Dieta e prevenção cvd versão slideshare

354 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
354
On SlideShare
0
From Embeds
0
Number of Embeds
5
Actions
Shares
0
Downloads
6
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Dieta e prevenção cvd versão slideshare

  1. 1. DIETA E PREVENÇÃO CARDIOVASCULAR !Pedro Carrera Bastos, 2013!
  2. 2. COLESTEROL DIETÉTICO < 300 MG/DIA Dietary Guidelines for Americans, USDA, 2005
  3. 3. ALIMENTO (100 G) COLESTEROL (MG) Queijo de Azeitão 88 Nata 33% gordura 97 Costoleta de Porco (gorda) grelhada 111 Peito de vitela estufado 121 Camarão Cozido 198 Mexilhão cozido 360 Fígado de vitela grelhado 387 Ovo cozido 408Tabela de Composição dos Alimentos. Centro de Segurança Alimentar e Nutrição. Instituto nacional de Saúde Dr. Ricardo Jorge, 2006
  4. 4. Limite o consumo de gemas de ovo
  5. 5. US NATIONAL HEALTH AND NUTRITIONAL SURVEY (1984–1994)6 Okuyama H, et al. World Rev Nutr Diet. 2007;96:1-17.
  6. 6. BMJ 2013;346:e8539 doi: 10.1136/bmj.e8539 (Published 7 January 2013) BMJ 2013;346:e8539 doi: 10.1136/bmj.e8539 (Published 7 January 2013) Page 1 of 13 Research RESEARCH Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies OPEN ACCESS 12 12 12 Ying Rong doctoral student , Li Chen research fellow , Tingting Zhu research fellow , Yadong 12 12 12 Song research fellow , Miao Yu research fellow , Zhilei Shan research fellow , Amanda Sands 3 3 12 doctoral student , Frank B Hu professor , Liegang Liu professor 1 Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, People’s Republic of China; 2Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, People’s Republic of China; 3Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA, USA Abstract Conclusions Higher consumption of eggs (up to one egg per day) is Objective To investigate and quantify the potential dose-response not associated with increased risk of coronary heart disease or stroke. The increased risk of coronary heart disease among diabetic patientsFig 3 Forest plot of egg consumption and risk of coronary heart disease association between egg consumption and risk of coronary heart disease and stroke. and reduced risk of hemorrhagic stroke associated with higher egg consumption in subgroup analyses warrant further studies. Design Dose-response meta-analysis of prospective cohort studies. RISCO DE DOENÇA CARDÍACA CORONÁRIA Introduction Data sources PubMed and Embase prior to June 2012 and references of relevant original papers and review articles. Cardiovascular disease is now a public health crisis, affecting Eligibility criteria for selecting studies Prospective cohort studies millions of people in both developed and developing countries. with relative risks and 95% confidence intervals of coronary heart disease Although the rate of death attributable to the disease has declined or stroke for three or more categories of egg consumption. in developed countries in the past several decades, it is still the Results Eight articles with 17 reports (nine for coronary heart disease, leading cause of death and extorts a heavy social and economic eight for stroke) were eligible for inclusion in the meta-analysis (3 081 toll globally.1-3 In low and middle income countries, the
  7. 7. Fig 4 Dose-response analyses of egg consumption and risk of stroke BMJ 2013;346:e8539 doi: 10.1136/bmj.e8539 (Published 7 January 2013) Page 1 of 13 Research RESEARCH Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies OPEN ACCESS 12 12 12 Ying Rong doctoral student , Li Chen research fellow , Tingting Zhu research fellow , Yadong 12 12 12 Song research fellow , Miao Yu research fellow , Zhilei Shan research fellow , Amanda Sands 3 3 12 doctoral student , Frank B Hu professor , Liegang Liu professor 1 Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, People’s Republic of China; 2Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, People’s Republic of China; 3Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA, USA Abstract Conclusions Higher consumption of eggs (up to one egg per day) isFig 5 Forest plot of egg consumption and risk of stroke Objective To investigate and quantify the potential dose-response association between egg consumption and risk of coronary heart disease not associated with increased risk of coronary heart disease or stroke. The increased risk of coronary heart disease among diabetic patients and stroke. and reduced risk of hemorrhagic stroke associated with higher egg consumption in subgroup analyses warrant further studies. Design Dose-response meta-analysis of prospective cohort studies. RISCO DE AVC Introduction Data sources PubMed and Embase prior to June 2012 and references of relevant original papers and review articles. Cardiovascular disease is now a public health crisis, affecting Eligibility criteria for selecting studies Prospective cohort studies millions of people in both developed and developing countries. with relative risks and 95% confidence intervals of coronary heart disease Although the rate of death attributable to the disease has declined or stroke for three or more categories of egg consumption. in developed countries in the past several decades, it is still the Results Eight articles with 17 reports (nine for coronary heart disease, leading cause of death and extorts a heavy social and economic eight for stroke) were eligible for inclusion in the meta-analysis (3 081 toll globally.1-3 In low and middle income countries, the
  8. 8. EFEITOS NO CURTO PRAZOINCREMENTO DE 100 MG/D DE COLESTEROL DIETÉTICO AUMENTOU: ü  CT: 2.2 mg/dl ü  C- HDL: 0.3 mg/dl 9 Okuyama H, et al. World Rev Nutr Diet. 2007;96:1-17.
  9. 9. CHOLESTEROL SYNTHESIS, TRANSPORT, & EXCRETION / 225 ENTEROHEPATIC CIRCULATION HEPATIC PORTAL VEIN Diet (0.4 g/d) C CE GALL BLADDER Synthesis – – Bile acids (total pool, 3–5 g) BILE DUCT Unesterified cholesterol CE pool C ACAT CE Bile C C acids HL VLDL C TG Chylomicron CE TG ILEUM ,C CE E LDL C (apo B-100, E) TG LIVER receptor CE 8 –9 9 % 9 LDL C TG CE LRP receptor CE C TG CE CE TG C CE TP C Bile acids TG TG CE AT A-I (0.6 g/d) (0.4 g/d) CE LC CE IDL C C HDL Feces (VLDL remnant) Chylomicron remnant LPL C LDL (apo B-100, E) C receptor EXTRAHEPATIC C Synthesis TISSUES CE Murray R, et al. Harper’s Illustrated Biochemistry 26th Edition. McGraw-Hill, 2003Figure 26–6. Transport of cholesterol between the tissues in humans. (C, unesterified cholesterol; CE, cho-
  10. 10. LDL PEQUENAS E DENSAS ü  > Entrada no espaço subendotelial ü  Menos Vit E ü  + Susceptível à oxidação ü  Elevado TG/HDL-C é um bom preditor de sdLDL Griffin BA. Proc Nutr Soc 1999;58:163-69
  11. 11. 24, 25]. Other cholesterol-containing foods, such as dairy fed for 4 weeks with a 1-month washout period in between.products, also contain high concentrations of saturated fat, The participants were classified as insulin sensitive (n=65), Curr Atheroscler Rep (2010) 12:377–383which is a confounder for dietary cholesterol effects. This DOI 10.1007/s11883-010-0130-7 insulin resistant (n=75), and obese insulin resistant (OIR,might be the reason why controversial results exist n=58). Insulin-resistant and insulin-sensitive individuals hadregarding the effects of dairy products on CHD risk [26]. significant increases in LDL-C of 7.8% and 3.3%, respec- Clinical trials conducted in children [27], younger adults tively, after consuming 4 eggs per day, whereas OIR Revisiting Dietary Cholesterol Recommendations: LDL-C at any intake level.[24, 25], and the elderly [28, 29] have clearly demonstrated individuals had no changes inthat although dietary cholesterol provided by eggs signifi- Does the Evidence Support a LimitHDL-C was significantly increased for all groups In contrast, of 300 mg/d?cantly increases LDL-C in one third of the population, those even after the consumption of only 2 eggs per day. Theseindividuals considered hyper-responders to & a cholesterol Maria Luz Fernandez Mariana Calle studies suggest that dietary management of OIR individualschallenge exhibit increases in both LDL-C and HDL-C, with need not include restrictions on eggs.Table 2 Changes in LDL-C, HDL-C, LDL size, and HDL size as a response to dietary cholesterol provided by eggs in various populations Published online: 4 August 2010 # Springer Science+Business Media, LLC 2010Population Duration Additional dietary cholesterol LDL-C HDL-C LDL-C/HDL-C ratio LDL size HDL sizeChildren (n=54) [27] 4 Abstract The mg/d wk 518 perceived association between Increase Introduction No change dietary cho- Increase Increase ND lesterol (DC) and risk for coronary heart disease (CHD) hasWomen (n=51) [25] 4 resulted in recommendations of no more than 300 mg/d for Increase wk 640 mg/d Increase The AmericanNo change Heart Association (AHA)Increase recommends ND noMen (n=28) [32••] 12 healthy 640 mg/d the United States. These change Increase 300 Decrease wk persons in No dietary more than mg/d of dietary cholesterolIncrease healthy (DC) for Increase recommendations proposed in the 1960s had little scientificMen/women (n=42) [34] 12 wk 215 mg/d No change Increaseto prevent change risk for coronary heart disease persons No increased Increase Increase evidence other than the known association between (CHD) [1]. These recommendations are mostly based onMen/women (n=34) [28] 4 saturated640 and cholesterol and animal studies where Increase wk fat mg/d Increase No change Increase Increase the presence of both saturated fat and cholesterol in manyMen/women (n=56) [35•] 12 wk 250 mg/d No normal foods and onDecrease cholesterol was fed in amounts far exceeding change Increase data derived from animal studies where ND ND intakes. In contrast, European countries, Asian countries, supraphysiologic doses of cholesterol, ranging from theMen/women (n=45) [33•] 12 and Canada do not have an upper limit for DC. change No changeof 1,000 mg to 20,000 mg/d for humans, were wk 400 mg/d No Further, equivalent No change ND ND current epidemiologic data have clearly demonstrated that fed in order to produce atherosclerosis [2].HDL-C high-density lipoprotein increasing concentrations of DC arelipoprotein cholesterol; ND not determined. that many other countries do not cholesterol; LDL-C low-density not correlated with It is important to note increased risk for CHD. Clinical studies have shown that have the same guidelines for DC. Canada [3••], Korea [4•], even if DC may increase plasma low-density lipoprotein New Zealand [5], and India [6], for example, do not set an (LDL) cholesterol in certain individuals (hyper-responders), upper limit for DC, focusing instead on controlling the this is always accompanied by increases in high-density intake of saturated fat and trans fat, which are the major lipoprotein (HDL) cholesterol, so the LDL/HDL cholesterol determinants of blood cholesterol concentrations. Similarly, ratio is maintained. More importantly, DC reduces circu- the European guidelines on cardiovascular disease preven- lating levels of small, dense LDL particles, a well-defined tion have the following recommendations regarding healthy risk factor for CHD. This article presents recent evidence food choices: “consume a wide variety of foods, adjust from human studies documenting the lack of effect of DC energy intake to maintain a healthy weight, encourage on CHD risk, suggesting that guidelines for DC should be consumption of fruits and vegetables, replace saturated fat revisited. with mono or polyunsaturated fatty acids and reduce salt intake” [7]. In contrast to US policies, Europeans have no Keywords Dietary cholesterol . LDL cholesterol . dietary guidelines for DC [7]. A summary of the dietary
  12. 12. REDUZIR INGESTÃO DE GORDURA TOTAL DIMINUI RISCO DE DCV
  13. 13. lly twelve volunteers composite samples taken from each menu once during the s unable to complete study for both the stabilization diet and intervention diets.en complete physical The results for the seven composite samples were averagedwithin -10 to +20 per- to find the actual composition of the diets. No alcohol was in- tropolitan Life Insur-values from the 1983 TABLE 1r chronic disease was Composition of HNS*27 Diets, Proximal Analysis a on was not an exclu- Low-fat diets High-fat dietscruited tended to have (% of total calories) e for men in this age Target Target nsumption, and evi- Measured value Measured valuesionary. Macronutrient energyeers were confined to distribution Protein 15.9 16.0 15.7 16.0 tern Human Nutrition Fat 22.2 20.0 38.7 40.0 or the duration of the Carbohydrate 61.9 64.0 45.7 44.0 onfines of the Nutri- Cholesterol content sed outings, they had (mean, mg/day) -- 360 -- 360 cept that provided by Fatty acid energy distribution rotocol was, of neces- Saturated 6.4 5 10.6 10 was monitored, por- Monounsaturated 9.2 10 15.5 20 required to consume Polyunsaturated 6.6 5 12.6 10heir meals. (A rubber P/S ratio 1.0 1.0 1.2 1.0 ood was scraped from ap/s, polyunsaturated/saturated; HNS-2 7 diet. Nelson GJ, Schmidt PC, Kelley DS. Lipids. 1995 Nov;30(11):969-76
  14. 14. dicated an increase in the plasma very low density lipopro- factory because the conditions of this experiment were ca n (VLDL) level and a decrease in both the plasma HDL and fully controlled and the statistical power of the protocol wDL levels. Thus, the total cholesterol level remained con- excellent. nt because the increase in plasma VLDL cholesterol com- (ii) The average cholesterol level in the subjects was consated for the reduction in HDL-cholesterol and LDL-cho- siderably below that in the European and American popu terol. Because of individual variations, the standard devia- tions used to develop the Keys et aL (5) and Hegsted et al. TABLE 6 High- and Low-Fat Diets, Blood Cholesterol, Triglycerides, and Lipoprotein Values Total HDL- LDL- cholesterol Triglycerides cholesterol cholesterol Period Diet mean + SD mean _+ SD mean • SD mean • SD Entry A d libitum 176.3 + 33.1 85.8 + 28.4 46.3 _+ 14.0 112.8 • 26.8 Stabilization High-fat 172.5 + 30.3 75.3 • 46.4 44.8 • 11.6 112.6 • 21.9 Intervention Low-fat 173.2 _+27.3 91.5 • 38.0 40.5 • 12.4 114.5 • 21.3 Intervention High-fat 176.9 _+ 32.9 66.4 • 41.7 43.2 + 13.4 119.5 _+24.3 Paired t-test, Pvalues a 0.425 0.002 0.258 0.238 ~lhe t-test compares only the values at the end of the high- or low-fat diets with the values obtained at the end of the stabi- lization period, study day 20. Groups A and B values were taken at study day 70 and day 120, depending on the leg of the intervention diet for the each group; HDL, high density lipoprotein; LDL, low density lipoprotein. Lipids, Vol. 30, no. 11 (19 Nelson GJ, Schmidt PC, Kelley DS. Lipids. 1995 Nov;30(11):969-76
  15. 15. misnomer. The countries around the Mediterranean basin have differe differ in the amount of total fat, olive oil, type of meat andamount of total fat, olivemilk vs. cheese;intake; differ in the wine intake; oil, type of meat and wine frui the rates of coronary heart disease and cancer, with the lower death ra the rates of coronary heart disease and cancer, with the lower death rates andof Greece (the diet e Greece. Extensive studies on the traditional diet longer life be The Greece. Extensive studies on So Special about the ofGreece (the high intake of fruits, vegetables (particularly wildt Mediterranean Diets: What Is the traditional diet ofDiet of Greece? before 1960) indicate Greeks consists of a diet 1 of sourdough bread rather than pasta; more olive oil and olives; less m The Scientific Evidence of Greeks consists of a high intake of fruits, vegetables (particularly wild plants), nuts and cer and moderate amounts of wine, more so than other Mediterranean coun diet of Crete shows a number of protective substances, such as s of sourdough bread rather than pasta; more olive oil and olives; less(EFA), high amounts of fiber, antioxid Artemis P. Simopoulos2 (n-6):(n-3) essential fatty acids milk but more cheese polyphenols from olive oil), vitamins E and C, some of which have been and Center for Genetics, Nutrition and Health, Washington, DCthan othercancer, including cancer ofcountries. Analyses of th The moderate amounts of wine, more so Mediterranean the breast. These findings should serve intervention trials that will test the effect of specific dietary patterns in t diet of Crete shows a diet,” implying that all Mediterranean people with cancer. J. diet, is131:as selenium, glutathione ABSTRACT The term “Mediterranean number of protective substances, sucha 3065S–3073S, 2001. have the same Nutr. (n-6):(n-3) countries around the Mediterranean basin have different diets, religions andWORDS: Their antioxidants (especially resv misnomer. The essential fatty acids (EFA), high amounts of fiber, diets KEY cultures. diet of Crete (n-3) fatty acids c wild plants c a c c differ in the amount of total fat, olive oil, type of meat and wine intake; milk vs. cheese; fruits and vegetables; and polyphenols from olive oil), vitamins E and C, some of which have been shown to be assoc the rates of coronary heart disease and cancer, with the lower death rates and longer life expectancy occurring in The health of thedietary pattern the population in general individual and intake and cancer, including the traditionalvegetables (particularly wild These indicate that the should serve as aa strong incenti of Greeks consists of a high intake of fruits, of the breast. plants),is thefindings Greece. Extensive studies on cancer diet of Greece (the diet before 1960) and cereals mostly in the form genetics and number of diet” is a m nuts result of interactions between intervention trials that will testoil and olives; less of specificofdietarypattern of the an in the prevention but in facb of sourdough bread rather than pasta; more olive the effect milk but environmentalmore fish; less meat; more cheese; factors. Nutrition is major importance (1– patterns environmental factor of and moderate amounts of wine, more so than other Mediterranean countries. Analyses the dietary 4). Our genetic profile has not changed and m surprising Downloaded from jn.nutrition.org by on September 27, 2006 withofcancer. a number of protective substances, such as selenium, glutathione, a balanced ratio energy expenditure and phys- and diets. diet Crete shows J. Nutr. 131: 3065S–3073S, 2001. our food supply and in over the past 10,000 y, whereasofmajor changes have taken place in sin have d (n-6):(n-3) essential fatty acids (EFA), high amounts of fiber, antioxidants (especially resveratrol from wine and ical activity (5–17). Today industrialized societies are charac- polyphenols from olive oil), vitamins E and C, some of which have been shown to be associated with lower risk of Muslims d cancer, including cancer of the breast. These findings should serve as a strong incentivefollowing: 1) an increase in energy intake and terized by the for the initiation of drinks, wh KEY WORDS: diet of Crete (n-3) fatty acids wild plants intervention trials that will test the effect of specific dietary patterns in the prevention and management of patientsan c c c decrease in energy expenditure; 2) c increase in saturated fat, antioxidants canc c eat meat o with cancer. J. Nutr. 131: 3065S–3073S, 2001. (n-6) fatty acids and trans fatty acids and a decrease in (n-3) on. Althou fatty acid intake; 3) a decrease in complex carbohydrates and usually con KEY WORDS: diet of Crete (n-3) fatty acids wild plants antioxidants c cancer c (n-6) fattyin cereal grains and a decrease in fiber intake; 4) an increase acids (14.0 –18.0 The health of the individual and the population infruit andand calcium intakeand 5) a decreasehealth anti- general intake; (5–17). Furthermore, the ratio of intake and in protein, status. Ther c c c c vegetable Crete have oxidantis the the result of of the individual and the betweengeneral intakeisand a numberisof fattythe term 16.74:1, whereas during evolutionThere is n is result of interactions population number of diet” a misnomer. There(n-3) just acidsMediterranean diet The health interactions between genetics and a in genetics and health (n-6) to status. Therefore, not diet” is a misnomer. is “Mediterranean oneFig. 1). 1930 (19). as low a de Nutrition not changed but in fact manyit Mediterranean 1, butwhich not environmental factors. Nutrition is an major importance (1– 4). Our profile has was 2–1:1 (Tableenvironmental factors.genetic environmental an environmental factor of diets (18), the in isfact many Mediterran is factor of Recent investigations of dietary patterns and health United Na was 11.3–1 surprising becausestatus of the countries surrounding the ba- the countries along the Mediterranean Mediterranean basinmajor importancey,(1– 4). Our genetic profile hasdifferentchanged majorandsurprisingthem in both dietary countrie over the past 10,000 whereas major changes have taken sin have not clearly indicate religions, economic differences among because the cultural traditions ;10.6 in 1 place in our food supply and in energy expenditure and phys-over ical activity (5–17). Today industrialized societies are charac- changes have pork or drink wine and other alcoholic the past 10,000 y, whereas major Muslims do not eat taken and diets. Diets are influenced by religious habits, that is, sin have different religions, ec almost thr United Staplacedecrease in energy expenditure; 2) an increase inenergy expenditureWednesdays and Fridays but andwine, and so Diets are influence in our food supply and in saturated fat, eat meat on terized by the following: 1) an increase in energy intake and drinks, whereasand phys- populations usually do not Greek Orthodox drink diets. 1 Presented as part of the 11th Annual Research Conference on Diet, Nutrition and Cancer held in Washington, DC, July 16 –17, 2001. This conference was the traditio tries Studyical activity (5–17). Today industrialized on. Although Greece and the (n-6) fatty acids and trans fatty acids and a decrease in (n-3) societies are charac- Mediterranean countries are fatty acid intake; 3) a decrease in complex carbohydrates and Muslims do not eat pork or d sponsored by the American Institute for Cancer Research and was supported by the California Dried Plum Board, The Campbell Soup Company, General Mills, vascular di usually considered to be areas of medium-high death rates (United Stterized by thean increase in cereal1) an increase in (14.0 –18.0 per 1000 inhabitants), death rates on the island of fiber intake; 4) following: grains and a decrease in energy intake and Lipton, Mead Johnson Nutritionals, Roche Vitamins Inc. and Vitasoy USA. Guest drinks, whereas Greek Orthod editors for this symposium publication were Ritva R. Butrum and Helen A. goslavia, Ja fruit and vegetable intake; and 5) a decrease in protein, anti- Norman, American Institute for Cancer Research, Washington, DC.decrease in energy expenditure; 2)the ratio of 1930 (19). No other area in the Mediterranean basin has had Wednesdays and oxidant and calcium intake (5–17). Furthermore, an increase Cretein saturated fat, continuously since before have been below this level eat meat on 2 To whom correspondence should be addressed. E-mail: cgnh@bellatlantic.net order of 5- the field w(n-6) fatty acidsacids is 16.74:1, whereas during evolution aasdecrease inCrete, according to data compiled by the (n-6) to (n-3) fatty and1). trans fatty acids and low a death rate as (n-3)fatty status of intake; 3)ofathe dietary MediterraneanhealthDIETÉTICA:and © beforeusually IIforand G the patterns and basin United Nationsperin0022-3166/01 $3.00 2001yearbook for 1948. Nutritional Sciences. and th on. Although Greece acid the countries surroundingORDURA it was 2–1:1 (Table 1, Fig. their demographic It Recent investigations decrease in complex was 11.3–13.7 1000 inhabitants American Society considered to be area carbohydrates World War 37% E Tfiber clearly indicate major differences among in cereal grains;10.6 ina decrease Cancer and heart disease in the per 1000 inhabitan intake; 4) an increase them in both dietary almost three times as(19). indeaths proportionally caused DA NERGIA OTALas CONSUMIDA and 1946 –1948 manyfruit and vegetable intake; and 5) a decrease in protein,Greece before 1960.Crete have been below this l United States anti- (14.0 –18.0 in Crete (19). The diet of Crete represents the traditional diet of The Seven Coun- 3065Soxidant and calcium intake (5–17). Furthermore, was theratio establish credible data on cardio- tries Study the first to of 1 Presented as part of the 11th Annual Research Conference on Diet, Nutrition and Cancer held in Washington, DC, July 16 –17, 2001. This conference was sponsored by the American Institute for Cancer Research and was supported by 1930 (19). No other area in th(n-6) to (n-3) fatty acids is 16.74:1, whereas during evolution in contrasting populations vascular disease prevalence rates the California Dried Plum Board, The Campbell Soup Company, General Mills, goslavia, Japan and Greece), with differences low a death rate as Crete, acc as found on the (United States, Finland, The Netherlands, Italy, former Yu- Lipton, Mead Johnson Nutritionals, Roche Vitamins Inc. and Vitasoy USA. Guestit was 2–1:1 (Table 1, Fig. 1). editors for this symposium publication were Ritva R. Butrum and Helen A. United Nations in their demo Norman, American Institute for Cancer Research, Washington, DC. 2 To whom correspondence should be addressed. order of 5- to 10-fold in coronary heart disease (20). In 1958,
  16. 16. DIMINUIÇÃO DA GORDURATOTAL DE 35% PARA 32.3% Burr ML, Fehily AM, Gilbert JF, et al. Lancet 1989; 2:757-761.
  17. 17. dification Trial (CVD) prevention, butand some trials have linked diet needed. Context Multiple epidemiologic studies cation Trial disease diovascular long-term intervention data are with car- Linda Objective To test the hypothesis that a dietary intervention, intended to be low in Context Multiple epidemiologic some trials some trials have linked diet with risk. Context Multiple epidemiologic studies andstudies andhave linked diet with reduce CVD car-Hsia, MD; fat and high in vegetables, fruits, and grains to reduce cancer, wouldcar- . D; diovascular disease (CVD) prevention, but long-term intervention data are needed. are needed. diovascular disease (CVD) prevention, but long-term intervention dataL. ; L. Design, Setting, and Participants Randomized controlled trial of 48 835 post- arcia D Objective To test the that a dietary intervention, intended to be low in Objective To test the hypothesishypothesis that a dietary intervention, intended to be low in menopausal women aged 50 tograins to reduce cancer, would reduce CVD risk. 79 years, of diverse backgrounds and ethnicities, who fat and highand high in vegetables, fruits, and grains to reduce cancer, would reduce CVD risk. s; H. fat in vegetables, fruits, and Lewis H. participated in the Women’s Health Initiative Dietary Modification Trial. Women were Croix, PhDDesign,Design, Setting, and Participants 541 [40%]) or of 48 835trial of 48 835 post- PhD; ; Setting, and Participants Randomized controlled trial an intervention (19 Randomized controlled post- randomly assigned to 50 to 79 years, of diverse backgrounds and ethnicities, whogroup (29 294 comparison L. menopausal women aged orman L. [60%]) menopausal women agedStudy79 years, of diverse backgrounds and ethnicities, who in in the Women’s Health 50 to Dietary Modification Trial. Women 1993 and 1998 in ; , MD; participateda free-living setting.InitiativeenrollmentDietary Modification were Women were participated in the Women’s Health Initiative occurred between Trial. s 40 US clinical centers;intervention (19 541 in this 541 [40%]) orgroup (29 294 group (29 294 randomly assigned to an mean follow-up [40%]) analysis was 8.1 years. or comparison L. Karen L. [60%]) in a free-living setting.to an intervention (19 between 1993 and 1998 in randomly assigned Study enrollment occurred comparisonMD;D; , MD; InterventioninIntensive behavior Study enrollment group and individual sessions de- ysiw . 40 US clinical centers; mean follow-up in this analysis wasin occurred between 1993 and 1998 in [60%]) a free-living setting. modification 8.1 years. inda M. signed to reduce total fat intake tofollow-up calories and increase intakes of vegetables/PhD; 40 US clinical centers; mean 20% of in this analysis was 8.1 years. Intervention Intensive behavior modification in group and individual sessions de-Perri, PhD;fruits toInterventionand grains behavior modification inintakescomparison group received signed to5 servings/d intake to 20% of calories and increase group of vegetables/ sessions de- reduce total fat Intensive to at least 6 servings/d. The and individual D; L. oss diet-related educationgrains to at intake servings/d. The comparison group received of vegetables/ fruits to 5 servings/d and materials. signed to reduce total fat least 6 to 20% of calories and increase intakes bins, G. ; Main Outcome Measures grains to at least 6 servings/d. The comparison group received fruits to 5 servings/d and nda MD diet-related education materials. E. Fatal and nonfatal coronary heart disease (CHD), fatal diet-related education materials. RISCO 0% 5% 10% 15% 20% 25% DAC Total DCV RELATIVO GloriaG. and nonfatal stroke, and CVD and nonfatal coronary heart disease (CHD), fatal Linda E. Main Outcome Measures Fatal (composite of CHD and stroke). PhD;ns, MD; ;Linda G.nonfatal stroke, and CVD (compositeFatal and nonfatal coronary heart disease (CHD), fatal z, PhD and Main Outcome Measures of CHD and stroke). Results By year 6, mean fat intakeintake decreased byenergy intake in the inter- in the inter- Resultsand nonfatal stroke, and CVD (composite of CHD and stroke). intake Stevens, PhD; By year 6, mean fat decreased by 8.2% of 8.2% of energy PH; ; ventionvs the comparison group, with small decreases in saturated (2.9%), monoun- DrPH aurizio vention Results By year 6, mean fatwith small decreases in saturated (2.9%), monoun- vs the comparison group, intake decreased by 8.2% of energy intake in the inter-se R. ,ouise R. DrPH; tolins saturated (3.3%),the comparison group, withincreases occurred :in-intakes of veg-intakes of veg- saturated (3.3%), and polyunsaturated (1.5%) (1.5%) fat; increases occurred in and polyunsaturated fat; small decreases in saturated (2.9%), monoun- TRANS 22% D; vention vs ; Annlouiseetables/fruits (1.1(3.3%), and grains grains (0.5 serving/d). Low-density lipoprotein cholesterol etables/fruits (1.1 servings/d) R. (0.5 serving/d). Low-density lipoprotein cholesterol saturated servings/d) polyunsaturated (1.5%) fat; increases occurred in intakes of veg- and and y R. MD; levels,diastolic blood pressure, and factor VIIc levels were+11% Low-density lipoprotein cholesterolenry R. ord,; levels, diastolic blood pressure, and factor VIIc levels were significantly reduced16% HORTALIÇAS/FRUTA: +30% CEREAIS: significantly reduced by FIBRA: + etables/fruits and 4.29%, respectively; levels of high-density lipoprotein cho- (1.1 servings/d) and grains (0.5 serving/d). 3.55 by 3.55 PhD mg/dL, 0.31 mm Hg, D; ; Henry mg/dL, levels, mm Hg,blood 4.29%, respectively; levels of high-density lipoprotein 3.55 hD R. 0.31 diastolic and pressure, and factor VIIc levels were significantly reduced by cho- lesterol, triglycerides, glucose, and insulin did not significantly differ in the interventionunner, PhDlesterol,mg/dL, 0.31 mm numbers who developed CHD,significantly differ in the intervention ski, MD; ;vs comparison groups. The Hg, and 4.29%, respectively;stroke, of high-density lipoprotein cho- triglycerides, glucose, and insulin did not levels and CVD (annual- ,ette; ; vs comparison groups. 1000glucose, and JAMA.developed CHD, stroke, and CVD (annual- MD MD ized incidence rates) were The (0.63%), et al. insulin didand 1357 (0.86%)differ in the intervention lesterol, triglycerides, numbers who 2006 Feb 8;295(6):655-66 Howard BV, 434 (0.28%), not significantly in the in- hlebowski, ized incidence rates) were 1000 (0.63%), 434 (0.28%),CHD, 1357 (0.86%) in the in-D; MD; tervention and 1549 (0.65%), 642 (0.27%), and 2088 (0.88%) in the comparison group. CVD (annual- vs comparison groups. The numbers who developed and stroke, and ranek, MD; The diet ized no significant effects on incidence of CHD434 (0.28%), and 0.97; 95% had incidence rates) were 1000 (0.63%), (hazard ratio [HR], 1357 (0.86%) in the in-
  18. 18. 50%45% RISCO RELATIVO40% EM MULHERES35% QUE TINHAM DCV30%25% RISCO 0% 5% 10% 15% 20% 25% DAC Total DCV RELATIVO20%15%10%5%0% DAC Total DCV Howard BV, etet al. JAMA. 2006 Feb 8;295(6):655-66 Howard BV, al. JAMA. 2006 Feb 8;295(6):655-66
  19. 19. 80 % Pessoas c/ Sd LDL 60 r = -0.95 P< 0.001 40 20 0% Gordura 0 10 20 30 40 50% CHO 75 65 55 45 35 Krauss RM. J Nutr 2001;131:340s-43s
  20. 20. ÁCIDOS GORDOS SATURADOSUSDA, AHA: < 10% DO TOTAL CALÓRICO Dietary Guidelines for Americans, USDA, 2010
  21. 21. Δ de TC/HDL-C Δ de LDL-C Δ de HDL-CMensink RP, Zock PL, Kester AD, Katan MB. Am J Clin Nutr. 2003 May;77(5):1146-55
  22. 22. larger effect of changes in the amount and quality of dieta and carbohydrates on CAD risk (89), and the possible reaso this were discussed elsewhere (90, 91). Effects of fatty acids and carbohydrates on serum lipid lipoproteins Our results suggest that isoenergetic replacement of SFA carbohydrates does not improve the serum total:HDL chole All natural fats contain both SFAs, which do not change this and unsaturated fatty acids, which lower it. As a result, ev replacement of dairy fat and tropical fats with carbohydrateMensink RP, Zock PL, Kester AD, Katan MB. Am J Clin Nutr. 2003 May;77(5):1146-55 FIGURE 3. Predicted changes (⌬) in the ratio of serum total t
  23. 23. Based on Evolutionary, Historical, Dietary Fat Quality and Coronary HeartGlobal, and Modern ed Theory Disease Prevention: A Unifi PerspectivesChristopher E.on Evolutionary, Historical, Based Ramsden, MD Global, and Modern PerspectivesKeturah R. Faurot, PA, MPHPedro ChristopherFaurot, PA, MPH Carrera-Bastos, MD Keturah R. E. Ramsden, BALoren Pedro Carrera-Bastos, BA Cordain, PhD Loren Cordain, PhDMichel De De Lorgeril, MD, PhD PhD Michel Lorgeril, MD,Laurence S. Sperling, MD Laurence S. Sperling, MD Corresponding authorCorresponding author Christopher E. Ramsden, MD Department of Physical Medicine and Rehabilitation, Program onChristopher E. Ramsden,University of North Carolina–Chapel Hill School Integrative Medicine, MDDepartment Medicine, CB# 7200, Chapel Hill, and Rehabilitation, Program on of of Physical Medicine NC 27599, USA. E-mail: cramsden@med.unc.eduIntegrative Current Treatment Options in Cardiovascular Medicine 2009, 11:289–301Hill School Medicine, University of North Carolina–Chapelof Medicine, CB# 7200, Chapel Hill, NC 27599, USA. Current Medicine Group LLC ISSN 1092-8464 Copyright © 2009 by Current Medicine Group LLCE-mail: cramsden@med.unc.eduCurrent Treatmentstatement in Cardiovascular Medicine 2009, 11:289–301 Opinion OptionsCurrent Medicine and growing body of evidence indicates that dietary fatty acids regulate A large Group LLC ISSN 1092-8464Copyright © 2009 by Current Medicine in the pathogenesis of coronary heart disease crucial metabolic processes involved Group LLC (CHD). Despite this evidence, optimal dietary fatty acid intakes for CHD preven- tion remain unclear. Significant gaps in the modern nutrition literature and contra- dictions in its interpretation have precluded broad consensus. These shortcomingsOpinion statement can be addressed through the incorporation of evolutionary, historical, and global perspectives. The objective of this review is to propose a unified theory of optimal A large and growing bodyCHD evidence indicates that dietary fatty acids regulate dietary fatty acid intake for of prevention that integrates critical insights from evolutionary, historical, global, and modern perspectives. This broad approach may crucial metabolic processesmethods to characterize optimal fatty acid intakes. coronary heart disease be more likely than previous involved in the pathogenesis of (CHD). Despite this evidence, optimal dietary fatty acid intakes for CHD preven- tion remain unclear. Significant gaps in the modern nutrition literature and contra- Introduction dictions Coronaryinterpretation have precluded broad consensus. Thesewith increasing dura- in its heart disease (CHD) incidence and mor- resident inhabitants, especially shortcomings can be addressed through the incorporation tion of residence [5–7]. tality reflect complex interactions between genetic of evolutionary, historical, and global susceptibilities and environmental factors. Although For instance, CHD is historically far more common in perspectives. CHD susceptibility genesthis review is to the United States unified theory of men of Japa- several The objective of have been identified propose a than in Japan [4]. Among optimal dietary fattyrather lines genetics is the main driver environ- nese ancestry,highestriskCaliforniain[8,9]. These differences ment acid intake for CHD prevention Hawaii,integrates is lowest Japan, intermediate in [1], several than of evidence indicate that of CHD that and CHD in critical insights from evolutionary, historical, global,CHD incidence and appear to reflect This broad of traditional Japanese risk [2]. Globally, age-adjusted and modern perspectives. the replacement approach may be moremortality vary as previous factors arepopulations cultural traditions with Western acid [8]. Indeed, Japa- likely than much as 10-fold across sensitive to nese Americans who maintained habits intakes. and [3,4]. CHD incidence and risk methods to characterize optimal fatty traditional customs lifestyle changes. When immigrants from traditionally habits had a CHD risk similar to that of their counterparts low-risk regions adopt the habits of high-risk popula- residing in Japan, whereas those who adopted Western cul- tions, their CHD incidence rises to approach that of ture had a three- to fivefold excess in CHD prevalence [8]. Introduction
  24. 24. CHINA RURAL: < 5% EUA: 11-12% CRS: 4-18%KITAVA: 17% MAASAI: 30-35% TOKELAU: 40%
  25. 25.      A meta-analysis of prospective epidemiologicstudies showed that there is no significantevidence for concluding that dietarysaturated fat is associated with anincreased risk of CHD or CVD      
  26. 26. AUMENTO DO RÁCIO PUFA/SAFA EM 100% DIMINUIÇÃO DA GORDURA TOTAL DE 35% PARA 32.3% Burr ML, Fehily AM, Gilbert JF, et al. Lancet 1989; 2:757-761.
  27. 27. Orange Juice on Inflammation, EndotoC l li in i icca l l C a rree//EEd uucca t t i o n / N u t r i t oo Expression e of cToll-Like ReceptC n a Ca d a andu the nn / P s y c h o s o c aa l R R s s e a r h h ion/N tritii /Psychosoci i l e ear c O R I I G I I N A LL O R G N A and Suppressor of Cytokine Signaling- A R TT I I CC L L EE A R RUPALI DEOPURKAR, PHD PRIYA MOHANTY, MD vital to the protection froDifferential Effects of Cream, Glucose, andDifferential Effects of Cream, Glucose, andHUSAM GHANIM, PHD JAY FRIEDMAN, PHD PRABHAKAR VISWANATHAN, PHD AJAY CHAUDHURI, MD ins and immunological commensal and pathoOrange Juice on Inflammation, Endotoxin,Orange Juice on Inflammation, Endotoxin, SANAA ABUAYSHEH, BSC PARESH DANDONA, MD, PHD bacteria. CHANG LING SIA, BSC In this context, we w which macronutrient waand the Expression of Toll-Like Receptor-4and the Expression of Toll-Like Receptor-4 the induction of oxidati OBJECTIVE — We have recently shown that a high-fat high-carbohydrate (HFHC) meal flammation, on the one hand Suppressor of Cytokine Signaling-3and Suppressor of Cytokine Signaling-3 induces an increase in plasma concentrations of endotoxin (lipopolysaccharide [LPS]) and the crease in LPS concent expression of Toll-like receptor-4 (TLR-4) and suppresser of cytokine signaling-3 (SOCS3) in mononuclear cells (MNCs) in addition to oxidative stress and cellular inflammation. Saturated expression of TLR-4 and fat and carbohydrates, components of the HFHC meal, known to induce oxidative stress and tokine signaling (SOCS)RUPALI DEOPURKAR, ,PHD RUPALI DEOPURKAR PHD PPRIYA induce an , MD in LPS, TLR-4, and SOCS3. toto the protection from To elucidate this, we inv inflammation, alsoMOHANTYMD RIYA MOHANTY, increase vital the protection from bacterial tox- vital bacterial tox-HUSAM GHANIM, ,PHD HUSAM GHANIM PHD PPRABHAKAR VISWANATHANPHD RABHAKAR VISWANATHAN, , PHD ins and immunological responses glucose, fect ofto the the most ins and immunological responses to theJJAYFRIEDMAN, ,PHD AY FRIEDMAN PHD RESEARCH DESIGN AND METHODS — Fasting normal subjects were given 300- hydrate, cream, a sat AAJAY CHAUDHURIMD JAY CHAUDHURI, , MD commensal and pathogenic intestinal commensal and pathogenic intestinalSANAA ABUAYSHEH, ,BSC SANAA ABUAYSHEH BSC calorie drinks of either glucose, saturated fat as cream, orange juice, or only water to ingest. Blood orange juice, a carbohy PPARESH DANDONAMD, PHD ARESH DANDONA, , MD, PHD bacteria.CHANG LING SSIA,BSC bacteria. food product, which do CHANG LING IA, BSC samples were obtained at 0, 1, 3, and 5 h for analysis. InIn this context, we wanted to analyzestress or in this context, we wanted to analyze ther oxidative which macronutrient was responsible for is a protein RESULTS — Indexes of inflammation including nuclear factor-␬B (NF-␬B) binding, andwas responsible for which macronutrient the SOCS3 the induction ofof in MNCs, stress and in- expression of SOCS3, tumor necrosis factor-␣ (TNF-␣), and interleukin (IL)-1␤ oxidative the induction oxidative stress and in- shown to interfere with iOBJECTIVE — We have recently shown thatsignificantly high-carbohydrate (HFHC) meal TLR-4 expressionon the one LPS signal transduction (2– OBJECTIVE — We have recently shown thata ahigh-fat after glucose and cream intake, but flammation, and plasma hand, and the in- increased high-fat high-carbohydrate (HFHC) meal flammation, on the one hand, and the in-induces an increase in plasma concentrations of endotoxin (lipopolysaccharide intake. The intake of orangein LPS water did not work has shown that SO concentrations increased only after cream [LPS]) and the induces an increase in plasma concentrations of endotoxin (lipopolysaccharide [LPS]) and the crease juice LPS concentrations and theexpression of Toll-like receptor-4 (TLR-4) andany change inof cytokineindexes measured. crease in or concentrations and the induce suppresser of of the signaling-3 (SOCS3) in expression of Toll-like receptor-4 (TLR-4) and suppresser anycytokine signaling-3 (SOCS3) in expression of TLR-4 and suppresser of cy-mononuclear cells (MNCs) in addition to oxidative stress and cellular inflammation. Saturated expression of TLR-4 and suppressercirculating mo mononuclear cells (MNCs) in addition to oxidative stress and cellular inflammation. Saturated tokine signaling (SOCS)-3 on the other. obese hu in the of cy- (MNCs) of thefat and carbohydrates, components of the HFHC meal, known toto induce oxidative stress and tokine signalingand an in- on the other. fat and carbohydrates, components of CONCLUSIONSknown induce oxidative stress and induce NF-␬B binding (SOCS)-3 increased when compar the HFHC meal, — Although both glucose and cream To elucidate this, we investigated the ef- inflammation, also induce an increase in LPS, the expression of SOCS3, TNF-␣, and IL-1␤ in MNCs, onlyelucidate this, increase normalthe ef-inflammation, also induce an increase in LPS, inTLR-4, and SOCS3. crease TLR-4, and SOCS3. To cream caused an we investigated subjects fectorange juice or watermost important carbo- (6). I in LPS concentration and TLR-4 expression. Equicaloric amounts of ofof glucose, the did not work carbo- fect glucose, the most important demonstrated that hydrate, cream, a a saturated fat, and hydrate, cream, saturated fat, andRESEARCH DESIGN AND METHODS — Fasting normal subjects were given 300-are relevant to the pathogenesis of sion in MNCs is inverse induce a change in any of these indexes. These changes RESEARCH DESIGN AND METHODS — Fasting normal subjects were given 300- orange juice, a carbohydrate-containingcalorie drinks of either glucose, saturatedatherosclerosisorange juice,resistance. water to ingest. Blood orange juice, a carbohydrate-containing fat as cream, and insulin or only water to ingest. Blood calorie drinks of either glucose, saturated fat as cream, orange juice, or only tyrosine phosphorylatiosamples were obtained at 0, 1, 3, and 55 h for analysis. samples were obtained at 0, 1, 3, and h for analysis. food product, which does not induce and directly rel product, which does receptor ei- foodCare 33:991–997, 2010 not induce ei- Diabetes ther oxidative stress oror inflammation. ther oxidative stress inflammation.insulin resistance (home O SOCS3 is is a protein that has beenRESULTS — Indexes of inflammation including nuclear factor-␬Bshown thatbinding, and the because the content of LPS sessment of a protein that has been insulin res ur recent work has (NF-␬B) binding, and the shown to interfere with insulin and leptin RESULTS — Indexes of inflammation including nuclear factor-␬B (NF-␬B) a great interest SOCS3expression of SOCS3, tumor necrosis factor-␣ (TNF-␣), and interleukin (IL)-1␤ ininthese meals is not to interfere with insulin and leptin MNCs, IR]), consistent with expression of SOCS3, tumor necrosis factor-␣ (TNF-␣), and interleukin (IL)-1␤ in MNCs, shown significantly differ- high-fat high-cholesterol (HFHC)increased significantly after glucose and cream intake, but TLR-4 expression and plasma LPS signal transduction (2–5). Our recent of insulin r increased significantly after glucose and cream intake, butoxidative and inflam- plasma LPS signal transduction (2–5). Our recent pathogenesis meal induces TLR-4 expression and ent, and, thus, it would appear that theconcentrations increased only after cream intake. The intake ofof orange juice or water did not work has shown that SOCS3 resistance in human obe concentrations increased only after cream intake. The intake orange juice oran inflammatory work has shownmay lead water did not expression matory stress in addition to inducing nature of the meal that SOCS3 expressioninduce any change in any of the indexes measured. inability of leptin to ca
  28. 28. (R01-D Differential Effects of Cream, Gluco the Am Orange Juice on Inflammation,The da End and we and the Expression of Toll-Likepretatio Rec and Suppressor of Cytokine Signal investig vestiga RUPALI DEOPURKAR, PHD PRIYA MOHANTY, MD vitalfor the to the pro HUSAM GHANIM, PHD PRABHAKAR VISWANATHAN, PHD ins and immu JAY FRIEDMAN, PHD AJAY CHAUDHURI, MD commensal p No a SANAA ABUAYSHEH, BSC PARESH DANDONA, MD, PHD bacteria. art this CHANG LING SIA, BSC In this con Nata which macron the induction OBJECTIVE — We have recently shown that a high-fat high-carbohydrate (HFHC) meal flammation, on induces an increase in plasma concentrations of endotoxin (lipopolysaccharide [LPS]) and the Referen crease in LPS expressionGh 1. of T expression of Toll-like receptor-4 (TLR-4) and suppresser of cytokine signaling-3 (SOCS3) in mononuclear cells (MNCs) in addition to oxidative stress and cellular inflammation. Saturated fat and carbohydrates, components of the HFHC meal, known to induce oxidative stress and tokine signalin nie inflammation, also induce an increase in LPS, TLR-4, and SOCS3. To elucidate th JM fect of glucose, RESEARCH DESIGN AND METHODS — Fasting normal subjects were given 300- tox hydrate, crea calorie drinks of either glucose, saturated fat as cream, orange juice, or only water to ingest. Blood orange juice, samples were obtained at 0, 1, 3, and 5 h for analysis. Sumo de of food product, Laranja cyt ther oxidative RESULTS — Indexes of inflammation including nuclear factor-␬B (NF-␬B) binding, and the SOCS3 is expression of SOCS3, tumor necrosis factor-␣ (TNF-␣), and interleukin (IL)-1␤ in MNCs, fol shown to inter increased significantly after glucose and cream intake, but TLR-4 expression and plasma LPS me signal transdu concentrations increased only after cream intake. The intake of orange juice or water did not work has show induce any change in any of the indexes measured. Dia in the circul (MNCs) ofRu 2. the CONCLUSIONS — Although both glucose and cream induce NF-␬B binding and an in- increased whe crease in the expression of SOCS3, TNF-␣, and IL-1␤ in MNCs, only cream caused an increase normal subje Wh in LPS concentration and TLR-4 expression. Equicaloric amounts of orange juice or water did not work demonstsul induce a change in any of these indexes. These changes are relevant to the pathogenesis of sion in MNCs atherosclerosis and insulin resistance. degFigure 3—Change in NF␬B binding activity in MNC (A) and plasma endotoxin concentrations tyrosine phosp Diabetes Care juice (OJ, ‚), Ch receptor and d(B) in normal subjects after a 300-calorie drink of cream (E), glucose (Œ), orange 33:991–997, 2010 3. Sen insulin resistan and ؉, P Ͻ 0.05 with a great interest because the content of LPSor water (F). Data are means Ϯ SEM. *ur recent work has shown thatRMANOVA comparing changes in sessment of in TA IR]), consisterelation to baseline after cream and glucose challenges; # andin $, P meals 0.05 significantly differ- high-fat high-cholesterol (HFHC) these Ͻ is not with two-way
  29. 29. LIGANDOS DOS TLRS
  30. 30. LPS •  Citoquinas •  Enzimas •  Moléculas de adesão TLR IkB Cinase P

×