Rôle des acides gras alimentaires dans la physiopathologie des hépatopathies alcooliques

Many experimental studies in animals suggest that dietary fat plays an important role in the pathogenesis of alcoholic liver disease. Polyunsaturated fatty acids potentiate alcohol-induced liver injury at least in part by inducing cytochrome P450 2E1, cyclooxygenase-2 and lipid peroxydation. On the other hand, dietary saturated fatty acids reduce steatosis, necrosis, inflammation and fibrosis in conjunction with decreased expression of TNF-α and cyclooxygenase-2, and reduce lipid peroxidation. Dilinoleoyl-phosphatidylcholine prevents alcohol-induced fibrosis and cirrhosis in baboons and stimulates collagenase activity in cultured lipocytes. There are few human studies which confirm these experimental results. Epidemiological studies suggest a relationship between daily fat intake, particularly dietary polyunsaturated fatty acids, and the risk of liver cirrhosis in alcoholics. The studies having demonstrated that being overweight is a risk factor of alcoholic cirrhosis and that the apolipoprotein E polymorphism influences the severity of liver injury in alcoholic cirrhotics strongly favor the role of fatty acids in the pathogenesis of human alcoholic liver disease.     

The Science of Fatty Acids and Inflammation

Inflammation is believed to play a central role in many of the chronic diseases that characterize modern society. In the past decade, our understanding of how dietary fats affect our immune system and subsequently our inflammatory status has grown considerably. There are compelling data showing that high-fat meals promote endotoxin [e.g., lipopolysaccharide (LPS)] translocation into the bloodstream, stimulating innate immune cells and leading to a transient postprandial inflammatory response. The nature of this effect is influenced by the amount and type of fat consumed. The role of various dietary constituents, including fats, on gut microflora and subsequent health outcomes in the host is another exciting and novel area of inquiry. The impact of specific fatty acids on inflammation may be central to how dietary fats affect health. Three key fatty acid–inflammation interactions are briefly described. First, the evidence suggests that saturated fatty acids induce inflammation in part by mimicking the actions of LPS. Second, the often-repeated claim that dietary linoleic acid promotes inflammation was not supported in a recent systematic review of the evidence. Third, an explanation is offered for why omega-3 (n–3) polyunsaturated fatty acids are so much less anti-inflammatory in humans than in mice. The article closes with a cautionary tale from the genomic literature that illustrates why extrapolating the results from inflammation studies in mice to humans is problematic.     

Palm oil and palmitic acid: a review on cardiovascular effects and carcinogenicity

We reviewed the scientific literature on the evidence of the relationship between palm oil and adverse effects on human health. Few studies have investigated the effects of palm oil per se, and the main reason why it has been associated with negative health effects is the relatively high content of saturated fatty acids (SFAs), particularly palmitic acid, which in turn have been associated with increased risk of coronary heart disease and some tumours. However, more recent investigations on the topic seem to have reconsidered the negative role of the dietary SFAs as a risk factor for cardiovascular diseases and show that not only the type of fat, but also that the triglyceride structure plays a role in cholesterolaemia. As regards to a role in cancer, specific studies on dietary palmitic acid or palm oil and the risk of cancer development are scanty, and the evidence is not convincing.     

High carbohydrate diets are positively associated with the risk of metabolic syndrome irrespective to fatty acid composition in women: the KNHANES 2007–2014

We evaluated that carbohydrates and fatty acids intake modifies the prevalence of metabolic syndrome (MetS) and we also determined gender–nutrient interaction in 38,766 adults in KNHANES (2007–2014). Carbohydrate intake was positively associated, and fat intake inversely associated, with the incidence of MetS. The association exhibited a gender interaction with the macronutrient intake; this association was significant in females. Furthermore, saturated fatty acid (SFA), monounsaturated fatty acid (MUFA) and polyunsaturated fatty acid (PUFA) intakes were inversely associated with MetS risk and only females showed the positive association. Both n-3 and n-6 fatty acids intake showed inverse associations with MetS risk, similar to PUFA intake. Among the MetS components, serum triglyceride levels and blood pressure had significant inverse associations with fatty acid intake irrespective of fatty acid types and exhibited a gender interaction. In conclusions, high carbohydrate intakes (≥74.2 En%) may increase the MetS risk and moderate fat intakes (≥20.7 En%), irrespective of fat types, may decrease it. These associations were significant only in women.     

An Increase in the Omega-6/Omega-3 Fatty Acid Ratio Increases the Risk for Obesity

In the past three decades, total fat and saturated fat intake as a percentage of total calories has continuously decreased in Western diets, while the intake of omega-6 fatty acid increased and the omega-3 fatty acid decreased, resulting in a large increase in the omega-6/omega-3 ratio from 1:1 during evolution to 20:1 today or even higher. This change in the composition of fatty acids parallels a significant increase in the prevalence of overweight and obesity. Experimental studies have suggested that omega-6 and omega-3 fatty acids elicit divergent effects on body fat gain through mechanisms of adipogenesis, browning of adipose tissue, lipid homeostasis, brain-gut-adipose tissue axis, and most importantly systemic inflammation. Prospective studies clearly show an increase in the risk of obesity as the level of omega-6 fatty acids and the omega-6/omega-3 ratio increase in red blood cell (RBC) membrane phospholipids, whereas high omega-3 RBC membrane phospholipids decrease the risk of obesity. Recent studies in humans show that in addition to absolute amounts of omega-6 and omega-3 fatty acid intake, the omega-6/omega-3 ratio plays an important role in increasing the development of obesity via both AA eicosanoid metabolites and hyperactivity of the cannabinoid system, which can be reversed with increased intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). A balanced omega-6/omega-3 ratio is important for health and in the prevention and management of obesity.     

UK recommendations for dietary fat: should they be reassessed in light of the recent joint FAO/WHO recommendations?

In 2008, the Food and Agricultural Organization (FAO)/World Health Organization (WHO) reviewed its recommendations on dietary fat and fatty acids in light of the growing evidence base on dietary fatty acids and health outcomes. These new FAO/WHO recommendations are considerably broader than the current UK recommendations, in that the FAO/WHO report makes separate recommendations for adults and children and sets ranges of intake for n‐3 and n‐6 polyunsaturated fatty acids (PUFAs) based, not only on prevention of deficiency, but also on their role in contributing to optimum and long‐term health. The key recommendation of this report is that saturated fatty acids (SFAs) should be limited to 10% of dietary energy intake and, compared with the UK recommendations, there is a stronger emphasis on replacing excess dietary SFAs with PUFAs (both n‐3 and n‐6) because of convincing evidence that this dietary exchange reduces low density lipoprotein cholesterol and the risk of coronary heart disease. It may therefore be timely to consider the need for a modification of the UK dietary guidelines on dietary fat and fatty acid intake to take account of the growing evidence base for the potential benefit of replacing SFAs with PUFAs.     

Dietary fat, insulin sensitivity and the metabolic syndrome

Insulin resistance is the pathogenetic link underlying the different metabolic abnormalities clustering in the metabolic syndrome. It can be induced by different environmental factors, including dietary habits. Consumption of energy-dense/high fat diets is strongly and positively associated with overweight that, in turn, deteriorates insulin sensitivity, particularly when the excess of body fat is located in abdominal region. Nevertheless the link between fat intake and overweight is not limited to the high-energy content of fatty foods; the ability to oxidize dietary fat is impaired in some individuals genetically predisposed to obesity. Insulin sensitivity is also affected by the quality of dietary fat, independently of its effects on body weight. Epidemiological evidence and intervention studies clearly show that in humans saturated fat significantly worsen insulin-resistance, while monounsaturated and polyunsaturated fatty acids improve it through modifications in the composition of cell membranes which reflect at least in part dietary fat composition. A recent multicenter study (KANWU) has shown that shifting from a diet rich in saturated fatty acids to one rich in monounsaturated fat improves insulin sensitivity in healthy people while a moderate alpha-3 fatty acids supplementation does not affect insulin sensitivity. There are also other features of the metabolic syndrome that are influenced by different types of fat, particularly blood pressure and plasma lipid levels. Most studies show that alpha-3 fatty acids reduce blood pressure in hypertensive but not in normotensive subjects while shifting from saturated to monounsaturated fat intake reduces diastolic blood pressure. In relation to lipid abnormalities alpha-3 fatty acids reduce plasma triglyceride levels but in parallel, increase LDL cholesterol. Substitution of unsaturated fat for saturated fat not only reduces LDL cholesterol but contributes also to reduce plasma triglycerides in insulin resistant individuals. In conclusion, there is evidence available in humans indicating that dietary fat quality influences insulin sensitivity and associated metabolic abnormalities. Therefore, prevention of the metabolic syndrome has to be targeted: (1) to correct overweight by reducing the energy density of the habitual diet (i.e., fat intake) and (2) to improve insulin sensitivity and associated metabolic abnormalities through a reduction of dietary saturated fat, partially replaced, when appropriate, by monounsaturated and polyunsaturated fats.     

Non-Alcoholic Fatty Liver Disease (NAFLD) and Its Connection with Insulin Resistance,Dyslipidemia, Atherosclerosis and Coronary Heart Disease

Non-alcoholic fatty liver disease is marked by hepatic fat accumulation not due to alcohol abuse. Several studies have demonstrated that NAFLD is associated with insulin resistance leading to a resistance in the antilipolytic effect of insulin in the adipose tissue with an increase of free fatty acids (FFAs). The increase of FFAs induces mitochondrial dysfunction and development of lipotoxicity. Moreover, in subjects with NAFLD, ectopic fat also accumulates as cardiac and pancreatic fat. In this review we analyzed the mechanisms that relate NAFLD with metabolic syndrome and dyslipidemia and its association with the development and progression of cardiovascular disease.     

Trans fatty acids, insulin resistance, and type 2 diabetes

Type 2 diabetes, a growing global health problem, has a complex etiology involving many interactions between genetic and environmental factors. Essential to the development of the disease is insulin resistance of the peripheral tissues. Insulin resistance may be partly modified by the specific types of dietary fatty acids. Trans fatty acids (TFAs), created through the transformation of polyunsaturated fatty acids from their natural cis form to the trans form, are abundant in the Western diet. TFAs take on similar properties as saturated fats, and appear to be more atherogenic. High intakes of saturated fats may promote insulin resistance. It is therefore reasonable to hypothesize that high intakes of TFAs would have similar, or stronger, effects. In this review, all current evidence on the topic of TFAs, insulin resistance, and type 2 diabetes is summarized and interpreted. Although there is some support from observational and experimental studies for the hypothesis that high intakes of TFAs may increase the risk for type 2 diabetes, inconsistencies across studies and methodological problems make it premature to draw definitive conclusions at this time. More experimental research in humans is needed to further address this question.     

Gut‐derived short‐chain fatty acids: A friend or foe for hepatic lipid metabolism?

This article describes how a British Nutrition Foundation Drummond Pump Priming Award was used to develop in vivo proof of concept for increasing colonic propionate as a therapeutic strategy to reduce liver fat in adults with non‐alcoholic fatty disease (NAFLD). An overview of how the gut‐derived short‐chain fatty acids propionate and acetate are taken up and metabolised by the liver is provided, as well as a summary of how acetate may have contrasting effects on hepatic lipid content depending on the metabolic health of the individual. Finally, the article proposes that raising colonic propionate production could interfere with hepatic acetate metabolism and have positive effects on liver fat accumulation in individuals with NAFLD.     

The role of fat in the diet – quantity,quality and sustainability

Dietary fat should supply at least 15% of food energy including 2.5% energy and 0.5% energy as linoleic acid and alpha‐linolenic acid respectively: docosahexaenoic acid may also need to be supplied in infants. The proportion of energy from fat is not linked to risk of obesity, cardiovascular disease and cancer. The total cholesterol/HDL cholesterol, which is the most robust lipid indicator of risk of coronary heart disease (CHD), is lowered by unsaturated fatty acids, increased by trans fatty acids and not affected by saturated fatty acids compared with carbohydrates. Using clinical outcomes as endpoints, trans fatty acids increase, polyunsaturated fatty acids decrease and monounsaturated and saturated fatty acids have no effect on CHD risk. Recent recommendations for the prevention of CHD suggest partial replacement of saturated with polyunsaturated fatty acids to give energy intakes in the range of 6–11% energy and a daily intake of 0.25 g long‐chain n‐3 polyunsaturated fatty acids. The recommendation to increase the intake of long‐chain n‐3 fatty acids needs to be considered against the backdrop of falling fish stocks; it is likely that a novel source will be needed in the future. The projected growth in world population will require more fat, mainly for food energy. The oil palm requires only one tenth of the land required by oil seeds to produce the same amount of oil. The impact of increased use of vegetable oils as biodiesel needs to be urgently reconsidered owing to the adverse environmental and economic consequences to people living in South East Asia.     

Dietary Fats and Cardio-Metabolic Outcomes in a Cohort of Italian Adults

Background: Dietary fats, and especially saturated fatty acid (SFA), have been blamed for being the culprit in the dramatic increase in obesity and its associated diseases. However multiple systematic reviews and recent meta-analyses do not support the association between SFA and cardiovascular diseases. Thus, the objective of this study was to test whether specific types and subtypes of dietary fats are associated with metabolic outcomes in a cohort of Italian adults. Methods: Nutritional and demographic data of 1936 adults living in the south of Italy were examined. Food frequency questionnaires (FFQs) were administered to assess the intake of total dietary fat and each specific class of dietary fat, such as SFA, monounsaturated fatty acid (MUFA) and polyunsaturated fatty acid (PUFA). The intake of fatty acids was also examined according to the carbon-chain length of each individual class. Cases of hypertension, type-2 diabetes and dyslipidemias were collected from previous doctor-confirmed diagnosis records (or direct measurement of blood pressure). Results: After adjustment for potential confounding factors, individuals reporting higher intakes of total and saturated fats were associated with lower likelihood of having hypertension (odds ratio (OR) = 0.57, 95% CI: 0.35, 0.91 and OR = 0.55, 95% CI: 0.34, 0.89, respectively). Moreover, higher intake of short-chain saturated fatty acids (SCSFAs) and medium-chain saturated fatty acids (MCSFAs) was inversely associated with dyslipidemia and diabetes (OR = 0.43, 95% CI: 0.23, 0.82 and OR = 0.25, 95% CI: 0.09, 0.72, respectively). Among MUFAs, C18:1 was inversely associated with hypertension and diabetes (OR = 0.52, 95% CI: 0.30, 0.92 and OR = 0.21, 95% CI: 0.07, 0.67, respectively), while C14:1 intake was inversely associated only with hypertension (OR = 0.57, 95% CI: 0.37, 0.88). In contrast, C20:1 intake was associated with dyslipidemia (OR = 3.35, 95% CI: 1.33, 8.42). Regarding PUFA, C18:2 and 20:5 were inversely associated with hypertension (OR = 0.33, 95% CI: 0.18, 0.60 and OR = 0.30, 95% CI: 0.10, 0.89, respectively). Conclusions: The consumption of SFA does not seem to be harmful to cardio-metabolic health and, on the contrary, SCSFA may exert beneficial effects. Further studies are needed to clearly validate the results of the present study.     

Fat Quality Influences the Obesogenic Effect of High Fat Diets

High fat and/or carbohydrate intake are associated with an elevated risk for obesity and chronic diseases such as diabetes and cardiovascular diseases. The harmful effects of a high fat diet could be different, depending on dietary fat quality. In fact, high fat diets rich in unsaturated fatty acids are considered less deleterious for human health than those rich in saturated fat. In our previous studies, we have shown that rats fed a high fat diet developed obesity and exhibited a decrease in oxidative capacity and an increase in oxidative stress in liver mitochondria. To investigate whether polyunsaturated fats could attenuate the above deleterious effects of high fat diets, energy balance and body composition were assessed after two weeks in rats fed isocaloric amounts of a high-fat diet (58.2% by energy) rich either in lard or safflower/linseed oil. Hepatic functionality, plasma parameters, and oxidative status were also measured. The results show that feeding on safflower/linseed oil diet attenuates the obesogenic effect of high fat diets and ameliorates the blood lipid profile. Conversely, hepatic steatosis and mitochondrial oxidative stress appear to be negatively affected by a diet rich in unsaturated fatty acids.     

Fatty acids and cardiovascular disease

Fatty acids have been classified into "good" or "bad" groups according to their degree of unsaturation or whether they are "animal fat" or "vegetable fat". Today, it appears that the effects of fatty acids are complex and vary greatly according to the dose and the nature of the molecule. Monounsaturated fatty acids are still considered as having a "neutral" status, but any benefits may be related to the chemical environment of the source food or the associated overall food pattern. Controversy surrounds omega-6 polyunsaturated fatty acids, because even though they lower LDL cholesterol levels, excessive intakes do not appear to be correlated with cardiovascular benefit. The omega-3 fatty acids are known to exert cardiovascular protective effects. Dairy fat and its cardiovascular impact are being evaluated. This review examines the existing literature on the relationships between the different fatty acids and cardiovascular disease.     

Types and amount of dietary fat and colon cancer risk: Prevention by omega-3 fatty acid-rich diets

Colorectal cancer is the second most common malignancy in the Western world including the United Sates. In recent years there is a strong upward trend in colon cancer risk in Japan mainly due to Americanization of Japanese food habits. Several epidemiological studies point to a strong association between nutrient composition of the diet and cancer of the colon. The role of types of dietary fat, especially saturated fats of animal origin, n−6- and n−3-rich polyunsaturated fatty acids (PUFAs) in the etiology of colorectal cancer has become increasingly apparent. Epidemiological studies indicate a positive association between the dietary intake of saturated fat and/or animal fat and colon cancer risk and an inverse relationship between the intake of fish and fish oil rich in n−3 PUFAs and colon cancer development. Although the evidence from case-control studies and international correlational studies is not totally consistent, these inconsistencies may have arisen, at least in part, from methodological limitations. Animal, model studies have unequivocally provided evidence that the colon tumor-promoting effect of dietary fat depends on its fatty acid composition and that high dietary n−3 PUFAs lacks colon tumor-promoting effect, as compared to diets high in n−6 PUFAs or saturated fats. Diets rich in n−3 PUFAs inhibit colon carcinogenesis through the modulation of colonicras-p21, cyclooxygenase-2, and inducible nitric oxide synthase activities and apoptosis. Gene expression analysis using DNA microarrays indicates that n−3 fatty acid, docosahexaenoic acid activates cyclin-dependent kinase inhibitors such as p21, p27, p57 and p19 and inactivates antiapoptotic Bcl-2 family of genes, and prostagland in family of genes. These results suggest that decreasing the intake of n−6 PUFAs and saturated fats and increasing that of n−3 PUFAs, particularly eicosapentaenoic acid and docosahexaenoic acid has the potential to be a major component of colon cancer control.     

Gender Differences in Plasma Lipid Response to Dietary Fat

The relationship between type of dietary fat, cardiovascular disease risk, and lipid/lipoprotein profiles has been studied since the early 1900s. For the most part, observational data from international comparisons, migration studies, and prospective studies have identified a positive relationship between saturated fatty acid (SFA) intake and coronary heart disease (CHD) risk, although in the latter case these observations were attenuated and in some cases became non-significant after adjusting for other dietary factors. Data from large-scale primary and secondary intervention studies support a positive relationship between CHD and SFA. The majority of data available were derived from male subjects, and if female subjects were included, few studies assessed the effect of gender on responsiveness. Recent evidence has emerged suggesting that females respond differently to diet with respect to CHD progression. This review discusses controlled clinical intervention studies that included data for both genders and their responses to dietary fat perturbations and lipoprotein profiles. The scope was limited for the most part to reports that included identifiers in the title or abstract that indicated data for female and male subjects were reported separately, although a statistical comparison between the genders may not have been reported. Overall, whether the studies assessed the effect of the ratio of SFA to monounsaturated fatty acids (MUFA), SFA to polyunsaturated fatty acids (PUFA), MUFA to PUFA, individual SFA, or SFA to trans fatty acids, female and male subjects responded similarly, and when differences were identified there was no consistent pattern.     

Modulation of breast cancer cell adhesion by unsaturated fatty acids

Triglycerides, which are major constituents of dietary fat, contain a mixture of saturated and unsaturated fatty acids. One newly recognized function of unsaturated fatty acids is modulation of cell adhesion to components of the extracellular matrix. Alterations in cell adhesiveness or cell adhesion molecule expression accompany the onset of a number of diseases including arthritis, atherosclerosis, and cancer. Cell adhesion is necessary for the metastatic spread of cancer cells to new organs. Circulating cancer cells adhere to endothelial cells and the underlying subendothelial basement membrane as an initial step in the process of invading target organs during metastasis. Several recent studies have provided convincing evidence that unsaturated fatty acids and their metabolites influence adhesion of cultured human cancer cells to individual components of the basement membrane. These unsaturated fatty acid effects appear to be dependent in some instances on the expression of specific cell surface adhesion molecules. Unsaturated fatty acids influence the development of metastases in animal tumor models by largely unexplored mechanisms; the possibility that cell adhesion is involved in this process has not been thoroughly investigated. Future studies of unsaturated fatty acid effects on cell adhesion molecule expression in breast cancer patients should reveal the clinical relevance of the studies reviewed here.     

Dietary fatty acid composition and metabolic syndrome in Tehranian adults

Objective

Several studies have shown that dietary and plasma fatty acid (FA) composition can modulate the development of metabolic syndrome, but epidemiologic data are scarce. The aim of this study was to evaluate the association between dietary FA composition and metabolic syndrome in Tehranian adults.

Methods

Dietary FA composition and symptoms of metabolic syndrome were assessed in a population-based cross-sectional study of 822 participants (354 men and 468 women, 18–74 y old) as part of the Tehran Lipid and Glucose Study. Metabolic syndrome was defined according to the guidelines presented by the Adult Treatment Panel III.

Results

The means ± standard deviations for dietary FA composition of total fat, linoleic acid, oleic acid, and saturated FA were 30.3 ± 7.5%, 1.43 ± 1.76%, 2.87 ± 2.19%, and 5.7 ± 2.2% of daily consumed energy, respectively. No significant correlation between the percentage of linoleic or oleic acids and metabolic syndrome was observed. Participants whose consumption of saturated FA was in the highest quartile had a significantly increased probability of acquiring metabolic syndrome (odds ratios by quartile 1, 0.83, 0.91, 0.95, P for trend <0.03). The odds ratios decreased after adjusting for indicators of a healthy lifestyle, including diet.

Conclusion

The data from this study indicate that increased consumption of dietary total fat, especially saturated FA, is associated with a higher risk of metabolic syndrome in Tehranian adults. The relation, apparently, is influenced by an individual’s lifestyle.     

3‐carboxy‐4‐methyl‐5‐propyl‐2‐furanpropanoic acid (CMPF): A metabolite identified after consumption of fish oil and fish

3‐carboxy‐4‐methyl‐5‐propyl‐2‐furanpropanoic acid (CMPF) is a known metabolite of furan fatty acids and was first referred to as a urofuran fatty acid, as it was found in urine of humans and other species after consumption of furan fatty acids or foods containing furan fatty acids. More recently, CMPF has been identified as a highly prominent metabolite following the consumption of fish oil, fish oil fractions and diets rich in fish, and can be regarded as biomarker of oil‐rich fish or fish oil intakes. As furan fatty acids are known to occur in fish and fish oil (at a low level), it is possible that the CMPF in plasma arises from these furan fatty acids. On a structural basis, this is a likely explanation rather than the CMPF being an actual metabolite of long‐chain marine omega‐3 fatty acids. Recent studies in high fat‐fed mice given purified CMPF suggest that CMPF might contribute to the improved metabolic effects observed following consumption of long‐chain marine omega‐3 fatty acids but much is still to be known about the relationships between CMPF and health.     

The health effects of dietary unsaturated fatty acids

• 2.1 The chemistry of fatty acids
• 2.2 Digestion, absorption and metabolism
• 2.3 Functions of unsaturated fatty acids

3 Unsaturated fatty acids in the UK diet

• 3.1 Sources of fat in the diet
• 3.2 Dietary recommendations for fat
• 3.3 Intakes of unsaturated fatty acids
• 3.4 Major contributors to unsaturated fatty acid intake
• 3.5 Trends in intake

4 Unsaturated fatty acids in health and disease

• 4.1 Unsaturated fatty acids and cardiovascular disease
• 4.2 Unsaturated fatty acids and diabetes
• 4.3 Unsaturated fatty acids and cancer
• 4.4 Unsaturated fatty acids and inflammatory conditions
• 4.5 Unsaturated fatty acids in fetal and infant development
• 4.6 Unsaturated fatty acids and cognitive function and behaviour
• 4.7 Emerging aspects of unsaturated fatty acids and health

5 Unsaturated fatty acids and public health

• 5.1 Labelling of unsaturated fatty acids
• 5.2 Are current UK recommendations adequate?
• 5.3 Opportunities to increase intake of long chain n‐3 PUFAs
• 5.4 Implications of optimising intakes of unsaturated fatty acids

6 Conclusions

Acknowledgements

References

Appendix 1

Summary Fat provides energy; indeed it is the most energy dense of all the macronutrients, with 1 g providing 37 kJ (9 kcal). However, the constituent parts of fat, fatty acids, are required by the body for many other functions than simply as an energy source, and there is an increasing awareness of the potential health benefits of specific types of fatty acids. Fatty acids are long hydrocarbon chains, with a methyl group at one end (the omega or n‐end) and an acid group at the other. Unsaturated fatty acids are hydrocarbon chains containing at least one carbon–carbon double bond; monounsaturated fatty acids contain one double bond, and polyunsaturated fatty acids (PUFAs) contain many double bonds. The position of the double bond relative to the omega end determines whether a PUFA is an n‐3 (omega 3) or an n‐6 (omega 6) fatty acid. Most fatty acids can be synthesised in the body, but humans lack the enzymes required to produce two fatty acids. These are called the essential fatty acids and must be acquired from the diet. In humans, the essential fatty acids are the n‐3 PUFA α‐linolenic acid and the n‐6 PUFA linoleic acid. Although humans can elongate dietary α‐linolenic acid to the long chain n‐3 PUFAs eicosapentaenoic acid and docosahexaenoic acid, the rate of synthesis may not be sufficient to meet requirements, and it is, therefore, recommended that good sources of these fatty acids, namely, oil‐rich fish, are also included in the diet. Fat is found in most food groups, and foods containing fat generally provide a range of different fatty acids, both saturated and unsaturated. In the UK, the major dietary sources of unsaturated fatty acids include meat & meat products, cereals & cereal products and potatoes & savoury snacks; primarily as a result of the vegetable oil used in processing. Recommended intakes of both total fat and the different types of fatty acids have been set for the UK population, and it is possible to monitor fat intake from the data collected in nationwide dietary surveys. As a population, we are not currently meeting these recommendations, so there is still scope for dietary change. In Western diets, n‐6 fatty acids are the predominant PUFAs, and this is in line with current dietary advice to consume a minimum of 1% energy as n‐6 PUFAs and 0.2% energy as n‐3 PUFAs. The balance of n‐3 and n‐6 PUFAs in Western diets has changed substantially over the last 100 years or so, and as the two families of PUFAs share a common metabolic pathway, concerns have been raised that this might be detrimental to health; what is becoming increasingly clear is that both n‐3 and n‐6 PUFAs have independent health effects in the body, and as intakes of the n‐6 PUFAs are within the guidelines for a healthy diet, concerns about the n‐6 to n‐3 ratio are driven by low intakes of n‐3 rather than high intakes of n‐6. Currently in adults n‐6 PUFAs contribute to 5.3% energy. Detecting associations between components of the diet and risk of various diseases is notoriously complex and in many cases, the evidence is still accumulating. Cardiovascular disease, characterised by hardening and narrowing of blood vessels and/or the development of blood clots, is one of the leading causes of mortality and morbidity worldwide. The type and total amount of dietary fat has a clear part to play in affecting an individual’s disease risk, yet the precise mechanisms by which unsaturated fatty acids reduce cardiovascular disease risk are still unclear. A number of mechanisms whereby dietary fatty acids could influence the progression of cardiovascular disease and its risk factors have been identified. These include effects on blood lipid concentrations, blood pressure, inflammatory response, arrhythmia and endothelial function, along with many other effects, both known and as yet undefined. A well‐established risk factor for cardiovascular disease is an elevated plasma low density lipoprotein (LDL) cholesterol concentration. Replacing saturated fatty acids with either monounsaturated fatty acids or n‐6 PUFAs reduces LDL (the ‘bad’) cholesterol, and so reduces the risk of developing the disease. Unsaturated fatty acids, such as linoleic acid or monounsaturated fatty acids, also slightly raise high density lipoprotein (HDL) (the ‘good’) cholesterol, which assists in the removal of triacylglycerols from the bloodstream. Interest in the health effects of the long chain n‐3 PUFAs found in fish oils is also increasing. There is strong supportive, but not yet conclusive, evidence that these fatty acids protect against fatal heart disease. On the basis of this conclusion, in 2004 the Scientific Advisory Committee on Nutrition advised the UK government to adopt the population‐wide dietary recommendation to eat at least two portions of fish per week, of which one should be oil‐rich, equivalent to 0.45 g of the long chain n‐3 PUFAs per day. In recent years, the potential health benefits of α‐linolenic acid has attracted attention, and evidence is mounting on the role that this n‐3 fatty acid may play in preventing the progression of cardiovascular disease, although it is currently unclear what, if any, association exists. Brain cells are especially rich in certain long chain PUFAs. This has led to the suggestion that dietary status of these long chain fatty acids might influence cognitive function and behaviour. Research in this field is still in its early stages, but there is a small amount of evidence to suggest improvements in cognitive function following fatty acid supplementation. In contrast, it is well established that pregnant women must have an adequate supply of the long chain n‐3 PUFAs before and throughout pregnancy and lactation to support normal growth, neurological development and cognitive function of the baby. As n‐6 PUFAs are more abundant in the diet, achieving an adequate intake is less problematic. However, this is not the case for the n‐3 PUFAs; increasing fish consumption beyond two servings of oil‐rich fish per week or relying on fish oil supplementation is not appropriate during pregnancy due to the potential problems associated with heavy metal contamination of fish, or the high vitamin A level in some fish oil supplements. Unsaturated fatty acids have also been associated with a number of other diseases and although the evidence is by no means conclusive, it is an area that is attracting a huge amount of interest. Dietary fat affects a number of different metabolic pathways, including those involved with glycaemic control, so the types and amounts of dietary fat may have a role to play in the management of type 2 diabetes. Unsaturated fatty acids may also be associated with a reduced risk of developing certain cancers, including cancers of the colon, breast and prostate, although currently the level of evidence is not deemed sufficient by authoritative bodies, such as the World Cancer Research Fund, World Health Organization and the Department of Health, to make any specific dietary recommendations. There are a number of inflammatory conditions, such as asthma, Crohn’s disease and arthritis, which could potentially be alleviated by dietary modification. The fatty acid composition of cell membranes can be altered by consumption of both n‐3 and n‐6 PUFAs, and this can result in reduced inflammatory activity. However, whether this effect brings about a significant reduction in clinical symptoms is still unclear. It is also important to note that there are concerns that the beneficial effects on certain disease outcomes are only observed with very high intakes of unsaturated fatty acids, which could realistically only be achievable by supplementation. Few nutritionists would be comfortable recommending supplement use as the only alternative to fish, as this can be expensive and goes against the idea that all the nutrients that our bodies require can be obtained from the food that we eat if the right choices are made. Unsaturated fatty acids are now a nutritional hot topic, and their presence in foods has attracted both public and industrial interest. There is currently no specific legislation to control the use of health claims relating to the fatty acid content of foods. However, a European Union (EU) Directive is expected imminently which will formally set down the criteria that a product will have to meet in order to make any nutrition or health claim. With regards to the current recommendations, those for the UK are in line with those around the world. However, as a population, we need to increase our consumption of long chain n‐3 PUFAs and decrease intake of saturated fatty acids. To facilitate this, food technologists are looking at ways in which the fatty acid profile of a food can be modified in order to bring dietary improvements without requiring a major change in dietary habits. However, public health messages surrounding the optimum intakes of fatty acids must be clear and consistent to ensure that a favourable change in the fatty acid profile of the UK diet occurs.