Reduction in saturated fat intake for cardiovascular disease

BACKGROUND: Reducing saturated fat reduces serum cholesterol, but effects on other intermediate outcomes may be less clear. Additionally, it is unclear whether the energy from saturated fats eliminated from the diet are more helpfully replaced by polyunsaturated fats, monounsaturated fats, carbohydrate or protein. OBJECTIVES: To assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA), monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity, using all available randomised clinical trials. SEARCH METHODS: We updated our searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and Embase (Ovid) on 15 October 2019, and searched Clinicaltrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) on 17 October 2019. SELECTION CRITERIA: Included trials fulfilled the following criteria: 1) randomised; 2) intention to reduce saturated fat intake OR intention to alter dietary fats and achieving a reduction in saturated fat; 3) compared with higher saturated fat intake or usual diet; 4) not multifactorial; 5) in adult humans with or without cardiovascular disease (but not acutely ill, pregnant or breastfeeding); 6) intervention duration at least 24 months; 7) mortality or cardiovascular morbidity data available. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed inclusion, extracted study data and assessed risk of bias. We performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity analyses, funnel plots and GRADE assessment. MAIN RESULTS: We included 15 randomised controlled trials (RCTs) (16 comparisons, ~59,000 participants), that used a variety of interventions from providing all food to advice on reducing saturated fat. The included long-term trials suggested that reducing dietary saturated fat reduced the risk of combined cardiovascular events by 21% (risk ratio (RR) 0.79; 95% confidence interval (CI) 0.66 to 0.93, 11 trials, 53,300 participants of whom 8% had a cardiovascular event, I² = 65%, GRADE moderate-quality evidence). Meta-regression suggested that greater reductions in saturated fat (reflected in greater reductions in serum cholesterol) resulted in greater reductions in risk of CVD events, explaining most heterogeneity between trials. The number needed to treat for an additional beneficial outcome (NNTB) was 56 in primary prevention trials, so 56 people need to reduce their saturated fat intake for ~four years for one person to avoid experiencing a CVD event. In secondary prevention trials, the NNTB was 32. Subgrouping did not suggest significant differences between replacement of saturated fat calories with polyunsaturated fat or carbohydrate, and data on replacement with monounsaturated fat and protein was very limited. We found little or no effect of reducing saturated fat on all-cause mortality (RR 0.96; 95% CI 0.90 to 1.03; 11 trials, 55,858 participants) or cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 10 trials, 53,421 participants), both with GRADE moderate-quality evidence. There was little or no effect of reducing saturated fats on non-fatal myocardial infarction (RR 0.97, 95% CI 0.87 to 1.07) or CHD mortality (RR 0.97, 95% CI 0.82 to 1.16, both low-quality evidence), but effects on total (fatal or non-fatal) myocardial infarction, stroke and CHD events (fatal or non-fatal) were all unclear as the evidence was of very low quality. There was little or no effect on cancer mortality, cancer diagnoses, diabetes diagnosis, HDL cholesterol, serum triglycerides or blood pressure, and small reductions in weight, serum total cholesterol, LDL cholesterol and BMI. There was no evidence of harmful effects of reducing saturated fat intakes. AUTHORS' CONCLUSIONS: The findings of this updated review suggest that reducing saturated fat intake for at least two years causes a potentially important reduction in combined cardiovascular events. Replacing the energy from saturated fat with polyunsaturated fat or carbohydrate appear to be useful strategies, while effects of replacement with monounsaturated fat are unclear. The reduction in combined cardiovascular events resulting from reducing saturated fat did not alter by study duration, sex or baseline level of cardiovascular risk, but greater reduction in saturated fat caused greater reductions in cardiovascular events

Oboe Works by Petr Eben

I will present oboe works by a Czech composer, Petr Eben (1929 - 2007) at the International Double Reed Society Conference in Oxford, Ohio, will not only increase awareness of fine European composer, but will also promote Grand Valley State University at a prestigeous international event. Each year, the IDRS Conference attracts over 1000 oboists and bassoonists from across the whole world. Eben established his reputation as a well respected musician in Europe. Some of his organ works are performed in the United States, but most of his music is yet to be discovered. Eben was a visiting professor of composition at the Royal Northern College of Music in Manchester and a composer-in-residence at the Darlington International Summer School. He also served as a Professor of Composition and president of the Praguue Spring Music Festival. For his contributions, Eben was awarded country\u27s highest honor for artists by President Vaclav Havel. I will perform three of his oboe compositions: Sonata for oboe and piano, Miniatures for oboe and piano, and Amoroso for oboe and piano

Adolescencia : guía para padres y madres

Este trabajo es fruto del Seminario de Formación para padres de adolescentes. El objetivo es dar unas orientaciones a padres y madres para facilitar la comunicación con sus hijos durante la adolescencia. Se alude brevemente a los cambios físicos y psíquicos de los jóvenes en esta etapa y concluye con unas reflexiones..MadridES

A study of oboe reed construction

The construction of reeds is of much interest in the oboe community, because professional oboists spend as much time making reeds as they do practicing. Each oboist uses an individual methodology resulting from different training and personal physiology. To investigate how different reed construction affects the resulting sound, 22 professional oboists were recruited to make three reeds apiece for this study. First, a controlled batch of reed cane (internodes of the grass Arundo Donax) was selected based on microscopic inspection of cellular composition as well as macroscopic physical characteristics. For most of the participants, the cane was then processed identically to the stage known as a blank, after which the participants finished their reeds according to their usual methods. (The few participants who made their own blanks still used the controlled cane and also a controlled staple, the metal cylinder that attaches the reed to the oboe.) The sound spectra of recordings of each participant playing on his/her respective reeds were analyzed, as was a spectrum of the crow (sound without the oboe attached) of each reed in an anechoic chamber. These spectra were correlated to measured physical attributes of the reeds

Vliv akumulace dusíku na vřesoviště a suché trávníky v Národním parku Podyjí

The increasing availability of soil mineral nitrogen is often considered as a cause of expansion of nitrogen-demanding tall grasses into oligotrophic species-rich heathlands and dry grasslands dominated by Festuca ovina. Consequentlythese ecosystems tend to lose their biodiversity. This paper summarizes the main results of different studies focused on the soil nitrogen transformation and availability in the heathlands and dry grasslands in the Podyjí National Park (southern Czech Republic). Increasing soil mineral nitrogen availability ccelerates expansion of competitive tall grasses Calamagrostis epigejos and Arrhenatherum elatius there. Subsequently, due to higher plant and microbialdemands for soil mineral nitrogen, the soil nitrogen availability in the tall-grass sites decreases. At the same time, experimental addition of carbon in the form of cellulose into dry grassland decreased nitrogen availability, which indicates that such ecosystem needs more carbon to effectively use the current levels of available soil nitrogen.Substantial differences between A. elatius a C. epigejos were found in their capability to (i) accumulate nitrogen in plant tissues, (ii) resorb nitrogen from above-ground biomass during senescence and (iii) release nitrogen fromplant litter during decomposition. These observations point out to different growth and nutrient use strategies of the studied grass species and associated microbial communities in the rhizosphere

Orientación al estudiante : conócete, oriéntate y decide

Las VII Jornadas de Orientación al estudiante, que se presentan bajo el lema, Conócete, Oriéntate y Decide, tienen como objetivo guiar a los jóvenes en el campo académico y profesional. Se divide en varias partes. La primera, contiene un cuestionario que permite reflexionar al estudiante sobre las asignaturas que más le han gustado, aquellas que les gustaría estudiar, intereses y habilidades personales. Esta parte termina con una serie de itinerarios educativos de tercero y cuarto de la ESO, Bachillerato, Educación de personas adultas y Garantía Social, escuelas taller y casas de oficio. La segunda parte, se centra aspectos legales, Educación Infantil, Primaria, Secundaria Obligatoria y Ordenación del Sistema Educativo. La tercera parte, comprende los planes de estudios del Bachillerato LOGSE en sus cuatro modalidades. La cuarta parte, se centra en la Formación Profesional. Por un lado se explica la Formación Profesional específica, características de los niveles y relación de familias profesionales en el territorio nacional. Por otro lado, los criterios de prioridad en la admisión de los ciclos formativos de grado superior en la Comunidad de Madrid. La quinta parte se ciñe a las enseñanzas de artes plásticas y diseño; estudios superiores de cerámica; enseñanzas de música y danza y enseñanzas de arte dramático. La sexta parte, se dedica a los estudios universitarios, a los aspectos relacionados con las pruebas de acceso a la universidad; estudios de primero, segundo y de tercer ciclo; pasarelas; simultaneidad de estudios; créditos; diferentes tipos de materias; plazos de matrícula; convocatorias; permanencia; notas de corte y opción preferente y acceso desde los ciclos formativos de grado superior. Por último, incluye información sobre becas y ayudas que convocan los distintos organismos, y otras modalidades de estudio, como Programas de Garantía Social, Formación ocupacional, educación de adultos y otros estudios. Las dos últimas partes comprenden la oferta educativa de la zona noroeste de la Comunidad de Madrid, consejos básicos y directorio de organismos públicos.MadridES