Do Saturated Fats Cause Chronic - PDF Document

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  1. Do Saturated Fats Cause Chronic Metabolic Diseases? Ronald P. Mensink Department of Nutrition and Movement Sciences NUTRIM, School for Nutrition and Translational Research in Metabolism Maastricht University Maastricht The Netherlands

  2. Research Funding • Netherlands Organisation for Scientific Research • Dutch Top Sector Life Sciences and Health • Dutch Top Sector Agri & Food • Alpro Foundation • Unilever R&D, Vlaardingen • Upfield

  3. Committees • Dutch Health Council • Standing Committee on Healthy Nutrition of the Dutch Health Council • Scientific advisor ILSI-Europe Task Force “Qualitive Fat Intake” • Expert group member (ILSI): • Update Update on Health Effects of Different Dietary Saturated Fats • Establishment of the Efficacy of Intervention in those with the Metabolic Syndrome • Omega-3 and Omega-6 PUFA Intakes, Ratios and Health Effects • Scientific Committee Healthy Choices Logo • Wetenschappelijke Adviescommissie Akkoord verbetering productsamenstelling

  4. Chronic Metabolic Diseases • Metabolic syndrome • Cardiovascular diseases • Dyslipidemia • Type 2 diabetes • Hypertension • Obesity • Non-alcoholic fatty liver disease (NAFLD) • ……

  5. Chronic Metabolic Diseases • Metabolic syndrome • Cardiovascular diseases • Dyslipidemia • Type 2 diabetes • Hypertension • Obesity • Non-alcoholic fatty liver disease (NAFLD) • ……

  6. Some Facts on Saturated Fatty Acids • Present in all foods • Intakes are in general poorly reflected by body lipid pools  exception: C15:0 and C17:0 • De novo synthesis • Are not one single compound - MCT - Lauric acid - Myristic acid - Palmitic acid - Stearic acid

  7. Intakes of Saturated Fatty Acids in Western Countries 12 Nurses Health Study Boston Area (Puerto Ricans) Porto 8 En% 4 0 C12:0 C14:0 C16:0 C18:0 SAFA Hu FB et al. Am J Clin Nutr, 1999; Smith CE et al. Obesity, 2013; Santos S et al. Nutrition, 2013.

  8. Dietary Guidelines to Lower CHD-risk Are Mainly Focused on Lowering LDL-cholesterol

  9. For Dietary Recommendations We Often Rely on Biomarkers Risk Factor Model: Causality LDL-cholesterol CHD Saturated fatty acids ✔ ✔ Do SFA increase LDL-cholesterol? ✔ ✔ Is LDL-cholesterol a risk factor for CHD? ✔ ✔ Include in dietary guidelines

  10. Effects of Different Classes of Fatty Acids on LDL-cholesterol Relative to carbohydrates • SFA • Cis-MUFA • Cis-PUFA change LDL-cholesterol  Effects of cis-PUFA slightly more favorable Compared with CARB 0.06 Change (mmol/L) adversely favorably favorably * 0.03 0 * * -0.03 LDL-cholesterol SFA Cis-PUFA Cis-MUFA

  11. Effects of Different Classes of Fatty Acids and Carbohydrates on LDL-cholesterol Compared with CARB Compared with cis-PUFA 0.06 0.06 Change (mmol/L) Change (mmol/L) * 0.03 0.03 0 0 * * * * * -0.03 -0.03 LDL cholesterol LDL-cholesterol SFA Carb Cis-MUFA SFA Cis-PUFA Cis-MUFA

  12. Effects of Individual Saturated Fatty Acids on LDL-cholesterol Relative to carbohydrates • C12:0 (lauric acid) • C14:0 (myristic acid) • C16:0 (palmitic acid) have an adverse effect on LDL- cholesterol  C18:0 (stearic acid) has no effect Compared with CARB 0.06 Change (mmol/L) * * * 0.03 * SFA C12 C14 C16 C18 0 -0.03 LDL-cholesterol

  13. Replacement of Saturated Fat Intake and CHD - A Meta-Analysis of 15 RCTs - 1.5 RR – CHD events 1.0 0.5 0.0 Replacement No of participants >3000 No of events PUFA Carb >51,000 2846 Protein >51,000 2833 737 Hooper L et al. Cochrane Database of Systematic Reviews 2015, Issue 6. Art. No.: CD011737

  14. There Is Confusion on the Relation between SFA Intake and CHD Heart Specialist Calls for Major Repositioning on Saturated Fat, as It’s NOT the Cause of Heart Disease

  15. What Causes the Confusion? • Several - but not all - prospective epidemiological studies and meta-analyses have not shown a relation between saturated fat intake with CHD

  16. Prospective Cohort Studies and RCTs Can Give Complementary - and Contradictory - Information • Some examples in the field of cardiovascular disease - Anti-oxidants - Folic acid (Homocysteine) - Saturated fatty acids

  17. Estimating Nutrient Intake is Not That Easy • Important sources of variation • Errors in identifying foods in food tables • Discrepancy between food table values and the true composition • Errors in estimating quantities of food eaten • Errors in remembering what was eaten • Variability in food patterns Jacobs Jr et al. Am J Epidemiol, 1979

  18. Estimating Nutrient Intake is Not That Easy • Important sources of variation • Errors in identifying foods in food tables • Discrepancy between food table values and the true composition • Errors in estimating quantities of food eaten • Errors in remembering what was eaten • Variability in food patterns For saturated fat, 22 randomly collected 24-h dietary recalls are needed to estimate the true individual mean intake within ±20 % (Balogh et al., Am J Clin Nutr, 1971). Many epidemiological studies have only one recall or a food frequency measure Jacobs Jr et al. Am J Epidemiol, 1979

  19. In Observational Studies, Saturated Fat Intake and Serum LDL-cholesterol Often Do Not Correlate • Difficult to estimate dietary intake at the individual level • Variability in serum LDL-cholesterol between and within individuals • Diet is not the major determinant of individuals’ LDL-cholesterol If saturated fat intake and LDL-cholesterol do not correlate, can we then expect an association between saturated fat intake with CHD?

  20. Can We Expect an Association between Saturated Fat Intake with CHD? 8 Non-diet Diet 7 LDL-cholesterol (mmol/L) 6 5 4 3 2 1 0 #1 #2 #3 #4 #5 #6 #7 #8 #9 SFA intake SFA intake SFA intake Risk for CHD

  21. What is the Best (Combination of) Lipid Biomarkers to Predict CHD-risk? LDL cholesterol Apolipoprotein B Small dense LDL HDL cholesterol Apolipoprotein AI Triacylglycerol Total to HDL cholesterol Lp[a] Postprandial metabolism

  22. We Need to Focus on Substitution Scenarios

  23. Non-Alcoholic Fatty Liver Disease (NAFLD) Relates to Many Metabolic Risk Factors Non-Alcoholic Fatty Liver Disease (NAFLD) - characterized by a build up of fat in the liver - relates to many metabolic risk factors Lonardo et al. Metabolism, 2016

  24. Overfeeding SFA or Simple Sugars Increase Intra Hepatic TriGlyceride (IHTG) Content Luukkonen et al. Diabetes Care, 2018

  25. Conclusions • SFA are present in all foods and needed by the body • There is convincing evidence that diets low in SFA (and high in cis-UFA) lowers CHD-risk • The different SFA have different metabolic effects • Do not only focus on CHD • Discuss substitution scenarios • Nutrients – Foods – Food patterns

  26. Effects of Different Classes of Fatty Acids and Carbohydrates on ApoB100 Compared with CARB Compared with cis-PUFA 12 4 Change (mg/dL) * Change (mgl/dL) 8 0 * * 4 -4 * * 0 -8 ApoB100 ApoB100 SFA Carb Cis-MUFA SFA Cis-PUFA Cis-MUFA