Scientific basis of fat requirement for Indians and recent trends in CVD

Dietary fats have several roles such as provision of metabolic energy, fat soluble vitamins and essential fatty acids (linoleic, LA and ?-linolenic, ALNA). Fats improve texture and palatability and have a satiety role. LA and ALNA and their long-chain polyunstaturated fatty acids (LC n-6 PUFA and LC n-3 PUFA respectively) are important structural membrane components and therefore essential for formation of new tissues. LC n-3 PUFA have specific role in vision and nervous system. Both n-6 and n-3 PUFA are essential for fetal and early infant growth and development and nervous tissue development.  The absolute levels and ratio of n-6 and n-3 PUFA in membrane affect a wide range of physiological processes either directly or through eicosanoids. The individual components of fats affect the risk of diet - related chronic diseases through the atherogenic effects of plasma lipids, insulin resistance, thrombosis, endothelial dysfunction as well as pathways of inflammation. The chain length/geometric configuration of double bonds and position of saturated (SFA), mono unsaturated (MUFA) or PUFA on glycerol backbone (triglyceride structure) modify the nutritional and metabolic effects of dietary fats. The non-glyceride components present in the vegetable oils have hypocholesterolemic and antioxidant effects. Several lines of evidence have documented that restrictions in SFA and cholesterol, negligible intake of trans fatty acids (TFA) on the one hand and preference for more than one type of vegetable oil (to ensure adequate absolute intakes of LA, ALNA and their ratio), adding n-3 PUFA from fish or plant sources, and ensuring moderate intake of  total fat in  the diet  substantially reduces the risk of diet-related chronic diseases. Studies were done at National Institute of Nutrition  on intake of individual  fatty acids, the pro/anti-athero-thrombogenic effects of different types of visible fats in Indian adults, insulin sensitivity and the antioxidant properties of  unique non glyceride components of some of the  commonly consumed edible oils. From the data generated, the quantity and combination of visible fats, foods to be preferred so as to increase ‘healthy fats', foods to be avoided/restricted to reduce ‘unhealthy fats' have  been worked out. Ensuring optimal intake of fat (quantity and quality) throughout life-span may contribute to the widely prevalent nutrition and health problems in India (low birth weight, chronic energy deficiency and diet-related chronic diseases). The rapid increase in prevalence of diet-related chronic diseases including type 2 diabetes, obesity and hypertension worldwide possess an immense public health and medical challenge for the implementation of successful preventive and treatment strategies.  Insulin resistance is an important risk factor for type 2 diabetes and is often associated with other metabolic abnormalities and cardiovascular risk factors. Moreover it is also an important risk factor for cardiovascular diseases (CVD).  Obesity when associated with abdominal adiposity is an important determinant of insulin resistance and represents the most important risk factor for type 2 diabetes and metabolic syndrome.  The explanation for the explosion of the epidemic of chronic diseases involve changes in dietary habits and or / increasing the sedentary life style, since our genetic pool remained stable.  Poor control of the life style risk factors results in metabolic dysregulation, endothelial dysfunction and increased adiposity which in turn together lead to dyslipidemia, hypertension, type 2 diabetes, systemic inflammation, thrombosis and risk of arrhythmia (1).  The ultimate result is sub clinical and then clinically apparent CVD including coronary heart disease (CHD), cardiac arrhythmia, heart failure and stroke.  The best way of preventing chronic diseases is to take a balanced diet that does not provide excess calories along with regular physical activity.  Over the past few decades evidences that has accumulated suggests that both the quality and quantity of dietary fat is associated with pathogenesis of several diet-related chronic diseases (2)

Safety and immunogenicity of the two-dose heterologous Ad26.ZEBOV and MVA-BN-Filo Ebola vaccine regimen in children in Sierra Leone: a randomised, double-blind, controlled trial

Background—Children account for a substantial proportion of cases and deaths from Ebola virus disease. We aimed to assess the safety and immunogenicity of a two-dose heterologous vaccine regimen, comprising the adenovirus type 26 vector-based vaccine encoding the Ebola virus glycoprotein (Ad26.ZEBOV) and the modified vaccinia Ankara vectorbased vaccine, encoding glycoproteins from the Ebola virus, Sudan virus, and Marburg virus, and the nucleoprotein from the Tai Forest virus (MVA-BN-Filo), in a paediatric population in Sierra Leone. Methods—This randomised, double-blind, controlled trial was done at three clinics in Kambia district, Sierra Leone. Healthy children and adolescents aged 1–17 years were enrolled in three age cohorts (12–17 years, 4–11 years, and 1–3 years) and randomly assigned (3:1), via computer-generated block randomisation (block size of eight), to receive an intramuscular injection of either Ad26.ZEBOV (5 × 1010 viral particles; first dose) followed by MVA-BN-Filo (1 × 108 infectious units; second dose) on day 57 (Ebola vaccine group), or a single dose of meningococcal quadrivalent (serogroups A, C, W135, and Y) conjugate vaccine (MenACWY; first dose) followed by placebo (second dose) on day 57 (control group). Study team personnel (except for those with primary responsibility for study vaccine preparation), participants, and their parents or guardians were masked to study vaccine allocation. The primary outcome was safety, measured as the occurrence of solicited local and systemic adverse symptoms during 7 days after each vaccination, unsolicited systemic adverse events during 28 days after each vaccination, abnormal laboratory results during the study period, and serious adverse events or immediate reportable events throughout the study period. The secondary outcome was immunogenicity (humoral immune response), measured as the concentration of Ebola virus glycoprotein-specific binding antibodies at 21 days after the second dose. The primary outcome was assessed in all participants who had received at least one dose of study vaccine and had available reactogenicity data, and immunogenicity was assessed in all participants who had received both vaccinations within the protocol-defined time window, had at least one evaluable post-vaccination sample, and had no major protocol deviations that could have influenced the immune response. This study is registered at ClinicalTrials.gov, NCT02509494. Findings—From April 4, 2017, to July 5, 2018, 576 eligible children or adolescents (192 in each of the three age cohorts) were enrolled and randomly assigned. The most common solicited local adverse event during the 7 days after the first and second dose was injection-site pain in all age groups, with frequencies ranging from 0% (none of 48) of children aged 1–3 years after placebo injection to 21% (30 of 144) of children aged 4–11 years after Ad26.ZEBOV vaccination. The most frequently observed solicited systemic adverse event during the 7 days was headache in the 12–17 years and 4–11 years age cohorts after the first and second dose, and pyrexia in the 1–3 years age cohort after the first and second dose. The most frequent unsolicited adverse event after the first and second dose vaccinations was malaria in all age cohorts, irrespective of the vaccine types. Following vaccination with MenACWY, severe thrombocytopaenia was observed in one participant aged 3 years. No other clinically significant laboratory abnormalities were observed in other study participants, and no serious adverse events related to the Ebola vaccine regimen were reported. There were no treatment-related deaths. Ebola virus glycoprotein-specific binding antibody responses at 21 days after the second dose of the Ebola virus vaccine regimen were observed in 131 (98%) of 134 children aged 12–17 years (9929 ELISA units [EU]/mL [95% CI 8172–12 064]), in 119 (99%) of 120 aged 4–11 years (10 212 EU/mL [8419–12 388]), and in 118 (98%) of 121 aged 1–3 years (22 568 EU/mL [18 426–27 642]). Interpretation—The Ad26.ZEBOV and MVA-BN-Filo Ebola vaccine regimen was well tolerated with no safety concerns in children aged 1–17 years, and induced robust humoral immune responses, suggesting suitability of this regimen for Ebola virus disease prophylaxis in children

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Safety and long-term immunogenicity of the two-dose heterologous Ad26.ZEBOV and MVA-BN-Filo Ebola vaccine regimen in adults in Sierra Leone: a combined open-label, non-randomised stage 1, and a randomised, double-blind, controlled stage 2 trial

Background The Ebola epidemics in west Africa and the Democratic Republic of the Congo highlight an urgent need for safe and effective vaccines to prevent Ebola virus disease. We aimed to assess the safety and long-term immunogenicity of a two-dose heterologous vaccine regimen, comprising the adenovirus type 26 vector-based vaccine encoding the Ebola virus glycoprotein (Ad26.ZEBOV) and the modified vaccinia Ankara vector-based vaccine, encoding glycoproteins from Ebola virus, Sudan virus, and Marburg virus, and the nucleoprotein from the Tai Forest virus (MVA-BN-Filo), in Sierra Leone, a country previously affected by Ebola. Methods The trial comprised two stages: an open-label, non-randomised stage 1, and a randomised, double-blind, controlled stage 2. The study was done at three clinics in Kambia district, Sierra Leone. In stage 1, healthy adults (aged ≥18 years) residing in or near Kambia district, received an intramuscular injection of Ad26.ZEBOV (5×1010 viral particles) on day 1 (first dose) followed by an intramuscular injection of MVA-BN-Filo (1×108 infectious units) on day 57 (second dose). An Ad26.ZEBOV booster vaccination was offered at 2 years after the first dose to stage 1 participants. The eligibility criteria for adult participants in stage 2 were consistent with stage 1 eligibility criteria. Stage 2 participants were randomly assigned (3:1), by computer-generated block randomisation (block size of eight) via an interactive web-response system, to receive either the Ebola vaccine regimen (Ad26.ZEBOV followed by MVA-BN-Filo) or an intramuscular injection of a single dose of meningococcal quadrivalent (serogroups A, C, W135, and Y) conjugate vaccine (MenACWY; first dose) followed by placebo on day 57 (second dose; control group). Study team personnel, except those with primary responsibility for study vaccine preparation, and participants were masked to study vaccine allocation. The primary outcome was the safety of the Ad26.ZEBOV and MVA-BN-Filo vaccine regimen, which was assessed in all participants who had received at least one dose of study vaccine. Safety was assessed as solicited local and systemic adverse events occurring in the first 7 days after each vaccination, unsolicited adverse events occurring in the first 28 days after each vaccination, and serious adverse events or immediate reportable events occurring up to each participant’s last study visit. Secondary outcomes were to assess Ebola virus glycoprotein-specific binding antibody responses at 21 days after the second vaccine in a per-protocol set of participants (ie, those who had received both vaccinations within the protocol-defined time window, had at least one evaluable post-vaccination sample, and had no major protocol deviations that could have influenced the immune response) and to assess the safety and tolerability of the Ad26.ZEBOV booster vaccination in stage 1 participants who had received the booster dose. This study is registered at ClinicalTrials.gov, NCT02509494. Findings Between Sept 30, 2015, and Oct 19, 2016, 443 participants (43 in stage 1 and 400 in stage 2) were enrolled; 341 participants assigned to receive the Ad26.ZEBOV and MVA-BN-Filo regimen and 102 participants assigned to receive the MenACWY and placebo regimen received at least one dose of study vaccine. Both regimens were well tolerated with no safety concerns. In stage 1, solicited local adverse events (mostly mild or moderate injection-site pain) were reported in 12 (28%) of 43 participants after Ad26.ZEBOV vaccination and in six (14%) participants after MVA-BN-Filo vaccination. In stage 2, solicited local adverse events were reported in 51 (17%) of 298 participants after Ad26.ZEBOV vaccination, in 58 (24%) of 246 after MVA-BN-Filo vaccination, in 17 (17%) of 102 after MenACWY vaccination, and in eight (9%) of 86 after placebo injection. In stage 1, solicited systemic adverse events were reported in 18 (42%) of 43 participants after Ad26.ZEBOV vaccination and in 17 (40%) after MVA-BN-Filo vaccination. In stage 2, solicited systemic adverse events were reported in 161 (54%) of 298 participants after Ad26.ZEBOV vaccination, in 107 (43%) of 246 after MVA-BN-Filo vaccination, in 51 (50%) of 102 after MenACWY vaccination, and in 39 (45%) of 86 after placebo injection. Solicited systemic adverse events in both stage 1 and 2 participants included mostly mild or moderate headache, myalgia, fatigue, and arthralgia. The most frequent unsolicited adverse event after the first dose was headache in stage 1 and malaria in stage 2. Malaria was the most frequent unsolicited adverse event after the second dose in both stage 1 and 2. No serious adverse event was considered related to the study vaccine, and no immediate reportable events were observed. In stage 1, the safety profile after the booster vaccination was not notably different to that observed after the first dose. Vaccine-induced humoral immune responses were observed in 41 (98%) of 42 stage 1 participants (geometric mean binding antibody concentration 4784 ELISA units [EU]/mL [95% CI 3736–6125]) and in 176 (98%) of 179 stage 2 participants (3810 EU/mL [3312–4383]) at 21 days after the second vaccination. Interpretation The Ad26.ZEBOV and MVA-BN-Filo vaccine regimen was well tolerated and immunogenic, with persistent humoral immune responses. These data support the use of this vaccine regimen for Ebola virus disease prophylaxis in adults

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Scientific basis of fat requirement for Indians and recent trends in CVD

Dietary fats have several roles such as provision of metabolic energy, fat soluble vitamins and essential fatty acids (linoleic, LA and α-linolenic, ALNA). Fats improve texture and palatability and have a satiety role. LA and ALNA and their long-chain polyunstaturated fatty acids (LC n-6 PUFA and LC n-3 PUFA respectively) are important structural membrane components and therefore essential for formation of new tissues. LC n-3 PUFA have specific role in vision and nervous system. Both n-6 and n-3 PUFA are essential for fetal and early infant growth and development and nervous tissue development.  The absolute levels and ratio of n-6 and n-3 PUFA in membrane affect a wide range of physiological processes either directly or through eicosanoids. The individual components of fats affect the risk of diet - related chronic diseases through the atherogenic effects of plasma lipids, insulin resistance, thrombosis, endothelial dysfunction as well as pathways of inflammation. The chain length/geometric configuration of double bonds and position of saturated (SFA), mono unsaturated (MUFA) or PUFA on glycerol backbone (triglyceride structure) modify the nutritional and metabolic effects of dietary fats. The non-glyceride components present in the vegetable oils have hypocholesterolemic and antioxidant effects. Several lines of evidence have documented that restrictions in SFA and cholesterol, negligible intake of trans fatty acids (TFA) on the one hand and preference for more than one type of vegetable oil (to ensure adequate absolute intakes of LA, ALNA and their ratio), adding n-3 PUFA from fish or plant sources, and ensuring moderate intake of  total fat in  the diet  substantially reduces the risk of diet-related chronic diseases. Studies were done at National Institute of Nutrition  on intake of individual  fatty acids, the pro/anti-athero-thrombogenic effects of different types of visible fats in Indian adults, insulin sensitivity and the antioxidant properties of  unique non glyceride components of some of the  commonly consumed edible oils. From the data generated, the quantity and combination of visible fats, foods to be preferred so as to increase ‘healthy fats', foods to be avoided/restricted to reduce ‘unhealthy fats' have  been worked out. Ensuring optimal intake of fat (quantity and quality) throughout life-span may contribute to the widely prevalent nutrition and health problems in India (low birth weight, chronic energy deficiency and diet-related chronic diseases). \ud The rapid increase in prevalence of diet-related chronic diseases including type 2 diabetes, obesity and hypertension worldwide possess an immense public health and medical challenge for the implementation of successful preventive and treatment strategies.  Insulin resistance is an important risk factor for type 2 diabetes and is often associated with other metabolic abnormalities and cardiovascular risk factors. Moreover it is also an important risk factor for cardiovascular diseases (CVD).  Obesity when associated with abdominal adiposity is an important determinant of insulin resistance and represents the most important risk factor for type 2 diabetes and metabolic syndrome.  The explanation for the explosion of the epidemic of chronic diseases involve changes in dietary habits and or / increasing the sedentary life style, since our genetic pool remained stable.  Poor control of the life style risk factors results in metabolic dysregulation, endothelial dysfunction and increased adiposity which in turn together lead to dyslipidemia, hypertension, type 2 diabetes, systemic inflammation, thrombosis and risk of arrhythmia (1).  The ultimate result is sub clinical and then clinically apparent CVD including coronary heart disease (CHD), cardiac arrhythmia, heart failure and stroke.  The best way of preventing chronic diseases is to take a balanced diet that does not provide excess calories along with regular physical activity.  Over the past few decades evidences that has accumulated suggests that both the quality and quantity of dietary fat is associated with pathogenesis of several diet-related chronic diseases (2)

Scientific basis of fat requirement for Indians and recent trends in CVD

Dietary fats have several roles such as provision of metabolic energy, fat soluble vitamins and essential fatty acids (linoleic, LA and α-linolenic, ALNA). Fats improve texture and palatability and have a satiety role. LA and ALNA and their long-chain polyunstaturated fatty acids (LC n-6 PUFA and LC n-3 PUFA respectively) are important structural membrane components and therefore essential for formation of new tissues. LC n-3 PUFA have specific role in vision and nervous system. Both n-6 and n-3 PUFA are essential for fetal and early infant growth and development and nervous tissue development.  The absolute levels and ratio of n-6 and n-3 PUFA in membrane affect a wide range of physiological processes either directly or through eicosanoids. The individual components of fats affect the risk of diet - related chronic diseases through the atherogenic effects of plasma lipids, insulin resistance, thrombosis, endothelial dysfunction as well as pathways of inflammation. The chain length/geometric configuration of double bonds and position of saturated (SFA), mono unsaturated (MUFA) or PUFA on glycerol backbone (triglyceride structure) modify the nutritional and metabolic effects of dietary fats. The non-glyceride components present in the vegetable oils have hypocholesterolemic and antioxidant effects. Several lines of evidence have documented that restrictions in SFA and cholesterol, negligible intake of trans fatty acids (TFA) on the one hand and preference for more than one type of vegetable oil (to ensure adequate absolute intakes of LA, ALNA and their ratio), adding n-3 PUFA from fish or plant sources, and ensuring moderate intake of  total fat in  the diet  substantially reduces the risk of diet-related chronic diseases. Studies were done at National Institute of Nutrition  on intake of individual  fatty acids, the pro/anti-athero-thrombogenic effects of different types of visible fats in Indian adults, insulin sensitivity and the antioxidant properties of  unique non glyceride components of some of the  commonly consumed edible oils. From the data generated, the quantity and combination of visible fats, foods to be preferred so as to increase ‘healthy fats', foods to be avoided/restricted to reduce ‘unhealthy fats' have  been worked out. Ensuring optimal intake of fat (quantity and quality) throughout life-span may contribute to the widely prevalent nutrition and health problems in India (low birth weight, chronic energy deficiency and diet-related chronic diseases). \ud The rapid increase in prevalence of diet-related chronic diseases including type 2 diabetes, obesity and hypertension worldwide possess an immense public health and medical challenge for the implementation of successful preventive and treatment strategies.  Insulin resistance is an important risk factor for type 2 diabetes and is often associated with other metabolic abnormalities and cardiovascular risk factors. Moreover it is also an important risk factor for cardiovascular diseases (CVD).  Obesity when associated with abdominal adiposity is an important determinant of insulin resistance and represents the most important risk factor for type 2 diabetes and metabolic syndrome.  The explanation for the explosion of the epidemic of chronic diseases involve changes in dietary habits and or / increasing the sedentary life style, since our genetic pool remained stable.  Poor control of the life style risk factors results in metabolic dysregulation, endothelial dysfunction and increased adiposity which in turn together lead to dyslipidemia, hypertension, type 2 diabetes, systemic inflammation, thrombosis and risk of arrhythmia (1).  The ultimate result is sub clinical and then clinically apparent CVD including coronary heart disease (CHD), cardiac arrhythmia, heart failure and stroke.  The best way of preventing chronic diseases is to take a balanced diet that does not provide excess calories along with regular physical activity.  Over the past few decades evidences that has accumulated suggests that both the quality and quantity of dietary fat is associated with pathogenesis of several diet-related chronic diseases (2)