Τροφοφάρμακα: O ρόλος τους στη ρύθμιση των δυσλιπιδαιμιών σύμφωνα με τις νεότερες ελληνικές κατευθυντήριες οδηγίες
•Download as PPT, PDF•
1 like•552 views
Στα πλαίσια του 12ου ετήσιου Κλινικού Φροντιστηρίου της Εταιρείας Μελέτης Παραγόντων Κινδύνου για Αγγειακά Νοσήματα (ΕΜΠΑΚΑΝ) -που πραγματοποιήθηκε στην Καλαμπάκα από τις 24 έως τις 26 Φεβρουαρίου 2017, η Κλινική Διαιτολόγος-Διατροφολόγος Ιωάννα Κατσαρόλη, πραγματοποίησε ομιλία για το πως μεμονωμένοι διατροφικοί παράγοντες δρουν επικουρικά, αλλά και συνεργιστικά της φαρμακοθεραπείας για τη ρύθμιση των δυσλιπιδαιμιών.
Recommended
Recommended
More Related Content
What's hot
What's hot (19)
Viewers also liked
Viewers also liked (20)
Similar to Τροφοφάρμακα: O ρόλος τους στη ρύθμιση των δυσλιπιδαιμιών σύμφωνα με τις νεότερες ελληνικές κατευθυντήριες οδηγίες
Similar to Τροφοφάρμακα: O ρόλος τους στη ρύθμιση των δυσλιπιδαιμιών σύμφωνα με τις νεότερες ελληνικές κατευθυντήριες οδηγίες (20)
More from medNutrition
More from medNutrition (9)
Τροφοφάρμακα: O ρόλος τους στη ρύθμιση των δυσλιπιδαιμιών σύμφωνα με τις νεότερες ελληνικές κατευθυντήριες οδηγίες
- 1. Τροφοφάρμακα: O ρόλος τους στη ρύθμιση των δυσλιπιδαιμιών σύμφωνα με τις νεότερες Ελληνικές κατευθυντήριες οδηγίες. Ιωάννα Κατσαρόλη Κλινική Διαιτολόγος – Αθλητική Διατροφολόγος, MSc Μέλος Επιστημονικής Ομάδας Ειδικών Αθλητικής Διατροφής ΠΣΔΔ Επιστημονική Συνεργάτης MedNutrition.gr
- 2. Global Health Observatory (GHO) data, World Health Organization, 2017 Υπεριλιπιδαιμία & Καρδιαγγειακός Κίνδυνος
- 3. Σε μεγάλο βαθμό μπορεί να προληφθεί με διαχείριση του τρόπου ζωής και ιατρική παρέμβαση. Είναι αδιαμφισβήτητο ότι διατροφικοί παράγοντες μπορούν να επηρεάσουν την αθηρογένεση άμεσα ή έμμεσα επιδρώντας σε παράγοντες κινδύνου όπως είναι τα λιπίδια, η αρτηριακή πίεση και η γλυκόζη αίματος. 2016, ESC/EAS Guidelines for the Management of Dyslipidaemias; Vazquez-Benitez, G. et al, Diabetes Care 38, 905–912 (2015 Συμπεριφορικοί Παράγοντες & Καρδιαγγειακός Κίνδυνος
- 4. National Cholesterol Education Program (NECP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, 2002; AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, 2014; MiguelÁ.Martínez-González, Progress in Cardiovascular dieases, 2015 National Cholesterol Education Program Therapeutic Lifestyle Changes’ (TLC) Διαλυτές Ίνες: 5-10 γραμ./ημέρα Φυτικές Στερόλες: 2 γραμ/ημέρα Ω-3 λιπαρά οξέα Καμία αναφορά σε άλλα διατροφικά συμπληρώματα ή λειτουργικά τρόφιμα American Heart Association/American College of Cardiology Lifestyle Management Διατροφικά Πρότυπα π.χ. Μεσογειακή Διατροφή Δεν συμπεριλαμβάνονται συστάσεις για συμπληρώματα διατροφής European Society of Cardiology –European Atherosclerosis Society DASH – Μεσογειακή Διατροφή Τροφοφαρμακα Διαλυτές Ίνες, Φυτικές Στερόλες, Ω-3 Μαγιά κόκκινου ρυζιού, Πρωτεΐνη Σόγιας, Πολικοσανόλη, Βερβερίνη Υγιεινοδιαιτητική Παρέμβαση
- 5. Ekta K. Kalra1, AAPS PharmSci 2003; Ciccero et al. IJC Metabolic& Endocrine. 2015; Department of Health & Human Services, US Food & Drug Administration. What is a dietary supplement? http://www.fda.gov/AboutFDA/Transparency/Basics/ ucm195635.htm (2015 Τα θρεπτικά συστατικά που περιλαμβάνονται φυσικά σε τρόφιμα επηρεάζουν σημαντικά την ομοιόσταση του οργανισμού. Σε μεγαλύτερες δόσεις μπορούν να έχουν ειδικές ενεργές δράσεις. Τα τροφοφάρμακα (nutraceuticals) αναφέρονται σε θρεπτικά συστατικά που όταν χορηγούνται σε συγκεκριμένες δόσεις έχουν φαρμακολογικές ιδιότητες και παρέχουν δομικό, φυσιολογικό ή λειτουργικό όφελος για την υγεία. Τροφή + Φάρμακο = Τροφοφάρμακο Stephen DeFelice, MD, founder and chairman of the Foundation for Innovation in Medicine (FIM), Cranford, NJ, 1989 Φάρμακο η τροφή σου
- 6. Dickinson, A., Blatman, J., El-Dash, N. & Franco, J. C. Consumer usage and reasons for using dietary supplements: report of a series of surveys. J. Am. Coll. Nutr. 33, 176–182 (2014). Η χρήση τους είναι ιδιαίτερα δημοφιλής. Περιορισμένες κλινικές οδηγίες για τη χρήση ασφαλών και δραστικών συμπληρωμάτων Επικουρικά της φαρμακοθεραπείας -δυνητικά θα μπορούσαν να μειώσουν τη δόση του φαρμάκου. Λίγες μελέτες μακράς διάρκειας - clinical end points: mortality/cardiac events. Τροφοφάρμακα
- 7. ΑποδεδειγμένηΑποδεδειγμένη ΔράσηΔράση ΠεριορισμένηΠεριορισμένη ΔράσηΔράση Αμφιλεγόμενη ΔράσηΑμφιλεγόμενη Δράση Φυτικές Στερόλες Φύκι Πολικοσανόλη Ω-3 λιπαρά οξέα Βερβερίνη Ρεσβρατρόλη Μαγιά κόκκινου ρυζιού Σκόρδο Guggulsterone (Commiphora wightii) Πρωτεΐνη Σόγιας Κράταιγος Πράσινο Τσάι Προβιοτικά Paola M. Hunter and Robert A. Hegele. Functional foods and dietary supplements for the management of dyslipidaemia. NATURE REVIEWS | ENDOCRINOLOGY. 2017 Τροφοφάρμακα και Υπεριλιπαιδαιμίες
- 8. Υπολιπιδαιμική Δράση ↓ T.Chol & LDLc × HDLc & TG × Έμφραγμα Μυοκαρδίου και Θνησιμότητα Διάρκεια <12 εβδ. Συνιστώμενη Ημερήσια Δόση 10 γραμμάρια 3-5 %↓ LDLc Πηγές: Ψύλλιο, Κριθάρι, Βρώμη Tchol: -0.20 mmol/L, 95% CI -0.34 to -0.06 LDLc :-0.14 mmol/L, 95% CI -0.22 to -0.06 TG: 0.00 mmol/L, 95% CI -0.04 to 0.05 Hartley, L., May, M. D., Loveman, E., Colquitt, J. L. & Rees, K. Dietary fibre for the primary prevention of cardiovascular disease. Cochrane Database Syst. Rev. http://dx.doi.org/10.1002/14651858.CD011472. pub2 (2016). Διαλυτές Φυτικές Ίνες
- 9. Υπολιπιδαιμική Δράση ↓ TChol & LDLc × HDLc & TG × Έμφραγμα Μυοκαρδίου και Θνησιμότητα Συνιστώμενη Ημερήσια Δόση 2-3 γραμμάρια 5-15 %↓ LDLc Πρόσθετη ↓ 5–10% σε συγχορήγηση με στατίνες Ανεπιθύμητη Δράση ↓ καροτενοειδών και λιποδιαλυτών βιταμινών Να αποφεύγονται Σε ασθενείς με σιτοστερολαιμία, ελάττωμα στον μεταφορέα ABCG5–ABCG8 Πηγές: Εμπλουτισμένα τρόφιμα Paola M. Hunter and Robert A. Hegele. Functional foods and dietary supplements for the management of dyslipidaemia. NATURE REVIEWS | ENDOCRINOLOGY. 2017 Φυτικές Στερόλες
- 10. Δοσο-εξαρτώμενη σχέση;Δοσο-εξαρτώμενη σχέση; Ελαφρά αυξημένη συγκέντρωση φυτικών στερολών στο πλάσμα δεν σχετίζεται με αύξηση στον CVD risk. Όχι πρόσθετο όφελος σε δόσεις μεγαλύτερες των 3 γραμμαρίων/ημέρα Πρακτικά ζητήματα: εμπλουτισμός, κόστος, συμμόρφωση καταναλωτών Είδος εμπλουτισμένου τροφίμου;Είδος εμπλουτισμένου τροφίμου; Φυτικές στερόλες σε υγρά τρόφιμα ίσως είναι λιγότερο αποτελεσματικές (εν. στερεών τροφίμων): Ταχύτερη διέλευση Κατανάλωση φαγητού (π.χ. λίπους) για την έκκριση χολής Rouyanne T. Ras. LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis of randomised controlled studies. British Journal of Nutrition (2014), 112, 214–219 Φυτικές Στερόλες
- 11. 1. Σε άτομα με αυξημένη χοληστερόλη σε ενδιάμεσο ή χαμηλό CVD risk που δεν εντάσσονται σε φαρμακοθεραπεία. 2. Επικουρικά στη φαρμακοθεραπεία σε ασθενείς με υψηλό και πολύ υψηλό κίνδυνο που δεν επιτυγχάνουν τον στόχο της LDL ή έχουν δυσανοχή στις στατίνες. 3. Σε ενήλικες και παιδιά >6 ετών με Οικογενή Υπερχοληστερολαιμία. AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, 2014; MiguelÁ.Martínez-González, Progress in Cardiovascular dieases, 2015 Φυτικές Στερόλες
- 12. Υπολιπιδαιμική Δράση ↓ T.Chol Μικρή ↑ LDL (Fish oil) × CVD συμβάματα Συνιστώμενη Ημερήσια Δόση 2-4 γραμμάρια Πηγές: Ψάρια, Krill oil (↑ EPA:DHA; Μεγαλύτερη βιοδιαθεσιμότητα) Ανεπιθύμητες Ενέργειες Γαστρεντερικές Διαταραχές Μεγαλύτερη επιρρέπεια σε αιμορραγίες (αντιθρομβωτική δράση) ιδιαίτερα μαζί με aspirin/clopidogrel. 2 μερίδες λιπαρών ψαριών/εβδομάδα ή συμπληρωματική χορήγηση ω3 American Heart Association AHA AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, 2014; Paola M. Hunter and Robert A. Hegele. Functional foods and dietary supplements for the management of dyslipidaemia. NATURE REVIEWS | ENDOCRINOLOGY. 2017 Ω-3 λιπαρά οξέα (EPA, DHA)
- 13. AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, 2014; Paola M. Hunter and Robert A. Hegele. Functional foods and dietary supplements for the management of dyslipidaemia. NATURE REVIEWS | ENDOCRINOLOGY. 2017 Ω-3 λιπαρά οξέα
- 14. ≥ 4 γραμ./ημέρα ω-3 PUFA (ψάρια και EPA/DHA- εμπλουτισμένα τρόφιμα 9-26 % 1–5 γραμ./ημέρα EPA/DHA συμπλήρωμα 4-51 % DHA ↑ LDL 4.63 mg/dL (95% CI, 2.15–7.10) περισσότερο από EPA Υπερλιπιαδαιμίες Άτομα με φυσιολογικό προφίλ λιπιδίων Leslie et al. Lipids in Health and Disease (2015); Paola M. Hunter and Robert A. Hegele. Functional foods and dietary supplements for the management of dyslipidaemia. NATURE REVIEWS | ENDOCRINOLOGY. 2017 Ω-3 λιπαρά οξέα
- 15. Sradha Kotwal. Omega 3 Fatty Acids and Cardiovascular OutcomesSystematic Review and Meta-Analysis. Circ Cardiovasc Qual Outcomes. 2012 Ω-3 λιπαρά οξέα
- 16. Υπολιπιδαιμική Δράση ↓ LDLc 20-30% ↓ TG 10-20% ↓ Καρδιαγγειακής Θνησιμότητας Συνιστώμενη Ημερήσια Δόση 2.5–10 mg Μονακολίνη K 3 mg/day ↓ LDL (10-15%) 10 mg ↓ LDL (έως 20%) EFSA Ανεπιθύμητη Δράση Δεν είναι σαφής ( Συνενζύμου↓ Q10, Νεφρική βλάβη: citrinin, Μυοπάθειες,Ραβδομυόλυση) Πηγές: Ζύμωση Ρυζιού από Monascus purpureus Paola M. Hunter and Robert A. Hegele. Functional foods and dietary supplements for the management of dyslipidaemia. NATURE REVIEWS | ENDOCRINOLOGY. 2017 Μαγιά Κόκκινου Ρυζιού - Μονακολίνη Κ (Λοβοστατίνη)
- 17. Yinhua Li, A Meta-Analysis of Red Yeast Rice: An Effective andRelatively Safe Alternative Approach for Dyslipidemia. PLoS ONE 9(6): e98611.2014 Μαγιά Κόκκινου Ρυζιού - Μονακολίνη Κ (Λοβοστατίνη)
- 18. Yinhua Li, A Meta-Analysis of Red Yeast Rice: An Effective andRelatively Safe Alternative Approach for Dyslipidemia. PLoS ONE 9(6): e98611.2014 Μαγιά Κόκκινου Ρυζιού - Μονακολίνη Κ (Λοβοστατίνη)
- 19. Σε ποιους απευθύνεται: 1.Σε ασθενείς που δεν εντάσσονται σε φαρμακοθεραπεία (βάσει του CVD risk) ή σε παιδιά. 2.Σε ασθενείς με μυοπάθειες προκαλούμενες από στατίνες. 3.Δε συνίσταται η χορήγησή τους συνδυαστικά με στατίνες Σημεία που χρήζουν προσοχής: Ορισμένα συμπληρώματα περιέχουν σε αξιόλογες ποσότητες Μονακολίνη Κ και προκαλούν τις ίδιες ανεπιθύμητες δράσεις όπως η λοβοστατίνη. Συνήθως αναγράφεται η περιεκτικότητα σε Μ.Κ.Ρ. και όχι η ποσότητα της Μονακολίνης Κ. Όταν η Μονακολίνη Κ δεν περιέχεται σε ίχνη, τότε το σκεύασμα θεωρείται φάρμακο και δεν μπορεί να πωλείται ως συμπλήρωμα (FDA). Lindsey Childress, Review of red yeast rice content and current Food and Drug Administration oversight. Journal of Clinical Lipidology (2013) 7, 117–122; AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, 2014; MiguelÁ.Martínez-González, Progress in Cardiovascular dieases, 2015 Μαγιά Κόκκινου Ρυζιού - Μονακολίνη Κ (Λοβοστατίνη)
- 20. Υπολιπιδαιμική Δράση ↓ LDLc ↑ HDL Συνιστώμενη Ημερήσια Δόση 2-40 mg Πηγές: Ζαχαροκάλαμο Ανεπιθύμητες Δράσεις Καμία Μηχανισμός Δράσης Αναστολή σύνθεσης χοληστερόλης Paola M. Hunter and Robert A. Hegele. Functional foods and dietary supplements for the management of dyslipidaemia. NATURE REVIEWS | ENDOCRINOLOGY. 2017 Πολυκοσανόλη
- 21. Υπολιπιδαιμική Δράση ↓ Tchol, TG, LDLc ↑ HDL Συνιστώμενη Ημερήσια Δόση 0,5 γραμμάρια/3 φορές/ημέρα Πηγές: Φυτικό Αλκαλοειδές (Coptis Root & Phellodendron Chinese) Tchol :- 0.61 mmol/L; 95 % confidence interval - 0.83 to - 0.39 ; LDL:-0.65 mmol/L; 95 % confidence interval - 0.76 to - 0.54 TG:- 0.50 mmol/L; 95 % confidence interval - 0.69 to - 0.31; HDL: 0.05 mmol/L; 95 % confidence interval 0.02 to 0.09. Συγχορήγηση με σιμβαστατίνη: Πρόσθετη μείωση LDL: 0,61 mmol/L •Paola M. Hunter and Robert A. Hegele. Functional foods and dietary supplements for the management of dyslipidaemia. NATURE REVIEWS | ENDOCRINOLOGY. 2017; Dong, H., Zhao, Y., Zhao, L. & Lu, F. The effects of berberine on blood lipids: a systemic review and meta-analysis of randomized controlled trials. Planta Med.2013). Lan, J. et al. Meta-analysis of the effect and safety of berberine in the treatment of type 2 diabetes mellitus, hyperlipemia and hypertension. J. Ethnopharmacol. 2015 Βερβερίνη
- 22. Υπολιπιδαιμική Δράση ↓ LDLc (4,3%) Συνιστώμενη Ημερήσια Δόση 25-50 γραμμάρια Πηγές: Προϊόντα Σόγιας, Συμπλήρωμα Ανεπιθύμητες Δράσεις Δ.Α. •Paola M. Hunter and Robert A. Hegele. Functional foods and dietary supplements for the management of dyslipidaemia. NATURE REVIEWS | ENDOCRINOLOGY. 2017 Πρωτεϊνη Σόγιας
- 23. Oluwabunmi A. Tokede, Soya products and serum lipids: a meta-analysis of randomised controlled trials. British Journal of Nutrition (2015) LDL: 3%↓ TG: 4%↓ Πρωτεϊνη Σόγιας
- 24. T.Chol: 2%↓ HDL: ↑3% Oluwabunmi A. Tokede, Soya products and serum lipids: a meta-analysis of randomised controlled trials. British Journal of Nutrition (2015) Πρωτεϊνη Σόγιας
- 25. Σημεία που χρήζουν προσοχής Μεγαλύτερη επίδραση σε άτομα με αυξημένο CVD risk. Φυσικά προϊόντα σόγιας μάλλον είναι πιο αποτελεσματικά από την επεξεργασμένη σόγια. Μείωση LDL σε παρεμβάσεις μικρής διάρκειας(4-8 εβδ.) εν. TG (10-52 εβδ.) Η χορήγηση ισοφλαβονών (χωρίς πρωτείνη σόγιας) δεν επηρέασε σημαντικά τα λιπίδια. Δεν παρατηρήθηκε δοσοεξαρτώμενη σχέση Σε πληθυσμούς που χρησιμοποιούν σόγια GM τα αποτελέσματα δεν ήταν σημαντικά. Συνολικό Μοτίβο Διατροφής Oluwabunmi A. Tokede, Soya products and serum lipids: a meta-analysis of randomised controlled trials. British Journal of Nutrition (2015) Πρωτεϊνη Σόγιας
- 26. Υπολιπιδαιμική Δράση ↓ LDLc, T.Chol ↓ CVD risk (μελέτες παρατήρησης) Συνιστώμενη Ημερήσια Δόση ≥200 mg κατεχίνες ~2.5 φλιτζάνια πράσινο τσάι/ημέρα Ανεπιθύμητες Δράσεις Κοιλιακό άλγος, Αύξηση Αρτηριακής Πίεσης T. Chol: −0.13 mmol/l; 95% CI: −0.2 to −0.07 LDL: −0.19 mmol/l; 95% CI: −0.3 to −0.09 •Paola M. Hunter and Robert A. Hegele. Functional foods and dietary supplements for the management of dyslipidaemia. NATURE REVIEWS | ENDOCRINOLOGY. 2017 Pon Velayutham, Green Tea Catechins and Cardiovascular Health: An UpdateCurr Med Chem. 2008; Onakpoya, I., Spencer, E., Heneghan, C. & Thompson, M. The effect of green tea on blood pressure and lipid profile: a systematic review and meta-analysis of randomized clinical trials. Nutr. Metab. Cardiovasc. Dis. 24, 823–836 (2014). Πράσινο Τσάι - Κατεχίνες
- 27. •Paola M. Hunter and Robert A. Hegele. Functional foods and dietary supplements for the management of dyslipidaemia. NATURE REVIEWS | ENDOCRINOLOGY. 2017 Πράσινο Τσάι - Κατεχίνες
- 28. ΤροφοφάρμακοΤροφοφάρμακο Αναμενόμενη ΔράσηΑναμενόμενη Δράση Συνιστώμενη ΔόσηΣυνιστώμενη Δόση Διαλυτές Φυτικές Ίνες ↓ LDL 3–5% 10 γραμ./ημέρα Φυτικές στερόλες ↓LDL 5–15% 2-3 γραμ./ημέρα Ω-3 λιπαρά οξέα ↓TG 25–30%/; Μπορεί να ελαφρά↑ LDL 2-4 γραμ./ημέρα Μαγιά Κόκκινου ρυζιού ↓LDL 20–30% TG↓ 10–20% Μπορεί να ↑HDL 1,2-4,8 γραμ./ημέρα Πρωτεΐνη Σόγιας ↓LDL 3–5% 25-50 γραμ./ημέρα Βερβερίνη ↓ TChol, ↓LDL, TG↓ 10–20%; Μπορεί να ↑HDL 0,5 γραμ. x 3 φορές/ημέρα Σκόρδο ↓ TChol ~5% ~10 mg αλλισίνη/ημέρα Πράσινο τσάι Μικρή ↓ Tchol & LDL; ↓ 5% CVDrisk/φλιτζάνι ≥200 mg κατεχίνες/~2.5 φλιτζ. πράσινο τσάι/ημέρα Προβιοτικά ↓ TChol & LDL ~3%; might Μπορεί να ↑HDL 107 CFU/ημέρα;175–350 γραμ./ημέρα γιαούρτι με προβιοτικά Φύκι Μπορεί να ↓TG & να ↑HDL 48 γραμ./ημέρα Κράταιγος Μπορεί να ↓ TChol & LDL 1,2 γραμ/ημέρα Νιασίνη ↓TC, LDL, Apo BTGs, VLDL, 1-4 γραμ./ημέρα Λιναρόσπορος ↓ TChol, ↓LDL, TG↓ 14 - 40 γραμ/ημέρα Σουσάμι ↓ LDL 9% 40 γραμ/ημέρα Κουρκουμίνη ↓ TChol , ↑HDL 500 mg/ημέρα Paola M. Hunter NATURE REVIEWS | ENDOCRINOLOGY , 2017; Mark Houston The Role of Nutraceutical Supplements in the Treatmentof Dyslipidemia J Clin Hypertens (Greenwich). 2012
- 29. Joe W.E. Moss and Dipak P. Ramji.Nutraceutical therapies for atherosclerosis. Nat Rev Cardiol. 2016
- 30. Λειτουργικά Τρόφιμα -Πρωτεΐνη Σόγιας -Πράσινο Τσάι -Φυτικές Στερόλες -Γιαούρτι με Προβιοτικά Συμπληρώματα -Ω-3 -Μαγιά κόκκινου Ρυζιού Περιορισμένη Δράση Φύκι, Βερβερίνη, Κράταιγος, Σκόρδο Καμία Δράση Πολικοσανόλη, Ρεσβερατρόλη, Γκουγκουλστερόνη Υγιεινοδιαιτητική Παρέμβαση Επικουρικά σε υπολιπιδαιμική αγωγή Σαφής κανονισμός Paola M. Hunter NATURE REVIEWS | ENDOCRINOLOGY , 2017; Mark Houston The Role of Nutraceutical Supplements in the Treatmentof Dyslipidemia J Clin Hypertens (Greenwich). 2012 Συμπερασματικά…
- 31. Σας ευχαριστώ για την προσοχή σας! Ιωάννα Κατσαρόλη Κλινική Διαιτολόγος – Αθλητική Διατροφολόγος, MSc Μέλος Επιστημονικής Ομάδας Ειδικών Αθλητικής Διατροφής ΠΣΔΔ Επιστημονική Συνεργάτης MedNutrition.gr
Editor's Notes
- Η προέλευσή τους είναι κυρίως φυτική και είναι συνήθως εκχυλίσματα ή έλαια που έχουν αναγνωριστεί για την προαγωγή της υγείας. Nutraceuticals must not only supplement the diet but should also aid in the prevention and/or treatment of disease and/or disorder. Μία νέα κατηγορία «εμπλουτισμένων» τροφίμων με θρεπτικές, ιαματικές-φαρμακευτικές ιδιότητες εμφανίστηκε στα ράφια των υπεραγορών (supermarket) που είναι γνωστά ως «υγιεινές» τροφές ή «τροφοθεραπευτικά ή τροφοφάρμακα» (nutraceuticals) ή «λειτουργικά τρόφιμα» (functional foods). Τα τροφοθεραπευτικά, λειτουργικά ή φαρμακευτικά τρόφιμα είναι έννοιες που συχνά χρησιμοποιούνται για να περιγράψουν τρόφιμα ή προϊόντα που βοηθούν τη φυσιολογική λειτουργία του ανθρώπινου οργανισμού ή/και μειώνουν την πιθανότητα χρόνιων παθήσεων Παρόλο που οι όροι είναι ευρέως διαδεδομένοι, δεν υπάρχει πλήρης ομοφωνία ως προς τη σημασία τους. Πιο συγκεκριμένα, τα τροφοθεραπευτικά (nutraceuticals) είναι συστατικά που απομονώνονται από τρόφιμα και πωλούνται σε φαρμακευτική μορφή (χάπια, σκόνες).
- Use of functional foods and dietary supplements is becoming increasingly prevalent among those individuals at risk of cardiovascular disease; however, limited clinical guidance is available for the use of safe and effective supplements Functional foods and dietary supplements can be used in addition to pharmacotherapy to provide additional lipid lowering and could potentially reduce medication dose however, limited clinical guidance is available for the use of safe and effective supplements Very few long-term studies have been conducted, which has led to a paucity of information on clinical end points such as mortality and cardiac events USA, with an estimated 53% of adults reporting regular supplement use13. Of supplement users, 29% cited heart health and 19% reported maintaining healthy cholesterol levels as their reason for consuming dietary supplements13
- Evidence supports the use of products such as soy protein, green tea, plant sterols, probiotic yogurt, marine-derived omega-3 fatty acids and lovastatin-containing red yeast rice in patients with dyslipidaemia • Products such as seaweed, berberine, hawthorn and garlic might confer some limited lipid-lowering benefit in certain patient populations • Policosanol, guggulsterone and resveratrol are unlikely to have lipid-lowering effects
- Soluble fibre, found in psyllium, oats and barley, can absorb water in the gastrointestinal tract, which results in increased bulk of stools and a reduction in the intestinal transit time. Soluble fibre has the ability to bind to cholesterol and bile acids, thus inhibiting their intestinal absorption and increasing their excretion in faeces14 (FIG. 1). Soluble fibre also undergoes some colonic fe16rmentation to produce short-chain fatty acids, which have beneficial effects on cholesterol metabolism15 Studies in humans have consistently found that soluble fibre intake is associated with decreased levels of total cholesterol and LDL cholesterol. Several recent meta-analyses have shown statistically significant reductions in both total cholesterol and LDL cholesterol with soluble fibre intake16–21. Most studies have found no significant effects of soluble fibre consumption on triglyceride or HDL cholesterol levels To attain cholesterol-lowering effects, at least 3 g per day of soluble fibre should be consumed16; however, at least 10 g per day is recommended to achieve a clinically relevant reduction in levels of LDL cholesterol of 3–5%22. participants randomised, mean difference -0.20 mmol/L, 95% CI -0.34 to -0.06), and LDL cholesterol levels (mean difference -0.14 mmol/L, 95% CI -0.22 to -0.06) but not on triglyceride levels (mean difference 0.00 mmol/L, 95% CI -0.04 to 0.05), and there was a very small but statistically significant decrease rather than increase in HDL levels with increased fibre intake (mean difference -0.03 mmol/L, 95% CI -0.06 to -0.01).
- Plant sterols, or phytosterols, are steroid compounds that are found in plants and have a structure that is similar to cholesterol. Consumption of 2–3 g per day of plant sterols has been associated with a 5–15% reduction in LDL cholesterol levels, even in those individuals taking a statin23. not found a statistically significant effect of plant sterol supplementation on levels of HDL cholesterol25,26. One meta-analysis found a 6% reduction in triglyceride levels with no change in HDL cholesterol levels in patients with hypercholesterolaemia27. As most trials have been of short duration, no data are available on cardiovascular end points. Plant sterol supplements seem to be generally safe, although their use should be avoided in rare patients known to have sitosterolaemia, in whom a defect in the ABCG5–ABCG8 transporter prevents plant sterol excretion28. The recommended dose of plant sterols to achieve cholesterol lowering is 2–3 g per day; however, as plant sterols are present at only very low amounts in plants, the main dietary source of plant sterols is from functional food products fortified with plant sterols (such as margarine and orange juice). These products typically provide 1 g of plant sterols per standard serving. Further information on plant sterols can be found elsewhere29 The dietary intake of plant sterols ranges between an average of 250 mg/day in Northern Europe to 500 mg/day in Mediterranean countries.
- So far, meta-analyses have suggested that the LDL-cholesterol-lowering effect of PS tapers off at intakes of 2–3 g/d with little additional benefit at higher intakes(6,11). Consequently, several health authorities have included 2 g/d of PS from enriched foods as part of their diet and lifestyle guidelines in the management of hypercholesterolaemia(7,8,25). From the present analysis, it appears that at least up to approximately 3 g/d of PS, there is a proportional dose–response effect. As the inhibition of cholesterol absorption by PS is probably a saturable process, some tapering-off effect would, however, be expected, but probably at doses slightly higher than 3 g/d. If indeed PS intakes .3 g/d lead to a greater LDL-cholesterol benefit, this would bemeaningful froma clinical viewpoint as additional LDL-cholesterol lowering could lead to a greater CVD risk reduction. However, the practical implications of higher PS intakes, such as the technical feasibility of incorporating higher amounts of PS into foods, cost–benefit aspects and, especially, the compliance of consumers, need to be considered. Based on research in populations that actually use foods with added PS, it appears that the intake of PS in real life is far below the recommendation(26,27); on average, users consume 14 g/d of PS-enriched margarine, which corresponds to a PS intake of approximately 1 g/d. Therefore, encouraging people to consume PS at amounts exceeding approximately 3 g/d seems unrealistic. In addition, because of the observations of premature atherosclerosis in rare homozygous sitosterolaemic patients(28) and due to epidemiological evidence suggesting a positive association between plasma plant sterol concentrations and CVD risk(29), some concerns have been raised related to the increase in plasma plant sterol concentrations following Also, liquid foods (drinks) are not per definition consumed together with a meal; sufficient ingestion of food (i.e. fat) is required to trigger bile release for PS to optimally compete with cholesterol for micellar incorporation and subsequently to optimally inhibit cholesterol absorption
- Plant sterols, or phytosterols, are steroid compounds that are found in plants and have a structure that is similar to cholesterol. Consumption of 2–3 g per day of plant sterols has been associated with a 5–15% reduction in LDL cholesterol levels, even in those individuals taking a statin23. not found a statistically significant effect of plant sterol supplementation on levels of HDL cholesterol25,26. One meta-analysis found a 6% reduction in triglyceride levels with no change in HDL cholesterol levels in patients with hypercholesterolaemia27. As most trials have been of short duration, no data are available on cardiovascular end points. Plant sterol supplements seem to be generally safe, although their use should be avoided in rare patients known to have sitosterolaemia, in whom a defect in the ABCG5–ABCG8 transporter prevents plant sterol excretion28. The recommended dose of plant sterols to achieve cholesterol lowering is 2–3 g per day; however, as plant sterols are present at only very low amounts in plants, the main dietary source of plant sterols is from functional food products fortified with plant sterols (such as margarine and orange juice). These products typically provide 1 g of plant sterols per standard serving. Further information on plant sterols can be found elsewhere29 The dietary intake of plant sterols ranges between an average of 250 mg/day in Northern Europe to 500 mg/day in Mediterranean countries.
- Fish oil is rich in the omega‑3 polyunsaturated fatty acids eicosapentaenoic acid (EPA; C20:5,n‑3) and docosahexaenoic acid (DHA; C22:6,n‑3). Meta-analyses have shown a consistent triglyceride-lowering effect of fish oil supplements, especially in patients with hypertriglyceridaemia30–33. These studies have also noted small, concurrent increases in levels of LDL cholesterol30–33; however, this effect has not been found with krill oil34,35. Krill oil has a greater ratio of EPA to DHA than fish oil, and most EPA and DHA in krill oil are in the form of phospholipids, which have higher bioavailability34. For this reason, lower doses of krill oil are able to produce triglyceride-lowering effects that are similar to the effects of higher doses of fish oil. Meta-analyses have also shown that, although DHA is more efficient at lowering triglyceride levels than EPA, DHA raises LDL cholesterol levels to a greater extent than EPA31. Several mechanisms by which EPA and DHA act to reduce triglycerides exist. Primary triglyceride-lowering actions include activation of peroxisome proliferator-activated receptors (PPARs) to increase expression of genes encoding proteins that are involved in fatty acid oxidation, inhibition of fatty acid incorporation into triglycerides and reduction of hepatic VLDL synthesis36. EPA and DHA also increase the activity of LPL, which secondarily reduces triglyceride levels32,36. Given that hypertriglyceridaemia is typically associated with low levels of HDL cholesterol, a concomitant increase in levels of HDL cholesterol with fish oil supplementation is expected; however, the available data are inconsistent. One meta-analysis found that monotherapy with DHA increased HDL cholesterol levels considerably more than placebo32, whereas a randomized controlled trial (RCT) found that krill oil supplements, but not fish oil supplements, significantly increased levels of HDL cholesterol35. Fish oils have also been studied for their effects on other cardiovascular risk factors such as body weight and blood pressure; however, the data are not robust33. Many studies on fish oil supplementation have reported mortality and cardiac events as end points. A 2004 meta-analysis did not find a statistically significant reduction in total mortality, cardiac mortality or cardiac events in those individuals consuming fish oil supplements; however, a significant protective effect on heart failure was observed33. A later analysis in 2009 found a significantly reduced risk of cardiac death and all-cause mortality in high-risk groups consuming fish oil supplements37. Overall, robust evidence exists to suggest that fish oil supplements reduce triglyceride levels. However, fish oil supplements might also slightly increase levels of LDL cholesterol, although whether this translates to altered risk of cardiac events or mortality is uncertain. For patients with high levels of triglycerides and LDL cholesterol, a krill oil supplement should be considered, as the LDL cholesterol-raising effect has not been observed with krill oil. To achieve a reduction in triglyceride levels of 25–30%, a dose of 2–4 g per day of fish oil is recommended38. Further information on marine-derived omega‑3 fatty acids is available elsewhere38. The increase in LDL was observed in patients with very high triglyceride levels and following the use of DHA alone compared with studies using EPA alone
- The reduction of high or very high triglyceride with EPA or DHA is associated with different effects on LDL. Treatment with either lowered triglyceride levels, but DHA was more often associated with an increases in LDL and EPA on the other hand, decreased LDL or resulted in no significant change of LDL. Ongoing trials are currently underway to evaluate the efficacy of v-3 fatty acids on the prevention of CVD. Based on the present review, the beneficial effects of n-3 PUFA, specifically EPA and DHA, which have been substantiated in hyperlipidemic individuals, extend to individuals with normal to borderline high levels of serum lipids. In summary, using select search terms and criteria, our review of the existing evidence has shown that consumption of ≥ 4 g/day of n-3 PUFA through marine and EPA and/or DHA-enriched food sources, or 1–5 g/ day of EPA and/or DHA in supplement form, has the ability to reduce serum TG by 9-26 % and 4-51 %, respectively, in normolipidemic to borderline hyperlipidemic and otherwise healthy individuals. This provides evidence that the consumption of marine based n-3 PUFA is not only extremely useful to treat dyslipidemia, but is also beneficial for otherwise healthy populations in the prevention of hyperlipidaemia and may subsequently reduce the risk of developing CVD.
- On the basis of the positive results of early trials, various clinical guidelines recommend the use of omega 3 fatty acid supplements to reduce mortality and cardiovascular risk. • Several recent large trials have reported no benefit of omega 3 acids on cardiovascular outcomes; however, the recommendations for their use remain. WHAT THE STUDY ADDS This meta-analysis, which includes 20 trials and &gt;60 000 patients, summarizes the entire body of evidence on this subject including all the recent trials. The results of this meta-analysis report that omega 3 fatty acids protect against vascular death, but there is no clear effect on total mortality, sudden death, stroke, or arrhythmia. The beneficial effects of omega 3 fatty acids are not as large as previously implied and recommendations for widespread use should be tempered.
- Red yeast rice is produced by fermentation of rice by Monascus purpureus, a species of mould. The active ingredient, monacolin K, was the first statin drug (lovastatin) to be isolated and approved for treatment of high cholesterol levels. Lovastatin reduces cholesterol levels by inhibiting HMG-CoA reductase, an enzyme that functions in hepatic cholesterol biosynthesis (FIG. 2). Given that the active ingredient is lovastatin, red yeast rice is regulated as a drug in the USA, and any over-the-counter supplements containing red yeast rice cannot contain lovastatin39. In other countries, red yeast rice is regulated as a supplement and can be purchased without prescription. Lovastatin-containing red yeast rice has been shown to be effective in lowering levels of LDL cholesterol and triglycerides40–44. Lovastatin-containing red yeast rice supplements can reduce levels of LDL cholesterol by 20–30% (comparable to low-dose statins) and triglyceride levels by 10–20%45.
- Red yeast rice is produced by fermentation of rice by Monascus purpureus, a species of mould. The active ingredient, monacolin K, was the first statin drug (lovastatin) to be isolated and approved for treatment of high cholesterol levels. Lovastatin reduces cholesterol levels by inhibiting HMG-CoA reductase, an enzyme that functions in hepatic cholesterol biosynthesis (FIG. 2). Given that the active ingredient is lovastatin, red yeast rice is regulated as a drug in the USA, and any over-the-counter supplements containing red yeast rice cannot contain lovastatin39. In other countries, red yeast rice is regulated as a supplement and can be purchased without prescription. Lovastatin-containing red yeast rice has been shown to be effective in lowering levels of LDL cholesterol and triglycerides40–44. Lovastatin-containing red yeast rice supplements can reduce levels of LDL cholesterol by 20–30% (comparable to low-dose statins) and triglyceride levels by 10–20%45.
- Policosanol is a long-chain sugar alcohol compound that is extracted from sugar cane, wheat germ, rice or maize47. Early promising studies of policosanol supplementation showed reductions in both total and LDL cholesterol levels48,49; however, over the past ten years, these studies have been called into question. These initial studies were performed by the same group in Cuba and were funded by Dalmer Laboratories. No other group outside of Cuba has yet been able to reproduce their results, even when using an identical policosanol preparation50. The data from these early Cuban studies skew meta-analytic data to suggest that an effect of policosanol exists51. No recent, high-quality trials have found policosanol to be effective at reducing cholesterol levels in humans50,52–56. Despite these findings, policosanol is still found in many combination supplements marketed as lowering lipid levels. Although policosanol is probably safe to consume, evidence suggests that the supplement is only minimally effective for use in treating dyslipidaemia. Further information on policosanol can be found elsewhere
- A 2013 meta-analysis found that, at doses of 0.6–1.5 g per day, berberine was associated with statistically significant reductions in levels of total cholesterol (−0.61 mmol/l), triglycerides (−0.50 mmol/l) and LDL cholesterol (−0.65 mmol/l), and significant increases in levels of HDL cholesterol (+0.05 mmol/l) in diverse adult populations62. Furthermore, when a berberine supplement was co‑administered with simvastatin, the combined lipid-lowering effect was significantly greater than that of simvastatin alone, lowering levels of LDL cholesterol by 0.61 mmol/l62. As this analysis included all trials using berberine as an intervention and reporting lipid parameters as an outcome, some of the included patients probably did not have elevated levels of lipids. To address this gap in knowledge, a second meta-analysis that was performed in 2015 examined berberine intervention specifically in hyperlipidaemic populations63. This analysis found that berberine in combination with lipid-lowering therapy was associated with improvements in levels of total cholesterol, LDL cholesterol and HDL cholesterol compared with lipid-lowering therapy alone63. A limitation of both of these analyses was that most included studies were of low quality. Although current evidence suggests that berberine has a modest effect on improving lipid parameters, additional research is needed, particularly high-quality RCTs and studies looking at cardiovascular-risk end points. A dose of berberine of 0.5 g three times per day is recommended to achieve reductions in levels of LDL cholesterol and triglycerides of 10–20%64. Evidence exists suggesting that berberine also is a promising dietary supplement for use in patients with diabetes mellitus63 or fatty liver disease65.
- A 2013 meta-analysis found that, at doses of 0.6–1.5 g per day, berberine was associated with statistically significant reductions in levels of total cholesterol (−0.61 mmol/l), triglycerides (−0.50 mmol/l) and LDL cholesterol (−0.65 mmol/l), and significant increases in levels of HDL cholesterol (+0.05 mmol/l) in diverse adult populations62. Furthermore, when a berberine supplement was co‑administered with simvastatin, the combined lipid-lowering effect was significantly greater than that of simvastatin alone, lowering levels of LDL cholesterol by 0.61 mmol/l62. As this analysis included all trials using berberine as an intervention and reporting lipid parameters as an outcome, some of the included patients probably did not have elevated levels of lipids. To address this gap in knowledge, a second meta-analysis that was performed in 2015 examined berberine intervention specifically in hyperlipidaemic populations63. This analysis found that berberine in combination with lipid-lowering therapy was associated with improvements in levels of total cholesterol, LDL cholesterol and HDL cholesterol compared with lipid-lowering therapy alone63. A limitation of both of these analyses was that most included studies were of low quality. Although current evidence suggests that berberine has a modest effect on improving lipid parameters, additional research is needed, particularly high-quality RCTs and studies looking at cardiovascular-risk end points. A dose of berberine of 0.5 g three times per day is recommended to achieve reductions in levels of LDL cholesterol and triglycerides of 10–20%64. Evidence exists suggesting that berberine also is a promising dietary supplement for use in patients with diabetes mellitus63 or fatty liver disease65.
- Based on baseline lipid concentrations in the study population, our results show a significant 3 % reduction in serum LDL, 4 % reduction in serum TAG and a 2 % reduction in TC concentrations after an intervention with soya products for a period ranging from 4 to 52 weeks. We also observed a significant 3 % increase in serum HDL concentrations. This beneficial effect seemed stronger in individuals with a higher risk of CHD (hypercholesterolaemic, obese and diabetic subjects). It also appears that consumption of natural soya products is more effective in lowering serum cholesterol than intake of processed soya (e.g. soya protein extract preparations or supplements). LDL reduction was significant in the shorter-duration studies (4–8 weeks), whereas TAG reduction was only significant in the longer-lasting studies (10–52 weeks). Isoflavone supplementation only (i.e. without soya proteins) did not appear to significantly influence the serum lipid profile. It is important to note, however, that a dose–response effect of soya protein on cholesterol reduction was not observed in our analyses and is yet to be established. As soyabeans are grown around the world under many different climatic conditions, there is a wide range of soyabean varieties. Unlike in Europe, GM soyabeans have become the predominant type grown in the Americas. When our results were stratified by study location, the studies completed in Europe, Asia and Australia showed highly significant positive effects. Conversely, the studies completed in North/South America (where &gt;85 % of soyabean produced is GM) showed non-significant results, except for a mild elevation of serum HDL. In an earlier study, we
- Based on baseline lipid concentrations in the study population, our results show a significant 3 % reduction in serum LDL, 4 % reduction in serum TAG and a 2 % reduction in TC concentrations after an intervention with soya products for a period ranging from 4 to 52 weeks. We also observed a significant 3 % increase in serum HDL concentrations. This beneficial effect seemed stronger in individuals with a higher risk of CHD (hypercholesterolaemic, obese and diabetic subjects). It also appears that consumption of natural soya products is more effective in lowering serum cholesterol than intake of processed soya (e.g. soya protein extract preparations or supplements). LDL reduction was significant in the shorter-duration studies (4–8 weeks), whereas TAG reduction was only significant in the longer-lasting studies (10–52 weeks). Isoflavone supplementation only (i.e. without soya proteins) did not appear to significantly influence the serum lipid profile. It is important to note, however, that a dose–response effect of soya protein on cholesterol reduction was not observed in our analyses and is yet to be established. As soyabeans are grown around the world under many different climatic conditions, there is a wide range of soyabean varieties. Unlike in Europe, GM soyabeans have become the predominant type grown in the Americas. When our results were stratified by study location, the studies completed in Europe, Asia and Australia showed highly significant positive effects. Conversely, the studies completed in North/South America (where &gt;85 % of soyabean produced is GM) showed non-significant results, except for a mild elevation of serum HDL. In an earlier study, we
- Tea is made from the dried leaves of the Camellia sinensis plant. To produce black tea, the leaves are allowed to oxidize in a controlled environment, whereas green tea is produced from the unoxidized leaves. About 30% of adult individuals in the USA are tea drinkers, and consumption of green tea has been on the rise in North America, probably owing to its purported health benefits120. Catechins are a class of flavonol that are found in tea and have been postulated to be responsible for its cholesterol-lowering properties. The most abundant catechin compound in tea is epigallocatechin gallate121. Consumption of green tea catechins in supplement form (either capsule or powder) has been shown to have marked cholesterol-lowering effects in several meta-analyses122–124. Catechins are powerful antioxidants that prevent oxidation of LDL both in vitro and in vivo in humans125. Catechins also have a direct inhibitory effect on cholesterol synthesis in vitro, by inhibiting squalene oxidase, which catalyses a rate-limiting step in hepatic cholesterol biosynthesis126. Green tea might also inhibit intestinal lipid absorption by interfering with micelle formation127 REVIEWS Several meta-analyses have been conducted examining the effects of tea consumption on lipid parameters and have consistently shown a cholesterol-lowering effect of green tea or green tea extracts122–124,128–130. Meta-analyses have also found a small but significant LDL cholesterol-lowering effect of black tea; however, this reduction was not associated with a concurrent reduction in levels of total cholesterol129,131,132. Analyses comparing intake from beverages with that from supplements have produced conflicting results123,124. In observational studies, consumption of both green and black tea was associated with a significantly decreased risk of all-cause mortality; however, only green tea consumption was associated with a significantly reduced risk of cardiovascular mortality133. Risk of cardiovascular mortality was reduced by 5% per additional cup of green tea per day133. Frequent green tea drinkers possibly lead overall healthier lifestyles than non-tea drinkers, which might have contributed to the observed effect. Tea is the second most consumed beverage worldwide after water (Kris-Etherton 2002) and due to such high frequency of intake worldwide,evenasmallimpactofteaonhumanhealthcouldhave large implications for public health (Peters 2001). (40, 000 άτομα 11-year follow-up, 1995–2005) study involving over 40,000 middle-aged Japanese, those who drank over two cups (about 17 ounces) of green tea per day reduced their risk of death from CVD by 22 to 33 %, compared to those who drank less than a half-cup of green tea daily
- Tea is made from the dried leaves of the Camellia sinensis plant. To produce black tea, the leaves are allowed to oxidize in a controlled environment, whereas green tea is produced from the unoxidized leaves. About 30% of adult individuals in the USA are tea drinkers, and consumption of green tea has been on the rise in North America, probably owing to its purported health benefits120. Catechins are a class of flavonol that are found in tea and have been postulated to be responsible for its cholesterol-lowering properties. The most abundant catechin compound in tea is epigallocatechin gallate121. Consumption of green tea catechins in supplement form (either capsule or powder) has been shown to have marked cholesterol-lowering effects in several meta-analyses122–124. Catechins are powerful antioxidants that prevent oxidation of LDL both in vitro and in vivo in humans125. Catechins also have a direct inhibitory effect on cholesterol synthesis in vitro, by inhibiting squalene oxidase, which catalyses a rate-limiting step in hepatic cholesterol biosynthesis126. Green tea might also inhibit intestinal lipid absorption by interfering with micelle formation127 REVIEWS Several meta-analyses have been conducted examining the effects of tea consumption on lipid parameters and have consistently shown a cholesterol-lowering effect of green tea or green tea extracts122–124,128–130. Meta-analyses have also found a small but significant LDL cholesterol-lowering effect of black tea; however, this reduction was not associated with a concurrent reduction in levels of total cholesterol129,131,132. Analyses comparing intake from beverages with that from supplements have produced conflicting results123,124. In observational studies, consumption of both green and black tea was associated with a significantly decreased risk of all-cause mortality; however, only green tea consumption was associated with a significantly reduced risk of cardiovascular mortality133. Risk of cardiovascular mortality was reduced by 5% per additional cup of green tea per day133. Frequent green tea drinkers possibly lead overall healthier lifestyles than non-tea drinkers, which might have contributed to the observed effect. Tea is the second most consumed beverage worldwide after water (Kris-Etherton 2002) and due to such high frequency of intake worldwide,evenasmallimpactofteaonhumanhealthcouldhave large implications for public health (Peters 2001). (40, 000 άτομα 11-year follow-up, 1995–2005) study involving over 40,000 middle-aged Japanese, those who drank over two cups (about 17 ounces) of green tea per day reduced their risk of death from CVD by 22 to 33 %, compared to those who drank less than a half-cup of green tea daily
- Use of health-promoting functional foods and dietary supplements has been increasing over the past few decades. Lifestyle modification is emphasized as a foundation for longevity; in particular, a diet high in fruits, vegetables and whole grains and low in saturated and trans fats can reduce the risk of CVD. Functional foods such as soy protein, green tea, plant sterol-fortified products and probiotic yogurt can be incorporated into a heart-healthy diet and might promote further reductions in cholesterol levels if consumed often. Good evidence exists to support the use of fish oil supplements (2–4 g per day) to lower triglyceride levels and of lovastatin-containing red yeast rice to produce cholesterol-lowering effects that are similar to those of low-dose statins. Other products such as seaweed, berberine, hawthorn and garlic might offer some limited lipidlowering benefit; however, additional research is needed to determine the mechanism and magnitude of their effects. Other supplements marketed at people with dyslipidaemia, such as policosanol, guggulsterone and resveratrol, are unlikely to have any benefit. Although this Review focused on lipids, several functional foods and supplements have been shown to improve other cardiovascular risk factors such as blood pressure and glycaemic control. Overall, most functional foods and supplements being studied for the treatment of dyslipidaemia have only a small effect on lipid parameters, and non-pharmacological treatment of dyslipidaemia should focus on the whole diet. Given that many of these functional foods and supplements exert their effects through different mechanisms (FIG. 1,2), the potential for additive effects when taken in combination should be taken into account. The supplement industry is not well regulated, and many products available might be ineffective. Furthermore, a lack of standardization exists, which means that some products might contain contaminants (including pharmaceuticals) or doses of the bioactive compound in excess of that reported on the label149 This nutritional and nutraceutical supplement treatment is a valid alternative for patients who are statin intolerant, cannot take other drugs for the treatment of dyslipidemia, or in those who prefer alternative treatments. This new approach to lipid management to decrease vascular disease uses a more functional medicine approach with a broader treatment program that addresses the multitude of steps involved in lipid-induced vascular damage.