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

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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 profile

Fatty streaks

Hemostatic factors

Fibrinogen, FVIIc, FXIIa FVIIag, tPA, PAI-1

• TxB2. PGF1

Platelet aggregation TC, LDLC, TAG, HDLC, LDLC/HDLC, TC/HDLC

Chronic inflammation

CRP, TNF-α Interleukins

Vascular endothelium

Vessel wall adhesivity CAMs Induce 13-HODE PGI2 vWF ApoA1 ApoB100

Impact of dietary fats on CVD:

Major factors to consider

 Major fat components: TFA, 12-16C SFA, MUFA, PUFA  Minor components: cholesterol, plant stanols/sterols, T3, etc  Dietary fat level Stereospecific positioning of FA in fat molecules

HOW MUCH FAT SHOULD WE TAKE?

Western communities

35- 40% en 30% en

WHO/FAO Target

20-30%en.

Desirable levels for Malaysians: 20% en. Minimum level: “LOW” “HIGH”

45-67g fat @ 2000-kcal diet

15%

Impact of dietary fats on CVD:

Major factors to consider

 Major fat components: TFA, 12-16C SFA, MUFA, PUFA  Minor components: cholesterol, plant stanols/sterols, T3, etc  Dietary fat level Stereospecific positioning of FA in fat molecules

C12-16 SFA: 14:0, 12:0, 16:0

TFA

(esp. trans monoenes)

PUFA: Linoleic acid

(18:2,n-6)

FATTY ACIDS, CHOLESTEROLEMIA FATTY ACIDS, CHOLESTEROLEMIA & CVD RISK & CVD RISK

n

• 3

F A s

18:1 18:0 <12:0 Cholesterol

• raising

Cholesterol

• lowering

Neutral

TC = 2.74 S - 1.31 P + 1.5Z [Keys et al., 1965] = 1.35 (2S - P) + 1.5Z

Used to predict changes in serum TC brought about by changes in dietary fats.

TC = 8.45 S14 + 2.12 S16 - 1.87 P + 5.64 C - 6.24

[Hegsted, 1965]

1 2

Equations useful, but have limitations!

Predictive equations of Keys, Hegsted

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*

6.4 13.6

• 12.7

12.2 17.4

• 15
• 10
• 5

5 10 15 20 TRANS FAT SAT FAT TC LDLC HDLC

MONO diet (oleic acid-diet)

*Mensink & Katan (1989).

NEJM, 321:436-441.

(+ve control) (11% en) Durch study: 25M, 34F consumed each test diet for 3wk. Total fat =36%en, test fat= 11%en, 18:2 kept const at 4.6% en.

SAT FAT vs TRANS FAT

10 normocholesterolemic women fed either 30%en

• f high PO diet or high

trans diet for weeks. 3.1%en TFA

• 0.2

0.8 0.2 0.4 0.6 1.0 0.0 1 2 3 4 5 6 7 8 9 10

Percentage of Energy from Fatty Acids (% kcal) C h a n g e i n LDLC R a t i

• HDLC

TRANS SFAs

IMPACT ON THE PLASMA LDLC/HDLC RATIO: TRANS VS SFAs*

P<0.001 P<0.001 P<0.001 P<0.001 P<0.001 P<0.001 P<0.001 P<0.001 P<0.005 P<0.005 P<0.05 P<0.05

9 8 2 7 6 4 5 1

9Mensink and Katan (1990); 8Zock and Katan (1992); 7Nestel et al. (1992); 6Judd et al. (1994); 5Judd et al. (1998); 4Lichtenstein et al. (1993); 3Aro et al. (1997); 2Sundram et al. (1997); 1Lichtenstein et al. (1999)

* *Ascherio et al. (1997) N Engl J Med, 340:1994. Best-fit regression lines

3 1 1 1

T r a n s F A s a r e w

• r

s e t h a n t h e 1 2

• 1

6 C S F A s !

93 17

• 19
• 38

2

• 60
• 40
• 20

20 40 60 80 100

TRANS SFAs MONO PUFA Total Fat

% Change in CHD risk

2% kcal 5% kcal 5% kcal 5% kcal 5% kcal

*Estimated changes in CHD risk when CHO is

substituted by a specified dietary component

Nurses Health Study:

80,082 nurses followed-up 14 years [Hu et al. (1997) NEJM, 337:1491-1499]

TRANS fats bad for your heart; worse than SFAs!

TRANS fats also increase risk of type 2 diabetes!

Overall: TFAs 2 to 10 times worse than the C12-16 SFAs when impact on

• ther risk

factors considered!

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:

Dietary Sources of TFAs

Hydrogenated fat

Containing mainly trans-monoenes + smaller amounts

• f trans dienes &

trienes Conjugated Linoleic Acid (CLA) [~1%] [Prominent form = rumenic acid (n-7 FA), (c9,t11-CLA)] Meat & Dairy Products

PUFA-rich edible oils

Commercial hydrogenation: high temp, Ni catalyst

Ingestion of unsaturated fat by ruminant

Partial hydrogenation by bacteria in rumen

Vaccenic acid

+ other TFAs in rumen (2-4%)

9-desaturase

Solid-fat food applications:

• eg. margarines,

shortenings, vegetable ghee, bakery fat, etc.

CODEX:

TFA content in foods should not exceed 3%

• f total FAs.

WHO:

TFA <1% kcal

• f diet

(18:1 trans-11)

2 1

• 2
• 1

2 1

• 1
• 2

r =0.923

Use of Hegsted Equation

2 1

• 1
• 2
• 2
• 1

1 2

r =0.995

Use of Modified Hegsted Equation (-16:0)

Observed TC values (mmol/L)

EARLY SCIENTIFIC EVIDENCE THAT PALMITIC ACID (16:0) FROM PALM OIL TENDS TO BE NEUTRAL*

Observed TC values (mmol/L) Predicted TC values (mmol/L) Predicted TC values (mmol/L) *Hayes et al. (1991) AJCN, 53:491-498:

24 monkeys from 3 species rotated through 5 purified diets containing 31% energy as various palm fat blends for 12- week periods to compare the impact of specific dietary FAs on plasma lipids and lipoproteins.

CONCLUSION: PALM 16:0 TENDS TO BE “NEUTRAL”

18

Reference Choudhury et al. (1995) Ng et al. (1992) Voon et al. (2011) Subjects (n) 12 males, 12 females 20 males, 13 females 36 females, 9 males Age (y) 19-44 22-41 30±8 BMI (kg/m

2)

<25 <28 <28 Design RCT 30 days RCT 6 weeks RCT 5 weeks Test fats PO OO PO OO PO OO

Dietary fatty acids (%E)

Total fat 30 31 34 34 31 31 16:0 12.1 3.3 13.4 6.3 9.7 4.8 18:1 13 24.1 13.8 21.4 12.3 19.1 18:2 3.2 2 3.5 2.6 4.0 3.5 TC (mg/dL) 175 194 <200 <200 Lipids (mmol/ L) P>0.05 TC 4.7 4.6 4.9 4.9 4.8 4.7 TAG 1.0 1.0 1.2 1.2 0.8 0.8 LDLC 3.3 3.4 3.4 3.3 3.2 3.1 HDLC 0.9 0.8 1.1 1.1 1.3 1.3

Palm Oil vs Olive Oil studies

Ng et al (1992)

Choudhury et al (1995)

1 2 3 4 5 TC LDL-C HDL-C L/H

Voon et al (2011)

PO OO 1 2 3 4 5 TC LDL-C HDL-C L/H

Choudhury et al (1995)

PO OO

• 56
• 38
• 67
• 62
• 80
• 70
• 60
• 50
• 40
• 30
• 20
• 10

Palm

• lein

Olive oil Palm

• lein

Olive oil

Males Females

Coconut oil il “baseline”

P< P<0.05

Change in TxB2/PGF1 ratios after palm olein and

• live oil periods relative to coconut oil period

Cha hang nge in n TxB2/PGF GF1 ratio

• (%)

Palm oil has anti-thrombotic properties! Palm oil has anti Palm oil has anti-

• thrombotic

thrombotic properties! properties!

(TxB2) “Bad” Thromboxanes “Bad” Thromboxanes “Good” Prostacyclins (PGI2) “Good” Prostacyclins (PGI2)

Thrombotic tendency Inhibit

Blood Platelets Aggregation (“clumping”) Thrombus (“Clot”)

PALM OLEIN PALM OLEIN VS VS OLIVE OLIVE OIL STUDY OIL STUDY

Source: Ng et al. (1992) J Am Coll Nutr

• 30
• 20
• 10

10 20 30

TC LDLC HDLC LDL/HDL

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)

Test Diets % change from baseline values

AHA

fat blend

Canola

(18:1-rich)

Palm

(16:0-rich)

SFA: 13.0% en MUFA: 14.3% en PUFA: 4.1% en SFA: 6.0% en MUFA: 17.5% en PUFA: 7.7% en SFA: 10.1% en MUFA: 12.9% en PUFA: 8.3% en

Impact of dietary fats on CVD:

Major factors to consider

 Major fat components: TFA, 12-16C SFA, MUFA, PUFA  Minor components: cholesterol, plant stanols/sterols, T3, etc  Dietary fat level Stereospecific positioning of FA in fat molecules

*(Qureshi et al.,

Atherosclerosis 2001)

• 4
• 10
• 17
• 20
• 19
• 5
• 11
• 21
• 25
• 24
• 30
• 25
• 20
• 15
• 10
• 5

AHA Step-1 diet TRF 25 TRF 50 TRF 100 TRF 200

Various doses of TRF (mg/day) + AHA Step-1 diet

Percent change compared with baseline

TC LDL-chol

Apparent threshold effect for cholesterol- lowering action!

• 10
• 13
• 25
• 26
• 30
• 25
• 20
• 15
• 10
• 5

Total cholesterol Thromboxane B2

Palmvitee* and -tocotrienol lower serum TC and TxB2 relative to the AHA Diet

Experimental Groups AHA diet

[Qureshi et al. (1995). Lipids, 30(12)1171-1177] Expt design: n=16: Baseline-AHA-AHA-T3 n=20: Baseline-AHA-Palmvitee

Palm vitee -T3

1 0 5 18 20 1 2 3

5 10 15 20 MR R NC P MP

Palmvitee Placebo 1 0 6 1615 2 6 4

5 10 15 20 MR R NC P MP

Change in carotid stenosis

*Tomeo et al.(1995)

Lipids, 30(12):1179 Kenneth L. Jordan Research Center

MR=marked regression; R=regression; NC=no change P=progression; MP=marked progression

Change in carotid stenosis in groups receiving tocotrienols or placebo for 6 and 12 months*

After 6 months After 12 months

Impact of dietary fats on CVD:

Major factors to consider

 Major fat components: TFA, 12-16C SFA, MUFA, PUFA  Minor components: cholesterol, plant stanols/sterols, T3, etc  Dietary fat level Stereospecific positioning of FA in fat molecules

St Structure of f Fat Mo Molecule Affe ffects Cho holesterolemi mia St Structure of f Fat Mo Molecule St Structure of f Fat Mo Molecule Affe ffects Affe ffects Cho holesterolemi mia Cho holesterolemi mia

FA

sn-2

FA

sn-2 sn-1 FA

FA

sn-3

Position Matters!

Stereospecific positioning of fatty acids in selected fats

Fatty acid Position in fat molecule

16:0 18:0 18:1 18:2

sn-1

60 3 27 9

sn-2

13 trace 68 18

Palm oil sn-3

72 8 14 3

sn-1

16 15 46 11

sn-2

58 3 13 7

Human milk sn-3

6 2 50 15

sn-1

10 30 51 6

sn-2

72 2 13 3

Lard sn-3

trace 7 70 18

sn-1

34 50 12 1

sn-2

2 2 87 9

Cocoa butter sn-3

37 53 9 trace (Adapted from: Christie ww et al. Biochim Biophys 1970. Brockerhoff H et al. J Lipid Res 1991)

2.13 1.81 1.97 1.63 1.31 1.47 1.00 1.00 1.00

0.5 1 1.5 2 2.5

Atherosclerosis (0-4 scale) Randomised PO RBD PO RPO

Test fats

Impact of RBD palm oil (PO), randomised PO, and RPO on atherosclerosis in rabbits fed 0.2% cholesterol-diets for 65 days

Aortic arch Thoracic aorta Average of the 2 sites

Source: Kritchevsky (2000). Nutr Res, 20(6):887-892 P<0.05 P<0.05

M’sian: 3.0-7.0 en% M’sian: 0.3-1.2 en% 1 PART 5-10 PARTS WHO: 1.0-2.0 en% WHO: 5.0-8.0 en%

n-6/n-3 Fatty Acid Balance

n-3 PUFA n-6 PUFA

DIETARY FATTY ACID THRESHOLDS & CHOLESTEROLEMIA (Hayes & Khosla, 1992)

1 2 3 4 5 6

7

8 9 10 11 12 80 160 200 240 120 18:0 18:1 16:0 14:0

Percent dietary energy from 18:2 Plasma LDL-chol (mg/dl)

Lower Threshold

Below this PUFA level, LDLr-activity is exceedingly vulnerable to down- regulation by certain SFAs

Upper Threshold

• Max. hepatic LDLr-activity

inducible by 18:2

All dietary FAs approx. equal above max. threshold of 18:2

Normal LDL-chol

The Linoleic Acid Threshold!

Take Home Message:

Different types of fat all have a role to play in our diet.

Moderation is the

Terima Kasih (Thank You)