Dietary Fiber and Saturated Fat Intake Associations with Cardiovascular Disease Differ by Sex in the Malmö Diet and Cancer Cohort: A Prospective Study

BACKGROUND: The aim of the study was to examine associations between intake of macronutrients and dietary fiber and incident ischemic cardiovascular disease (iCVD) in men and women. METHODS: We used data from 8,139 male and 12,535 female participants (aged 44-73 y) of the Swedish population-based Malmö Diet and Cancer cohort. The participants were without history of CVD and diabetes mellitus, and had reported stable dietary habits in the study questionnaire. Diet was assessed by a validated modified diet history method, combining a 7-d registration of cooked meals and cold beverages, a 168-item food questionnaire (covering other foods and meal patterns), and a 1-hour diet interview. Sociodemographic and lifestyle data were collected by questionnaire. iCVD cases, which included coronary events (myocardial infarctions or deaths from chronic ischemic heart disease) and ischemic strokes, were ascertained via national and local registries. Nutrient-disease associations were examined by multivariate Cox regressions. RESULTS: During a mean follow-up of 13.5 years, we identified 1,089 male and 687 female iCVD cases. High fiber intakes were associated with lower incidence rates of iCVD in women and of ischemic stroke in men. In post-hoc analysis, we discovered statistically significant interactions between intake of fiber and saturated fat; these interactions also differed between men and women (p<0.001). CONCLUSIONS: In this well-defined population, a high fiber intake was associated with lower risk of iCVD, but there were no robust associations between other macronutrients and iCVD risk. Judging from this study, gender-specific nutrient analysis may be preferable in epidemiology

Evidence on the magnitude of the economic, health and population effects of palm cooking oil consumption: an integrated modelling approach with Thailand as a case study

BACKGROUND: Palm oil’s high yields, consequent low cost and highly versatile properties as a cooking oil and food ingredient have resulted in its thorough infiltration of the food sector in some countries. Longitudinal studies have associated palm oil’s high saturated fatty acid content with non-communicable disease, but neither the economic or disease burdens have been assessed previously. // METHODS: This novel palm oil-focussed disease burden assessment employs a fully integrated health, macroeconomic and demographic Computable General Equilibrium Model for Thailand with nine regional (urban/rural) households. Nutritional changes from food consumption are endogenously translated into health (myocardial infarction (MI) and stroke) and population outcomes and are fed back into the macroeconomic model as health and caregiver-related productive labour supply effects and healthcare costs to generate holistic 2016–2035 burden estimates. Model scenarios mirror the replacement of palm cooking oil with other dietary oils and are compared with simulated total Thai health and macroeconomic burdens for MI and stroke. // RESULTS: Replacing consumption of palm cooking oil with other dietary oils could reduce MI/stroke incident cases by 8280/2639 and cumulative deaths by 4683/894 over 20 years, removing approximately 0.5% of the total Thai burden of MI/stroke. This palm cooking oil replacement would reduce consumption shares of saturated/monounsaturated fatty acids in Thai household consumption by 6.5%/3% and increase polyunsaturated fatty acid consumption shares by 14%, yielding a 1.74% decrease in the population-wide total-to-HDL cholesterol ratio after 20 years. The macroeconomic burden that would be removed is US$308mn, approximately 0.44% of the total burden of MI/stroke on Thailand’s economy or 0.003% of cumulative 20-year GDP. Bangkok and Central region households benefit most from removal of disease burdens. // CONCLUSIONS: Simulations indicate that consumption of palm cooking oil, rather than other dietary oils, imposes a negative health burden (MI and stroke) and associated economic burden on a high consuming country, such as Thailand. Integrated sectoral model frameworks to assess these burdens are possible, and burden estimates from our simulated direct replacement of palm cooking oil indicate that using these frameworks both for broader analyses of dietary palm oil use and total burden analyses of other diseases may also be beneficial

Maximal response to a plasma cholesterol-lowering diet is achieved within two weeks.

BACKGROUND AND AIM: Replacing saturated fat with polyunsaturated fat reduces plasma cholesterol concentrations; however, it has not been well documented how rapidly the decline occurs nor how long is required to reach the maximum cholesterol-lowering effect. The aim of the present study was to determine the time course of change in plasma cholesterol concentrations when participants adopt a lipid-lowering diet. METHODS AND RESULTS: Participants (n = 19) were asked to follow for 19 days a diet high in saturated fat and then crossed over--without washout--for 19 days to a diet high in n-6 polyunsaturated fat. Participants were asked to maintain a total fat intake of 30-33% of total energy on both diets. Energy and nutrient intakes were assessed by self-reported food records covering 3 days. Plasma total cholesterol concentrations were measured on days 0, 1, 2, 5, 8, 12, and 19 of the n-6 polyunsaturated fat rich diet. Mean (95% CI) plasma total cholesterol concentration declined from 5.10 mmol/L (4.77, 5.46) at day 0 to 4.25 mmol/L (3.83, 4.67) on day 12 and remained unchanged at 4.23 mmol/L (3.85, 4.61) on day 19. A statistically significant decrease in plasma cholesterol concentration was achieved on day 2 of the intervention; by day 5, 59% (0.51 mmol/L) of the maximum reduction (0.87 mmol/L) had been reached. CONCLUSIONS: Adopting a lipid lowering diet initiates an immediate decline in plasma cholesterol concentration, the full effect of which is achieved within two weeks

Fatty acid composition of adipose tissue and blood in humans and its use as a biomarker of dietary intake

Accurate assessment of fat intake is essential to examine the relationships between diet and disease risk but the process of estimating individual intakes of fat quality by dietary assessment is difficult. Tissue and blood fatty acids, because they are mainly derived from the diet, have been used as biomarkers of dietary intake for a number of years. We review evidence from a wide variety of cross-sectional and intervention studies and summarise typical values for fatty acid composition in adipose tissue and blood lipids and changes that can be expected in response to varying dietary intake. Studies in which dietary intake was strictly controlled confirm that fatty acid biomarkers can complement dietary assessment methodologies and have the potential to be used more quantitatively. Factors affecting adipose tissue and blood lipid composition are discussed, such as the physical properties of triacylglycerol, total dietary fat intake and endogenous fatty acid synthesis. The relationship between plasma lipoprotein concentrations and total plasma fatty acid composition, and the use of fatty acid ratios as indices of enzyme activity are also addressed. © 2008 Elsevier Ltd. All rights reserved

Dietary-induced changes in fatty acid composition of human plasma, platelet, and erythrocyte lipids follow a similar time course.

The dietary-induced changes in the fatty acid composition of plasma, platelet, and erythrocyte lipids were measured as a function of time. Healthy adults consumed a diet rich in saturated fat (18% total energy, TE) for 19 d and then crossed over, without washout, to a diet rich in (n-6) polyunsaturated fat (10% TE) for a further 19 d. The fatty acid composition of plasma and blood cell lipids was measured in blood samples collected from fasting subjects on d 0, 1, 2, 5, 8, 12, and 19 of consuming the diet rich in (n-6) polyunsaturated fats. The linoleic acid composition of all plasma, platelet, and erythrocyte lipids increased to a plateau within 19 d, reaching at least 70% of maximum within 5 d. The maximum increase in linoleic acid composition of erythrocyte phosphatidylcholine was 3.8 mol% at d 12; the increase at d 1 was 2 mol% and at d 5 was 3.2 mol%. The decrease in pentadecanoic acid composition followed a similar time course in all lipids with the exception of plasma phospholipids. Our results show that the time course of dietary-induced changes in erythrocyte fatty acid composition is similar to that in plasma and platelet lipids. These results provide convincing, albeit indirect evidence that the exchange of fatty acids from plasma to erythrocytes and platelets is a major determinant of their membrane fatty acid composition

The effect of replacing dietary saturated fat with polyunsaturated or monounsaturated fat on plasma lipids in free-living young adults.

OBJECTIVE: To examine, in free-living adults eating self-selected diets, the effects on plasma cholesterol of substituting saturated fat rich foods with either n-6 polyunsaturated or monounsaturated fat rich foods while at the same time adhering to a total fat intake of 30-33% of dietary energy. DESIGN: Two randomised crossover trials. SETTING: General community. SUBJECTS: Volunteer sample of healthy free-living nutrition students at the University of Otago. Trial I, n=29; and trial II, n=42. INTERVENTIONS: In trials I and II participants were asked to follow for 2(1/2) weeks a diet high in saturated fat yet with a total fat content that conformed to nutrition recommendations (30-33% energy). During the 2(1/2) week comparison diet, saturated fat rich foods were replaced with foods rich in n-6 polyunsaturated fats (trial I) whereas in trial II the replacement foods were rich in monounsaturated fats. Participants were asked to maintain a total fat intake of 30-33% of energy on all diets. MAIN OUTCOME MEASURES: Energy and nutrient intakes, plasma triglyceride fatty acids, and plasma cholesterol. RESULTS: When replacing saturated fat with either n-6 polyunsaturated fat or monounsaturated fat, total fat intakes decreased by 2.9% energy and 5.1% energy, respectively. Replacing saturated fat with n-6 polyunsaturated fat (trial I) lowered plasma total cholesterol by 19% [from 4.87 (0.88) to 3.94 (0.92) mmol/l, mean (s.d.)], low density lipoprotein cholesterol by 22% [from 2.87 (0.75) to 2.24 (0.67) mmol/l], and high density lipoprotein cholesterol by 14% [from 1.39 (0.36) to 1.19 (0.34) mmol/l], whereas replacing saturated fat with monounsaturated fat (trial II) decreased total cholesterol by 12%, low density lipoprotein cholesterol by 15%, and high density lipoprotein cholesterol by 4%, respectively. The change in the ratio of total to high density lipoprotein cholesterol was similar during trial I and trial II. CONCLUSIONS: Young adults are very responsive to dietary-induced changes in plasma cholesterol even when an isocaloric replacement of saturated fat with n-6 polyunsaturated or monounsaturated fat is not achieved. Replacing saturated fat with either n-6 polyunsaturated or monounsaturated fat is equally efficacious at reducing the total to high density lipoprotein cholesterol ratio. SPONSORSHIP: University of Otago, Meadow Lea Ltd