Malaysian Healthy Ageing Society Dietary fats and cardiovascular - PowerPoint PPT Presentation

Organised by: Co-Sponsored: Malaysian Healthy Ageing Society

Dietary fats and cardiovascular effects Talk by: A/P Dr Tony Ng & Voon PT International Medical University

DIETARY FATS AND CARDIOVASCULAR EFFECTS Dietary fats Plasma lipid Hemostatic 13-HODE PGI2 Chronic profile factors Vascular Induce inflammation endothelium TC, Fibrinogen, CRP, TNF- α FVIIc, FXIIa LDLC, CAMs vWF FVIIag, Interleukins TAG, Platelet tPA, PAI-1 HDLC, Vessel wall aggregation TxB 2. PGF1  adhesivity LDLC/HDLC, Fatty TC/HDLC streaks ApoA1 ApoB100

Impact of dietary fats on CVD: Major factors to consider  Dietary fat level  Minor components: cholesterol,  Major fat plant stanols/sterols, T 3 , etc components: TFA,  Stereospecific 12-16C SFA, positioning of FA MUFA, in fat molecules PUFA

HOW MUCH FAT SHOULD WE TAKE? “HIGH” Western communities 35- 40% en WHO/FAO Target “LOW” Desirable 30% en levels for Malaysians: Minimum 20-30%en. level: 20% 15% en. 45-67g fat @ 2000-kcal diet

Impact of dietary fats on CVD: Major factors to consider  Dietary fat level  Minor components: cholesterol,  Major fat plant stanols/sterols, T 3 , etc components: TFA,  Stereospecific 12-16C SFA, positioning of FA MUFA, in fat molecules PUFA

FATTY ACIDS, CHOLESTEROLEMIA FATTY ACIDS, CHOLESTEROLEMIA & CVD RISK & CVD RISK Cholesterol -raising TFA Neutral C12-16 SFA: (esp. trans 18:1 monoenes) 14:0, 12:0, 16:0 PUFA: 18:0 n - 3 <12:0 Linoleic acid F A s (18:2,n-6) Cholesterol -lowering

Predictive equations of Keys, Hegsted Used to predict changes in serum TC brought about by changes in dietary fats. Equations useful, but have limitations! 1 TC = 2.74 S - 1.31 P + 1.5Z [Keys et al., 1965] = 1.35 (2S - P) + 1.5Z 2 TC = 8.45 S 14 + 2.12 S 16 - 1.87 P + 5.64 C - 6.24 [Hegsted, 1965]

A meta-analysis of 60 selected trials and calculated the effects of the amount and type of fat on total:HDL cholesterol and on other lipids*. *

SFAs raise both LDLC and HDLC

Impact of TFAs on the serum lipid profile* SAT FAT vs * Mensink & Katan (1989). NEJM, 321:436-441. TRANS FAT TC 20 17.4 LDLC 13.6 15 HDLC 12.2 10 6.4 5 0 MONO diet -5 (oleic acid-diet) Durch study: -10 25M, 34F consumed -12.7 each test diet for 3wk. -15 Total fat =36%en, test TRANS FAT SAT FAT fat= 11%en, 18:2 kept const at 4.6% en. (11% en) (+ve control)

3.1%en TFA 10 normocholesterolemic women fed either 30%en of high PO diet or high trans diet for weeks.

IMPACT ON THE PLASMA LDLC/HDLC RATIO: TRANS VS SFAs* 2 P<0.05 P<0.05 1.0 e r a s A F e s h n t a n r o T a 0.8 h t e i s ! r s t o A w a F S P<0.001 P<0.001 C R 6 1 - 2 P<0.001 9 0.6 P<0.001 TRANS 1 LDLC HDLC 5 P<0.001 P<0.001 7 1 3 0.4 P<0.005 P<0.005 4 6 8 n SFAs 1 1 i 0.2 e 1 g P<0.001 P<0.001 n Best-fit 0.0 a regression h C lines -0.2 * * Ascherio et al. 0 1 2 3 4 5 6 7 8 9 10 (1997) N Engl J Percentage of Energy from Fatty Acids (% kcal) Med, 340:1994. 9 Mensink and Katan (1990); 8 Zock and Katan (1992); 7 Nestel et al. (1992); 6 Judd et al. (1994); 5 Judd et al. (1998); 4 Lichtenstein et al. (1993); 3 Aro et al. (1997); 2 Sundram et al. (1997); 1 Lichtenstein et al. (1999)

* Estimated changes in CHD risk when CHO is substituted by a specified dietary component Nurses Health Study: TRANS fats 80,082 nurses followed-up % Change in worse than bad for your 14 years [Hu et al. (1997) heart; 100 93 NEJM, 337:1491-1499] 80 TRANS fats also SFAs! increase risk of 60 type 2 diabetes! 40 CHD risk Overall: TFAs 17 20 2 to 10 times 2 worse than 0 the C12-16 TRANS SFAs MONO PUFA Total SFAs when -20 2% Fat 5% -19 impact on kcal 5% kcal -40 5% other risk -38 kcal kcal factors 5% -60 considered! kcal

TRANS FATS- “bad”, worst kind of dietary fat! Adverse effects: * (raise the risk factors TC, LDLC, Lp(a) but lower the “good” HDLC) relative to cis C12-16 SATs

TRANS FATS: CODEX: TFA content in Dietary Sources of TFAs foods should not exceed 3% Ingestion of unsaturated PUFA-rich of total FAs. fat by ruminant edible oils WHO: Partial Commercial TFA <1% kcal hydrogenation by hydrogenation: of diet bacteria in rumen high temp, Vaccenic acid Ni catalyst (18:1 trans-11) + other Hydrogenated fat TFAs in rumen (2-4%) Containing mainly  9 -desaturase trans -monoenes + smaller amounts Solid-fat food Conjugated Linoleic Meat & of trans dienes & Dairy applications: Acid ( CLA ) [~1%] trienes eg. margarines, Products [Prominent form = shortenings, rumenic acid (n-7 FA), vegetable ghee, ( c 9, t 11-CLA) ] bakery fat, etc.

EARLY SCIENTIFIC EVIDENCE THAT PALMITIC ACID (16:0) FROM PALM OIL TENDS TO BE NEUTRAL* Predicted TC values 2 r =0.923 Use of 1 (mmol/L) Hegsted 0 Equation *Hayes et al. (1991) -1 AJCN, 53:491-498: -2 24 monkeys from 3 -2 -1 0 1 2 species rotated through 5 Observed TC values (mmol/L) purified diets containing 31% energy as various 2 palm fat blends for 12- Predicted TC values week periods to compare Use of r =0.995 the impact of specific 1 dietary FAs on plasma (mmol/L) Modified lipids and lipoproteins. Hegsted 0 Equation CONCLUSION: (-16:0) -1 PALM 16:0 TENDS TO BE “NEUTRAL” -2 -2 -1 0 1 2 Observed TC values (mmol/L)

Ng et al (1992) 5 4.5 Palm Oil vs Olive Oil studies 4 3.5 3 Reference Choudhury Ng et al . Voon et al. PO 2.5 et al . (1995) (1992) (2011) OO 2 1.5 Subjects (n) 12 males, 20 males, 36 females, 1 12 females 13 females 9 males 0.5 0 Age (y) 19-44 22-41 TC LDL-C HDL-C L/H 30±8 2 ) BMI (kg/m <25 <28 <28 Choudhury et al (1995) Choudhury et al (1995) Design RCT 30 RCT 6 RCT 5 days weeks weeks 5 5 4 4 Test fats PO OO PO OO PO OO 3 3 PO PO Total 30 31 34 34 31 31 OO OO 2 2 fat Dietary 1 1 16:0 12.1 3.3 13.4 6.3 9.7 4.8 fatty 0 0 acids TC TC LDL-C LDL-C HDL-C HDL-C L/H L/H 18:1 13 24.1 13.8 21.4 12.3 19.1 (%E) 18:2 3.2 2 3.5 2.6 4.0 3.5 Voon et al (2011) TC (mg/dL) 175 194 <200 <200 5 Lipids TC 4.7 4.6 4.9 4.9 4.8 4.7 (mmol/ 4 TAG 1.0 1.0 1.2 1.2 0.8 0.8 L) 3 P>0.05 PO LDLC 3.3 3.4 3.4 3.3 3.2 3.1 OO 2 HDLC 0.9 0.8 1.1 1.1 1.3 1.3 1 18 0 TC LDL-C HDL-C L/H

Change in TxB 2 /PGF 1  ratios after palm olein and olive oil periods relative to coconut oil period PALM OLEIN PALM OLEIN Coconut oil il 0 VS OLIVE OLIVE VS “baseline” Palm Olive oil Palm Olive oil -10 o (%) olein olein OIL STUDY OIL STUDY -20 GF 1  ratio n nge in -30 hang -40 TxB 2 /PGF -38 Cha -50 -60 -56 -62 P<0.05 P< -70 Palm oil has anti- -thrombotic thrombotic Palm oil has anti Palm oil has anti-thrombotic -67 Males Females -80 properties! properties! properties! “Bad” “Bad” Thromboxanes Thromboxanes “Good” “Good” Thrombotic (TxB 2 ) Prostacyclins Prostacyclins tendency (PGI 2 ) (PGI 2 ) Inhibit Blood Aggregation Thrombus Source: Ng et al. (“clumping”) (“Clot”) Platelets (1992) J Am Coll Nutr

Comparable effects of 16:0 and 18:1 on TC and LDL/HDL ratio in normocholesterolemic men Sundram K, Hayes KC & Othman HS (1995), Nutr Biochem, 6(4):179-187) 30 TC % change from 20 baseline values LDLC HDLC 10 LDL/HDL 0 -10 -20 AHA Canola Palm fat (18:1-rich) (16:0-rich) blend -30 SFA: 10.1% en SFA: 6.0% en SFA: 13.0% en MUFA: 12.9% en MUFA: 17.5% en MUFA: 14.3% en PUFA: 8.3% en PUFA: 7.7% en PUFA: 4.1% en Test Diets

Impact of dietary fats on CVD: Major factors to consider  Dietary fat level  Minor components: cholesterol,  Major fat plant stanols/sterols, T 3 , etc components: TFA,  Stereospecific 12-16C SFA, positioning of FA MUFA, in fat molecules PUFA

0 Percent change compared AHA Step-1 TRF 25 TRF 50 TRF 100 TRF 200 diet -5 -4 -5 -10 with baseline -10 -11 - 15 -17 - 20 -19 -20 * (Qureshi et al., -21 Atherosclerosis 2001) -25 -24 TC -25 Apparent threshold LDL-chol effect for cholesterol- lowering action! -30 Various doses of TRF (mg/day) + AHA Step-1 diet

Palmvitee* and  -tocotrienol lower serum TC and TxB 2 relative to the AHA Diet [Qureshi et al. (1995). Lipids, 30(12)1171-1177] Palm  -T 3 vitee AHA 0 diet -5 -10 Total cholesterol -10 Thromboxane B2 -13 -15 -20 Expt design: n=16: Baseline-AHA-AHA-  T3 -25 -25 n=20: Baseline-AHA-Palmvitee -26 -30 Experimental Groups

Change in carotid stenosis in groups receiving tocotrienols or placebo for 6 and 12 months* MR=marked regression; R=regression; NC=no change P=progression; MP=marked progression 20 20 20 After 6 After 12 18 months months 1615 15 15 Palmvitee 10 10 Placebo 6 6 5 5 5 4 3 1 2 2 1 0 1 0 0 0 0 0 0 0 MR R NC P MP MR R NC P MP * Tomeo et al.(1995) Change in carotid stenosis Lipids, 30(12):1179 Kenneth L. Jordan Research Center

Impact of dietary fats on CVD: Major factors to consider  Dietary fat level  Minor components: cholesterol,  Major fat plant stanols/sterols, T 3 , etc components: TFA,  Stereospecific 12-16C SFA, positioning of FA MUFA, in fat molecules PUFA