolysis in whites or African-Americans.

Dietary monounsaturated fatty acids and haemostasis

Diets high in monounsaturated fatty acids (MUFA) are increasingly being recommended as a highly-effective cholesterol-lowering strategy in populations at risk of CHD. However, the need for a re-appraisal of the benefits of diets rich in MUFA became apparent as a result of recent studies showing that meals high in olive oil cause greater postprandial activation of blood coagulation factor VII than meals rich in saturated fatty acids. The present review evaluates the evidence for the effects of MUFA-rich diets on fasting and postprandial measurements of haemostasis, and describes data from a recently-completed long-term controlled dietary intervention study. The data show that a background diet high in MUFA has no adverse effect on fasting haemostatic variables and decreases the postprandial activation of factor VII in response to a standard fat-containing meal. Since the same study also showed a significant reduction in the ex vivo activation of platelets in subjects on the high-MUFA diet, the overall findings suggest that there is no reason for concern regarding adverse haemostatic consequences of high-MUFA diets.

Haemostasis in Relation to Dietary Fat as Estimated by Erythrocyte Fatty Acid Composition: The Prime Study

We investigated whether haemostatic variables were related with dietary fatty acid composition as estimated by the fatty acid content of erythrocytes. Subjects were a subsample (n=283) of the participants in the Prospective Epidemiological Study of Myocardial Infarction (PRIME) Study. Factor VII, fibrinogen, tissue-type plasminogen activator antigen (tPA-ag), plasminogen activator inhibitor type 1 (PAI-1), D-dimer and von Willebrand factor (vWf) were measured and the fatty acid composition was determined in the phospholipids of total erythrocytes by gas chromatography. Statistical analyses were performed using multiple linear regression analyses with adjustment for age, center and body mass index. tPA-ag was significantly related to the n-3 fatty acids derived from fish. This was reflected in an inverse association of all n-3 fatty acids combined with tPA-ag (beta=-0.37 ng/ml/%, 95% confidence intervals: -0.45, -0.29, P<.01). Positive and significant associations of D-dimer with arachidic and eicosamonoenoic acid were observed (P<.01). No relationships were found between fatty acids and fibrinogen, vWf, PAI-1 or factor VII. The results of this study suggest that consumption of n-3 fatty acids derived from fish may favourably influence tPA-ag.

Effects of high-fat, low-cholesterol diets on hepatic lipid peroxidation and antioxidants in apolipoprotein E-deficient mice

The present study describes the effects of several high-fat low-cholesterol antiatherogenic diets on the hepatic lipid peroxidation and hepatic antioxidant systems in apolipoprotein E-deficient mice. Eighty mice were distributed into five groups and fed with regular mouse chow or chow supplemented with coconut, palm, olive and sunflower seed oils. After ten weeks, they were sacrificed and the livers were removed so that lipid peroxidation and alpha-tocopherol concentrations, and superoxide dismutase, glutathione peroxidase and glutathione reductase activities could be measured. The size of the atherosclerotic lesions in the aortas was also measured. Results showed that the diets supplemented with olive oil, palm oil or sunflower seed oil significantly decreased the size of the lesion. However, there was an association between those mice that were on diets supplemented with palm or coconut oils and a significant increase in hepatic lipid peroxidation. This association was not found in animals fed with olive or sunflower seed oils, the diets with the highest content of vitamin E. The dietary content of vitamin E was significantly correlated (r = 0.98; p < 0.05) with the hepatic concentration of this compound. Our study suggests that the high content of vitamin E in olive oil or sunflower seed oil may protect from the undesirable hepatotoxic effects of high-fat diets in apo E-deficient mice and that this should be taken into account when these diets are used to prevent atherosclerosis.

[Mediterranean diet improves low density lipoprotein susceptibility to oxidative modifications]

Most experts, specially from Anglo-Saxon countries, recommend a low fat diet in order to prevent cardiovascular diseases. However, mortality rate by ischemic cardiopathy is low in Mediterranean countries, probably because of the consumption of a Mediterranean diet, with a high level of monounsaturated fats provided by the olive oil. We have conducted this study in order to investigate the possible influence of this kind of diet on the oxidation of LDL in vitro, the key element for the development of atherosclerosis.

PATIENTS AND METHODS

41 healthy male subjects were submitted to three consecutive 4-week diets. The first was a saturated fat-rich diet (SAT diet, 38% fat, 20% saturated). This was followed by a low fat diet (NCEP-I, 28% fat, 10% saturated) and after that a Mediterranean diet (38% fat, 22% monounsaturated fat). Plasma levels of total cholesterol, LDL-c, HDL-c, triglycerides, apolipoproteins A-I and B, -tocopherol, and the in vitro susceptibility to oxidation of LDL particles. Both hypolipidemic diets produced a significant decrease in total cholesterol, LDL-c, and apo-B plasma levels. However, it was only the NCEP-I diet that revealed a decrease in the HDL-c. The shift from a saturated fat-rich diet, or a diet rich in carbohydrates, to a Mediterranean diet increased the resistance of LDL particles to oxidation increasing the lag time period (p < 0.038), and decreasing (p < 0.001) the progression rate of the curve of oxidation of LDL. Our results point out two positive consequences of the consumption of a Mediterranean diet by healthy young males, compared with the low fat diet recommended by most Anglo-Saxon experts. On the one hand, the Mediterranean diet increases HDL-c plasma levels, and on the other hand, it decreases the susceptibility of LDL to oxidation. This is why the Mediterranean diet must be recommended in order to prevent cardiovascular diseases.

[Cholesterolemia control in Spain, 2000: a tool for cardiovascular disease prevention]

The document "Cholesterolemia control in Spain, 2000: a tool for cardiovascular disease prevention" reviews the current evidence on cardiovascular disease prevention and the therapeutic advances achieved in recent years, in order to aid risk-based clinical decision-making. Cardiovascular diseases rank as the first cause of death in Spain. Their demographic, health and social impact is increasing and it is likely to continue to do so in the next decades. Appropriate treatment for high blood cholesterol and other major risk factors is crucial in cardiovascular disease prevention. Individual risk stratification is essential to determine follow-up periodicity and treatment. Priorities for the control of cholesterolemia and the consequent cardiovascular risk are based on risk stratification. In primary prevention, the therapeutic objective in high risk patients has been established as LDL-cholesterol < 130 mg/dl. In secondary prevention, drug treatment is indicated when LDL-cholesterol > or = 130 mg/dl and the therapeutic objective is LDL-cholesterol < 100 mg/dl. Statins are first line drugs for treatment of high blood cholesterol. In moderate-severe hypertriglyceridemia or low HDL-cholesterol, fibrates are preferred. In acute coronary syndrome, hypolipemiant treatment, should be started as soon as possible, when indicated. Secondary prevention programmes that continually provide good clinical and risk factor control should be provided to coronary heart disease patients.

A residential study comparing the effects of diets rich in stearic acid, oleic acid, and linoleic acid on fasting blood lipids, hemostatic variables and platelets in young healthy men

Dietary fat is known to influence the variables of blood coagulation and fibrinolysis associated with vascular disease. However, the role of fat content and/or fat composition of the diet in this regard is still not well understood. In the present study, we investigated the effects of three isoenergic diets of differing fat composition in nine healthy young men in a strictly controlled residential study. Subjects consumed the three experimental diets for periods of 2 weeks each, separated by a washout period of at least 5 weeks in a randomized crossover design. The diets provided 38% of total energy intake as fat, 45% as carbohydrate, and 17% as protein, and differed only with respect to the fatty acid composition (stearic acid-rich diet: 34.1% stearic acid, 36.6% oleic acid; oleic acid-rich diet: 65.8% oleic acid; linoleic acid-rich diet: 36.5% linoleic acid, 38% oleic acid). Blood samples were collected at the beginning and at the end of each dietary period from fasted subjects for determination of factor VII coagulant activity (FVIIc), activated factor VII (FVIIa), factor VII antigen (FVIIag), tissue plasminogen activator (tPA) activity, plasminogen activator inhibitor type 1 (PAI-1) activity, fibrinogen, prothrombin fragment 1+2 (F(1+2)), and plasma lipids. There were no significant differences between diets in fasting plasma concentrations of FVIIc, FVIIa, FVIIag, fibrinogen, F(1+2), PAI-1 activity, and tPA activity. Plasma concentrations of lipids (high density lipoproteins, low density lipoproteins, triacylglycerols, and total cholesterol) were also unaffected. Although there were no changes in platelet aggregation response and membrane fluidity observed in any of the diets, increased anti-aggregatory prostaglandin E(1) binding to platelet membranes was observed only in the case of linoleic acid-rich diet. In conclusion, diets with very different fatty acid compositions, at 38% of energy as fat intake, did not significantly influence blood coagulation, fibrinolysis, or blood lipids in the fasting state in young healthy men.

[Control of cholesterolemia in Spain, 2000. A tool for cardiovascular prevention]

The document "Cholesterolemia Control in Spain, 2000: A Tool for Cardiovascular Disease Prevention" reviews the current evidence on cardiovascular disease prevention and the therapeutic advances achieved in recent years, in order to aid risk-based clinical decision-making. Cardiovascular diseases rank as the first cause of death in Spain. Their demographic, health and social impact is increasing and it is likely to continue to do so in the next decades. Appropriate treatment for high blood cholesterol and other major risk factors is crucial in cardiovascular disease prevention. Individual risk stratification is essential to determine follow-up periodicity and treatment. Priorities for the control of cholesterolemia and the consequent cardiovascular risk are based on risk stratification. In primary prevention, the therapeutic objective in high risk patients has been established as LDL-cholesterol < 130 mg/dl. In secondary prevention, drug treatment is indicated when LDL-cholesterol > or = 130 mg/dl and the therapeutic objective is LDL-cholesterol < 100 mg/dl. Statins are first line drugs for treatment of high blood cholesterol. In moderate-severe hypertriglyceridemia or low HDL-cholesterol, fibrates are preferred. In acute coronary syndrome, hypolipemiant treatment, should be started as soon as possible, when indicated. Secondary prevention programmes that continually provide good clinical and risk factor control should be provided to coronary heart disease patients.

Dietary treatment of the metabolic syndrome--the optimal diet

The treatment of the metabolic syndrome aims to improve insulin sensitivity and correct/prevent the associated metabolic and cardiovascular abnormalities. Since many individuals with the metabolic syndrome are overweight, dietary treatment should be primarily focused on weight reduction. This approach can improve insulin sensitivity and exert beneficial effects on all the other abnormalities clustering in the syndrome. Insulin sensitivity can also be influenced by diet composition. In this respect, the specific effects of the quality of dietary fat are of great interest, given the considerable evidence in experimental animals that saturated fat in the diet may lead to insulin resistance. In man, there is indirect evidence that a higher saturated fat intake is associated with impaired insulin action. Human studies have also attempted to evaluate the relationship between total fat intake and insulin sensitivity. They are consistent in showing that fat intake is correlated with both plasma insulin values (positively) and insulin sensitivity (negatively). However, these correlations are largely mediated by body weight. Conversely, intervention studies are consistent in showing that when total fat intake is moderately increased (from 20 to 40%), no major effect is observed on insulin sensitivity. We have recently undertaken a large, multicentre intervention study in 162 healthy individuals given either a high-saturated-fat or a high-monounsaturated-fat diet for 3 months. It shows that a high-monounsaturated-fat diet significantly improves insulin sensitivity compared to a high-saturated-fat diet. However, this beneficial effect of monounsaturated fat disappears when total fat intake exceeds 38% of total energy. Independently of its effects on insulin sensitivity, diet composition can influence the factors clustering in the metabolic syndrome. Dietary carbohydrate increases blood glucose levels, particularly in the postprandial period, and consequently also insulin levels and plasma triglycerides. The detrimental effects of a high-carbohydrate diet on plasma glucose/insulin, triglyceride/HDL or fibrinolysis occur only when carbohydrate foods with a high glycaemic index are consumed, while they are abolished if the diet is based largely on fibre-rich, low-glycaemic-index foods. In conclusion, weight reduction is a powerful measure for the treatment of metabolic syndrome. Moreover, the diet for the treatment of the metabolic syndrome should be limited in the intake of saturated fat, while high fibre/low-glycaemic-index foods should be used without specific limitations. Moderate amounts of monounsaturated fat could be permitted as they do not induce detrimental metabolic effects.

High-monounsaturated fatty acid diets lower both plasma cholesterol and triacylglycerol concentrations

BACKGROUND

Low-fat diets increase plasma triacylglycerol and decrease HDL-cholesterol concentrations, thereby potentially adversely affecting cardiovascular disease (CVD) risk. High-monounsaturated fatty acid (MUFA), cholesterol-lowering diets do not raise triacylglycerol or lower HDL cholesterol, but little is known about how peanut products, a rich source of MUFAs, affect CVD risk.

OBJECTIVE

The present study compared the CVD risk profile of an Average American diet (AAD) with those of 4 cholesterol-lowering diets: an American Heart Association/National Cholesterol Education Program Step II diet and 3 high-MUFA diets [olive oil (OO), peanut oil (PO), and peanuts and peanut butter (PPB)].

DESIGN

A randomized, double-blind, 5-period crossover study design (n = 22) was used to examine the effects of the diets on serum lipids and lipoproteins: AAD [34% fat; 16% saturated fatty acids (SFAs), 11% MUFAs], Step II (25% fat; 7% SFAs, 12% MUFAs), OO (34% fat; 7% SFAs, 21% MUFAs), PO (34% fat; 7% SFAs, 17% MUFAs), and PPB (36% fat; 8% SFAs, 18% MUFAs).

RESULTS

The high-MUFA diets lowered total cholesterol by 10% and LDL cholesterol by 14%. This response was comparable with that observed for the Step II diet. Triacylglycerol concentrations were 13% lower in subjects consuming the high-MUFA diets and were 11% higher with the Step II diet than with the AAD. The high-MUFA diets did not lower HDL cholesterol whereas the Step II diet lowered it by 4% compared with the AAD. The OO, PO, and PPB diets decreased CVD risk by an estimated 25%, 16%, and 21%, respectively, whereas the Step II diet lowered CVD risk by 12%.

CONCLUSION

A high-MUFA, cholesterol-lowering diet may be preferable to a low-fat diet because of more favorable effects on the CVD risk profile.