Improved fat quality in food slashes CVD risk

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Exchanging a few commercially regular-consumed food items with improved fat quality reduces total and LDL cholesterol, corresponding to  27% reduction in cardiovascular disease risk, found a double-blind randomised controlled University of Oslo trial.

Exchanging few regular-consumed food items with improved fat quality in the daily diet for eight weeks reduces the serum total cholesterol and LDL-cholesterol by 9 % and 11 %, respectively. This change corresponds to a 27 % reduction in cardiovascular disease risk. In the human trial saturated fat was replaced by polyunsaturated fat in key food items such as spread on bread, fat for cooking, cheese, bread and cereals.

Cardiovascular disease (CVD) remains the major contributor to the global burden of disease worldwide. Even though there has been substantial reduction in CVD mortality over the last 30 years, new reports show an increase in acute myocardial infarction among the younger population in Norway, and similar observations have been reported also from other countries.

Elevated plasma low-density lipoprotein cholesterol (LDL-C) is an established risk factor of CVD, and dietary fatty acids play a significant role in modulating plasma LDL-C and thereby influencing the risk of CVD. In particular there is strong evidence that replacing saturated fatty acids (SFA) with polyunsaturated fatty acids (PUFA) will reduce the risk of CVD. However, controversy still exist about beneficial versus potential harmful effects of n-6 PUFA since n-6 PUFA has been suggested to promote inflammation.

Adherence to a healthy Nordic diet based on the Nordic nutrition recommendations has previously been shown to have beneficial effect on blood lipids among subjects at risk of CVD. However, the extent of food changes needed to achieve these effects is less explored. In order to increase compliance to dietary fat intake recommendations in the general population it is important that one can achieve this with relatively small dietary changes, leading to improved lipid profile.

The aim of the study was to investigate the effects of exchanging few commercially regularly-consumed key food items (spread on bread, fat for cooking, cheese, bread and cereals) with improved fat quality on total cholesterol, LDL-C and inflammatory markers in a double-blind randomised, controlled trial.

In total 115 moderately hyper-cholesterolemic non-statin treated adults (25-70 y) were randomly assigned to an experimental diet group (Ex-diet group) or control diet group (C-diet group) for eight weeks with commercially available food items with different fatty acid composition (replacing saturated fatty acids with mostly n-6 polyunsaturated fatty acids).

In the Ex-diet group, serum total cholesterol (P<0.001) and LDL-C (P<0.001) were reduced after eight weeks, compared to the C-diet group. The difference in change between the two groups at the end of the study was -9 % and -11 % in total cholesterol and LDL-C, respectively. No difference in change in plasma levels of inflammatory markers was observed between the groups.

In conclusion, exchanging few regularly-consumed food items with improved fat quality reduces total cholesterol, with no negative effect on levels of inflammatory markers. This shows that an exchange of few commercially available food items was easy and manageable and leads to clinically relevant cholesterol reduction potentially affecting future CVD risk.

Abstract
The healthy Nordic diet has been previously shown to have health beneficial effects among subjects at risk of CVD. However, the extent of food changes needed to achieve these effects is less explored. The aim of the present study was to investigate the effects of exchanging a few commercially available, regularly consumed key food items (e.g. spread on bread, fat for cooking, cheese, bread and cereals) with improved fat quality on total cholesterol, LDL-cholesterol and inflammatory markers in a double-blind randomised, controlled trial. In total, 115 moderately hypercholesterolaemic, non-statin-treated adults (25–70 years) were randomly assigned to an experimental diet group (Ex-diet group) or control diet group (C-diet group) for 8 weeks with commercially available food items with different fatty acid composition (replacing SFA with mostly n-6 PUFA). In the Ex-diet group, serum total cholesterol (P<0·001) and LDL-cholesterol (P<0·001) were reduced after 8 weeks, compared with the C-diet group. The difference in change between the two groups at the end of the study was −9 and −11 % in total cholesterol and LDL-cholesterol, respectively. No difference in change in plasma levels of inflammatory markers (high-sensitive C-reactive protein, IL-6, soluble TNF receptor 1 and interferon-γ) was observed between the groups. In conclusion, exchanging a few regularly consumed food items with improved fat quality reduces total cholesterol, with no negative effect on levels of inflammatory markers. This shows that an exchange of a few commercially available food items was easy and manageable and led to clinically relevant cholesterol reduction, potentially affecting future CVD risk.

Authors
Stine M Ulven, Lena Leder, Elisabeth Elind, Inger Ottestad, Jacob J Christensen, Vibeke H Telle-Hansen, Anne J Skjetne, Ellen Raael, Navida A Sheikh, Marianne Holck, Kristin Torvik, Amandine Lamglait, Kari Thyholt, Marte G Byfuglien, Linda Granlund, Lene F Anderse, Kirsten B Holven

University of Oslo Faculty of Medicine material
British Journal of Nutrition abstract


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