Similar effects of diets rich in stearic acid or trans-fatty acids on platelet function and endothelial prostacyclin production in humans

Dietary Fats and Cardio-Metabolic Outcomes in a Cohort of Italian Adults

Background: Dietary fats, and especially saturated fatty acid (SFA), have been blamed for being the culprit in the dramatic increase in obesity and its associated diseases. However multiple systematic reviews and recent meta-analyses do not support the association between SFA and cardiovascular diseases. Thus, the objective of this study was to test whether specific types and subtypes of dietary fats are associated with metabolic outcomes in a cohort of Italian adults. Methods: Nutritional and demographic data of 1936 adults living in the south of Italy were examined. Food frequency questionnaires (FFQs) were administered to assess the intake of total dietary fat and each specific class of dietary fat, such as SFA, monounsaturated fatty acid (MUFA) and polyunsaturated fatty acid (PUFA). The intake of fatty acids was also examined according to the carbon-chain length of each individual class. Cases of hypertension, type-2 diabetes and dyslipidemias were collected from previous doctor-confirmed diagnosis records (or direct measurement of blood pressure). Results: After adjustment for potential confounding factors, individuals reporting higher intakes of total and saturated fats were associated with lower likelihood of having hypertension (odds ratio (OR) = 0.57, 95% CI: 0.35, 0.91 and OR = 0.55, 95% CI: 0.34, 0.89, respectively). Moreover, higher intake of short-chain saturated fatty acids (SCSFAs) and medium-chain saturated fatty acids (MCSFAs) was inversely associated with dyslipidemia and diabetes (OR = 0.43, 95% CI: 0.23, 0.82 and OR = 0.25, 95% CI: 0.09, 0.72, respectively). Among MUFAs, C18:1 was inversely associated with hypertension and diabetes (OR = 0.52, 95% CI: 0.30, 0.92 and OR = 0.21, 95% CI: 0.07, 0.67, respectively), while C14:1 intake was inversely associated only with hypertension (OR = 0.57, 95% CI: 0.37, 0.88). In contrast, C20:1 intake was associated with dyslipidemia (OR = 3.35, 95% CI: 1.33, 8.42). Regarding PUFA, C18:2 and 20:5 were inversely associated with hypertension (OR = 0.33, 95% CI: 0.18, 0.60 and OR = 0.30, 95% CI: 0.10, 0.89, respectively). Conclusions: The consumption of SFA does not seem to be harmful to cardio-metabolic health and, on the contrary, SCSFA may exert beneficial effects. Further studies are needed to clearly validate the results of the present study.

Trans-fatty acid promotes thrombus formation in mice by aggravating antithrombogenic endothelial functions via Toll-like receptors

SCOPE

Since excessive intake of trans-fatty acid (TFA) increases the risk of myocardial infarction, we investigated the effects of TFA on thrombus formation using animal and cell culture experiments.

METHODS AND RESULTS

C57BL/6 mice were fed a diet containing TFA or cis-fatty acid (5% each of total calories) or a chow diet for 4 weeks, and thrombus formation was induced in the carotid artery by He-Ne laser irradiation. The high-TFA diet significantly promoted thrombus formation in the carotid artery compared to the chow or cis-fatty acid diet. TFA activated the inflammatory signaling pathway in cultured endothelial cells and in mice; aortic gene expression levels of antithrombogenic molecules, including thrombomodulin and tissue factor pathway inhibitor, were decreased, and the expression levels of prothrombogenic molecules were increased in TFA-treated mice. TFA markedly upregulated the prothrombogenic molecules and downregulated the antithrombogenic molecules in endothelial cells. In addition, TFA induced phosphorylation of c-Jun N-terminal kinase, extracellular signal-regulated kinase, and nuclear factor-κB. The TFA-activated signal pathways and prothrombogenic phenotypic changes of endothelial cells were inhibited by genetic or pharmacological inactivation of Toll-like receptors 2 and 4.

CONCLUSION

TFA aggravates the antithrombogenic phenotypes of vascular endothelial cells via Toll-like receptors and promotes thrombus formation in mice.

Nutrient signaling: evolutionary origins of the immune-modulating effects of dietary fat

Many dietary fatty acids (FA) have potent effects on inflammation, which is not only energetically costly, but also contributes to a range of chronic diseases. This presents an evolutionary paradox: Why should the host initiate a costly and damaging response to commonly encountered nutrients? We propose that the immune system has evolved a capacity to modify expenditure on inflammation to compensate for the effects of dietary FA on gut microorganisms. In a comprehensive literature review, we show that the body preferentially upregulates inflammation in response to saturated FA that promote harmful microbes. In contrast, the host opften reduces inflammation in response to the many unsaturated FA with antimicrobial properties. Our model is supported by contrasts involving shorter-chain FA and omega-3 FA, but with less consistent evidence for trans fats, which are a recent addition to the human diet. Our findings support the idea that the vertebrate immune system has evolved a capacity to detect diet-driven shipfts in the composition of gut microbiota from the profile of FA consumed and to calibrate the costs of inflammation in response to these cues. We conclude by extending the nutrient signaling model to other nutrients, and consider implications for drug discovery and public health.

Dietary supplementation withtrans-11- andtrans-12-18 : 1 increasescis-9,trans-11-conjugated linoleic acid in human immune cells, but without effects on biomarkers of immune function and inflammation

Trans-fatty acid intake is associated with an increased risk of CHD and diabetes. The effects of singletrans-fatty acid isomers are largely unexplored. The present study examined the effects of a 6-week supplementation with twotrans-18 : 1 isomers (trans-11 andtrans-12) in human subjects on immune cells, several inflammatory and immunological biomarkers (for example, IL, TNFα, C-reactive protein, adiponectin, intercellular adhesion molecule-1, prostacyclin, phagocytic process). Following a 2-week adaptation period without supplements, the test group (n12) received vaccenic acid (trans-11-18:1) andtrans-12-18 : 1 in equal amounts (6·0 g/d) for 6 weeks. The control group (n12) consumed an oil withouttrans-fatty acids and conjugated linoleic acids (CLA). Samples were collected at the end of both periods.Trans-11- andtrans-12-18 : 1 were significantly increased in cellular lipids. The endogenous synthesis ofcis-9,trans-11-CLA fromtrans-11-18 : 1 was demonstratedviaincreased CLA in cellular lipids of the test group. Generally,trans-isomer supplementation did not affect either inflammatory biomarkers (for example, IL-6, IL-8, TNFα) or immune function (for example, phagocytosis) during the present study. The dietary supplementation oftrans-11- andtrans-12-18 : 1 (6 g/d) and their accumulation in leucocytes had no effects on biomarkers of inflammation and immune function. However, because of the limited data on the safety oftrans-fatty acid intake and effects of individualtransisomers on human health (for example,trans-9-18 : 1,trans-10-18 : 1) at present, it is prudent to reducetrans-fat intake in general.

Fatty acids and CHD

During the last century much evidence has accumulated to suggest that from a public health perspective the type of fat is more important than the amount of fat. Saturated andtrans-fatty acids increase and bothn-6 andn-3 PUFA decrease the risk of CHD. Most of the knowledge about the effects of dietary fatty acids on CHD risk is based on observational studies and controlled dietary experiments with intermediate end points (e.g. blood lipoprotein fractions). Information from high-quality randomised controlled trials on fatty acids and CHD is lacking. The Netherlands Institute for Public Health has calculated the potential health gain that can be achieved if the fatty acid composition of the current Dutch diet is replaced by the recommended fatty acid composition. The recommendations of The Netherlands Health Council are: saturated fatty acids <10% energy intake;trans-fatty acids <1% energy intake; fish consumption (an indicator ofn-3 PUFA) once or twice weekly. Implementation of this recommendation could reduce the incidence of CHD in The Netherlands by about 25 000/year and the number of CHD-related deaths by about 6000/year and increase life expectancy from age 40 years onwards by 0.5 year. These projections indicate the public health potential of interventions that modify the fatty acid composition of the diet.

Dietary trans fatty acids: Review of recent human studies and food industry responses

Dietary trans FA at sufficiently high levels have been found to increase low density lipoprotein (LDL)-cholesterol and decrease high density lipoprotein (HDL)-cholesterol (and thus to increase the ratio of LDL-cholesterol/HDL-cholesterol) compared with diets high in cis monounsaturated FA or PUFA. The dietary levels of trans FA at which these effects are easily measured are around 4% of energy or higher to increase LDL-cholesterol and around 5 to 6% of energy or higher to decrease HDL-cholesterol, compared with essentially trans-free control diets. Very limited data at lower levels of intake (less than 4% of energy) are available. Most health professional organizations and some governments now recommend reduced consumption of foods containing trans FA, and effective January 1, 2006, the U.S. Food and Drug Administration requires the labeling of the amounts of trans FA per serving in packaged foods. In response, the food industry is working on ways to eliminate or greatly reduce trans FA in food products. Current efforts focus on four technological options: (i) modification of the hydrogenation process, (ii) use of interesterification, (iii) use of fractions high in solids from natural oils, and (iv) use of trait-enhanced oils. Challenges to the food industry in replacing trans FA in foods are to develop formulation options that provide equivalent functionality, are economically feasible, and do not greatly increase saturated FA content.

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.

Fatty acids and atherosclerotic risk

Most research concerning the effects of dietary fatty acids on atherosclerotic risk has focused on their effects on lipid and lipoprotein metabolism. However, it is known that fatty acids also influence a number of other relevant mechanisms involved in atherosclerosis such as lipid peroxidation, inflammation and haemostasis. The most favourable distribution of cholesterol over the various lipoproteins is achieved when saturated and trans fatty acids are replaced by a mixture of cis-unsaturated fatty acids. Furthermore, fatty acids from fish oil lower triacylglycerol concentrations. Effects on other atherosclerotic risk markers are less evident. Monounsaturated fatty acids maybe preferable above other fatty acids with respect to low-density lipoprotein oxidation as measured by indirect in vitro assays. The relevance of these assays for the in vivo situation is, however, limited. With respect to inflammation, mainly the effects of n-3 polyunsaturated fatty acids from fish oil have been studied, but results were inconsistent. Also results from studies evaluating the effects of fatty acids on haemostatic risk markers were inconsistent, which may be partly related to the use of different analytical methods. The most consistent finding however is the potential beneficial effect of moderate intakes of fish oil on platelet aggregation. Furthermore, reducing total fat intake rather than changing the fatty acid composition of the diet may beneficially affect the coagulation system. In conclusion, while beneficial effects on atherosclerotic risk are mainly ascribed to cis-unsaturated fatty acids, it remains debateable whether trans and saturated fatty acids in the diet have to be replaced by cis-unsaturated fatty acids or by carbohydrates. To answer this question adequately more validated methods are needed that reflect in vivo lipid peroxidation, inflammation and haemostasis.

Dietary fats and oils: Technologies for improving cardiovascular health

The role of dietary lipids in the etiology of coronary heart disease (CHD) continues to evolve as we gain a better understanding of the metabolic effects of individual fatty acids and their impact on surrogate markers of risk. A recent meta-analysis of 60 human studies suggests that for each 1% energy replacement of carbohydrates in the diet with saturated fat or trans fat, serum low-density lipoprotein cholesterol concentrations increase by 0.032 (1.23 mg/dL) and 0.04 mmol/L (1.54 mg/dL), respectively. Current dietary recommendations to keep saturated fat and trans fat intake as low as possible, and to increase the intake of cis mono-unsaturated and polyunsaturated fatty acids, as well as growing recognition of these recommendations by consumers and food regulatory agencies in the United States, have been major driving forces for the edible oil industry and food manufacturers to develop alternative fats and oils with nutritionally improved fatty acid compositions. As solutions for use of trans fatty acids are being sought, oilseeds with modified fatty acid compositions are being viewed as a means to provide such solutions. Additionally, oilseeds with modified fatty acid composition, such as enhanced content of long-chain omega-3 fatty acids or conjugated linoleic acid, have been developed as a way to increase delivery of these fatty acids directly into the food supply or indirectly as use for feed ingredients for livestock. New processing technologies are being utilized around the world to create dietary fats and oils with specific physiologic functions relevant to risk factors for cardiovascular disease.

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.

Short-term diets enriched in stearic or palmitic acids do not alter plasma lipids, platelet aggregation or platelet activation status

OBJECTIVE

To determine whether healthy males who consumed increased amounts of dietary stearic acid compared with increased dietary palmitic acid through the consumption of commercially available foods, exhibited any changes in plasma lipids, platelet aggregation or platelet activation status.

DESIGN

A randomised cross-over dietary intervention.

SUBJECTS AND INTERVENTIONS

Nine free-living healthy males consumed two experimental diets (stearic acid enriched, diet S, and palmitic acid enriched, diet P) for 3 weeks in a randomised cross-over design separated by a 3 week washout phase. The diets consisted of approximately 30% of energy as fat (30% of which was derived from the treatment diets) providing approximately 13 g/day as stearic acid and 17 g/day as palmitic acid on diet S and approximately 7 g/day as stearic acid and 22 g/day as palmitic acid on diet P. The dietary ratio of stearic to palmitic acids was 0.76 on diet S compared with 0.31 on diet P. Blood samples were collected on days 0 and 21 of each dietary period.

RESULTS

LDL cholesterol levels and platelet aggregation response to the agonist ADP were significantly decreased (P<0.025) in subjects on diet S compared with day 0. Apart from that, there were no significant changes in plasma lipids, platelet aggregation, mean platelet volume and platelet reactivity between diets. There were no significant changes in stearic or palmitic acid levels in plasma phospholipid or triacylglycerol. There was a significant difference in palmitic acid levels in platelet phospholipids between the two diets.

CONCLUSIONS

Use of commonly available foods led to a 27% increase in stearic acid (diet S) and a 19% increase in palmitic acid (diet P), on diets S and P respectively, and no significant differences between the two diets in plasma lipoprotein concentrations, platelet aggregation or platelet activation status.

Dietary trans fatty acid

Trans fatty acids are unsaturated fatty acids that contain at least one double bond in the trans configuration. In the diet they occur at relatively low levels in meat and dairy products as a by-product of fermentation in ruminant animals or in hydrogenated fats as a consequence of the hydrogenation process. In general, dietary hydrogenated fat/trans fatty acids have been reported to increase LDL cholesterol levels relative to oil in the natural state or cis fatty acids. In contrast, dietary hydrogenated fat/trans fatty acids have been reported have to have little effect or decrease HDL cholesterol levels, the later observation restricted to relatively high intakes of trans fatty acids. These two effects result in higher, therefore less favorable, total or LDL cholesterol/HDL cholesterol ratios. Significant increases in Lp(a) levels have been reported after consumption of diets relatively high in trans fatty acids compared with either unsaturated or saturated fatty acids. However, the magnitude of the change is for the most part small and the physiological significance of this observation has yet to be resolved. Data related to the mechanism by which hydrogenated fat/trans fatty acids alter serum lipid levels and other risk factors for cardiovascular disease are in the nascent stages. At this time it would appear prudent that public health recommendations should be aimed at encouraging the moderate consumption of products low in saturated fat or minimally hydrogenated. Trans fatty acids intake should not be stressed at the expense of saturated fat but should augment it.

Trans fatty acids and cardiovascular disease risk

Recent studies continue to confirm previous observations that trans fatty acids elevate low density lipoprotein cholesterol levels, and at relatively high intakes decrease high density lipoprotein cholesterol levels. Considerable interest is focused on the potential benefits of trans-free margarines. Both adipose and plasma trans fatty acid levels reflect dietary intake. Current estimates of trans fatty acid intake in developed countries range from 0.5 to 2.6% of energy, contributed to primarily by differences in food availability and preference, and partly by the methodological differences used to calculate the data.

Estimated intakes of trans fatty and other fatty acids in the US population

OBJECTIVE

To estimate mean level of trans fatty acid intakes using a representative sample of the US population.

DESIGN

The study used food intake data from the 1989-1991 Continuing Survey of Food Intakes by Individuals (CSFII) and the trans fatty acid contents of specific foods calculated from a database compiled by the US Department of Agriculture (USDA) to estimate the mean level and deciles of trans fatty acid intake of the representative US population.

SUBJECTS/SETTING

Trans fatty acid intakes were estimated for each subject (N = 11,258) in the CSFII data who completed both a 24-hour recall and a 2-day food record.

STATISTICAL ANALYSES PERFORMED

Weights developed by USDA for the survey were used for all data analyses. The Technical Assessment Systems (TAS) International Diet Research System (TAS-DIET), software developed by TAS, was used to derive weighted estimates of the mean and percentiles of the intake distribution. PC CARP, software designed by Iowa State University, was used to estimate standard errors.

RESULTS

Mean percentage of energy ingested as trans fatty acids was 2.6% and the mean percentage of total fat ingested as trans fatty acids was 7.4%. Across all age and gender groups examined, estimates ranged from 2.6% to 2.8% and 7.1% to 7.9%, respectively.

APPLICATIONS/CONCLUSIONS

Dietetics practitioners can use the representative data of this study to help clients achieve desired changes in consumption levels of trans fatty acids.

A high linoleic acid diet increases oxidative stress in vivo and affects nitric oxide metabolism in humans

Evidence from in vitro studies shows that increased intake of polyunsaturated fatty acids leads to increased oxidative stress, which may be associated with endothelial damage. We measured the urinary levels of 8-iso-PGF2alpha and nitric oxide metabolites as well as plasma sICAM-1 levels from healthy subjects after strictly controlled diets rich in either linoleic acid (LA, C18:2 n-6) or oleic acid (OA, C18:1 n-9). Thirty-eight volunteers (20 women and 18 men, mean age 27 years) consumed a baseline diet rich in saturated fatty acids (SFA) for 4 weeks and were then switched to either a high LA diet (11.5 en%) or a high OA diet (18.0 en%) also for 4 weeks. During the LA and OA diets, nearly all food was provided for the whole day. A control group of 13 subjects consumed their habitual diet throughout the study. Urinary excretion of 8-iso-PGF2alpha was significantly increased after the LA diet (170 vs 241 ng/mmol creatinine, P=0.04), whereas the urinary concentration of nitric oxide metabolites decreased (4.2 vs 2.6 mg/mmol creatinine, P=0.03). No significant changes were seen in the OA group. Significant differences between the LA and control group were found for both 8-oxo-PGF2alpha (P=0.03) and NO (P=0.02), whereas the OA and LA groups did not differ with respect to any parameter. Also plasma sICAM-1 remained unchanged in both groups throughout the study. In conclusion, the high-LA diet increased oxidative stress and affected endothelial function in a way which may in the long-term predispose to endothelial dysfunction.

Functional food science and the cardiovascular system

Cardiovascular disease has a multifactorial aetiology, as is illustrated by the existence of numerous risk indicators, many of which can be influenced by dietary means. It should be recalled, however, that only after a cause-and-effect relationship has been established between the disease and a given risk indicator (called a risk factor in that case), can modifying this factor be expected to affect disease morbidity and mortality. In this paper, effects of diet on cardiovascular risk are reviewed, with special emphasis on modification of the plasma lipoprotein profile and of hypertension. In addition, dietary influences on arterial thrombotic processes, immunological interactions, insulin resistance and hyperhomocysteinaemia are discussed. Dietary lipids are able to affect lipoprotein metabolism in a significant way, thereby modifying the risk of cardiovascular disease. However, more research is required concerning the possible interactions between the various dietary fatty acids, and between fatty acids and dietary cholesterol. In addition, more studies are needed with respect to the possible importance of the postprandial state. Although in the aetiology of hypertension the genetic component is definitely stronger than environmental factors, some benefit in terms of the development and coronary complications of atherosclerosis in hypertensive patients can be expected from fatty acids such as alpha-linolenic acid, eicosapentaenoic acid and docosahexaenoic acid. This particularly holds for those subjects where the hypertensive mechanism involves the formation of thromboxane A2 and/or alpha 1-adrenergic activities. However, large-scale trials are required to test this contention. Certain aspects of blood platelet function, blood coagulability, and fibrinolytic activity are associated with cardiovascular risk, but causality has been insufficiently proven. Nonetheless, well-designed intervention studies should be initiated to further evaluate such promising dietary components as the various n-3 and n-6 fatty acids and their combination, antioxidants, fibre, etc. for their effect on processes participating in arterial thrombus formation. Long-chain polyenes of the n-3 family and antioxidants can modify the activity of immunocompetent cells, but we are at an early stage of examining the role of immune function on the development of atherosclerotic plaques. Actually, there is little, if any, evidence that dietary modulation of immune system responses of cells participating in atherogenesis exerts beneficial effects. Although it seems feasible to modulate insulin sensitivity and subsequent cardiovascular risk factors by decreasing the total amount of dietary fat and increasing the proportion of polyunsaturated fatty acids, additional studies on the efficacy of specific fatty acids, dietary fibre, and low-energy diets, as well as on the mechanisms involved are required to understand the real function of these dietary components. Finally, dietary supplements containing folate and vitamins B6 and/or B12 should be tested for their potential to reduce cardiovascular risk by lowering the plasma level of homocysteine.