dairy fat and cvd risk: a rather complex issue · benoît lamarche, phd inaf, université laval...

Dairy Fat and CVD Risk: Dairy Fat and CVD Risk: A Rather Complex IssueA Rather Complex Issue

BenoBenoîît Lamarche, PhDt Lamarche, PhD

INAF, UniversitINAF, Universitéé Laval Laval QuQuéébec, Canadabec, Canada

Colloque STELA / Colloque STELA / SymposiumSymposium

QuQuéébec, Qcbec, Qc

29 Sept, 201029 Sept, 2010

Seven Country StudySeven Country Study

Finlande Est

Finlande OuestHollande

Slavonie

États-Unis

RomeMontegiorgio

CrevalcoreCorfou

Japon CrêteVelnika Krsna

DalmatieZrenjanin

Dea

th b

y C

HD

(/100

,000

)

Saturated Fat (% kcal)

Adapted from Keys. Am J Epidemiol. 1986

0 10 20 300

200

400

600

800

1000

1200

1400

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HDL-CHDL-C

* * *

Change in dietary lipids:Change in dietary lipids:CHO (1% energy) replaced by SAT, cis MUFA, cis CHO (1% energy) replaced by SAT, cis MUFA, cis PUFA, or trans PUFA, or trans Mensink, R. P et al. Am J Clin Nutr 2003;77:1146Mensink, R. P et al. Am J Clin Nutr 2003;77:1146--11551155

SATSATPUFAPUFA

MUFAMUFATransTrans

LDL-CLDL-C

**

**

Chol/HDL-CChol/HDL-C

**

*

mm

ol/l

mm

ol/l

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Change in plasma lipids:Change in plasma lipids:CHO (1% energy) replaced by lauric acid (12:0), CHO (1% energy) replaced by lauric acid (12:0), myristic (14:0), palmitic (16:0) or stearic (18:0)myristic (14:0), palmitic (16:0) or stearic (18:0)Mensink, R. P et al. Am J Clin Nutr 2003;77:1146Mensink, R. P et al. Am J Clin Nutr 2003;77:1146--11551155

Chol/HDL-CChol/HDL-C LDL-CLDL-C HDL-CHDL-C

LauricLauricPalmiticPalmitic

MyristicMyristicStearicStearic

*

* **

**

*

mm

ol/l

mm

ol/l

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Composition of dairy fat, USDA National Nutrient Composition of dairy fat, USDA National Nutrient Database for Standard Reference, Release 20 (2007)Database for Standard Reference, Release 20 (2007)

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Contribution (%) of dairy products to daily intake Contribution (%) of dairy products to daily intake Dutch National Food Consumption Surveys, 1998Dutch National Food Consumption Surveys, 1998German et al, German et al, Eur J Nutr (2009) 48:191Eur J Nutr (2009) 48:191––203203

Meta-analysis of prospective cohort studies evaluating the association

of saturated fat with CVDSiri-Tarino et al Am J Clin Nutr 2010

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Milk and dairy consumption and incidence of CVD and Milk and dairy consumption and incidence of CVD and allall--cause mortality: dosecause mortality: dose--response metaresponse meta--analysis of analysis of prospective cohort studiesprospective cohort studiesSoedamahSoedamah--Muthu SS et al, Muthu SS et al, AJCN 2011;93:158AJCN 2011;93:158––7171

Relative risk, CVD

Protection Increase

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Relative risk, CHD

Protection Increase

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Relative risk, Stroke

Protection Increase

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Biomarkers of dairy intake and the risk of heart diseaseBiomarkers of dairy intake and the risk of heart diseaseAslibekyan S et al, Nutr Metab Cardiovasc Disease 2011, in pressAslibekyan S et al, Nutr Metab Cardiovasc Disease 2011, in press

Dairy intake (FFQ)Adipose Tissue 15:0Adipose tissue 17:0

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Dairy fat in cheese raises LDL cholesterol less than that Dairy fat in cheese raises LDL cholesterol less than that in butter in mildly hypercholesterolaemic subjectsin butter in mildly hypercholesterolaemic subjectsNestel PJ et al, EJCN 2005;59:1059Nestel PJ et al, EJCN 2005;59:1059––10631063

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MetaMeta--analysis of RCTs evaluating effects of increasing analysis of RCTs evaluating effects of increasing PUFA consumption in place of SFA and CHD eventsPUFA consumption in place of SFA and CHD eventsMozaffarian D et al, PLoS Mozaffarian D et al, PLoS 2010; 7:e10002522010; 7:e100025220112011

Protection Increase

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Conclusions: SATConclusions: SAT

• PUFA is better than SAT• Further research is needed to clarify the role of

SFA in CVD risk compared with that of different forms of carbohydrates rather than carbohydrates as a whole. Astrup (AJCN 2010)

• We eat foods, not nutrients…

Trans fatty acids (TFA)Trans fatty acids (TFA)

1 3 5 7 9 13 15 1711

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IntroductionIntroduction(Mozaffarian N Engl J Med.2006)

Change in the TFA content of french fries in CanadaSecond Set of Trans Fat Monitoring Data - July 2008

Change in the TFA content of french fries in CanadaSecond Set of Trans Fat Monitoring Data - July 2008

0

10

20

30

40

50

McDonald A&W KFC BKing

200620072008%

of f

at

Mean intake of iTFA and rTFA in Denmark from 1978 to 2005

Stender et al, Food Nutr Res 2008

Mean intake of iTFA and rTFA in Denmark from 1978 to 2005

Stender et al, Food Nutr Res 2008

012345678

1975 1980 1985 1990 1995 2000 2005 2010

Inta

ke o

f TFA

(g/d

ay)

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Dietary vaccenic acid has anti-atherogenic effects in LDLr-/- miceDietary vaccenic acid has anti-atherogenic effects in LDLr-/- mice

(Bassett et al, J Nutr 2010;140:18-24)

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Dietary vaccenic acid has anti-atherogenic effects in LDLr-/- miceDietary vaccenic acid has anti-atherogenic effects in LDLr-/- mice

(Bassett et al, J Nutr 2010;140:18-24)

• iTFA enhances the progression of atherosclerosis even in the absence of chol in this LDLr KO mice model.

• rTFA intake is not associated with atherosclerotic plaque formation athérosclérotique in this model.

• rTFA intake attenuates plaque formation following chol intake in this model.

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Evidence from epidemiologyEvidence from epidemiology

Adapted from Weggemans et alEur. J. Lipid Sci. Technol. 2004

2.0

1.51.0

0.5

030 1 2

rTFA intake (g/day)

ATBCCase-control studyNHSZutphen

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0.5 0.6 0.7 0.8 0.9 1 1.1 1.2

All

Women

<60yr

>60yr

Men

<60yr

>60yr

HR (0.5g rTFA, energy-adjusted)

1.09

0.94

0.81

0.77

0.59

1.05

1.05

Study design• 4 isoenergetic diets of 4 weeks each :

1. High in TFA from ruminants (10.2 g/2500 kcal)2. Moderate in TFA from ruminants (4.2 g/2500 kcal)3. High in TFA from industrial sources (10.2 g/2500 kcal)4. Control (minimal quantities of TFA) (2.2 g/2500 kcal)

Methods

A B C D

Controlled diets

Wash out

Motard-Bélanger, AJCN 2008;87:593-599

Nutritionnal value of the dietsMethods

4.03.54.44.6PUFA

rTFA% of energy

3.73.71.50.8TFA

10.110.011.811.8MUFA

18.019.418.318.5Saturated fat

37.038.137.437.0Lipids

14.014.014.014.0 Proteins

50.248.849.750.1 Carbohydrates

iTFAHighModerateControl


% change from the control diet

LDL-C HDL-C C/HDL-C

rTFA (moderate)rTFA (high)iTFA


• iTFA: 1 donut= 2.3 g 1 popcorn = 10.0 g

• Moderated rTFA4 servings of cheese 33% = 1.64 g 2 servings of whole milk= 0.52 g 175 g yogurt 3.25 % = 0.14 g 40 g butter = 1.9 g

• High rTFA is unachievable…

4.2 g rTFA

12.3 g iTFA

Implications

Study of the impact of trans fatty acids from ruminants on blood lipids and other risk factors for cardiovascular disease in women

Study of the impact of trans fatty acids from ruminants on blood lipids and other risk factors for cardiovascular disease in women

EB 2011

April 2011

Washington, DC

EB 2011

April 2011

Washington, DC

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LDLLDL--C % change from baselineC % change from baselineTRANSFACT. AJCN 2008:87:558TRANSFACT. AJCN 2008:87:558––6666

Men Women AlliTFArTFA

(P=0.99) (P=0.001) (P=0.02)

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Study designStudy design

rTFA CTL

Isocaloric feeding4 weeks

Wash out

rTFACTL

ScreeningRandomization

High rTFA: 4.8 g/2500 kcal, 1.5Control: 1.5 g/2500 kcal, 0.6%

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2 x 250ml whole milk: 0.8 g

4 x 50g cheddar 30%fat: 2.0 g

2 x175g yogurt 1.5%fat: 0.4 g

34 g butter: 1.6g

2 x 250ml whole milk: 0.8 g

4 x 50g cheddar 30%fat: 2.0 g

2 x175g yogurt 1.5%fat: 0.4 g

34 g butter: 1.6g

4.8 g rTFA4.8 g rTFA

High rTFA…High rTFA…

High rTFA: 4.8 g/2500 kcal, 1.5Control: 1.5 g/2500 kcal, 0.6%

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High rTFA butter•Dairy cows fed with carthame oil for 4 weeks•Highest producers were selected to yield the high rTFA butter

Control butter•Selected to contain low values of rTFA

Study designStudy design

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Diet compositionDiet composition

Control High rTFA

Energy (kcal) 2279±268 2280±233

CHO (%) 54.4 54.3

Proteins (%) 15.0 15.0

Lipids (%) 33.0 33.0

SAT (%) 10.2 10.5

cis-MUFA (%) 14.3 12.9

PUFA (%) 6.0 5.9

Trans (%) 0.6 1.7

Fibres (g/2500 kcal) 28.2 28.2

Chol (mg/2500 kcal) 320.6 322.1

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Study flow sheetStudy flow sheetScreeningn = 111

Randomizedn = 72

Completersn = 61

Exclusionn = 39

Drop outs n=8: too demandingWithdrawnn=2: menopausal statusn=1: missing data

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Characteristics of participantsCharacteristics of participants

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Results (N=61)Results (N=61)

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ResultsResults∆

LD

L-C

, %

Baseline LDL-C (mmol/l)

Pinteraction= 0.21

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<1.5 1.5-1.8 ≥1.8

ResultsResults∆

HD

L-C

, %

Baseline HDL-C (mmol/l)

Pinteraction= 0.74

P<0.05 P<0.05

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ResultsResults

Pinteraction= 0.18

∆H

DL-C

, %

P≤0.01

Menopausal statusYES

59±6 yrs NO

26±5 yrs

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InterpretationInterpretation

Dietary intake of 4.8g/day rTFA (/2500kcal):

• Has no impact on LDL-C, TG and blood pressure in women;

• Is associated with a small but significant reduction in HDL-C, particularly among older women, or with high baseline values

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InterpretationInterpretation

Dietary intake of 4.8g/day rTFA (/2500kcal):

• Among women who show reduced HDL-C with rTFA, values remain high;

• Changes in HDL-C are unrelated to effects on CETP, Endothelial Lipase and Hepatic lipase (not shown)

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Conclusion, rTFAConclusion, rTFA

The impact of very high but yet achievable intake of rTFA has minimal impact, if any, on CHD risk among women (and men).

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ConclusionsConclusions

• Saturated fat may not be as much a problem as perceived

• rTFA should not be an issue• We eat foods, not nutrients and

isolated fats. • More studies on:

• Whole dairy products• Risk factors other than LDL

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AcknowledgementsAcknowledgements

Chair in Nutrition and Cardiovascular

Health

dairy fat and cvd risk: a rather complex issue · benoît lamarche, phd inaf, université laval...

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