Fats, Cholesterol and Heart Disease

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Fats, Cholesterol and Heart Disease

• NUTR 100
• 7/25/07
• Liz Hill Ruder, RD
• Liz-ruder_at_psu.edu

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Contributions of Dietary Fat

• Energy at 9 kcal / gram
• Essential fatty acids linolenic (the omega-3s)
  and linoleic acid (omega-6s)
• Fat soluble vitamins DEKA
• Increase flavor of food
• Contribute to satiety
• Component of cell walls

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Cholesterol as a Risk Factor

• Cholesterol Desirable Borderline High
• Total lt200 200-239 gt240
• LDL lt130 130-159 gt160
• HDL gt60 40-59 lt40
• Triglyceride lt150 150-200 gt200
• Unit mg/dl of plasma Total HDL lt 4.0
• HDL women gt men
• optimal LDL is below 100

Source Adult Treatment Panel (ATP) III, National
Cholesterol Education Program
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Do You Know Your Numbers?
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Fig. 19-8, p. 6
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Mneumonic for LDL and HDL

• LDL lousy, keep it low
• HDL healthy, keep it high

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Body Fat

• Important for
• Insulation (subcutaneous fat)
• Cushion and protect organs
• Energy

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Types of fat in our bodies and foods

• Triglycerides this is the way fat is packaged in
  foods
• Saturated Fatty Acids sources mainly include
  animal products
• Unsaturated Fatty Acids sources include
  vegetable oils, avocados, fish, nuts, whole
  grains

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Triglyceride

• Major form of fat in diet
• Complete digestion splits TG ? glycerol 3 fatty
  acids

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Classification of Fatty Acids

• Saturated fatty acids
• NO double bonds
• solid at room temp
• Unsaturated Fats (include mono and polys)
• Monounsaturated FA (MUFA)
• One double bond
• liquid at room temp
• Polyunsaturated FA (PUFA)
• 2 or more double bonds
• liquid at room temp
• Omega-6 PUFA ( plants)
• Omega-3 PUFA ( fish)
• Cis vs. trans forms

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Saturated vs. Unsaturated Fat
Saturated Fat Vs. Unsaturated Fat
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Omega-3 and 6 Fatty Acids

• Omega 3 fatty acids (alpha-linolenic acids) and
  omega 6 fatty acids (linoleic) are essential
  PUFAs that cannot be made by the human body and
  must be obtained through diet

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Sources of Omega 3 and 6 FA
Note ALA can be converted into EPA and DHA, but
the conversion is not efficient
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Table 18-4, p. 8
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What about hydrogenation and trans fats?

• Hydrogenation adds hydrogen to liquid unsaturated
  fats, making them more saturated and solid
• Hydrogenation changes the formation of the
  hydrogen atoms around the carbon from the cis to
  the trans formation

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trans, cis and saturated
trans unsaturated cis unsaturated saturated
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Why are trans fats bad?

• Trans fats raise LDL (bad) cholesterol similar to
  saturated fats
• Unlike saturated fats, which may raise HDL (good)
  cholesterol, trans fats have no effect on HDL
  cholesterol

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Major Food Sources of Trans Fat for American
Adults(Average Daily Trans Fat Intake is 5.8
Grams or 2.6 Percent of Calories)
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Butter or Margarine?

• Generally speaking, liquid or soft tub margarines
  contain little saturated or trans fat.
• According to American Heart Association, look for
  margarine which contains liquid vegetable oil as
  the first ingredient and no more than 2 grams of
  saturated fat per tablespoon.
• Butter is generally a better choice than stick
  margarine, which generally does not meet the
  above guidelines.

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Dietary Recommendations for Fat

• Total fat intake should be 20-35 of total
  energy, including
• Up to 10 polyunsaturated fatty acids
• Consume 6 oz fatty fish / week
• Up to 20 monounsaturated fatty acids
• Saturated Fat Intake Should lt10 total energy
• Keep trans fat intake a low as possible and under
  1 of total energy

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Whats all the fuss about fat?

• Saturated and trans fat raise blood cholesterol,
  a risk factor for cardiovascular disease
• Diets high in total fat tend to be high in
  calories, thereby putting individuals at risk for
  obesity

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Amount of fat (in grams) on a 30 fat diet
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Comparison of Oils
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Reasons for Revised Recommendations of Fat Intake

• Since 1970, total energy from fat has declined,
  yet carbohydrate intake and obesity have
  increased
• Question for the class
• Do carbohydrates make you fat?

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Mediterranean Diet

• 40 energy from fat, most of which is
  monounsaturated
• Rich in whole grains, fruits, vegetables, nuts,
  dried beans, 1-2 glasses wine / day, fish, poultry

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Total Cholesterol
270
257
246
241
The American Journal of Medicine, 2002,
1139(S2), 13-24.
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IMPORTANT TAKE HOME POINT!

• So long as total fat intakes is between 20-35 of
  total energy, quality of the fat is more
  important for health than quantity
• All fats are not created equal

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Cholesterol

• Sources of cholesterol
• 2/3 of an individuals cholesterol is
  manufactured by their own liver
• 1/3 comes from diet

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Endogenous vs. Exogenous
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Cholesterol Facts

• Cholesterol is found in every cell of the body
• Cholesterol serves as a building bloc of
  estrogen, testosterone, vitamin D

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Cholesterol Facts, continued

• Cholesterol is a major component of the nerves
  and brain
• Cholesterol contains no calories
• Despite all this, cholesterol is completely
  unessential in the diet (your liver can make all
  that you need!)

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Cholesterol Dietary Recommendation

• Consume less than 300 mg / day of dietary
  cholesterol
• Individuals with high cholesterol, (LDL gt160 )
  consume less than 200 mg / day of cholesterol

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Cholesterol Content of Common Foods
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p. 5a
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Actually Lupe and Sharon, I disagree. 3.5 oz. of
shrimp has 147 mg of cholesterol and 0.5g DHA.
Canned tuna has 36 g cholesterol and 1.7g DHA.
Shrimp should be an occasional treat, perhaps 1x
/ month for someone with high LDL.
p. 6
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Why is high cholesterol a problem?

• Cholesterol in the blood can stick to the walls
  of arteries, causing plaque formation and
  narrowing of the arteries.

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Atherosclerosis

• Atherosclerosis is the narrowing and hardening or
  arteries caused by the buildup of plague

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What is Heart Disease?

• Heart or coronary disease refers disorders of the
  heart and vessels within the heart myocardial
  infarction (heart attack), valve problems
• Cardiovascular disease includes diseases of the
  heart and vessels throughout the entire body,
  including hypertension (high blood pressure), and
  stroke

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Folate and Heart Disease

• Folate is a B-vitamin
• Helps prevent birth defects
• Also prevents formation of homocysteine, an amino
  acid which increase artery plaque formation
• Food sources include dark green leafy
• vegetables, orange juice, enriched
• fortified grains

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Statins

• Statins refers to a groups of drugs (ie. Zocor,
  Lipitor, Vytorin) that that inhibit an enzyme
  that controls endogenous cholesterol production
  by the liver
• Adherence to special diets low in saturated fat,
  cholesterol, and high in dietary fiber along with
  lifestyle modification (stress reduction, no-
  smoking) can be as effective as statin

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Plant Stanol and Sterols

• Incorporated into margarines such as Take Control
  and Benecol
• Must be consumed at amounts of 2 TBS / day
• Drop LDL cholesterol by 14 without adversely
  affecting HDL

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Plant Stanols and Sterols
Cholesterol
Plant Stanol
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QUESTIONS?