Effect of dietary fat on the fecal excretion of cholesterol and its degradation products in man

Dietary fat quality, plasma atherogenic lipoproteins, and atherosclerotic cardiovascular disease: An overview of the rationale for dietary recommendations for fat intake

The scientific evidence supporting the current dietary recommendations for fat quality keeps accumulating; however, a paradoxical distrust has taken root among many researchers, clinicians, and in parts of the general public. One explanation for this distrust may relate to an incomplete overview of the totality of the evidence for the link between fat quality as a dietary exposure, and health outcomes such as atherosclerotic cardiovascular disease (ASCVD). Therefore, the main aim of the present narrative review was to provide a comprehensive overview of the rationale for dietary recommendations for fat intake, limiting our discussion to ASCVD as outcome. Herein, we provide a core framework - a causal model - that can help us understand the evidence that has accumulated to date, and that can help us understand new evidence that may become available in the future. The causal model for fat quality and ASCVD is comprised of three key research questions (RQs), each of which determine which scientific methods are most appropriate to use, and thereby which lines of evidence that should feed into the causal model. First, we discuss the link between low-density lipoprotein (LDL) particles and ASCVD (RQ1); we draw especially on evidence from genetic studies, randomized controlled trials (RCTs), epidemiology, and mechanistic studies. Second, we explain the link between dietary fat quality and LDL particles (RQ2); we draw especially on metabolic ward studies, controlled trials (randomized and non-randomized), and mechanistic studies. Third, we explain the link between dietary fat quality, LDL particles, and ASCVD (RQ3); we draw especially on RCTs in animals and humans, epidemiology, population-based changes, and experiments of nature. Additionally, the distrust over dietary recommendations for fat quality may partly relate to an unclear understanding of the scientific method, especially as applied in nutrition research, including the process of developing dietary guidelines. We therefore also aimed to clarify this process. We discuss how we assess causality in nutrition research, and how we progress from scientific evidence to providing dietary recommendations.

Voluntary wheel running increases bile acid as well as cholesterol excretion and decreases atherosclerosis in hypercholesterolemic mice

OBJECTIVE

Regular physical activity decreases the risk for atherosclerosis but underlying mechanisms are not fully understood. We questioned whether voluntary wheel running provokes specific modulations in cholesterol turnover that translate into a decreased atherosclerotic burden in hypercholesterolemic mice.

METHODS

Male LDLR-deficient mice (8 weeks old) had either access to a voluntary running wheel for 12 weeks (RUN) or remained sedentary (CONTROL). Both groups were fed a western-type/high cholesterol diet. Running activity and food intake were recorded. At 12 weeks of intervention, feces, bile and plasma were collected to determine fecal, biliary and plasma parameters of cholesterol metabolism and plasma cytokines. Atherosclerotic lesion size was determined in the aortic root.

RESULTS

RUN weighed less (∼13%) while food consumption was increased by 17% (p=0.004). Plasma cholesterol levels were decreased by 12% (p=0.035) and plasma levels of pro-atherogenic lipoproteins decreased in RUN compared to control. Running modulated cholesterol catabolism by enhancing cholesterol turnover: RUN displayed an increased biliary bile acid secretion (68%, p=0.007) and increased fecal bile acid (93%, p=0.009) and neutral sterol (33%, p=0.002) outputs compared to control indicating that reverse cholesterol transport was increased in RUN. Importantly, aortic lesion size was decreased by ∼33% in RUN (p=0.033).

CONCLUSION

Voluntary wheel running reduces atherosclerotic burden in hypercholesterolemic mice. An increased cholesterol turnover, specifically its conversion into bile acids, may underlie the beneficial effect of voluntary exercise in mice.

n-6 fatty acid-specific and mixed polyunsaturate dietary interventions have different effects on CHD risk: a meta-analysis of randomised controlled trials

Randomised controlled trials (RCT) of mixed n-6 and n-3 PUFA diets, and meta-analyses of their CHD outcomes, have been considered decisive evidence in specifically advising consumption of 'at least 5-10 % of energy as n-6 PUFA'. Here we (1) performed an extensive literature search and extracted detailed dietary and outcome data enabling a critical examination of all RCT that increased PUFA and reported relevant CHD outcomes; (2) determined if dietary interventions increased n-6 PUFA with specificity, or increased both n-3 and n-6 PUFA (i.e. mixed n-3/n-6 PUFA diets); (3) compared mixed n-3/n-6 PUFA to n-6 specific PUFA diets on relevant CHD outcomes in meta-analyses; (4) evaluated the potential confounding role of trans-fatty acids (TFA). n-3 PUFA intakes were increased substantially in four of eight datasets, and the n-6 PUFA linoleic acid was raised with specificity in four datasets. n-3 and n-6 PUFA replaced a combination of TFA and SFA in all eight datasets. For non-fatal myocardial infarction (MI)+CHD death, the pooled risk reduction for mixed n-3/n-6 PUFA diets was 22 % (risk ratio (RR) 0.78; 95 % CI 0.65, 0.93) compared to an increased risk of 13 % for n-6 specific PUFA diets (RR 1.13; 95 % CI 0.84, 1.53). Risk of non-fatal MI+CHD death was significantly higher in n-6 specific PUFA diets compared to mixed n-3/n-6 PUFA diets (P = 0.02). RCT that substituted n-6 PUFA for TFA and SFA without simultaneously increasing n-3 PUFA produced an increase in risk of death that approached statistical significance (RR 1.16; 95 % CI 0.95, 1.42). Advice to specifically increase n-6 PUFA intake, based on mixed n-3/n-6 RCT data, is unlikely to provide the intended benefits, and may actually increase the risks of CHD and death.

Associations of low density lipoprotein particle composition with atherogenicity

PURPOSE OF REVIEW

A growing body of data suggests that in addition to LDL-cholesterol concentrations, compositional properties of LDL, including size and fatty acid composition, are important in determining the relative degree of atherogenicity. This review examines current research in this field to evaluate which properties of LDL may most directly influence the risk of coronary heart disease.

RECENT FINDINGS

The presence of small dense LDL has been correlated with an increased risk of coronary heart disease, but this has not been shown to be fully independent of related factors such as elevated plasma triacylglycerol concentrations. An increased susceptibility of small dense LDL to in-vitro oxidation has also been demonstrated, but its importance to coronary heart disease risk has not been established. Other studies have found that the presence of enlarged LDL, modified (oleate enriched) fatty acyl composition of LDL, and higher numbers of LDL particles in plasma also are endpoints associated with an increased risk of coronary heart disease.

SUMMARY

LDL size may indicate a metabolic condition associated with increased CHD risk as opposed to the direct promotion of atherosclerosis by specific particle types of LDL. In most claims of detrimental effects of small dense LDL, neither LDL particle concentrations nor the fatty acid composition of the particles were established, both factors being important in contributing to the atherogenic potential of LDL. The predisposition to premature coronary heart disease cannot currently be objectively assigned to any one type of LDL particle.

Effects of LDL enriched with different dietary fatty acids on cholesteryl ester accumulation and turnover in THP-1 macrophages

LDL enriched with either saturated, monounsaturated, n-6 polyunsaturated, or n-3 polyunsaturated fatty acids were used to study the effects of dietary fatty acids on macrophage cholesteryl ester (CE) accumulation, physical state, hydrolysis, and cholesterol efflux. Incubation of THP-1 macrophages with acetylated LDL (AcLDL) from each of the four diet groups resulted in both CE and triglyceride (TG) accumulation, in addition to alterations of cellular CE, TG, and phospholipid fatty acyl compositions reflective of the individual LDLs. Incubation with monounsaturated LDL resulted in significantly higher total and CE accumulation when compared with the other groups. After TG depletion, intracellular anisotropic lipid droplets were visible in all four groups, with 71% of the cells incubated with monounsaturated AcLDL containing anisotropic lipid droplets, compared with 30% of cells incubated with n-3 AcLDL. These physical state differences translated into higher rates of both CE hydrolysis and cholesterol efflux in the n-3 group. These data suggest that monounsaturated fatty acids may enhance atherosclerosis by increasing both cholesterol delivery to macrophage foam cells and the percentage of anisotropic lipid droplets, while n-3 PUFAs decrease atherosclerosis by creating more fluid cellular CE droplets that accelerate the rate of CE hydrolysis and the efflux of cholesterol from the cell.

Dietary monounsaturated versus polyunsaturated fatty acids: which is really better for protection from coronary heart disease?

PURPOSE OF REVIEW

The purpose is to evaluate recent findings concerning dietary fats and the risk of coronary heart disease. Monounsaturated fatty acids are often regarded as healthy, and many have recommended their consumption instead of saturated fatty acids and polyunsaturated fatty acids. Support for the benefits of monounsaturated fatty acids comes largely from epidemiological data, but they have not been an isolated, single variable in such studies. Beneficial effects on the plasma lipid profile and LDL oxidation rates have also been identified. More recent findings have questioned the impact of suspected beneficial effects on coronary heart disease, indicating that studies with more conclusive endpoints are needed.

RECENT FINDINGS

Human dietary studies often produce conflicting results regarding the effects of monounsaturated and polyunsaturated fatty acids on the plasma lipid profile. Monounsaturated and polyunsaturated fatty acids both appear to reduce total and LDL-cholesterol compared with saturated fatty acids; however, the effect on HDL is less clear. Lowered HDL levels in response to low-fat or polyunsaturated fatty acid diets and the decreased protection from oxidation of polyunsaturated fatty acid-enriched LDL may not indicate increased coronary heart disease risk. Several lines of evidence also suggest that polyunsaturated fatty acids may protect against atherosclerosis.

SUMMARY

Recommendations to substitute monounsaturated fatty acids for polyunsaturated fatty acids or a low-fat carbohydrate diet seem premature without more research into the effects on the development of atherosclerosis. Current opinions favoring monounsaturated fatty acids are based on epidemiological data and risk factor analysis, but are questioned by the demonstrated detrimental effects on atherosclerosis in animal models.

Dietary stearic acid reduces cholesterol absorption and increases endogenous cholesterol excretion in hamsters fed cereal-based diets

The observation that dietary stearic acid does not raise plasma cholesterol concentration is well documented, although the regulating mechanisms are not completely understood. Therefore, we examined the effect of dietary stearic acid on cholesterol absorption and sterol balance using male Syrian hamsters fed modified NIH-07 cereal-based diets selectively enriched in palmitic acid (16:0), stearic acid (18:0), trans fatty acid (18:1t), cis oleic acid (18:1c) or linoleic acid (18:2). All diets contained 17 g/100 g total fat and 0.05 g/100 g cholesterol; the five fat blends were enriched 30% with the fatty acid of interest above a constant fatty acid background. Cholesterol absorption efficiency was 50-55% in all treatment groups except for the 18:0 group, in which cholesterol absorption was significantly reduced to 21%. Plasma total cholesterol concentration was significantly lower in the 18:0 group compared to the 16:0 group. Fecal neutral steroid excretion was significantly greater in hamsters fed the high 18:0 diet compared to the other treatment groups. After accounting for unabsorbed dietary cholesterol, endogenous cholesterol excretion was about 100% higher in the 18:0 group. Consequently, the calculated rate of whole body cholesterol synthesis was significantly increased by dietary 18:0. Bile acid excretion accounted for only 12-20% of total sterol output by the hamsters in this study. Thus, the data suggest that reduced plasma cholesterol concentration in hamsters fed high 18:0 diets may be influenced by reduced cholesterol absorption and increased excretion of endogenous cholesterol.

Use of hierarchical models for meta-analysis: experience in the metabolic ward studies of diet and blood cholesterol

Overviews that combine single effect estimates from published studies generally use a summary statistic approach where the effect of interest is first estimated within each study and then averaged across studies in an appropriately weighted manner. Combining multiple regression coefficients from publications is more problematic, particularly when there are differences in study design and inconsistent reporting of effect sizes and standard errors. This paper describes the use of a hierarchical model in such circumstances. Its use is illustrated in a meta-analysis of the metabolic ward studies that have investigated the effect of changes in intake of various dietary lipids on blood cholesterol. These studies all reported average blood cholesterol for groups of individuals who were studied on one or more diets. Thirty-one studies had randomized cross-over designs, 12 had matched parallel group designs, 12 had non-randomized Latin square designs and 16 had other uncontrolled designs. The hierarchical model allowed the different types of comparison (within-group between-diet, between matched group) that were made in the various studies to each contribute to the overall estimates in an appropriately weighted manner by distinguishing between-study variation, within-study between-matched-group variation and within-group between-diet variation. The hierarchical models do not require consistent specification of effect sizes and standard errors and hence have particular utility in combining results from published studies where the relationships between a dependent variable and two or more predictors have been investigated using heterogeneous methods of analysis.

Abnormal taurocholate ileal transepithelial transport in atherosclerotic mini-pigs and effects of ACE inhibitors

In atherosclerotic mini-pigs, we attempted to determine (i) whether high-fat atherogenic diet disturbs the taurocholate transepithelial transport and incorporation in the ileal epithelium mounted in Ussing chambers, and (ii) whether these processes are sensitive to angiotensin converting enzyme (ACE) inhibitors which slow the development of vascular atherosclerosis. In atherosclerotic mini-pigs, the mucosal to serosal transepithelial fluxes were markedly lower (72% inhibition) and free diffusion was more altered than active processes. Taurocholate incorporation into enterocyte (75% inhibition) paralleled the flux reduction. The transport disturbance observed here might be explained by changes in bile salt permeability in relation to alterations of the membrane properties. Taurocholate absorption was lowered by atherogenic diet, whereas bile salts were not trapped in the enterocyte, therefore atherosclerosis-induced alterations preferentially affected the passage through the brush-border. In the ACE inhibitor treated atherosclerotic mini-pigs, perindopril and enalapril similarly inhibited serum ACE activities. Perindopril further corrected taurocholate fluxes by 50% and fully restored taurocholate incorporation. Since enalapril did not restore the atherosclerosis-induced alterations, the involvement of intestinal ACE in bile acid recycling and of an ACE inhibitor class effect on these mechanisms both remain to be ascertained.

Dietary saturated fatty acids increase cholesterol synthesis and fecal steroid excretion in healthy men and women

In a strictly controlled 6-week trial with 47 healthy volunteers we have determined the effect of replacement of polyunsaturated by saturated fatty acids on the fecal steroid excretion and on the rate of whole body cholesterol synthesis, as measured both by the sterol balance method and by the concentration of the cholesterol precursor lathosterol in serum. Subjects were fed mixed natural diets, of which the total fat content was kept constant at 45% energy. Consumption of polyunsaturated fatty acids, mainly linoleic acid, was 21% energy for the first 3-week period (P:S ratio 1.9), and 5% of energy (P:S ratio 0.2) for the next 3-week period, or vice versa. Cholesterol intake as determined by analysis of duplicate diets was 41 mg MJ-1 (about 500 mg day-1) during both periods. Feces were collected for 5 days at the end of both periods. The steroid composition of the feces was not affected by the change of diets. The fecal excretion of neutral steroids was significantly higher on the low P:S high-saturated-fat (2.25 +/- 0.68 mmol day-1) than on the high P:S high-linoleic-acid diet (2.00 +/- 0.69 mmol day-1; P < 0.01). The excretion of bile acids was similar (0.77 +/- 0.40 and 0.79 +/- 0.41 mmol day-1, respectively). The cholesterol balance and the rate of cholesterol synthesis were higher during the low P:S (1.86 +/- 0.83 mmol day-1) than during the high P:S period (1.55 +/- 0.85 mmol day-1; P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of diets low and high in refined sugars on gut transit, bile acid metabolism, and bacterial fermentation

Increasing consumption of refined sugar has been implicated in many gastrointestinal disorders on epidemiological grounds. Nine volunteers agreed to participate in a study comparing the effects of a diet containing 165 g refined sugar/day with a diet of only 60 g/day on gut transit, bile acid metabolism, and fermentative activity of the intestinal flora. The wet and dry weight, pH, and water content of the stools were similar on the two diets. On the high sugar diet mouth-to-anus transit time was significantly prolonged, despite a shortened mouth-to-caecum transit time. The faecal concentration of total bile acids and the faecal concentration of secondary bile acids increased significantly. Diet affected neither the serum bile acid pattern nor the concentration. Breath hydrogen tests showed significantly enhanced H2 production on the high sugar diet. We conclude that the quantity of refined sugar in the diet can significantly influence gut function and the composition of bowel contents.

Whole body and hepatic cholesterol synthesis rates in the guinea-pig: effect of dietary fat quality

The effects of polyunsaturated, monounsaturated and saturated dietary fat on total and hepatic cholesterol synthesis were studied in the guinea-pig. Male Hartley guinea-pigs were fed semi-synthetic diets containing 7.5% (w/w) of either corn oil (CO), olive oil (OL) or lard for a period of 5 weeks and rates of endogenous cholesterol synthesis were determined from the incorporation of [3H]water into digitonin-precipitable sterols (DPS) and by measurement of sterol balance. In addition, total and expressed 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase activities were determined in hepatic microsomes. Rates of whole body cholesterol synthesis determined by incorporation of [3H]water into DPS were significantly lower for guinea-pigs on the CO diet with values of 18.7 +/- 1.8 mumol/h (n = 4) vs. 26.7 +/- 4.8 and 24.6 +/- 1.8 mumol/h for animals on the OL (n = 4) and lard (n = 3) diets (P less than 0.001), respectively. Hepatic cholesterol synthesis rates were significantly decreased in animals on the OL diet, whether determined from incorporation of [3H]water into DPS or by analysis of HMG-CoA reductase activity. Hepatic total and free cholesterol levels were not different for animals on the three dietary fats; however, cholesteryl ester levels were 35% lower in guinea-pigs fed the lard diet (P less than 0.02). Sterol balance measurements indicated that whole body cholesterol synthesis rates were not affected by dietary fat quality (51.9 +/- 12.2, 42.8 +/- 7.6 and 51.2 +/- 20.2 mg/kg per day for animals on the CO, OL and lard diets, respectively). This is in striking contrast to the observed reduction in cholesterol synthesis rates for animals on the polyunsaturated CO diet as determined by incorporation of [3H]water into DPS. One possible explanation for the discrepancy between the sterol balance and [3H]water incorporation data is a polyunsaturated fat-mediated effect on energy utilization, which affects the equilibration of NADPH with the body water pool such that the [3H]NADPH has a lower specific activity than body [3H]water.

Serum and biliary lipid pattern in rabbits feeding a diet enriched with unsaturated fatty acids

Adult male New Zealand white rabbits were fed for 3 months a stock diet supplemented with 6% (w/w) soybean oil heated at 240 degrees C for 60 min. After the first month of treatment a significant increase in total lipid content of serum was observed mainly due to the cholesterol ester fraction. Simultaneously, grossly induced atherosclerosis and marked liver damage were histologically and clinically demonstrated. Lipid peroxide values, performed by thiobarbituric acid test in lipid extracts from liver, aorta and bile showed a significant increase as compared to controls. Lipoperoxidation rate increased with the duration of feeding. Parallel to this there was a marked reduction in the activities of glutathione peroxidase, superoxide dismutase and catalase in liver and aorta, all enzymes involved in the mechanism of detoxification of lipid peroxides. The results are in agreement with the hypothesis that lipid peroxidation can play a significant role in the pathogenesis of atherosclerosis.

Cholesterol homeostasis in guinea pigs fed saturated and polyunsaturated fat diets

Whole body sterol balance, hepatic 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase activity, hepatic low-density lipoprotein (LDL) receptor levels and net tissue cholesterol concentrations were determined in guinea pigs fed either a corn oil- or lard-based purified diet for 6-7 weeks. In comparison to the saturated lard diet, the polyunsaturated corn oil diet resulted in a 34% reduction in plasma total cholesterol levels (P less than 0.02) and a 40% lower triacylglycerol level (P less than 0.02). Feeding the corn oil diet altered very-low-density lipoprotein (VLDL) and LDL composition; the percent cholesterol ester in both particles was decreased and the relative percentages of VLDL triacylglycerol and LDL phospholipid increased. The ratio of surface to core components of LDL from corn oil-fed guinea pigs was significantly higher compared to LDL from animals fed lard. Dietary fat quality had no effect on fecal neutral or acidic steroid excretion, net tissue accumulation of cholesterol, whole body cholesterol synthesis or gallbladder bile composition. Consistent with these results was the finding that fat quality did not alter either expressed (non-phosphorylated) or total hepatic HMG-CoA reductase activities. The hepatic concentrations of free and esterified cholesterol were significantly increased in corn oil-fed animals, as were cholesterol concentrations in intestine, adipose tissue, muscle and total carcass. Analysis of receptor-mediated LDL binding to isolated hepatic membranes demonstrated that the polyunsaturated corn-oil based diet caused a 1.9-fold increase in receptor levels (P less than 0.02). The data indicate that the hypocholesterolemic effects of dietary polyunsaturated fat in the guinea pig are not attributable to changes in endogenous cholesterol synthesis or catabolism but rather may result from a redistribution of plasma cholesterol to body tissue due to an increase in tissue LDL receptors.

Serum and liver lipids of rats fed rubber seed oil

Crude rubber seed oil (RSO) was incorporated at the 5% level in diets free of cholesterol or containing 1% cholesterol, respectively. These studies were initiated for the purpose of evaluating the palatability and potential toxicity of RSO. Corn oil was used as a control. A considerable amount of unsaponifiable matter was detected in RSO. In addition, RSO was found to possess a fatty acid profile which was fairly different from that of corn oil, primarily due to a much higher content of linolenic acid and a lower content of linoleic acid in RSO. No adverse effects on food intake and average daily gain were observed in rats fed RSO in both cholesterol-free and cholesterol diets. The presence of RSO in cholesterol-free diets results in lower (p less than 0.05) serum and liver total cholesterol levels than in control animals. A relative hypercholesterolemic effect compared to corn oil was observed however, when RSO was added to diets containing 1% cholesterol. In summary, the physicochemical properties of RSO as well as the presence of cholesterol in the diet are important factors in evaluating the cholesterolemic effect of RSO.

Regulation of indices of cholesterol synthesis in human mononuclear leukocytes by dietary cholesterol and fat saturation

The responses of 2 indices of cholesterol synthesis, 3-hydroxy-3-methylglutaryl-CoA reductase activity and incorporation of [14C]acetate into sterols, in mononuclear leukocytes freshly isolated from peripheral blood to variation in the ratio of saturated to unsaturated fat (S:U) and the amount of cholesterol absorbed from the diet were examined in 24 free-living men. Increasing S:U was associated with increasing plasma cholesterol level (r = 0.27, P = 0.03) and increasing reductase activity in leukocytes (r = 0.60, p less than 0.001). This finding is consistent with the hypothesis that saturated fat decreases the flux of cholesterol from plasma into cells thereby releasing reductase from product feedback inhibition. Reductase activity, after controlling for the effect of S:U, was negatively correlated with absorbed cholesterol from sources other than eggs (r = 0.42, P = 0.02). Surprisingly, change in reductase activity was positively correlated with change in absorbed cholesterol upon eating eggs (r = 0.49, P = 0.008). Sterol labeling was negatively correlated with absorbed cholesterol from all sources including eggs (r = -0.64, P less than 0.001) and was uncorrelated with S:U. Reductase activity and sterol labeling responded in parallel to cholesterol in foods other than eggs but not to egg feeding nor to S:U, thus it is unclear which test best reflects endogenous sterol synthesis in these cells.

Heterogeneity of cholesterol homeostasis in man. Response to changes in dietary fat quality and cholesterol quantity

Studies were carried out to examine the effects of dietary fat and cholesterol on cholesterol homeostasis in man. 75 12-wk studies were carried out during intake of 35% of calories as either saturated or polyunsaturated fat, first low and then high in dietary cholesterol. Dietary fat and cholesterol intakes, plasma lipid and lipoprotein levels, cholesterol absorption and sterol synthesis in isolated blood mononuclear leukocytes were measured during each diet period. In 69% of the studies the subjects compensated for the increased cholesterol intake by decreasing cholesterol fractional absorption and/or endogenous cholesterol synthesis. When an increase in plasma cholesterol levels was observed there was a failure to suppress endogenous cholesterol synthesis. Plasma cholesterol levels were more sensitive to dietary fat quality than to cholesterol quantity. The results demonstrate that the responses to dietary cholesterol and fat are highly individualized and that most individuals have effective feedback control mechanisms.

Cholesterol metabolism in juvenile baboons. Influence of infant and juvenile diets

The deferred effects of infant diets and the effects of juvenile diets on cholesterol metabolism were estimated in 83 baboons (Papio sp.) at 3.5 years of age. As infants, the animals were breast-fed or fed one of three formulas containing approximately 2, 30, or 60 mg/dl cholesterol. After weaning at 14 weeks of age, the animals were fed one of four juvenile diets high or low in cholesterol with saturated (P/S = 0.37) or unsaturated (P/S = 2.1) fats. Cholesterol absorption and cholesterol turnover were measured by fecal isotopic methods, and variables of cholesterol metabolism were estimated from a two-pool model. Among juvenile animals breast-fed during infancy, the percentage of cholesterol absorption was higher, while the fluxes of cholesterol from Pool A (QAA, QA, and QAB) and the cholesterol mass of Pool B were lower, compared to those fed formulas. The level of cholesterol in formulas fed during infancy did not influence cholesterol metabolism during the juvenile period. During the juvenile period, saturated fat significantly decreased the cholesterol production rate (QA) and increased the rate constants for cholesterol flux between Pool A and Pool B (KAB and KBA) compared to unsaturated fat. High cholesterol intake increased bile acid and neutral steroid excretion, cholesterol turnover rate, the mass of Pool A, and the rate constant KA and fluxes QA and QAA for removal of cholesterol from Pool A. However, KAB, t1/2 B (half-time of Pool B), and the percentage of cholesterol absorbed were decreased.(ABSTRACT TRUNCATED AT 250 WORDS)

Relationship between changes in plasma lipoprotein concentrations and fecal steroid excretion in man during consumption of four experimental diets

Limited information is available on the mechanism by which changes in nutrient intake influence plasma lipids. We compared the effects on plasma lipoprotein levels of 3 dietary modifications involving changes in total fat intake (27-40% of calories), cholesterol intake (100-250 mg/1000 kcal), the dietary polyunsaturated to saturated fatty acid ratio (0.3-1.0) and intake of vegetable-derived fiber and protein. On these 3 diets, plasma low density lipoprotein was reduced by 26-34%. Fecal bile acid excretion was similar on all diets (363-379 mg/day). There was no alteration in fecal bile acid output associated with an increase in polyunsaturated or total fat intake. Sterol balance became significantly more negative during consumption of only 1 of the 3 cholesterol-lowering diets. The observed reduction in plasma cholesterol levels was not associated with an increase in fecal bile acid output suggesting that diet-induced changes in circulating cholesterol are not maintained by an increase in sterol turnover but may reflect alterations in hepatic cholesterol and lipoprotein synthesis.

Hypo-atherogenic effect of dietary corn oil exceeds hypo-cholesterolemic effect in swine

Three groups of young swine were fed semi-purified diets enriched in fat and cholesterol for 90 days. In one group 40% of calories were from butter; in another 40% were from corn oil; in a third group 20% were from corn oil. Mean serum cholesterol values were respectively 530, 458 and 400 mg/dl. Amounts of atherosclerosis in the abdominal aortas expressed as mean number of nuclear profiles per cross-section were respectively 1611, 734 and 585; expressed as mean lesion area per cross section 46.7, 21.4 and 19.4 mm2 X 10(2). All differences between the butter group and either of the two corn oil groups were statistically significant. We found that intimal response to the butter containing diet was significantly greater than to the corn oil containing diet for equivalent hypercholesterolemic response. We present detailed statistical validation of the disproportionately larger intimal response to butter containing diet. Furthermore, we suggest that estimates of comparative atherogenic risk of food fats based on response of serum cholesterol may mask important atherogenic differences.

Dietary fat saturation and hepatic acylcoenzyme A:cholesterol acyltransferase activity. Effect of n-3 polyunsaturated and long-chain saturated fat

The acylcoenzyme A:cholesterol acyltransferase (ACAT) activity in liver microsomes from rats fed a diet containing 14% menhaden oil (Mp) for 11 days was 117% higher than that in microsomes from rats fed a corresponding diet containing 14% cocoa butter (Ms). There were no differences in the cholesterol and phospholipid contents of Mp and Ms or in the activities of palmitoyl coenzyme A hydrolase and NADPH cytochrome c reductase. NADPH-dependent lipid peroxidation was higher in Mp, whereas glucose 6-phosphatase activity was higher in Ms. These findings indicate that the ACAT response to differences in dietary fat saturation is not due to a nonspecific effect of these diets on microsomal enzymes. When 1% cholesterol was added to the diets, the cholesterol content and ACAT activity of both microsomal preparations increased, but the ACAT activity of Mp remained 60% higher than that of Ms. Addition of cholesterol by incubation of the microsomes with liposomes also increased ACAT activity. At corresponding cholesterol contents, however, the ACAT activity of Mp remained 50% to 70% above that of Ms. There was no difference in the plasma cholesterol concentration in the two groups of rats, indicating that the ACAT effect probably is not due to a difference in the amount of circulating cholesterol available to the liver. Mp contained 40% more polyunsaturated fatty acids and five times more n-3 polyunsaturates than Ms. These findings suggest that the increase in ACAT activity in Mp is due, at least in part, to the difference in the fatty acid composition of the microsomes.

Faecal excretion of bile acids and neutral steroids on diets differing in type and amount of dietary fat in young healthy persons

The effect of different amounts and types of dietary fat on faecal steroid excretion in healthy volunteers was examined. In the first experiment with sixty volunteers four diets which differed in type and amount of dietary fat only were compared during a test-period of 5 weeks. Faeces were collected during 7 days before and at the end of the test period and analysed individually. In the second experiment with thirty-five volunteers, a low fat diet containing 22% of energy as total fat (4% as polyunsaturated fatty acids) was compared with a moderate fat diet (30% of energy as total fat; 11% as polyunsaturated fatty acids) during 13 weeks. Faeces were collected during the first 7 days of the test period and during 7 consecutive days near the end of the test period and pooled per dietary group. Excretion of faecal neutral steroids and bile acids was not significantly influenced by amounts of total fat ranging from 22% to 40% of daily energy or by differences in polyunsaturated to saturated fatty acids ratio from 0 . 2 to 1 . 7. The only exception was the excretion of bile acids in the second experiment which was 0 . 19 mmol/24 h (75 mg/24 h) higher on the low fat diet than on the moderate fat, high polyunsaturated fat diet (P less than 0 . 01).

Modes of action of lipid-lowering diets in man: studies of apolipoprotein B kinetics in relation to fat consumption and dietary fatty acid composition

The mechanisms by which dietary fat influences fasting plasma lipid concentrations have been investigated in hyperlipidaemic subjects. The synthetic and fractional catabolic (FCR) rates of the apoprotein B (apo B) of very-low density (VLDL) and low-density (LDL) lipoproteins were measured using radioiodinated autologous lipoproteins. Reductions of LDL concentration in eight subjects during low-fat (25% of energy) diets were largely explained by diminished synthesis (-20%, P less than 0.02), and possibly also by an increased FCR (+15%, P = 0.05) of LDL, compared with observations made during a high-fat (45% of energy) diet of similar fatty acid composition. VLDL apo B synthesis and FCR were not significantly altered. When a diet rich in polyunsaturated fatty acids was exchanged for one high in saturated fatty acids (fat providing 45% of energy on both occasions) in four subjects, the synthetic rates of both VLDL apo B (-31%, P less than 0.02) and LDL apo B (-23%, P less than 0.10) were reduced while their FCRs were unchanged.

Fecal cholesterol excretion studies in type II hypercholesterolemic patients treated with the soybean protein diet

The fecal steroid elimination profile was studied in 7 type II hyperlipoproteinemic patients given a low-lipid diet with textured soybean proteins, in order to define the mechanism of the hypocholesterolemic activity of this new dietary regimen. Four of the patients followed a 3- + 3-week cross-over protocol, comparing the soybean diet with a reference low-lipid diet with animal proteins. In these, fecal neutral steroids and bile acids were analyzed by chromatography during the two dietary periods. In spite of the clear hypocholesterolemic effect, no significant differences in steroid output were noted between the two dietary periods. In the 3 remaining patients, a chromatographic + isotopic method (by injecting 14C-labelled cholesterol i.v. 4-6 weeks prior to the dietary study) was employed. Again, no marked changes were noted in the fecal neutral steroid and bile acid outputs and the slope of the decay curve of the plasma cholesterol-specific activity was not changed by the experimental diet, in spite of the remarkable decrease in plasma cholesterol. The reported results do not provide a definitive contribution to the mode of action of the soybean protein diet. They suggest, however, that it is not an effect mediated by undigestible dietary components. The possibility of a cholesterol redistribution from plasma to tissue pools should be considered.

The dietary treatment of hyperlipidemia. Rationale, technique and efficacy

Working from the foundation of the role of diet in the pathogenesis of hyperlipidemia, the authors present a rational, detailed therapy for treating the disorder. A three-phase approach is offered so that the patient can gradually incorporate new eating behavior into his or her lifestyle.

Effect of changing dietary fat saturation on low-density lipoprotein metabolism in man

The mechanism of change in low-density lipoprotein (LDL) levels by diets differing in fat saturation have been studied. Turnover of 125I-LDL was measured in eight subjects with type II hyperlipoproteinemia and in seven normal control subjects during two dietary periods containing 40% of calories as either safflower oil (polyunsaturated fat, PSF) or as lard (saturated fat, SF). Higher levels of LDL apoprotein and LDL-cholesterol were observed in both groups on saturated fat. Subjects with elevated LDL levels (type II) showed a more marked effect of polyunsaturated fat with 25% lower LDL production rate as compared to a reduction of only 10% for the control group. On the PSF diet, the production rate in type II (12.7 mg.kg-1.day-1) was not statistically different from normal subjects (10.5 mg.kg-1.day-1). On this diet, the higher levels of LDL cholesterol in the type II subjects (as compared to controls) were due to a lower fractional clearance rate, mean of 0.27/day compared to a mean of 0.39/day for the normal subjects. Although individuals with type II hyperlipoproteinemia may have a primary clearance defect, the major reduction in plasma cholesterol concentrations achieved with a diet high in polyunsaturated fat can be attributed to a significantly lower LDL production.

Effects of long-term ingestion of soya phospholipids on serum lipids in humans

The average reduction of 22 percent in serum cholesterol and 26 percent in triglycerides in the participants in this study was achieved by a diet low in fat and cholesterol supplemented with lecithin. The results are important because all of the participants were able to follow the diet protocol while continuing their normal activities and did so willingly and eagerly over the entire 26 month period. Although the statistical analyses of the data in this small group do not enable us to conclude that lecithin added to the low fat diet actually produced the reduced levels of cholesterol and triglycerides, the trend is encouraging. Because the lecithin and low fat diet was tolerated well with no significant side effects for 2 years, we suggest that a long-term prospective randomized study with a larger group of patients, including appropriate linoleic acid controls, be carried out to confirm or deny these preliminary findings.

Effects of three dietary fats on plasma lipids and lipoproteins in fasting and post-prandial humans after a short-term diet

The effects of 3 dietary fats (olive oil, canbra oil and butter) on the fatty acids of blood lipids and on serum lipoproteins were compared in 6 healthy adult outpatients, after a 6-day normocaloric diet including 35% of the studied fat. Important, although incomplete, changes appeared in the fatty acid composition of the various serum lipids and in the composition and distribution of serum lipoproteins. These changes probably result from the degree of saturation of the fat ingested. Moreover, differences were observed among individual subjects. Genetic differences, which are important in clinical practice, are stressed in connection with risks of vascular diseases and hyperlipidemia and affect intestinal fat absorption and lipoprotein metabolism.

Influence of dietary oil, cholesterol, and soysterols on the fecal neutral and acidic steroid excretion in laying hens

The influence of dietary lipid factors (saturated and unsaturated oil, cholesterol, and plant sterols) upon the fecal neutral and acidic sterol excretion in the laying hen were investigated during a nine-week experimental period. Single Comb White Leghorn laying hens at thirty weeks of age were fed two basal diets containing 8.0% hydrogenated coconut oil or safflower oil, with or without supplementing 1.0% cholesterol, 2.0% soysterols, or combination of cholesterol and soysterols with each oil treatment. Feeding safflower oil increased the fecal excretion of bile acids and, to a lesser extent, catabolic neutral sterols as compared to hydrogenated coconut oil. The fecal excretion of sterol metabolites was further enhanced when soysterols and cholesterol were fed simultaneously. When soysterols were fed alone, endogenous cholesterol excretion in feces appeared to increase, but soysterol feeding with cholesterol did not retard the apparent absorption rate of cholesterol.

Swine in atherosclerosis research--Development of an experimental animal model and study of the effect of dietary fats on cholesterol metabolism

The effect of saturated (beef tallow) and polyunsaturated (corn oil) fat diets on plasma cholesterol, bile flow and composition, and excretion of fecal steroids, was studied in 5 female and 6 male miniature swine. The animals were fitted with a modified Baldwin T-tube in the common bile duct for bile sampling and a catheter in the duodenum for reinfusion. Plasma cholesterol levels were increased by beef tallow and decreased by corn oil. Both fats caused an increase in the secretion of bile, biliary lipids and bile acid pool size. The increases were significant when the source of fat was corn oil. The fecal neutral steroid excretion measured in the male swine was increased by both fats. However, only the polyunsaturated fat diet caused a significant increase in the fecal acidic steroid excretion.

Influence of diets high and low in animal fat on bowel habit, gastrointestinal transit time, fecal microflora, bile acid, and fat excretion

Epidemiological observations and animal experiments suggest that large bowel cancer is related to serveral factors. Among them, high dietary intakes of animal fat, the presence in the colon of relatively high levels of bile acids, specific patterns of intestinal microflora, slow transit through the gut, and low stool weights. Under metabolic conditions we have observed the effect on these variables of dietes containing 62 or 152 g/day of fat mainly of animal origin in six healthy young men over 4-wk periods. No change attributable to the diet was observed in the subjects' bowel habit, fecal weight, mean transit time through the gut, or in the excretion of dry matter. Total fecal bile acid excretion was significantly higher on the high fat diet (320 +/- 120 mg/day) than on the low fat diet (139.7) +/- 63 mg/day) t test = 7.78 P less than 0.001 as also was the total fecal fatty acid excretion, 3.1+/-0.71 and 1.14+/-0.35 g/day, respectively t test = 11.4 P less than 0.001). The fecal microflora including the nuclear dehydrogenating clostridia were unaltered by the dietary changes as was fecal beta-glucuronidase activity. Dietary changes which increase animal fat intake clearly influence fecal bile acid excretion in a way that would favor the development of large bowel cancer if current theories prove to be true. Dietary fat however has no effect on overall colonic function so other components of the diet must be responsible for the observed associations of bowel cancer with slow transit and reduced fecal bulk.

Physical exercise and the prevention of atherosclerosis and cholesterol gall stones

There is accumulating evidence in man and experimental animals that even mild exercise, if regularly repeated, may alter the metabolism of lipids. Exercise has been reported as decreasing peripheral tissue cholesterol in red blood cells, working muscle, lungs and the liver. During physical activity, the output of cholesterol and bile acids into the bile increases. This probably leads to higher faecal losses of sterols which may lead to lower cholesterol levels in the peripheral tissues and in the bile, when exercise is repeated regularly. Preferential release of unsaturated fatty acids from the adipose tissue during exercise and the linoleic acid-dependent LCAT enzyme (transporting plasma cholesterol) may be partly responsible for this effect of exercise. The experimental data reviewed provide supportive basis for epidemiological studies reporting on the beneficial effect of regular exercise.

Physical activity is an important factor in the phylogeny of all animal species, secondary only to food intake and reproduction. Exercise is readily available to all population groups. There is good evidence that the amount of exercise required for a protective effect is easily accessible for time-pressured and older individuals. Short bursts of activity repeated several times a day may be equally or more beneficial than prolonged exhaustive exercise. Modified exercise is also beneficial for patients with coronary heart disease and for elderly patients, provided this is done under strict medical supervision. To be effective, physical exercise should be regular and continuous throughout life.

Effects of saturated and unsaturated fats given with and without dietary cholesterol on hepatic cholesterol synthesis and hepatic lipid metabolism

Hepatic cholesterol synthesis was studied in rats after consuming diets of varying neutral lipid and cholesterol content. Cholesterol synthesis was evaluated by measuring 3-hydroxy-3-methylglutaryl-CoA reductase and by determining the rate of 3H-labeled sterol production from [3H]mevalonate. Results were correlated with sterol balance data and hepatic lipid content. Hepatic cholesterol synthesis was relatively great when cholesterol was excluded from the diet. The source of neutral dietary lipids, saturated vs. unsaturated, produced no change in hepatic sterol synthesis. Values for fecal sterol outputs and hepatic cholesterol levels were also similar in rats consuming either saturated or unsaturated fats. When 1% cholesterol was added to the diet, hepatic cholesterol synthesis was suppressed but the degree of suppression was greater in rats consuming unsaturated vs. saturated fats. This was associated with greater accumulation of cholesterol in livers from rats consuming unsaturates and a reduction in fecal neutral sterol output in this group as opposed to results from rats on saturated fats. Cholesterol consumption also altered the fatty acid composition of hepatic phospholipids producing decreases in the percentages of essential polyunsaturated fatty acids. It is concluded that dietary cholesterol alters cholesterol and fatty acid metabolism in the liver and that this effect is enhanced by dietary unsaturated fats.