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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.
Acid group Methyl group Monounsaturated (Oleic acid) Saturated w Polyunsaturated (Essential fatty acids) N-3 N-6 Linolenic acid Linoleic acid Types of fatty acids
Saturated =0.032* Change in LDL-C (mmol/L) =-0.009* Mono- unsaturated =-0.019* Poly-unsaturated percentage of calories vs. carbohydrate Effects of Dietary Fats on LDL-Cholesterol 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 14:0 (myristic) =0.048* 16:0 (palmitic) =0.039* Change in LDL-C (mmol/L) 18:0 (stearic) =-0.004 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 Palm Lard Olive Tholstrup T. AJCN 2011
Acid group Methyl group Oleic acid Stearic acid w Linolenic acid Linoleic acid Oleic acid trans 18-carbon fatty acids
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 ClinNutr 2003;77:1146
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.
OmniHeart: LDL-cholesterol (mg/dL)All diets low in saturated fat, healthful DASH-type dietary patterns 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