Dietary Fats and Oils: Relation to Blood Cholesterol

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Presentation transcript:

Dietary Fats and Oils: Relation to Blood Cholesterol Frank M. Sacks, MD Professor, Nutrition Department, Harvard School of Public Health; Professor of Medicine, Harvard Medical School Senior Physician, Brigham & Women’s Hospital

LDL-cholesterol The “bad” cholesterol Goes into the arterial wall Causes atherosclerosis Lowering blood LDL-cholesterol by diet or by most drugs reverses atherosclerosis, prevents heart attacks In trials of dietary polyunsaturated fats, the decrease in LDL-cholesterol matches the decrease in heart disease.

Types of fatty acids w Saturated Monounsaturated (Oleic acid) Linolenic acid Linoleic acid Methyl group w Acid group Polyunsaturated (Essential fatty acids) N-6 N-3

Effects of Dietary Fats on LDL-Cholesterol =0.032* =-0.009* =-0.019* Poly-unsaturated Mono- unsaturated Saturated percentage of calories vs. carbohydrate Change in LDL-C (mmol/L) Based on Mensink & Katan 2003. Figure from Micha & Mozaffarian, Lipids 2010

Effects of Individual Saturated Fatty Acids on LDL cholesterol 12:0 (lauric) =0.052* LDL cholesterol =0.048* 14:0 (myristic) 16:0 (palmitic) =0.039* Change in LDL-C (mmol/L) =-0.004 18:0 (stearic) percentage of calories vs. carbohydrate Figure from Micha & Mozaffarian, Lipids 2010. Based on Mensink & Katan 2003.

Palm oil and Lard Increase LDL-Cholesterol Compared to Olive Oil: 3 weeks each oil, 17% energy Tholstrup T. AJCN 2011

18-carbon fatty acids w Oleic acid Stearic acid Linolenic acid Linoleic acid Methyl group w Acid group Oleic acid trans

Meta-analysis of 60 controlled trials on dietary fats and blood lipids: effect of replacing carbohydrate with cis- or trans-fat Mensink..Katan. Am J Clin Nutr 2003;77:1146

Plenary III Frank Sacks The OmniHeart Study Diets: Lower Carbohydrate Modifications of DASH Diet Emphasize: Fruits, Vegetables; High-protein foods including beans, whole grains, nuts, low-fat dairy, fish and poultry; Unsaturated Cooking Oils Reduced in: Carbohydrates, Saturated Fats, Red Meat, Sweets, and Sugar-containing Beverages. Higher unsaturated fat, higher protein lowered BP and improved lipid risk factors more than the original high-carbohydrate DASH diet. OK Healthy Kitchens, Healthy Lives

Mean Change from Baseline in Each Diet OmniHeart: LDL-cholesterol (mg/dL) All diets low in saturated fat, healthful DASH-type dietary patterns Mean Change from Baseline in Each Diet Baseline High CARB (DASH) High PROT High UNSAT FAT All 129 -12 -14 -13 LDL-C > 130 157 -20 -24 -22 LDL-C < 130 105 -4 -6 -5 Appel L, Sacks F, et al. JAMA 2007

Dietary Fats, Oils to Lower LDL-cholesterol and Prevent Heart Disease Best Choice: Polyunsaturated vegetable oils Peanut, Soybean, Corn, Rapeseed, sesame Next Best Monounsaturated vegetable oils Olive* (more benefits when polyphenols high) High-oleic sunflower, safflower Unhealthful Choices: Trans unsaturated oils Animal fats, high in saturated fatty acids Palm oil