Effect of Meat Replacement by Tofu on CHD Risk Factors Including Copper Induced LDL Oxidation

Objective: To investigate the effect of replacing lean meat with a soy product, tofu, on coronary heart disease risk factors including serum lipoproteins, lipoprotein (a), factor VII, fibrinogen and in vitro susceptibility of LDL to oxidation.

Design: A randomized cross over dietary intervention study.

Setting: Free-living individuals studied at Deakin University.

Subjects: Forty-five free-living healthy males aged 35 to 62 years completed the dietary intervention. Three subjects were non-compliant and excluded prior to analysis.

Interventions: A diet containing 150 grams of lean meat per day was compared to a diet containing 290 grams of tofu per day in an isocaloric and isoprotein substitution. Each dietary period was one month duration.

Results: Analysis of the seven-day diet record showed that diets were similar in energy, protein, carbohydrate, total fat, saturated and unsaturated fat, polyunsaturated to saturated fat ratio, alcohol and fiber. Total cholesterol and triglycerides were significantly lower, and in vitro LDL oxidation lag phase was significantly longer on the tofu diet compared to the meat diet. The hemostatic factors, factor VII and fibrinogen, and lipoprotein(a) were not significantly affected by the tofu diet.

Conclusions: The increase in LDL oxidation lag phase would be expected to be associated with a decrease in coronary heart disease risk.     

Low-fat diets, triglycerides and coronary heart disease risk

Nutritionists are currently debating whether low‐fat high‐carbohydrate diets protect against coronary heart disease (CHD). Traditionally, low‐fat diets were prescribed because they reduce plasma and low density lipoprotein (LDL) cholesterol concentrations. However, there is considerable concern because low‐fat diets also increase plasma triglyceride (TG) and reduce high density lipoprotein (HDL) cholesterol concentrations. Recent prospective epidemiological studies have shown that these are independent risk factors for future CHD risk. It has been proposed that the adverse effects of low‐fat, high‐carbohydrate diets on TG and HDL may counteract or negate the beneficial effect of reducing LDL cholesterol concentrations. Although there is also strong epidemiological evidence that reduced total fat intake is not protective against CHD, high‐fat diets predispose to obesity and insulin resistance, both of which adversely affect TG metabolism. This review presents the evidence in relation to the importance of TG as a risk factor for CHD, and explains the pathophysiology that may underlie the aetiological role of TG metabolism in the pathogenesis and progression of CHD. It also addresses the physiological consequences of advocating low‐fat high‐carbohydrate diets, with particular reference to the effects on lipoprotein metabolism and CHD risk.     

Effect of Low-Energy-Dense Diet Rich in Multiple Functional Foods on Weight-Loss Maintenance,Inflammation, and Cardiovascular Risk Factors: A Randomized Controlled Trial

Background: There are no investigations regarding the effects of consuming low-energy-dense diets rich in multiple functional foods on weight-loss maintenance, inflammatory markers, and cardiovascular disease (CVD) risk factors simultaneously.

Method: This randomized controlled trial design was conducted on 90 men and women who were under a previous weight loss diet. Three months of intervention with recruitment at Allzahra Hospital, Isfahan, Iran, was done. Intervention was conducted following achieving 7–11 kg weight loss. Participants were encouraged to consumed these three: an isocaloric control diet (50% of energy from carbohydrate, 35% from fat, 15% from protein), a low-glycemic-index diet (LE) (60% from carbohydrate, 25% from fat, and 15% from protein), and a low-glycemic-index diet rich in multiple functional foods (LE + FF) (60% from carbohydrate, 25% from fat, and 15% from protein). Fasting blood glucose, serum insulin level, lipid profiles, inflammatory markers, adiponectin, systolic and diastolic blood pressure, and anthropometric measurements were assessed using standard guidelines.

Results: The percent changes of weight, waist, and body mass index (BMI), systolic and diastolic blood pressure, malondialdehyde (MDA), high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor (TNF) α, total cholesterol, low-density lipoprotein (LDL) cholesterol, triglyceride, and fasting blood glucose (FBS) were substantially more decreased in the LE + FF group compared to the LE and control groups (p ≤ 0.03). Percent change of adiponectin among the LE + FF group was significantly more enhanced (7.29 ± 0.10) compared with the LE group (1.28 ± 0.20) (p = 0.001). Significantly more increment in the percent change of total antioxidant capacity (TAC) (6.91 ± 0.10) was obtained among the LE + FF group compared to the LE group (1.79 ± 0.04).

Conclusions: This study provides established evidence supporting the beneficial effects of a low-energy-dense diet rich in multiple functional foods diet on improving weight-loss maintenance, inflammation, and cardiovascular risk factors.     

The impact of the modified Atkins diet on lipid profiles in adults with epilepsy

Objectives: The modified Atkins diet (MAD) is a high fat, low carbohydrate ketogenic diet used to treat intractable seizures in children and adults. The long-term impact on fasting lipid profiles (FLPs) remains unknown. This study was designed to detect significant lipid changes in adults on MAD.

Methods: Patients were observed prospectively. A FLP was obtained in all patients at the first visit then serially. Patients were started on a 20?g per day net carbohydrate limit MAD. They were screened for risk for coronary heart disease and counseled to reduce saturated fats by a registered dietitian if deemed at risk. Patients that remained on MAD for 3 or more months with one or more follow-up FLP were included.

Results: Thirty-seven patients (14 male), mean age 33 years (SD 13, range 18–59) met study criteria. Median diet duration was 16 months (range 3–41). Total cholesterol and low-density lipoprotein (LDL) increased significantly over the first 3 months of MAD (P?=?0.01 and 0.008, respectively), but were not significantly different from baseline after 1 year of treatment (P?=?0.2 and P?=?0.5, respectively). High-density lipoprotein levels trended upward in the first 3 months (P?=?0.05) and triglycerides remained unchanged (P?=?0.5). In 12 patients followed for 3 or more years, no cardiovascular or cerebrovascular events were reported.

Discussion: Although total cholesterol and LDL increased over the first 3 months of the MAD, these values normalized within a year of treatment, including in patients treated with MAD for more than 3 years.     

Diet and Exercise Habits of Patients with Diabetes,Dyslipidemia, Cardiovascular Disease or Hypertension

Objective: The objective of this study was to determine whether free-living individuals diagnosed with diabetes, dyslipidemia, cardiovascular disease or hypertension follow standard dietary recommendations for treatment of these diet-modifiable disorders.

Methods: Data are from 1,782 adult men and women who completed an annual clinic visit as part of a large study of diet and health. Usual dietary intake over the previous month was assessed with a self-administered food frequency questionnaire. Trained staff obtained a detailed medical history and information on health and exercise habits, measured height and weight, and collected a fasting blood specimen to measure total serum cholesterol, triglycerides and carotenoids. Multivariate linear regression was used to test associations of diet-modifiable chronic diseases with diet and exercise habits.

Results: 42% of the study sample reported at least one diet-modifiable disease or risk factor for disease. These individuals had higher total serum cholesterol (p < 0.001) and triglycerides (p < 0.001) compared to those without these conditions. Diabetics consumed a greater percent of energy from fat (p < 0.01), and men with hypertension consumed a greater percent energy from saturated fat (p < 0.05) compared to those without these conditions. There were few other differences in dietary intake between diseased and healthy individuals, and on average, all participants had diets that were not consistent with recommended guidelines for prevention or treatment of these diet-modifiable disorders. Forty-six percent of all participants were overweight or obese, and BMI was significantly higher among participants with at least one diet-modifiable disorder (p < 0.001). Healthy and diseased participants exercised about 17 minutes per day, and compared to non-diabetics, persons with diabetes exercised with 25% less intensity (p < 0.05).

Conclusion: Participants in this sample with diet-modifiable disorders reported that they are motivated to eat less fat, but most are still overweight or obese, consume a diet high in fat and low in fruits and vegetables and engage in very little physical exercise. New strategies are needed to help patients adopt and maintain healthful dietary practices that will reduce their risk.     

Level of Dietary Iron,Not Type of Dietary Fat,is Hyperlipidemic in Copper-Deficient Rats

Objective: This study was conducted to determine whether high dietary iron will negate the protective effect of unsaturated fat against hyperlipidemia.

Methods: Forty-eight weanling, male Sprague Dawley rats were randomly assigned to eight dietary groups differing in the levels of copper and iron and type of dietary fat (saturated or unsaturated). The diets were either deficient (0.6 μg Cu/g) or adequate (6.8 μg Cu/g) copper and either adequate (53 μg Fe/g) or high (506 μg Fe/g) iron. All diets contained starch as the sole source of dietary carbohydrate.

Results: Regardless of the type of dietary fat, three copper-deficient rats fed the high levels of dietary iron died prematurely due to ruptured hearts. Surviving rats belonging to the copper deficiency and high-dietary iron regimen developed severe anemia, enlarged hearts and livers, and exhibited the highest levels of liver iron. These rats also developed hypercholesterolemia. Triglycerides were elevated by the consumption of high iron diets.

Conclusion: Data show that levels of dietary iron, not the type of dietary fat, are potential inducers of hypertriglyceridemia. Data also show that the combination of high iron intake and dietary copper deficiency is responsible for elevating blood cholesterol.     

Testing the boundaries of recommended carbohydrate intakes: Macronutrient exchanges,carbohydrate quality and nutritional adequacy

Aim: The aim of this study was to explore the relationships between dietary carbohydrate, other macronutrients, carbohydrate quality and nutritional adequacy in the diets of free‐living Australian teenagers, and to consider the implications for total carbohydrate recommendations. Methods: Using the Children's Nutrition and Physical Activity Survey (2007) database, the nutrient intakes of boys and girls aged 14–16 years were assessed by quintile of carbohydrate intake. Results: Carbohydrate intake was inversely associated with intakes of saturated fat, polyunsaturated fat, long‐chain omega 3, monounsaturated fat and protein (for each association, P for trend <0.001). Carbohydrate intake was associated with increased intake of fibre in boys (P for trend <0.05) but not girls, the association being nonlinear. As carbohydrate intake increased, the densities of fibre, vitamin C, folate, thiamin and β‐carotene declined and the density of sugar increased, implying a decline in carbohydrate quality. Nutritional adequacy was generally compatible with a wide range of carbohydrate intakes. Conclusions: In combination, the exchanges of carbohydrate for polyunsaturated fat, long‐chain omega 3, monounsaturated fat and protein would be expected to increase coronary disease risk via several mechanisms. This implies that there may be a progressive increase in coronary risk as carbohydrate intakes increase across the Acceptable Macronutrient Distribution Range (AMDR), as the exchange of carbohydrate for saturated fat is now considered to be neutral for coronary risk. There is a case for lowering the upper and lower boundaries of the AMDR for carbohydrate intake as a strategy for chronic disease prevention. Lower boundaries would be unlikely to increase the risk for obesity or nutrient inadequacy.     

Western diet-induced anxiolytic effects in mice are associated with alterations in tryptophan metabolism

Objectives: Western-style diets high in saturated fat and refined carbohydrate have been shown to alter gut microbiota as well as being associated with altered behaviour and learning ability. The objective of this study was to determine the effects of short-term intake of a Western-style diet on intestinal cytokine expression, tryptophan metabolism, and levels of neurotransmitters in the brain.

Methods: At 7 weeks of age, 129S1/SvImJ mice were placed on a standard chow or Western-style diet (fat 33%, refined carbohydrates 49%) for 3 weeks. Anxiety-like behaviour was assessed by the latency to step-down test and exploration assessed in a Barnes maze. Neurotransmitter levels in forebrains were analysed by high-pressure liquid chromatography. Liver metabolism was examined by ¹H nuclear magnetic resonance (NMR). Cytokine expression in the intestine was measured using MesoScale discovery platform. mRNA levels of tryptophan hydroxylase (Tph) and indoleamine 2,3-dioxygenase (IDO) in the brain and intestine were measured using qPCR.

Results: Results showed that mice fed the Western diet displayed reduced exploratory and anxiety-like behaviour. Anxiolytic effects correlated with increased hippocampal brain-derived neurotrophic factor (BDNF) and tryptophan levels. Brain serotonin was not altered. These changes were associated with reduced expression of small intestinal indoleamine 2,3-dioxygenase, a tryptophan-processing enzyme. Western diet-fed mice exhibited low-grade systemic and intestinal inflammation along with altered liver metabolic profiles.

Discussion: In conclusion, diets high in fat and refined sugar are associated with increased levels of brain BDNF and tryptophan and decreased exploratory and anxiety-like behaviour. These behavioural changes correlated with altered intestinal tryptophan metabolism and liver metabolic profiles.     

Meta-analysis of Egg Consumption and Risk of Coronary Heart Disease and Stroke

The possible relationship between dietary cholesterol and cardiac outcomes has been scrutinized for decades. However, recent reviews of the literature have suggested that dietary cholesterol is not a nutrient of concern. Thus, we conducted a meta-analysis of egg intake (a significant contributor to dietary cholesterol) and risk of coronary heart disease (CHD) and stroke. A comprehensive literature search was conducted through August 2015 to identify prospective cohort studies that reported risk estimates for egg consumption in association with CHD or stroke. Random-effects meta-analysis was used to generate summary relative risk estimates (SRREs) for high vs low intake and stratified intake dose–response analyses. Heterogeneity was examined in subgroups where sensitivity and meta regression analyses were conducted based on increasing egg intake. A 12% decreased risk (SRRE = 0.88, 95% confidence interval [CI], 0.81–0.97) of stroke was observed in the meta-analysis of 7 studies of egg intake (high vs low; generally 1/d vs <2/wk), with little heterogeneity (p-H = 0.37, I² = 7.50). A nonstatistically significant SRRE of 0.97 (95% CI, 0.88–1.07, p-H = 0.67, I² = 0.00) was observed in the meta-analysis of 7 studies of egg consumption and CHD. No clear dose–response trends were apparent in the stratified intake meta-analyses or the meta regression analyses. Based on the results of this meta-analysis, consumption of up to one egg daily may contribute to a decreased risk of total stroke, and daily egg intake does not appear to be associated with risk of CHD.

Key Teaching Points:

? The role of egg consumption in the risk of stroke and coronary heart disease has come under scrutiny over many years.

? A comprehensive meta-analysis of prospective cohort studies that reported risk estimates for egg consumption in association with CHD or stroke was performed on the peer-reviewed epidemiologic literature through August 2015.

? Overall, summary associations indicate that intake of up to 1 egg daily may be associated with reduced risk of total stroke.

? Overall, summary associations show no clear association between egg intake and increased or decreased risk of CHD.

? Eggs are a relatively low-cost and nutrient-dense whole food that provides a valuable source of protein, essential fatty acids, antioxidants, choline, vitamins, and minerals.     

Synergistic effects of dietary carbohydrate and cholesterol on serum lipids and lipoproteins in squirrel and spider monkeys.

Serum lipid and lipoprotein responses to diets with a high level of simple carbohydrate (69% w/w sucrose) and a low level of saturated fat (5% w/w butter-coconut oil, polyunsaturated/saturated fatty acid ratio 0.03) containing 0, 0.1, and 1.0 mg/kcal added cholesterol was studied in five squirrel (Saimiri sciurea) monkeys. Variations in response produced by altering the nature of dietary carbohydrate (sucrose versus dextrin) and the fat (polyunsaturated/saturated fatty acid ratio, 0.03 versus 1.5) in the above diets were studied in three groups (five per group) of spider monkeys (Ateles sp.). In the absence of exogenous cholesterol, feeding a sucrose-saturated fat diet for 6 weeks produced a consistent increase in serum cholesterol in both species and an increase in serum triglycerides only in squirrel monkeys. Exogenous cholesterol had a remarkable synergistic effect on the high carbohydrate diet in increasing the serum cholesterol and had a suppressing effect on serum triglycerides in both species. Polyunsaturated fat reduced the hypercholesterolemic effect of sucrose with or without exogenous cholesterol. Dextrin diets resulted in lower serum cholesterol responses than sucrose diets when the diets contained 0 or 0.1 mg/kcal added cholesterol. Serum cholesterol response was reflected in beta- and alpha-lipoproteins. These results emphasize the varied response of serum lipids and lipoproteins to dietary changes in carbohydrate, fat, and cholesterol that might have a bearing on experimental atherosclerosis.     

Author Index to Volume 6

Objective: To look for associations between changes in LDL cholesterol and baseline characteristics of patients receiving dietary therapy for hypercholesterolemia.

Methods: Ninety-six hypercholesterolemic individuals aged 30–65 from three primary care clinics and a worksite clinic received counseling by a physician and/or a dietitian for lifestyle and dietary modifications. Baseline nutritional intake was evaluated using three-day food diaries. Lipoprotein levels were evaluated at six weeks and thereafter every three months for one year. Partial (adjusted) correlations (β) were calculated between baseline parameters (demographic, anthropometric, nutritional and laboratory) and changes of LDL cholesterol for the short and long term (three and 12 months).

Results: The average LDL cholesterol level decreased by 6 ± 10% (p < 0.001) at the end of 12 months. This reduction was positively correlated with baseline LDL cholesterol level (β = +0.4, p = 0.001), and negatively correlated with the baseline BMI (β = ?0.2, p < 0.05) and saturated fat intake (β = ?0.3, p < 0.05). The differences between low and high subgroups of baseline LDL cholesterol, BMI and saturated fat intake became apparent only after six to twelve months of therapy and probably result from varying levels of adherence to the dietary regimen. A significant correlation was found between the change in LDL cholesterol after six weeks and the change in LDL cholesterol after 12 months (β = 0.4, p < 0.001).

Conclusions: The probability of successfully reducing LDL cholesterol with dietary therapy can be predicted by baseline LDL cholesterol level, BMI and saturated fat intake, as well as by the response to dietary changes within six weeks of therapy.     

Comparison of monounsaturated fat with carbohydrates as a replacement for saturated fat in subjects with a high metabolic risk profile: studies in the fasting and postprandial states

BACKGROUND: In subjects with a high prevalence of metabolic risk abnormalities, the preferred replacement for saturated fat is unresolved. OBJECTIVE: The objective was to study whether carbohydrate or monounsaturated fat is a preferred replacement for saturated fat. DESIGN: Fifty-two men and 33 women, selected to have any combination of HDL cholesterol < or = 30th percentile, triacylglycerol > or = 70th percentile, or insulin > or = 70th percentile, were enrolled in a 3-period, 7-wk randomized crossover study. The subjects consumed an average American diet (AAD; 36% of energy from fat) and 2 additional diets in which 7% of energy from saturated fat was replaced with either carbohydrate (CHO diet) or monounsaturated fatty acids (MUFA diet). RESULTS: Relative to the AAD, LDL cholesterol was lower with both the CHO (-7.0%) and MUFA (-6.3%) diets, whereas the difference in HDL cholesterol was smaller during the MUFA diet (-4.3%) than during the CHO diet (-7.2%). Plasma triacylglycerols tended to be lower with the MUFA diet, but were significantly higher with the CHO diet. Although dietary lipid responses varied on the basis of baseline lipid profiles, the response to diet did not differ between subjects with or without the metabolic syndrome or with or without insulin resistance. Postprandial triacylglycerol concentrations did not differ significantly between the diets. Lipoprotein(a) concentrations increased with both the CHO (20%) and MUFA (11%) diets relative to the AAD. CONCLUSIONS: In the study population, who were at increased risk of coronary artery disease, MUFA provided a greater reduction in risk as a replacement for saturated fat than did carbohydrate.     

Dietary cholesterol, eggs and coronary heart disease risk in perspective

Summary  The idea that dietary cholesterol increases risk of coronary heart disease (CHD) by turning into blood cholesterol is compelling in much the same way that fish oil improves arthritis by lubricating our joints! Dietary cholesterol, chiefly in the form of eggs, has long been outlawed as a causative agent in CHD through its association with serum cholesterol. However, the scientific evidence to support a role for dietary cholesterol in CHD is relatively insubstantial in comparison with the incontrovertible link between its circulating blood relative in low density lipoprotein (LDL) cholesterol and CHD. Interpretation of the relationship between dietary cholesterol and CHD has been repeatedly confounded by an often inseparable relationship between dietary cholesterol and saturated fat. It has also been exaggerated by the feeding of unphysiologically high intakes of eggs. Nonetheless, numerous studies have shown that dietary cholesterol can increase serum LDL-cholesterol, but the size of this effect is highly variable between individuals and, according to over 30 years of prospective epidemiology, has no clinically significant impact on CHD risk. Variation in response to dietary cholesterol is a real phenomenon and we can now identify nutrient–gene interactions that give rise to this variation through differences in cholesterol homeostasis. More importantly, to view eggs solely in terms of the effects of their dietary cholesterol on serum cholesterol is to ignore the potential benefits of egg consumption on coronary risk factors, including obesity, diabetes and metabolic syndrome. Cardiovascular risk in these conditions is largely independent of LDL-cholesterol. These conditions are also relatively unresponsive to any LDL-cholesterol raising effects of dietary cholesterol. Treatment is focused primarily on weight loss, and it is in this respect that eggs may have a new and emerging role in facilitating weight loss through increased satiety.     

Low Fat Intake and Coronary Artery Disease in a Population with Higher Prevalence of Coronary Artery Disease: The Indian Paradox

Objective: To determine the association between saturated fat intake and prevalence of coronary artery disease (CAD) and coronary risk factors.

Design and Setting: Total community cross sectional survey of 20 urban streets out of 196 streets, in the city of Moradabad in north India.

Subjects and Methods: Adult population between 25 to 64 years inclusive comprised of 1806 subjects (904 men, 902 women) were divided into three groups according to level of saturated fat intake as assessed by 7-day dietary intake records (very low <7%, low 7 to 10%, high >10% energy (en) per day).

Results: We examined the relationship between CAD risk and levels of % en from fat intake. Low (7 to 10% en/day) and high (>10% en/day) saturated fat were positively and significantly associated with higher prevalence of CAD. The prevalence of coronary risk factors (hypertension, hypercholesterolemia, obesity and sedentary lifestyle) were significantly higher among subjects with low and high saturated fat intake compared to subjects with very low (<7%) saturated fat intake. Logistic regression analysis with adjustment for age showed that hypercholesterolemia (OR: men 0.89, women 0.68), hypertension (men 0.92, women 0.56), physical activity (men 0.80, women 0.36), obesity (men 0.82, women 0.88) and smoking (0.70 men) were significant risk factors of CAD. Low and high saturated fat intake were associated with more prestigious occupations, higher and middle income status and better educational levels compared to very low saturated fat intake.

Conclusions: The prevalence of CAD and coronary risk factors was higher in urban Indians with low and high saturated fat intake than those with lower saturated fat intake. These findings suggest that the saturated fat intake should be <7% en/day for prevention of CAD in Indians.     

Comparative Cholesterol Lowering Properties of Vegetable Oils: Beyond Fatty Acids

Objective: Our laboratory has previously reported that the hypolipidemic effect of rice bran oil (RBO) is not entirely explained by its fatty acid composition. Although RBO has up to three times more serum cholesterol-raising saturated fatty acids (SATS) than some unsaturated vegetable oils, we hypothesized that its greater content of the unsaponifiables would compensate for its high SATS and yield comparable cholesterol-lowering properties to other vegetable oils with less SATS.

Methods: To study the comparative effects of different unsaturated vegetable oils on serum lipoprotein levels, nine cynomologus monkeys (Macaca fascicularis) were fed diets, for four weeks, in a Latin square design, containing rice bran, canola or corn oils (as 20% of energy) in a basal mixture of other fats to yield a final dietary fat concentration of 30% of energy. All animals were fed a baseline diet containing 36% of energy as fat with 15% SATS, 15% monounsaturated fatty acids (MONOS) and 6% polyunsaturated fatty acids (POLYS).

Results: Despite the lower SATS and higher MONOS content of canola oil and the higher POLYS content of corn oil, RBO produced similar reductions in serum total cholesterol (TC) (?25%) and low density lipoprotein cholesterol (LDL-C) (?30%). In addition, as compared to the baseline diet, the reduction in serum TC and LDL-C cholesterol with RBO was not accompanied by reductions in high density lipoprotein cholesterol (HDL-C) which occurred with the other two dietary oils. Using predictive equations developed from data gathered from several studies with non-human primates, we noted that the observed serum TC and LDL-C lowering capabilities of the RBO diet were in excess of those predicted based on the fatty acid composition of RBO.

Conclusions: These studies suggest that non-fatty acid components (unsaponifiables) of RBO can contribute significantly to its cholesterol-lowering capability.     

Relationship of Diet, Abdominal Obesity, and Physical Activity to Plasma Lipoprotein Levels in Asian Indian Physicians Residing in the United States

Objective To examine the relationship of total fat, saturated fat, carbohydrate and energy intake, leisure-time activity, waist-to-hip ratio (WHR), and body mass index to the prevalence of atherogenic plasma triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) levels in Asian Indians living in the United States. High plasma TG and low HDL-C levels have been documented in Asian Indians worldwide.Design This exploratory study examined medical history, demographics, anthropometries, plasma lipids levels, food intake frequency, and self-reported leisure-time activity.Subjects 153 Asian Indian male physicians (mean age=47 years) were recruited at two annual national conferences of the American Association of Physicians from India, with free medical assessments as incentives.Statistical analyses performed Correlational and multiple regression analyses were performed.Results Subjects’ diets averaged 56% energy from carbohydrate, 32% from total fat, and 8% from saturated fat. High total fat intake was associated with high WHR (r=.2l, P<.01) and high total carbohydrate intake (grams per day) was associated with high TG level (r=.24, P<.05). Leisure-time activity averaged 136 minutes/week and negatively correlated with total plasma cholesterol level (r=−.22, P<.01) and low-density lipoprotein cholesterol level (r=−.25, P<.001).Applications Dietitians should recommend moderate dietary carbohydrate intake and meal patterns with energy distributed throughout the day, in addition to decreasing fat consumption, to Asian Indian clients at risk for coronary artery disease. High carbohydrate intake and uneven diurnal distribution (no breakfast and large evening meals) are associated with high TG and low HDL-C levels in this population. J Am Diet Assoc. 1996; 96:257-261.     

Combined effects of saturated fat and cholesterol intakes on serum lipids: Tehran Lipid and Glucose Study

ObjectiveThis study investigated the combined effect of saturated fat and cholesterol intake on serum lipids among Tehranian adults.MethodsIn 443 subjects ≥18 y, dietary intake was assessed. Height and weight were measured and body mass index was calculated. Serum cholesterol, triacylglycerol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol levels were calculated. Cholesterol intakes ≥300 mg/d and saturated fat intakes ≥7% of total energy were defined as high intakes. Individuals were categorized into four groups based on cholesterol and saturated fat intakes.ResultsSubjects' mean age was 40.1 ± 14.6 y; those in whom cholesterol and saturated fat intake was normal had significantly less energy and fat intake than those with high cholesterol and saturated fat intakes (P < 0.01). Saturated fat intake had a significant effect on serum total and HDL-C levels. Subjects with a normal saturated fat intake had significantly less serum total and HDL-C than those who had high saturated fat intake (P < 0.01 and P < 0.05, respectively). Adjusting for age, sex, and body mass index, the main effect of cholesterol intake on HDL-C was significant (P = 0.05). Mean serum HDL-C was lower in subjects who had normal cholesterol intake than in those with high cholesterol intake.ConclusionThese results show that cholesterol and saturated fat intakes have no combined effect on serum low-density lipoprotein cholesterol level, whereas cholesterol intake per se affects serum HDL-C level.     

Consumption of Oxidized and Partially Hydrogenated Oils Differentially Induces Trans-Fatty Acids Incorporation in Rats' Heart and Dyslipidemia

Objectives: A direct effect of process-induced trans-fatty acids (TFAs) on nonalcoholic fatty liver disease (NAFLD) as a cardiovascular disease (CVD) risk factor has previously been shown. We hypothesized that TFAs directly induced CVD. This article describes an investigation of the association between TFAs, provided by the consumption of oxidized soybean oil and margarine, and plasma lipid profiles, coronary artery lesions, and coronary fatty acids distribution in rats. Male rats were fed a standard chow or high-fat diet containing different TFA levels ranging from <1%, <2%, and >2% of total fat in fresh soybean oil, oxidized soybean oil, and margarine, respectively, for 4 weeks.

Results: The results indicated that the high-fat diets differently changed the plasma lipid profiles by significantlt increasing triglycerides, total cholesterol, low-density lipoprotein cholesterol, and the ratio of low-density to high-density lipoprotein cholesterol compared to control rats. Compared to fresh soybean oil, oxidized oil further increased plasma lipid markers. The strongest inflammatory effect was induced by margarine, which contains the highest level of TFAs, or 2% of total fat. Total TFAs in the heart of the margarine-fed group were increased by 4.7 regarding to control and by 2.17 and 2.6 relative to groups receiving oxidized and fresh oil, respectively. Increased TFAs consumption was associated with increased histological aspects of atherosclerotic lesions in a dose-dependent manner.

Conclusion: In conclusion, process-induced TFAs cause changes including proatherogenic plasma lipid markers, heart fatty acid profiles, and coronary artery histology depending on the TFA level in the supplemented fat and therefore on the type of technological process used.     

Diet and coronary heart disease

The controversy over the role of diet in the development of coronary heart disease (CHD) continues. Most studies of dietary involvement have concentrated on the possible nutritional basis of the accepted risk factor - raised serum cholesterol. In animals, although high fat diets, particularly high saturated fatty acid diets, cause raised serum cholesterol levels, myocardial infarction rarely occurs. In human studies initial insight into the importance of dietary fat level and fatty acid composition was gleaned from international studies. Within population studies supported the association of raised serum cholesterol concentration with CHD in males up to 60years of age, and recognised the significance of the type of serum cholesterol, currently thought to be under genetic control. Although intervention studies have shown that high serum cholesterol levels can be reduced by dietary means, there has been no convincing evidence of a reduction in total mortality. An imbalance in the formation of inhibitors and promoters of platelet aggregation from polyunsaturated fatty acids in the diet is postulated as a possible nutritional basis for the formation of a thrombus in the coronary artery.