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Ⅰ Ⅱ INTRODUCTION Ⅲ Ⅳ RISK FACTORS 1. Lifestyle 2. Nutrition 3. Fat intake, obesity 4. Fat intake and plasma lipids ①  Dietary cholesterol ②Saturated fatty acids   ③ Unsaturated fatty acids ④ α-Linolenic acid    ⑤ Eicosapentaenoic and docosahexaenoic acid    ⑥ Trans unsaturated fatty acids  5. Dietary fat and atherosclerotic vascular disease CONTENTS CONCLUSION ◊  Practical aspects of dietary recommendations   ◊ Perspectives for public health  Functional food for CHD
INTRODUCTION Mortality rate per 100,000 population (men aged 35-74 years) Mortality from CVD and CHD in  Selected Countries
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],RISK&PREVENTION FACTORS
Lifestyle lower the mean cholesterol level Atherosclerosis   modifiable risk factors such as   lifestyle and nutritional behavior the extent of atherosclerosis plasma cholesterol CHD    In high risk populations such as Finland or Scotland    the rate of myocardial infarction is more than one order of   magnitude  higher than in low risk areas like China or Japan RISK FACTORS
Nutrition fat intake, specifically saturated fat,  mean total cholesterol levels , rates of CHD mortality Effect of fat consumption on cholcoronary risk . Association between intake of saturated fat, mean plasma esterol concentrations, and rates of fatal myocardial infarctions in various populations. Figure RISK FACTORS
Nutrition ,[object Object],[object Object],[object Object],RISK FACTORS Figure Effect of changes of lifestyle and nutrition on  causes of death.  Mortality from colon cancer and coronary heart disease (CHD) in Japanese migrants to the USA
Fat intake & obesity RISK FACTORS Fat & Body Mass Index ,[object Object],[object Object],[object Object],[object Object],Above 22 kg/m2 each BMI unit     4–5% higher mortality from coronary heart disease The body mass index may not be the most reliable parameter. But
Fat intake & obesity Effect of weight loss on common causes of death. Reduction of total mortality, cancer, coronary heart    disease (CHD), and diabetes-associated mortality by intentional weight loss of 0.5–9 kg in non-smoking women with preexisting obesity related health conditions like diabetes or hypertension observed over 12 years RISK FACTORS Figure HDL cholesterol Cholesterol  triglyceride levels  Obesity Fat & Body Mass Index
But ,[object Object],[object Object],Fat intake & Plasma lipids Fatty acid composition ,[object Object],[object Object],[object Object],[object Object],1 RISK FACTORS Dietary cholesterol Reduction of dietary cholesterol  200 mg/day     drop of total cholesterol by 5 mg/dl (0.1 mmol/l) Cholesterol  in the diet ▽    cholestreol synthesized    by the liver ▽ plasma cholesterol ▽
Fat intake & Plasma lipids ,[object Object],[object Object],[object Object],[object Object],Main mechanisms RISK FACTORS 2 Down –Regulation  hepatic LDL receptor Up-Regulation in cholesterol synthesis LDL cholesterol raising effect of saturated fatty acids Saturated fatty acids
Fat intake & Plasma lipids dietary  saturated fat    For the general population a reduction of total fat to less than 30% and saturated fat to less than 10% of calories is recommended. An intake of about 50% carbohydrates or more of total energy is suggested Facts and goals of diet. Macronutrient intake in Germany, Asia, and in a dietary intervention trial compared to the current German recommendations  RISK FACTORS Figure ,[object Object],[object Object],[object Object],2 Saturated fatty acids
Fat intake & Plasma lipids ,[object Object],[object Object],[object Object],[object Object],plasma    cholesterol level ,[object Object],[object Object],But increasing the consumption of unsaturated fats to  lower cholesterol    yield surplus caloric intake RISK FACTORS Unsaturated fatty acids 3
Fat intake & Plasma lipids ,[object Object],[object Object],[object Object],[object Object],Patients  with  myocardial infarction       surprising 70% reduction of coronary events and mortality RISK FACTORS α - Linolenic acid 4 Increased intake of α-linolenic acid within a mediterranean diet
Fat intake & Plasma lipids Japan Greenland Eskimos The  high   consumption of fish  a major source of  eicosapentaenoic acid (EPA) and   docosahexaenoic acid (DHA) Omega-3 fatty acids lower coronary risk Their diet is rich in fat and cholesterol  however contains  a larger proportion of n-3 fatty acids  from seal and whale  The supplementation of 1 g of EPA and DHA    reduction of fatal and non-fatal cardiac events between   10 and 30% RISK FACTORS Eicosapentaenoic and docosahexaenoic acid 5
Fat intake & Plasma lipids ,[object Object],[object Object],[object Object],Intakes of trans fatty acids range ◊  the traditional Japanese diet  : 0 g/day ◊  the United States : 12 g/day ◊  Germany : some 3–4 g/day RISK FACTORS Trans unsaturated fatty acids 6
Dietary fats like spread, fats for cooking and baking or fat contained in foods  should be low in both saturated fat and trans fatty acids. Fat intake & Plasma lipids ,[object Object],RISK FACTORS Figure Trans unsaturated fatty acids 6
Dietary fat  In the Lifestyle Heart Trial rigorous lipid-lowering vegetarian diet    Total fat intake : reduced from 31.5 to 6.8% of dietary energy     The P/S-ratio >1     The amount of dietary cholesterol    : reduced from 213 to 12.4 mg per day     The intake of complex carbohydrates   : raised to more than 70% of dietary energy    Lost 10.9 kg     LDL cholesterol levels decreased by 40% to about 100 mg/dl (2.6 mmol/l)    significant changes in coronary angiograms were detectable RISK FACTORS
Dietary fat  The Framingham study vegetarian diet    reduced plasma cholesterol to levels of 125–135 mg/dl   (3.2–3.5 mmol/l) Relationship Between Cholesterol and CHD Risk vegetarian diet     weight lost     reduction of hypertension     reversal of insulin resistance RISK FACTORS Figure 0 25 50 75 100 125 150 <204 205-234 235-264 265-294 >295 CHD incidence per 1000 Serum cholesterol (mg/100 mL)
Dietary fat  The St. Thomas Atherosclerosis Regression Study (STARS) Lipid-lowering diet / Lipid-lowering diet + cholestyramine    Total fat intake : reduced to 27% of dietary energy      saturated fatty acid :reduced to 8–10%     polyunsaturated fatty acids :increased to 8% Effect of fatty acids on coronary  atherosclerosis. ,[object Object],[object Object],RISK FACTORS Figure
[object Object],But without careful and regular counseling  not accepted for a long time and leads to disappointing results ,[object Object],[object Object],CONCLUSION Practical aspect s of dietary recommendations
[object Object],[object Object],[object Object],Dietary changes over the past centuries  decrease in mean serum cholesterol levels ◊  preference for unsaturated vegetable   oils  ◊  have a major impact on the decline   of  mortality rates of CHD CONCLUSION Perspectives for public health
General dietary recommendations.  Dietary advice for the prevention of atherosclerotic disease for  a healthy population free from specific metabolic diseases as derived from the experience of international observational studies and intervention trials. CONCLUSION Figure Perspectives for public health

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Dietary Fat Intake and Cardiovascular Risk Factors

  • 1. Ⅰ Ⅱ INTRODUCTION Ⅲ Ⅳ RISK FACTORS 1. Lifestyle 2. Nutrition 3. Fat intake, obesity 4. Fat intake and plasma lipids ① Dietary cholesterol ②Saturated fatty acids ③ Unsaturated fatty acids ④ α-Linolenic acid ⑤ Eicosapentaenoic and docosahexaenoic acid ⑥ Trans unsaturated fatty acids 5. Dietary fat and atherosclerotic vascular disease CONTENTS CONCLUSION ◊ Practical aspects of dietary recommendations ◊ Perspectives for public health Functional food for CHD
  • 2. INTRODUCTION Mortality rate per 100,000 population (men aged 35-74 years) Mortality from CVD and CHD in Selected Countries
  • 3.
  • 4. Lifestyle lower the mean cholesterol level Atherosclerosis modifiable risk factors such as lifestyle and nutritional behavior the extent of atherosclerosis plasma cholesterol CHD  In high risk populations such as Finland or Scotland the rate of myocardial infarction is more than one order of magnitude higher than in low risk areas like China or Japan RISK FACTORS
  • 5. Nutrition fat intake, specifically saturated fat, mean total cholesterol levels , rates of CHD mortality Effect of fat consumption on cholcoronary risk . Association between intake of saturated fat, mean plasma esterol concentrations, and rates of fatal myocardial infarctions in various populations. Figure RISK FACTORS
  • 6.
  • 7.
  • 8. Fat intake & obesity Effect of weight loss on common causes of death. Reduction of total mortality, cancer, coronary heart  disease (CHD), and diabetes-associated mortality by intentional weight loss of 0.5–9 kg in non-smoking women with preexisting obesity related health conditions like diabetes or hypertension observed over 12 years RISK FACTORS Figure HDL cholesterol Cholesterol triglyceride levels Obesity Fat & Body Mass Index
  • 9.
  • 10.
  • 11.
  • 12.
  • 13.
  • 14. Fat intake & Plasma lipids Japan Greenland Eskimos The high consumption of fish a major source of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) Omega-3 fatty acids lower coronary risk Their diet is rich in fat and cholesterol however contains a larger proportion of n-3 fatty acids from seal and whale The supplementation of 1 g of EPA and DHA  reduction of fatal and non-fatal cardiac events between 10 and 30% RISK FACTORS Eicosapentaenoic and docosahexaenoic acid 5
  • 15.
  • 16.
  • 17. Dietary fat In the Lifestyle Heart Trial rigorous lipid-lowering vegetarian diet  Total fat intake : reduced from 31.5 to 6.8% of dietary energy  The P/S-ratio >1  The amount of dietary cholesterol : reduced from 213 to 12.4 mg per day  The intake of complex carbohydrates : raised to more than 70% of dietary energy  Lost 10.9 kg  LDL cholesterol levels decreased by 40% to about 100 mg/dl (2.6 mmol/l)  significant changes in coronary angiograms were detectable RISK FACTORS
  • 18. Dietary fat The Framingham study vegetarian diet  reduced plasma cholesterol to levels of 125–135 mg/dl (3.2–3.5 mmol/l) Relationship Between Cholesterol and CHD Risk vegetarian diet  weight lost  reduction of hypertension  reversal of insulin resistance RISK FACTORS Figure 0 25 50 75 100 125 150 <204 205-234 235-264 265-294 >295 CHD incidence per 1000 Serum cholesterol (mg/100 mL)
  • 19.
  • 20.
  • 21.
  • 22. General dietary recommendations. Dietary advice for the prevention of atherosclerotic disease for a healthy population free from specific metabolic diseases as derived from the experience of international observational studies and intervention trials. CONCLUSION Figure Perspectives for public health