Studies
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for the English version
In deze lijst staan (alle)
studies naar welke wordt verwezen op de site, of die relevant zijn voor de
onderbouwing van de gepresenteerde theorie over voeding. Veel voorkomende
onderwerpen zijn: low carb, depressie, magnesium, EPA en DHA, visvetzuren,
schizofrenie en andere mentale aandoeningen. Op de NHANES studie na, betreffen
het de abstracts (samenvattingen). De complete uitwerkingen zijn vaak
via PubMed of andere bronnen te verkrijgen.
Klik op
een studie voor een samenvatting.
Inhoud:
48 studies
-
Arora SK,
McFarlane SI.The
case for low carbohydrate diets in diabetes management,
Nutr Metab (Lond). 2005 Jul 14;2:16
-
Hickey JT, Hickey L, Yancy WS, et al.
Clinical Use of a Carbohydrate-Restricted Diet to Treat
the Dyslipidemia of the Metabolic Syndrome, Metabolic
Syndrome and Related Disorders,
Sep 2003, Vol. 1, No. 3: 227-232
-
Dreon DM, Fernstrom HA,
Williams PT, Krauss RM. A very low-fat diet is not associated with
improved lipoprotein profiles in men with a predominance
of large, low-density lipoproteins, Am J Clin Nutr. 1999
Mar;69(3):411-8
-
Dreon DM et al.
Change in dietary saturated fat intake is correlated with change in mass of
large low-density-lipoprotein particles in men, Am J Clin Nutr. 1998
May;67(5):828-36
-
Berneis K et
al. Low-density lipoprotein
size and subclasses are markers of clinically apparent
and non-apparent atherosclerosis in type 2 diabetes,
Metabolism. 2005 Feb;54(2):227-34
-
Krauss RM.
Atherogenic lipoprotein phenotype and diet-gene interactions, J Nutr. 2001
Feb;131(2):340S-3S.(review)
-
Austin MA.
Triglyceride, small, dense low-density lipoprotein, and
the atherogenic lipoprotein phenotype,
Curr Atheroscler Rep. 2000 May;2(3):200-7 (review)
-
Hirano T, Ito Y, Yoshino G.
Measurement of small dense low-density lipoprotein
particles, J Atheroscler Thromb.
2005;12(2):67-72 (review)
-
Bell SJ, Sears B.
Low-glycemic-load diets: impact on obesity and chronic diseases, Crit Rev Food Sci Nutr. 2003;43(4):357-77
-
Ludwig DS.
Novel treatments for Obesity, Asia Pac J Clin Nutr. 2003;12 Suppl:S8
-
Stern L et al.
The effects of low-carbohydrate versus conventional
weight loss diets in severely obese adults: one-year
follow-up of a randomized trial.
-
Greene P, Willett W, Devecis J, et al.
Pilot 12-Week Weight-Loss Comparison: Low-Fat vs Low-Carbohydrate (Ketogenic)
Diets, Abstract Presented at The North American Association for the Study of
Obesity Annual Meeting 2003, Obesity Research, 11S, 2003, page 95OR.
-
Hays JH, Gorman RT, Shakir KM.
Results of use of metformin and replacement of starch with saturated fat in
diets of patients with type 2 diabetes,
Endocr
Pract. 2002 May-Jun;8(3):177-83
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He K,
Merchant A, Rimm EB, Rosner BA, Stampfer MJ, Willett WC,
Ascherio A. Dietary fat intake and risk of stroke in
male US healthcare professionals: 14 year prospective
cohort study, BMJ. 2003 Oct 4;327(7418):777-82
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Nielsen JV, Jonsson E, Nilsson AK.
Lasting improvement of hyperglycaemia and bodyweight:
low-carbohydrate diet in type 2 diabetes--a brief
report, Ups J Med Sci. 2005;110(1):69-73
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Sondike SB, Copperman N, Jacobson MS.
Effects of a low-carbohydrate diet on weight loss and
cardiovascular risk factor in overweight adolescents, J Pediatr. 2003 Mar;142(3):253-8.
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Seshadri P
et al. A randomized study comparing the effects of a
low-carbohydrate diet and a conventional diet on
lipoprotein subfractions and C-reactive protein levels in patients with severe
obesity, Am J Med. 2004 Sep 15;117(6):398-405
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McNamara DJ.
Dietary cholesterol and atherosclerosis, Biochim Biophys Acta. 2000 Dec 15;1529(1-3):310-20.
Review
-
Yancy WS et al. A
low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia,
Ann. Int. Med. 2004 May 18; 140 (10): p. 769-777
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Prior
IA, Davidson F, Salmond CE, Czochanska Z. Cholesterol, coconuts, and diet on
Polynesian atolls: a natural experiment: the Pukapuka and Tokelau island studies.
Am J Clin Nutr. 1981 Aug;34(8):1552-61
-
Sircar
S, Kansra U.
Choice
of cooking oils--myths and realities.
J Indian Med Assoc.
1998 Oct;96(10):304-7
-
Trends in Intake of Energy and
Macronutrients --- United States, 1971--2000 (NHANES)
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Lambert EV
et al. Enhanced
endurance in trained cyclists during moderate intensity
exercise following 2 weeks adaptation to a high fat diet, Eur J Appl Physiol Occup Physiol. 1994;69(4):287-93
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Lambert EV
et al. High-fat diet
versus habitual diet prior to carbohydrate loading:
effects of exercise metabolism and cycling performance, Int J Sport Nutr Exerc Metab. 2001 Jun;11(2):209-25
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Mensink
RP et al.
Effects of dietary
fatty acids and carbohydrates on the ratio of serum
total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials.
Am J Clin Nutr 2003;77:1146–55.
-
Huff MW.
Dietary cholesterol, cholesterol absorption,
postprandial lipemia and atherosclerosis,
Can J Clin Pharmacol. 2003 Winter;10 Suppl A:26A-32A (Review)
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Mann NJ. Paleolithic
nutrition: what can we learn from the past?, Asia Pac J Clin Nutr.
2004;13(Suppl):S17
-
Cordain L et al.
The paradoxical nature of hunter-gatherer diets:
meat-based, yet non-atherogenic.
-
Berneis K, Rizzo M. LDL size:
does it matter?, Swiss Med Wkly 2004;134:720–724
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Freedman DS et al.
Relation of lipoprotein subclasses as measured by
Proton Nuclear Magnetic Resonance Spectroscopy to coronary artery disease.
Arteriosler Thromb Vasc Biol. 1998;18:1046-1053
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Rele AS,
Mohile RB. Effect of mineral oil,
sunflower oil, and coconut oil on prevention of hair
damage. J Cosmet Sci. 2003 Mar-Apr;54(2):175-92.
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Agero AL,
Verallo-Rowell VM. A randomized
double-blind controlled trial comparing extra virgin
coconut oil with mineral oil as a moisturizer for mild
to moderate xerosis. Dermatitis. 2004 Sep;15(3):109-16
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Gesch CB.
Influence of supplementary vitamins, minerals and
essential fatty acids on the antisocial behaviour of
young adult prisoners. Randomised, placebo-controlled
trial. Br J Psychiatry. 2002 Jul;181:22-8.
-
Peet M, Stokes
C.
Omega-3 fatty acids in the treatment of psychiatric
disorders. Drugs. 2005;65(8):1051-9
-
Peet M.
Eicosapentaenoic acid in the
treatment of schizophrenia and depression: rationale and
preliminary double-blind clinical trial results.
Prostaglandins Leukot Essent Fatty Acids. 2003
Dec;69(6):477-85.
-
Kidd PM.
Bipolar disorder and cell
membrane dysfunction. Progress toward integrative
management. Altern Med Rev. 2004 Jun;9(2):107-35.
-
Freeman MP.
Omega-3 fatty acids in psychiatry: a
review. Ann Clin Psychiatry. 2000 Sep;12(3):159-65.
-
Colin A,
Reggers J, Castronovo V, Ansseau M.
Lipids, depression and suicide. Encephale. 2003
Jan-Feb;29(1):49-58.
-
Young G,
Conquer J.
Omega-3 fatty acids and
neuropsychiatric disorders. Reprod Nutr Dev. 2005
Jan-Feb;45(1):1-28.
-
Stoll AL et
al.
Omega 3 Fatty Acids in Bipolar
Disorder Arch Gen Psychiatry. 1999;56:407-412.
-
Peet M,
Brind J, Ramchand CN, Shah S, Vankar GK.
Two double-blind
placebo-controlled pilot studies of eicosapentaenoic
acid in the treatment of schizophrenia. Schizophr Res.
2001 Apr 30;49(3):243-51.
-
du Bois TM,
Deng C, Huang XF.
Membrane phospholipid composition, alterations in
neurotransmitter systems and schizophrenia. Prog
Neuropsychopharmacol Biol Psychiatry. 2005 Jul;
29(6):878-88.
-
Simopoulos AP.
Omega-3 fatty acids in inflammation and autoimmune
diseases. J Am Coll Nutr. 2002 Dec;21(6):495-505.
-
Simopoulos AP. The
importance of the ratio of omega-6/omega-3 essential
fatty acids. Biomed Pharmacother. 2002 Oct;56(8):365-79.
-
Simopoulos AP. The
Mediterranean diets: What is so special about the diet
of Greece? The scientific evidence. J Nutr. 2001
Nov;131(11 Suppl):3065S-73S.
-
Simopoulos AP. N-3 fatty
acids and human health: defining strategies for public
policy. Lipids. 2001;36 Suppl:S83-9.
-
Yam D, Eliraz A, Berry EM.
Diet and disease--the Israeli paradox: possible dangers
of a high omega-6 polyunsaturated fatty acid diet. Isr J
Med Sci. 1996 Nov;32(11):1134-43.
-
Mozaffarian D, Rimm EB, Herington
DM. Dietary fats, carbohydrate, and progression
of coronary atherosclerosis in postmenopausal women. Am
J Clin Nutr. 2004 Nov;80(5):1175-84
(naar boven)
1) The case for low carbohydrate diets in diabetes management,
Nutr Metab (Lond). 2005 Jul 14;2:16
Arora SK,
McFarlane SI.
Division of Endocrinology, Diabetes and Hypertension, SUNY Downstate Medical
Center, and Kings County Hospital Center, Brooklyn, NY 11203 NY 11203, USA.
Samy.McFarlane@downstate.edu.
A low fat, high carbohydrate diet in combination with regular exercise is the
traditional recommendation for treating diabetes. Compliance with these
lifestyle modifications is less than satisfactory, however, and a high
carbohydrate diet raises postprandial plasma glucose and insulin secretion,
thereby increasing risk of CVD, hypertension, dyslipidemia, obesity and
diabetes. Moreover, the current epidemic of diabetes and obesity has been, over
the past three decades, accompanied by a significant decrease in fat consumption
and an increase in carbohydrate consumption. This apparent failure of the
traditional diet, from a public health point of view, indicates that alternative
dietary approaches are needed. Because carbohydrate is the major secretagogue of
insulin, some form of carbohydrate restriction is a prima facie candidate for
dietary control of diabetes. Evidence from various randomized controlled trials
in recent years has convinced us that such diets are safe and effective, at
least in short-term. These data show low carbohydrate diets to be comparable or
better than traditional low fat high carbohydrate diets for weight reduction,
improvement in the dyslipidemia of diabetes and metabolic syndrome as well as
control of blood pressure, postprandial glycemia and insulin secretion.
Furthermore, the ability of low carbohydrate diets to reduce triglycerides and
to increase HDL is of particular importance. Resistance to such strategies has
been due, in part, to equating it with the popular Atkins diet. However, there
are many variations and room for individual physician planning. Some form of low
carbohydrate diet, in combination with exercise, is a viable option for patients
with diabetes. However, the extreme reduction of carbohydrate of popular diets
(<30 g/day) cannot be recommended for a diabetic population at this time without
further study. On the other hand, the dire objections continually raised in the
literature appear to have very little scientific basis. Whereas it is
traditional to say that more work needs to be done, the same is true of the
assumed standard low fat diets which have an ambiguous record at best. We see
current trends in the national dietary recommendations as a positive sign and an
appropriate move in the right direction.
(naar boven)
2)
Clinical Use of a Carbohydrate-Restricted Diet to Treat the Dyslipidemia of the
Metabolic Syndrome, Metabolic Syndrome and Related Disorders,
Sep 2003, Vol. 1, No. 3: 227-232
Hickey JT, Hickey L, Yancy WS, et al
Background:
The metabolic syndrome is characterized by an atherogenic dyslipidemia
identifiable using lipoprotein subclass analysis. This study assesses the effect
of a carbohydrate-restricted diet on the dyslipidemia of the metabolic syndrome
in a clinical setting.
Methods:
This is a retrospective chart review of patients attending a preventive medicine
clinic using lipoprotein subclass analysis (by NMR spectroscopy) to identify the
atherogenic dyslipidemia. If present, patients were counseled to begin a
carbohydrate-restricted diet (< 20 g/day). Patients already on statin therapy
were included only if the medication dose was not changed. The outcomes were
changes in body weight, fasting serum lipid profiles and serum lipoprotein
subclasses.
Results:
Of 122 patients identified, 80 patients had complete pre- and post-treatment
data. The mean (±SD) age was 66 ± 9 years, baseline weight was 85 ± 12 kg, BMI
was 28.1 ± 3.6, 73% were male, 99% were Caucasian. Sixty-five percent were
taking statin medication. Carbohydrate-restriction led to a 13% reduction in
total cholesterol, 16% reduction in LDL cholesterol, 38% reduction in
triglycerides, and a 13% increase in HDL cholesterol (all p values <
0.001). Carbohydrate-restriction also led to a reduction in LDL particle
concentration of 28%, a reduction in small LDL of 82%, a reduction of large VLDL
of 62%, and an increase in large HDL of 30% (all p values < 0.001).
Conclusions:
A carbohydrate-restricted diet recommendation led to improvements in lipid
profiles and lipoprotein subclass traits of the metabolic syndrome in a clinical
outpatient setting, and should be considered as a treatment for the metabolic
syndrome.
(naar boven)
3)
A very low-fat diet is not associated with improved lipoprotein profiles in men
with a predominance of large, low-density lipoproteins, Am J Clin Nutr. 1999
Mar;69(3):411-8
Dreon DM, Fernstrom HA,
Williams PT, Krauss RM
Donner Laboratory,
Lawrence Berkeley National Laboratory, University of California, Berkeley 94720,
USA.
BACKGROUND: We found previously that men with a predominance of large LDL
particles (phenotype A) consuming high-fat diets (40-46% fat) show less
lipoprotein benefits of low-fat diets (20-24% fat) than do men with a high-risk
lipoprotein profile characterized by a predominance of small LDL (phenotype B).
Furthermore, one-third of men with phenotype A consuming a high-fat diet
converted to phenotype B with a low-fat diet.
OBJECTIVE: We
investigated effects of further reduction in dietary fat in men with persistence
of LDL subclass phenotype A during both high- and low-fat diets.
DESIGN:
Thirty-eight men who had shown phenotype A after 4-6 wk of both high- and
low-fat diets consumed for 10 d a 10%-fat diet (2.7% saturates) with replacement
of fat with carbohydrate and no change in cholesterol content or ratio of
polyunsaturates to saturates.
RESULTS: In 26 men,
phenotype A persisted (stable A group) whereas 12 converted to phenotype B
(change group). LDL cholesterol did not differ from previous values for
20-24%-fat diets in either group, whereas in the change group there were higher
concentrations of triacylglycerol and apolipoprotein B; greater mass of HDL,
large LDL-I, small LDL-III and LDL-IV, and HDL3; lower concentrations of HDL
cholesterol, apolipoprotein A-I; and lower mass of large LDL-I and HDL2.
CONCLUSIONS: There
is no apparent lipoprotein benefit of reduction in dietary fat from 20-24% to
10% in men with large LDL particles: LDL-cholesterol concentration was not
reduced, and in a subset of subjects there was a shift to small LDL along with
increased triacylglycerol and reduced HDL-cholesterol concentrations.
(naar boven)
4)
Change in dietary saturated fat intake is correlated with change in mass of
large low-density-lipoprotein particles in men, Am J Clin Nutr. 1998
May;67(5):828-36
Dreon DM, Fernstrom HA, Campos H, Blanche P, Williams PT, Krauss RM.
Children's Hospital Oakland Research Institute, CA, USA.
We tested whether nutrient intakes estimated from 4-d diet records were
associated with plasma lipoprotein subclasses in 103 men who were randomly
assigned to a low-fat (24% fat) and a high-fat (46% fat) diet for 6 wk each in a
crossover design. Postheparin plasma lipoprotein lipase (LPL) and hepatic lipase
(HL) activities were also determined in a subset of 43 men. Changes in intake (ie,
high fat minus low fat) of total saturated fatty acids, as well as myristic
(14:0) and palmitic (16:0) acids, were positively correlated (P < 0.01) with
increases in mass of large LDL particles [measured by analytic
ultra-centrifugation as mass of lipoproteins of flotation rate (Sf) 7-12] and
with LDL peak particle diameter and flotation rate, but not with changes in LDL-cholesterol
concentration. Changes in total saturated fatty acids as well as myristic and
palmitic acids were also inversely associated with changes in HL activity (P <
0.05). With the high-fat diet only, variation in dietary total saturated fatty
acid intake was inversely correlated (P < 0.01) with concentrations of small,
dense LDL of Sf 0-5. This correlation was significant specifically for myristic
acid (P < 0.001). Stearic acid (18:0), monounsaturates, and polyunsaturates
showed no significant associations with lipoprotein concentrations. These data
indicate that a high saturated fat intake (especially 14:0 and 16:0) is
associated with increased concentrations of larger, cholesterol-enriched LDL and
this occurs in association with decreased HL activity.
(naar boven)
5) Low-density
lipoprotein size and subclasses are markers of clinically apparent and
non-apparent atherosclerosis in type 2 diabetes, Metabolism. 2005
Feb;54(2):227-34
Berneis K, Jeanneret C, Muser J, Felix B, Miserez AR.
Department of Internal Medicine and Central Laboratories, Basel University
Hospital Bruderholz, Switzerland 4101. kaspar@berneis.ch
The atherogenic lipoprotein phenotype is characterized by an increase in plasma
triglycerides, a decrease in high-density lipoprotein (HDL), and the prevalence
of small, dense low-density lipoprotein (LDL) particles. The present study
investigated the clinical significance of LDL size and subclasses as markers of
atherosclerosis in diabetes type 2. Thirty-eight patients with type 2 diabetes,
total cholesterol of less than 6.5 mmol/L, and hemoglobin A1c (HbA1c) of less
than 9% were studied. Median age was 61 years, mean (+/-SD) body mass index 29
+/- 4.3 kg/m2 , and mean HbA1c 7.1 +/- 0.9 %. Laboratory parameters included
plasma lipids and lipoproteins, lipoprotein (a), apolipoprotein (apo) A-I, apo
B-100, apo C-III, and high-sensitivity C-reactive protein. Low-density
lipoprotein size and subclasses were measured by gradient gel electrophoresis
and carotideal intima media thickness (IMT) by duplex ultrasound. By factor
analysis, 10 out of 21 risk parameters were selected: age, body mass index,
systolic blood pressure, smoking (in pack-years), HbA1c, high-sensitivity
C-reactive protein, lipoprotein (a), LDL cholesterol, HDL cholesterol, and LDL
particle size. Multivariate analysis of variance of these 10 risk parameters
identified LDL particle size as the best risk predictor for the presence of
coronary heart disease (P = .002). Smaller LDL particle size was associated with
an increase in IMT (P = .03; cut-off >1 mm). Within the different lipid
parameters (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides,
apo B, apo A-I, apo C-III, LDL particle size), LDL particle size was most
strongly associated with the presence of coronary heart disease (P = .002) and
IMT (P = .03). It is concluded that LDL size is the strongest marker for
clinically apparent as well as non-apparent atherosclerosis in diabetes type 2.
(naar boven)
6)
Atherogenic lipoprotein phenotype and diet-gene interactions, J Nutr. 2001
Feb;131(2):340S-3S.(review)
Krauss RM.
Department of Molecular and Nuclear Medicine, Life Sciences Division, Ernest
Orlando Lawrence Berkeley National Laboratory, University of California,
Berkeley, CA 94720, USA.
Studies employing analysis of LDL subclasses have demonstrated heterogeneity of
the LDL response to low fat, high carbohydrate diets in healthy nonobese
subjects. In individuals with a genetically influenced atherogenic lipoprotein
phenotype, characterized by a predominance of small dense LDL (LDL subclass
pattern B), lowering of plasma LDL cholesterol levels by diets with < or =24%
fat has been found to represent a reduction in numbers of circulating mid-sized
and small LDL particles, and hence an expected lowering of cardiovascular
disease risk. In contrast, in the majority of healthy individuals with larger
LDL (pattern A, found in approximately 70% of men and a larger percentage of
women), a significant proportion of the low fat diet-induced reduction in plasma
LDL cholesterol is made by depletion of the cholesterol content of LDL
particles. This change in LDL composition is accompanied by a shift from larger
to smaller LDL particle diameters. Moreover, with progressive reduction of
dietary fat and isocaloric substitution of carbohydrate, an increasing number of
subjects with pattern A convert to the pattern B phenotype. Studies in families
have indicated that susceptibility to induction of pattern B by low fat diets is
under genetic influence. Thus, diet-gene interactions affecting LDL subclass
patterns may contribute to substantial interindividual variability in the
effects of low fat diets on coronary heart disease risk.
(naar boven)
7) Triglyceride, small,
dense low-density lipoprotein, and the atherogenic lipoprotein phenotype,
Curr Atheroscler Rep. 2000 May;2(3):200-7 (review)
Austin MA.
Department of Epidemiology, Box 357236, School of Public Health and Community
Medicine, University of Washington, Seattle, WA 98195-7236, USA. maustin@u.washington.edu
This review provides an overview of the recent data evaluating triglyceride and
low-density lipoprotein (LDL) size, two highly interrelated, genetically
influenced, risk factors for cardiovascular disease (CVD). An examination of new
epidemiologic studies continues to demonstrate that plasma triglyceride levels
predict CVD. The first prospective study of the familial forms of
hypertriglyceridemia has shown that relatives in familial-combined
hyperlipidemia families are at increased risk for CVD mortality and that
triglyceride levels predicted 20-year, CVD mortality among relatives in familial
hypertriglyceridemia families. A meta-analysis of three, large-scale,
prospective studies in men, and the first study to examine the correlation of
LDL particle size distribution and vascular changes measured by B-mode
ultrasound, add to growing evidence that small, dense LDL is atherogenic.
Quantitative genetic analysis has recently shown substantial pleiotropic
(common) genetic effects on triglyceride and LDL size. At least part of this may
be explained by variation at the cholesterol ester transfer protein locus on
chromosome 16, possibly through its role in reverse cholesterol transport. Taken
together, these data provide new insights into the importance of triglyceride
and LDL particle size for understanding genetic susceptibility to cardiovascular
disease and its prevention.
(naar boven)
8) Measurement of small
dense low-density lipoprotein particles, J Atheroscler Thromb.
2005;12(2):67-72 (review)
Hirano T, Ito Y, Yoshino G.
Division of Diabetes and Metabolism, First Department of Internal Medicine,
Showa University School of Medicine, 1-5-8 Hattanodai, Shinagawa-ku, Tokyo
142-8666, Japan. hirano@med.showa-u.ac.jp
Low density lipoprotein (LDL) particles are heterogeneous with respect to their
size, density and lipid composition. Among LDL particles, the smaller and denser
LDL particles [small dense (sd) LDL] are more atherogenic and the sd LDL
phenotype is strongly associated with development of coronary heart disease.
Here we will review various methods for measurement of sd LDL. Although
ultracentrifugation, nuclear magnetic resonance (NMR) spectroscopy and
gradient-gel electrophoresis (GGE) are usually employed for the measurement of
sd LDL, such methods are either too laborious or expensive for general clinical
use. We recently established a simple precipitation method for the
quantification of sd LDL. This method is applicable to routine clinical use and
allows the rapid measurement of a large number of samples.
(naar boven)
9) Low-glycemic-load diets: impact on obesity and chronic diseases,
Crit Rev Food Sci Nutr. 2003;43(4):357-77
Bell SJ, Sears B.
Historically, carbohydrates have been thought to play only a minor role in
promoting weight gain and in predicting the risk of development of chronic
disease. Most of the focus had been on reducing total dietary fat. During the
last 20 years, fat intake decreased, while the number of individuals who were
overweight or developed a chronic conditions have dramatically increased.
Simultaneously, the calories coming from carbohydrate have also increased.
Carbohydrates can be classified by their post-prandial glycemic effect, called
the glycemic index or glycemic load. Carbohydrates with high glycemic indexes
and high glycemic loads produce substantial increases in blood glucose and
insulin levels after ingestion. Within a few hours after their consumption,
blood sugar levels begin to decline rapidly due to an exaggerated increase in
insulin secretion. A profound state of hunger is created. The continued intake
of high-glycemic load meals is associated with an increased risk of chronic
diseases such as obesity, cardiovascular disease, and diabetes. In this review,
the terms glycemic index and glycemic load are defined, coupled with an overview
of short- and long-term changes that occur from eating diets of different
glycemic indexes and glycemic loads. Finally, practical strategies for how to
design low-glycemic-load diets consisting primarily of low-glycemic
carbohydrates are provided.
(naar boven)
10) Novel
treatments for Obesity, Asia Pac J Clin Nutr. 2003;12 Suppl:S8
Ludwig DS.
Department of Medicine, Children's Hospital Boston, MA, USA.
Background - Excessive fat consumption is commonly believed to cause obesity
and, for this reason, conventional approaches to weight loss have focused on
decreasing dietary fat. However, the relationship between dietary fat and
adiposity has been questioned for several reasons: 1) weight loss on low-fat
diets is characteristically modest in nature; 2) prospective epidemiological
studies have not consistently found that individuals eating the most fat are
heavier than those eating the least fat; and 3) obesity prevalence has risen
markedly since the 1970s in the US despite a significant decrease in fat
consumption as a percent of total energy. As dietary fat has decreased,
carbohydrate consumption has increased in a compensatory fashion, and most of
this increase has been in the form of refined starchy food and concentrated
sugar that are high in glycemic index (GI) and/or glycemic load (GL). Review -
Physiological studies demonstrate that consumption of high GI/GL meals induce a
sequence of hormonal changes that limit availability of metabolic fuels in the
post-prandial period and cause overeating. Short-term feeding studies
consistently show less satiety or greater voluntary energy intake after
consumption of high compared to low GI meals. Several intermediate-term clinical
trials found greater weight loss among overweight individuals on low compared to
low GI diets. A recent study from our group found significantly greater weight
and fat mass decrease among obese adolescents consuming a reduced GL compared to
a reduced fat diet for 12 months. Animal studies support a role for GI in body
weight regulation. Moreover, GI and GL appear to affect risk for diabetes and
heart disease after controlling for body weight. Conclusions - Reduction in
GI/GL comprises a novel and exciting approach to the prevention and treatment of
obesity and related complications. A low GI/GL diet may be an ideal compromise
between low fat diets at one end of the spectrum, and very low carbohydrate
diets at the other. Long-term, large-scale studies of such diets should assume a
high public health priority.
(naar boven)
11) The
effects of low-carbohydrate versus conventional weight loss diets in severely
obese adults: one-year follow-up of a randomized trial.
Stern L, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams M,
Gracely EJ, Samaha FF.
Philadelphia Veterans Affairs Medical Center, University of Pennsylvania Medical
Center, and Drexel University College of Medicine, Philadelphia, Pennsylvania
19104, USA.
BACKGROUND: A previous paper reported the 6-month comparison of weight loss and
metabolic changes in obese adults randomly assigned to either a low-carbohydrate
diet or a conventional weight loss diet. OBJECTIVE: To review the 1-year
outcomes between these diets. DESIGN: Randomized trial. SETTING: Philadelphia
Veterans Affairs Medical Center. PARTICIPANTS: 132 obese adults with a body mass
index of 35 kg/m2 or greater; 83% had diabetes or the metabolic syndrome.
INTERVENTION: Participants received counseling to either restrict carbohydrate
intake to <30 g per day (low-carbohydrate diet) or to restrict caloric intake by
500 calories per day with <30% of calories from fat (conventional diet).
MEASUREMENTS: Changes in weight, lipid levels, glycemic control, and insulin
sensitivity. RESULTS: By 1 year, mean (+/-SD) weight change for persons on the
low-carbohydrate diet was -5.1 +/- 8.7 kg compared with -3.1 +/- 8.4 kg for
persons on the conventional diet. Differences between groups were not
significant (-1.9 kg [95% CI, -4.9 to 1.0 kg]; P = 0.20). For persons on the
low-carbohydrate diet, triglyceride levels decreased more (P = 0.044) and
high-density lipoprotein cholesterol levels decreased less (P = 0.025). As seen
in the small group of persons with diabetes (n = 54) and after adjustment for
covariates, hemoglobin A1c levels improved more for persons on the
low-carbohydrate diet. These more favorable metabolic responses to a
low-carbohydrate diet remained significant after adjustment for weight loss
differences. Changes in other lipids or insulin sensitivity did not differ
between groups. LIMITATIONS: These findings are limited by a high dropout rate
(34%) and by suboptimal dietary adherence of the enrolled persons.
CONCLUSION: Participants on a low-carbohydrate diet had more favorable overall
outcomes at 1 year than did those on a conventional diet. Weight loss was
similar between groups, but effects on atherogenic dyslipidemia and glycemic
control were still more favorable with a low-carbohydrate diet after adjustment
for differences in weight loss.
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12)
Pilot 12-Week Weight-Loss Comparison: Low-Fat vs Low-Carbohydrate (Ketogenic)
Diets, Abstract Presented at The North American Association for the Study of
Obesity Annual Meeting 2003, Obesity Research, 11S, 2003, page 95OR.
Greene P, Willett W, Devecis J, et al.,
Summary:
The following summarizes information presented at multiple conferences on a
pilot study conducted by Greene et al. This information was written by Atkins
professionals.
BACKGROUND: Some researchers claim that people only lose weight on very low carb
diets due to a reduction in calorie intake. Others have argued that very low
carb diets offer a “metabolic advantage” allowing people to lose weight without
restricting calories. The objective of this study was to evaluate if people who
follow very low carb diets lose weight only due to restricting calories.
METHOD: Twenty-one participants were recruited and were randomly assigned to
three separate diets for 12 weeks: a low fat diet (55% carb, 15% protein, and
30% fat) and two different very low carb diets (both had 5% carb, 30% protein,
and 65% fat). The low fat (LF) diet and one of the very low carb (LC1) diets
provided a total of 1500 calories a day for women and 1800 calories a day for
men. The second very low carb diet group was allowed 300 additional calories a
day (1800 calories for women and 2100 calories for men). Meals were provided
during the study.
RESULTS: After 12 weeks, all participants lost weight. Both the very low carb
groups lost more weight than the low fat group (LC1: -23 lbs, LC2: -20 lbs, and
LF: -17 lbs). The difference between the diets was not statistically
significant. More body fat was lost than lean body mass (such as muscle) or
water on all the diets. All participants lost inches from their waist and hips.
LDL, triglycerides, and total cholesterol to HDL ratio improved on the diets.
VLDL improved significantly more on the low carb diets. BUN increased on the low
carb diets only. However, creatinine levels (a marker of kidney function)
remained unchanged.
CONCLUSION: All three diets were effective in reducing weight in adults and
the weight lost was primarily body fat. Even participants consuming higher
calories on the very low carb diet were able to lose more weight compared to the
lower calorie, low fat diet. The low carb diets improved several risk factors
for heart disease. The authors concluded that very low carb diets do not reduce
weight only by restricting calories.
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Hays JH, Gorman RT, Shakir KM.
OBJECTIVE: To improve glycemic control by substituting saturated fat for starch,
to identify any adverse effect on lipids masked by the extensive use of
metformin and lipid-lowering drugs, and to attempt to separate dietary effects
from effects of multiple drugs.
METHODS: We undertook a retrospective review of medical records of patients who
completed 1 year of follow-up after dietary prescription. The study subjects
included 151 patients in the diet group (whose dietary instructions included
high saturated fat but starch avoidance) and 132 historical control subjects
(who were allowed unlimited monounsaturated fat but had restriction of starch in
their diets).
RESULTS: Hemoglobin A1c (HbA1c) levels improved in both study groups (-1.4 +/-
0.2% [P<0.001]; 95% confidence interval [CI], -1.9 to -0.9). Use of metformin
was associated with a decrease in HbA1c (-0.12 +/- 0.003%/mo [P<0.001]; 95% CI,
-0.17 to -0.07). The diet group had an additional decrease of -0.7 +/- 0.2%
(P<0.001; 95% CI, -1.1 to -0.3). Weight increase was associated with the use of
insulin (+0.3 +/- 0.07 kg/mo [P<0.001]; 95% CI, 0.2 to 0.5), sulfonylurea (+0.18
+/- 0.06 kg/mo [P<0.01]; 95% CI, 0.05 to 0.30), and troglitazone (+0.7 +/- 0.2
kg/mo [P<0.005]; 95% CI, 0.3 to 1.2). Although not statistically significant,
metformin therapy showed a trend for weight loss (-0.14 +/- 0.08 kg/mo; P =
0.07). An additional weight loss was noted in the diet group (-2.65 +/- 0.62 kg
[P<0.001]; 95% CI, -3.87 to -1.44). Hydroxymethylglutaryl-coenzyme A reductase
inhibitor use was associated with reduced total cholesterol level (-1.7 +/- 0.6
mg/dL per month [P<0.005]; 95% CI, -2.9 to -0.5). The diet group had an
additional decrease of -13.0 +/- 4.5 mg/dL (P<0.001; 95% CI, -21.9 to -4.1). No
significant effect of the diet on triglyceride, low-density lipoprotein, or
high-density lipoprotein levels was detected.
CONCLUSION: Addition of saturated fat and removal of starch from a
high-monounsaturated fat and starch-restricted diet improved glycemic control
and were associated with weight loss without detectable adverse effects on serum
lipids.
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14) Dietary fat intake and risk of stroke in male US healthcare professionals: 14
year prospective cohort study, BMJ. 2003 Oct 4;327(7418):777-82
He K,
Merchant A,
Rimm EB,
Rosner BA,
Stampfer MJ,
Willett WC,
Ascherio A.
Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue,
Boston, MA 02115, USA. hpkhe@channing.harvard.edu
OBJECTIVE: To examine the association between intake of total fat, specific
types of fat, and cholesterol and risk of stroke in men. Design and setting
Health professional follow up study with 14 year follow up. PARTICIPANTS: 43 732
men aged 40-75 years who were free from cardiovascular diseases and diabetes in
1986. MAIN OUTCOME MEASURE: Relative risk of ischaemic and haemorrhagic stroke
according to intake of total fat, cholesterol, and specific types of fat.
RESULTS: During the 14 year follow up 725 cases of stroke occurred, including
455 ischaemic strokes, 125 haemorrhagic stokes, and 145 strokes of unknown type.
After adjustment for age, smoking, and other potential confounders, no evidence
was found that the amount or type of dietary fat affects the risk of developing
ischaemic or haemorrhagic stroke. Comparing the highest fifth of intake with the
lowest fifth, the multivariate relative risk of ischaemic stroke was 0.91 (95%
confidence interval 0.65 to 1.28; P for trend = 0.77) for total fat, 1.20 (0.84
to 1.70; P = 0.47) for animal fat, 1.07 (0.77 to 1.47; P = 0.66) for vegetable
fat, 1.16 (0.81 to 1.65; P = 0.59) for saturated fat, 0.91 (0.65 to 1.28; P =
0.83) for monounsaturated fat, 0.88 (0.64 to 1.21; P = 0.25) for polyunsaturated
fat, 0.87 (0.62 to 1.22; P = 0.42) for trans unsaturated fat, and 1.02 (0.75 to
1.39; P = 0.99) for dietary cholesterol. Intakes of red meats, high fat dairy
products, nuts, and eggs were also not appreciably related to risk of stroke.
CONCLUSIONS: These findings do not support associations between intake of
total fat, cholesterol, or specific types of fat and risk of stroke in men.
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15) Lasting improvement
of hyperglycaemia and bodyweight: low-carbohydrate diet in type 2 diabetes--a
brief report, Ups J Med Sci. 2005;110(1):69-73
Nielsen JV, Jonsson E, Nilsson AK.
In two groups of obese patients with type 2 diabetes the effects of 2 different
diet compositions were tested with regard to glycaemic control and bodyweight. A
group of 16 obese patients with type 2 diabetes was advised on a
low-carbohydrate diet, 1800 kcal for men and 1600 kcal for women, distributed as
20 % carbohydrates, 30 % protein and 50 % fat. Fifteen obese diabetes patients
on a high-carbohydrate diet were control group. Their diet, 1600-1800 kcal for
men and 1400-1600 kcal for women, consisted of approximately 60 % carbohydrates,
15 % protein and 25 % fat. Positive effects on the glucose levels were seen very
soon. After 6 months a marked reduction in bodyweight of patients in the
low-carbohydrate diet group was observed, and this remained one year later.
After 6 months the mean changes in the low-carbohydrate group and the control
group respectively were (+/-SD): fasting blood glucose (f-BG): -3.4+/-2.9 and
-0.6+/-2.9 mmol/l; HBA1c: -1.4+/-1.1 % and -0.6+/-1.4 %; Body Weight: -11.4+/-4
kg and -1.8+/-3.8 kg; BMI: -4.1+/-1.3 kg/m_ and -0.7+/-1.3 kg/m_. Large changes
in blood glucose levels were seen immediately. CONCLUSION: A low-carbohydrate
diet is an effective tool in the treatment of obese patients with type 2
diabetes.
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16) Effects of a
low-carbohydrate diet on weight loss and cardiovascular risk factor in
overweight adolescents, J Pediatr. 2003 Mar;142(3):253-8.
Sondike SB, Copperman N, Jacobson MS.
Division of Adolescent Medicine, Schneider Children's Hospital, New Hyde
Park, New York 10128, USA.
OBJECTIVES: To compare the effects of a low-carbohydrate (LC) diet with those of
a low-fat (LF) diet on weight loss and serum lipids in overweight adolescents.
DESIGN: A randomized, controlled 12-week trial. SETTING: Atherosclerosis
prevention referral center. METHODS: Random, nonblinded assignment of
participants referred for weight management. The study group (LC) (n = 16) was
instructed to consume <20 g of carbohydrate per day for 2 weeks, then <40 g/day
for 10 weeks, and to eat LC foods according to hunger. The control group (LF) (n
= 14) was instructed to consume <30% of energy from fat. Diet composition and
weight were monitored and recorded every 2 weeks. Serum lipid profiles were
obtained at the start of the study and after 12 weeks. RESULTS: The LC group
lost more weight (mean, 9.9 +/- 9.3 kg vs 4.1 +/- 4.9 kg, P <.05) and had
improvement in non-HDL cholesterol levels (P <.05). There was improvement in LDL
cholesterol levels (P <.05) in the LF group but not in the LC group. There were
no adverse effects on the lipid profiles of participants in either group.
CONCLUSIONS: The LC diet appears to be an effective method for short-term weight
loss in overweight adolescents and does not harm the lipid profile.
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17) A randomized study
comparing the effects of a low-carbohydrate diet and a conventional diet on
lipoprotein subfractions and C-reactive protein levels in patients with severe
obesity, Am J Med. 2004 Sep 15;117(6):398-405
Seshadri P, Iqbal N, Stern L, Williams M, Chicano KL, Daily DA, McGrory J,
Gracely EJ, Rader DJ, Samaha FF.
Department of Internal Medicine, Division of Endocrinology, University of
Pennsylvania Health System, Philadelphia 19104, USA.
PURPOSE: To compare the effects of a low-carbohydrate diet and a conventional
(fat- and calorie-restricted) diet on lipoprotein subfractions and inflammation
in severely obese subjects. METHODS: We compared changes in lipoprotein
subfractions and C-reactive protein levels in 78 severely obese subjects,
including 86% with either diabetes or metabolic syndrome, who were randomly
assigned to either a low-carbohydrate or conventional diet for 6 months.
RESULTS: Subjects on a low-carbohydrate diet experienced a greater decrease in
large very low-density lipoprotein (VLDL) levels (difference = -0.26 mg/dL, P =
0.03) but more frequently developed detectable chylomicrons (44% vs. 22%, P =
0.04). Both diet groups experienced similar decreases in the number of
low-density lipoprotein (LDL) particles (difference = -30 nmol/L, P = 0.74) and
increases in large high-density lipoprotein (HDL) concentrations (difference =
0.70 mg/dL, P = 0.63). Overall, C-reactive protein levels decreased modestly in
both diet groups. However, patients with a high-risk baseline level (>3 mg/dL, n
= 48) experienced a greater decrease in C-reactive protein levels on a
low-carbohydrate diet (adjusted difference = -2.0 mg/dL, P = 0.005), independent
of weight loss. CONCLUSION: In this 6-month study involving severely obese
subjects, we found an overall favorable effect of a low-carbohydrate diet on
lipoprotein subfractions, and on inflammation in high-risk subjects. Both diets
had similar effects on LDL and HDL subfractions. (Copyright 2004 Elsevier Inc.)
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18)
Dietary cholesterol and atherosclerosis,
Biochim Biophys Acta. 2000 Dec 15;1529(1-3):310-20.
Review
McNamara DJ.
Egg Nutrition Center, 1050 17th St. NW, Suite 560, Washington, DC 20036, USA.
enc@enc-online.org
The perceived relationship between dietary cholesterol, plasma cholesterol and
atherosclerosis is based on three lines of evidence: animal feeding studies,
epidemiological surveys, and clinical trials. Over the past quarter century
studies investigating the relationship between dietary cholesterol and
atherosclerosis have raised questions regarding the contribution of dietary
cholesterol to heart disease risk and the validity of dietary cholesterol
restrictions based on these lines of evidence. Animal feeding studies have shown
that for most species large doses of cholesterol are necessary to induce
hypercholesterolemia and atherosclerosis, while for other species even small
cholesterol intakes induce hypercholesterolemia. The species-to-species
variability in the plasma cholesterol response to dietary cholesterol, and the
distinctly different plasma lipoprotein profiles of most animal models make
extrapolation of the data from animal feeding studies to human health extremely
complicated and difficult to interpret. Epidemiological surveys often report
positive relationships between cholesterol intakes and cardiovascular disease
based on simple regression analyses; however, when multiple regression analyses
account for the colinearity of dietary cholesterol and saturated fat calories,
there is a null relationship between dietary cholesterol and coronary heart
disease morbidity and mortality. An additional complication of epidemiological
survey data is that dietary patterns high in animal products are often low in
grains, fruits and vegetables which can contribute to increased risk of
atherosclerosis. Clinical feeding studies show that a 100 mg/day change in
dietary cholesterol will on average change the plasma total cholesterol level by
2.2-2.5 mg/dl, with a 1.9 mg/dl change in low density lipoprotein (LDL)
cholesterol and a 0.4 mg/dl change in high density lipoprotein (HDL)
cholesterol. Data indicate that dietary cholesterol has little effect on the
plasma LDL:HDL ratio. Analysis of the available epidemiological and clinical
data indicates that for the general population, dietary cholesterol makes no
significant contribution to atherosclerosis and risk of cardiovascular disease.
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19) A low-carbohydrate,
ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia, Ann. Int. Med. 2004 May 18; 140 (10): p. 769-777
Yancy WS, Olsen MK,
Guyton JR, Bakst RP, Westman EC
Background:
Low-carbohydrate diets remain popular despite a paucity of scientific evidence
on their effectiveness.
Objective: To compare the effects of a low-carbohydrate, ketogenic diet program
with those of a low-fat, low-cholesterol, reduced-calorie diet.
Design: Randomized, controlled trial. Setting: Outpatient research clinic.
Participants: 120 overweight, hyperlipidemic volunteers from the community.
Intervention: Low-carbohydrate diet (initially, <20 g of carbohydrate daily)
plus nutritional supplementation, exercise recommendation, and group meetings,
or low-fat diet (<30% energy from fat, <300 mg of cholesterol daily, and deficit
of 500 to 1000 kcal/d) plus exercise recommendation and group meetings.
Measurements: Body weight, body composition, fasting serum lipid levels, and
tolerability.
Results: A greater proportion of the low-carbohydrate diet group than the
low-fat diet group completed the study (76% vs. 57%; P = 0.02). At 24 weeks,
weight loss was greater in the low-carbohydrate diet group than in the low-fat
diet group (mean change, –12.9% vs. –6.7%; P < 0.001). Patients in both groups
lost substantially more fat mass (change, –9.4 kg with the low-carbohydrate diet
vs. –4.8 kg with the low-fat diet) than fat-free mass (change, –3.3 kg vs. –2.4
kg, respectively). Compared with recipients of the low-fat diet, recipients of
the low-carbohydrate diet had greater decreases in serum triglyceride levels
(change, –0.84 mmol/L vs. –0.31 mmol/L [–74.2 mg/dL vs. –27.9 mg/dL]; P = 0.004)
and greater increases in high-density lipoprotein cholesterol levels (0.14 mmol/L
vs. –0.04 mmol/L [5.5 mg/dL vs. –1.6 mg/dL]; P < 0.001). Changes in low-density
lipoprotein cholesterol level did not differ statistically (0.04 mmol/L [1.6 mg/dL]
with the low-carbohydrate diet and –0.19 mmol/L [–7.4 mg/dL] with the low-fat
diet; P = 0.2). Minor adverse effects were more frequent in the low-carbohydrate
diet group.
Limitations: We could not definitively distinguish effects of the
low-carbohydrate diet and those of the nutritional supplements provided only to
that group. In addition, participants were healthy and were followed for only 24
weeks. These factors limit the generalizability of the study results.
Conclusions:
Compared with a low-fat diet, a low-carbohydrate diet program had better
participant retention and greater weight loss. During active weight loss, serum
triglyceride levels decreased more and high-density lipoprotein cholesterol
level increased more with the low-carbohydrate diet than with the low-fat diet.
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20)
Cholesterol, coconuts, and diet on Polynesian atolls: a natural experiment: the
Pukapuka and Tokelau island studies.
Am J Clin Nutr. 1981 Aug;34(8):1552-61
Prior
IA, Davidson F, Salmond CE, Czochanska Z.
Two
populations of Polynesians living on atolls near the equator provide an
opportunity to investigate the relative effects of saturated fat and dietary
cholesterol in determining serum cholesterol levels. The habitual diets of the
toll dwellers from both Pukapuka and Tokelau are high in saturated fat but low
in dietary cholesterol and sucrose. Coconut is the chief source of energy for
both groups. Tokelauans obtain a much higher percentage of energy from coconut
than the Pukapukans, 63% compared with 34%, so their intake of saturated fat is
higher. The serum cholesterol levels are 35 to 40 mg higher in Tokelauans than
in Pukapukans. These major differences in serum cholesterol levels are
considered to be due to the higher saturated fat intake of the Tokelauans.
Analysis of a variety of food samples, and human fat biopsies show a high lauric
(12:0) and myristic (14:0) content. Vascular disease is uncommon in both
populations and there is no evidence of the high saturated fat intake having a
harmful effect in these populations.
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21) Choice
of cooking oils--myths and realities.
J Indian Med Assoc.
1998 Oct;96(10):304-7
Sircar
S, Kansra U.
Department of Medicine, Safdarjang Hospital, New Delhi.
In
contrast to earlier epidemiologic studies showing a low prevalence of
atherosclerotic heart disease (AHD) and type-2 dependent diabetes mellitus
(Type-2 DM) in the Indian subcontinent, over the recent years, there has been an
alarming increase in the prevalence of these diseases in Indians--both abroad
and at home, attributable to increased dietary fat intake. Replacing the
traditional cooking fats condemned to be atherogenic, with refined vegetable
oils promoted as "heart-friendly" because of their polyunsaturated fatty acid (PUFA)
content, unfortunately, has not been able to curtail this trend. Current data on
dietary fats indicate that it is not just the presence of PUFA but the type of
PUFA that is important--a high PUFA n-6 content and high n-6/n-3 ratio in
dietary fats being atherogenic and diabetogenic. The newer "heart-friendly" oils
like sunflower or safflower oils possess this undesirable PUFA content and there
are numerous research data now available to indicate that the sole use or excess
intake of these newer vegetable oils are actually detrimental to health and
switching to a combination of different types of fats including the traditional
cooking fats like ghee, coconut oil and mustard oil would actually reduce the
risk of dyslipidaemias, AHD and Type-2 DM.
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22) De NHANES studie van 1971 tot 2000 uit de VS
Trends in Intake of Energy and Macronutrients --- United
States, 1971--2000
During 1971--2000, the prevalence of obesity in the United States increased from
14.5% to 30.9% (1). Unhealthy diets and sedentary behaviors have been identified
as the primary causes of deaths attributable to obesity (2). Evaluating trends
in dietary intake is an important step in understanding the factors that
contribute to the increase in obesity. To assess trends in intake of energy (i.e.,
kilocalories [kcals]), protein, carbohydrate, total fat, and saturated fat
during 1971--2000, CDC analyzed data from four National Health and Nutrition
Examination Surveys (NHANES): NHANES I (conducted during 1971--1974), NHANES II
(1976--1980), NHANES III (1988--1994), and NHANES 1999--2000. This report
summarizes the results of that analysis, which indicate that, during 1971--2000,
mean energy intake in kcals increased, mean percentage of kcals from
carbohydrate increased, and mean percentage of kcals from total fat and
saturated fat decreased (Figures 1 and 2). An expert advisory committee
appointed by the U.S. Department of Health and Human Services and the U.S.
Department of Agriculture (USDA) is conducting a review of the Dietary
Guidelines for Americans (3). Revised guidelines will be published in 2005.
NHANES provides information on the health and nutritional status of the U.S.
civilian, noninstitutionalized population by using a complex, multistage
probability sample design. NHANES I sampled persons residing in the contiguous
48 states; subsequent surveys sampled all 50 states. Surveys consisted of a
household interview followed by an examination at a mobile examination center (MEC).
All of the surveys included a dietary recall interview that was conducted at the
MEC to obtain information on foods and beverages consumed during the preceding
24 hours. In this report, estimates of energy intake include kcals from
alcoholic beverages; however, the percentage of kcals from alcohol is not
presented separately. Age was recorded at the time of the household interview.
The upper age limit was 74 years for NHANES I and NHANES II. No upper age limit
was established for NHANES III and NHANES 1999--2000. To compare estimates
across surveys, the analysis included only adults aged 20--74 years. Sample
sizes ranged from 1,730 men and 2,003 women in NHANES 1999--2000 to 6,630 men
and 7,537 women in NHANES III (Table).
Statistical analyses were conducted by using SAS version 8.2 and SUDAAN version
8.0.0, which used sample weights and design variables to produce national
estimates. The recommended age categories used are based on the survey sample
domains (4). Because of differences in the relative age distribution, estimates
for persons aged 20--74 years were adjusted by direct standardization to the
2000 U.S. Census population by using the age groups 20--39, 40--59, and 60--74
years. Six persons who reported fasting (i.e., consuming 0 kcals) during the
preceding 24 hours were excluded from these analyses.
During 1971--2000, a statistically significant increase in average energy intake
occurred (Table). For men, average energy intake increased from 2,450 kcals to
2,618 kcals (p<0.01), and for women, from 1,542 kcals to 1,877 kcals (p<0.01).
For men, the percentage of kcals from carbohydrate increased between 1971--1974
and 1999--2000, from 42.4% to 49.0% (p<0.01), and for women, from 45.4% to 51.6%
(p<0.01) (Table). The percentage of kcals from total fat decreased from 36.9% to
32.8% (p<0.01) for men and from 36.1% to 32.8% (p<0.01) for women. In addition,
the percentage of kcals from saturated fat decreased from 13.5% to 10.9%
(p<0.01) for men and from 13.0% to 11.0% (p<0.01) for women. A slight decrease
was observed in the percentage of kcals from protein, from 16.5% to 15.5%
(p<0.01) for men and from 16.9% to 15.1% (p<0.01) for women.
The decrease in the percentage of kcals from fat during 1971--1991 is attributed
to an increase in total kcals consumed; absolute fat intake in grams increased
(5). USDA food consumption survey data from 1989--1991 and 1994--1996 indicated
that the increased energy intake was caused primarily by higher carbohydrate
intake (6). Data from NHANES for 1971--2000 indicate similar trends. The
increase in energy intake is attributable primarily to an increase in
carbohydrate intake, with a 62.4-gram increase among women (p<0.01) and a
67.7-gram increase among men (p<0.01). Total fat intake in grams increased among
women by 6.5 g (p<0.01) and decreased among men by 5.3 g (p<0.01).
Reported by: JD Wright, MPH, J Kennedy-Stephenson, MS, CY Wang, PhD, MA McDowell,
MPH, CL Johnson, MSPH, National Center for Health Statistics, CDC.
Editorial Note:
The increase in caloric intake described in this report is consistent with
previously reported trends in dietary intake in the United States (7). USDA
survey data for 1977--1996 suggest that factors contributing to the increase in
energy intake in the United States include consumption of food away from home;
increased energy consumption from salty snacks, soft drinks, and pizza (8); and
increased portion sizes (9).
The findings in this report are subject to at least two limitations. First,
information on dietary intake is self-reported and subject to recall bias.
Second, although the majority of the increase in average energy intake occurred
between 1976--1980 and 1988--1994, changes in the 24-hour dietary recall
interview method between these two periods might account for some of this
difference. Beginning in 1988, dietary recalls were collected for weekend days
as well as weekdays because food consumption differs on weekend days. The
interview format was revised, and questions were added that might have allowed
for collection of more complete dietary intake data.
The latest national dietary data available indicate that the previously reported
increase in energy intake has continued, reflecting primarily increased
carbohydrate intake. A focus on total energy intake and energy balance (i.e.,
the balance of energy intake with energy expenditure) is fundamental to
preventing and reducing obesity in the United States. Continuing efforts to
decrease saturated fat intake are important to reduce the risk for
cardiovascular disease and should include assessment of fat intake in grams in
addition to fat intake as a percentage of kcals. The energy- and
macronutrient-intake trends described in this report should help guide the
forthcoming revision of Dietary Guidelines for Americans and reviews of USDA's
Food Guide Pyramid and the Healthy People 2010 nutrition objectives.
References
Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity
among US adults, 1999--2000. JAMA 2002;288:1723--7.
U.S. Department of Health and Human Services. The Surgeon General's call to
action to prevent and decrease overweight and obesity. Rockville, Maryland: U.S.
Department of Health and Human Services, Public Health Service, Office of the
Surgeon General, 2001.
U.S. Department of Health and Human Services, U.S. Department of Agriculture.
Development of the 2005 Dietary Guidelines for Americans, 6th ed. Available at
http://www.health.gov/dietaryguidelines/dga2005/default.htm.
U.S. Department of Health and Human Services. NHANES 1999--2000 addendum to the
NHANES III analytic guidelines. Available at http://www.cdc.gov/nchs/data/nhanes/guidelines1.pdf.
Ernst ND, Obarzanek E, Clark MB, Briefel RR, Brown CD, Donato K. Cardiovascular
health risks related to overweight. J Am Diet Assoc 1997;97(suppl):S47--S51.
Chanmugam P, Guthrie JF, Cecilio S, Morton JF, Basiotis PP, Anand R. Did fat
intake in the United States really decline between 1989--1991 and 1994--1996? J
Am Diet Assoc 2003;103:867--72.
Federation of American Societies for Experimental Biology, Life Sciences
Research Office. Third Report on Nutrition Monitoring in the United States (vol.
1). Washington, DC: U.S. Government Printing Office, 1995.
Nielsen SJ, Siega-Riz AM, Popkin BM. Trends in energy intake in U.S. between
1977 and 1996: similar shifts seen across age groups. Obes Res 2002;10:370--8.
Nielsen SJ, Popkin BM. Patterns and trends in food portion sizes, 1977--1998.
JAMA 2003;289:450--3.
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23) Enhanced endurance in
trained cyclists during moderate intensity exercise following 2 weeks adaptation
to a high fat diet, Eur J Appl Physiol Occup Physiol. 1994;69(4):287-93
Lambert EV, Speechly DP, Dennis SC, Noakes TD.
Liberty Life Chair of Exercise and Sports Science, University of Cape Town
Medical School, Observatory, South Africa.
These studies investigated the effects of 2 weeks of either a high-fat
(HIGH-FAT: 70% fat, 7% CHO) or a high-carbohydrate (HIGH-CHO: 74% CHO, 12% fat)
diet on exercise performance in trained cyclists (n = 5) during consecutive
periods of cycle exercise including a Wingate test of muscle power, cycle
exercise to exhaustion at 85% of peak power output [90% maximal oxygen uptake
(VO2max), high-intensity exercise (HIE)] and 50% of peak power output [60%
VO2max, moderate intensity exercise (MIE)]. Exercise time to exhaustion during
HIE was not significantly different between trials: nor were the rates of muscle
glycogen utilization during HIE different between trials, although starting
muscle glycogen content was lower [68.1 (SEM 3.9) vs 120.6 (SEM 3.8) mmol.kg-1
wet mass, P < 0.01] after the HIGH-FAT diet. Despite a lower muscle glycogen
content at the onset of MIE [32 (SEM 7) vs 73 (SEM 6) mmol.kg-1 wet mass,
HIGH-FAT vs HIGH-CHO, P < 0.01], exercise time to exhaustion during subsequent
MIE was significantly longer after the HIGH-FAT diet [79.7 (SEM 7.6) vs 42.5 (SEM
6.8) min, HIGH-FAT vs HIGH-CHO, P < 0.01]. Enhanced endurance during MIE after
the HIGH-FAT diet was associated with a lower respiratory exchange ratio [0.87 (SEM
0.03) vs (SEM 0.02), P < 0.05], and a decreased rate of carbohydrate oxidation
[1.41 (SEM 0.70) vs 2.23 (SEM 0.40) g CHO.min-1, P < 0.05].(ABSTRACT TRUNCATED
AT 250 WORDS)
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24) High-fat diet versus habitual diet prior to carbohydrate loading: effects of
exercise metabolism and cycling performance, Int J Sport Nutr Exerc Metab.
2001 Jun;11(2):209-25
Lambert EV, Goedecke JH, Zyle C, Murphy K, Hawley JA, Dennis SC, Noakes TD.
Research Unit for Exercise Science and Sports Medicine in the Department of
Human Biology, Faculty of Health Sciences, University of Cape Town, Sports
Science Institute of South Africa, Newlands 7725, Cape Town, South Africa.
We examined the effects of a high-fat diet (HFD-CHO) versus a habitual diet,
prior to carbohydrate (CHO)-loading on fuel metabolism and cycling time-trial (TT)
performance. Five endurance-trained cyclists participated in two 14-day
randomized cross-over trials during which subjects consumed either a HFD (> 65%
MJ from fat) or their habitual diet (CTL) (30 +/- 5% MJ from fat) for 10 day,
before ingesting a high-CHO diet (CHO-loading, CHO > 70% MJ) for 3 days. Trials
consisted of a 150-min cycle at 70% of peak oxygen uptake (VaO2peak), followed
immediately by a 20-km TT. One hour before each trial, cyclists ingested 400 ml
of a 3.44% medium-chain triacylglycerol (MCT) solution, and during the trial,
ingested 600 ml/hour of a 10% 14C-glucose + 3.44% MCT solution. The dietary
treatments did not alter the subjects' weight, body fat, or lipid profile. There
were also no changes in circulating glucose, lactate, free fatty acid (FFA), and
b-hydroxybutyrate concentrations during exercise. However, mean serum glycerol
concentrations were significantly higher (p < .01) in the HFD-CHO trial. The
HFD-CHO diet increased total fat oxidation and reduced total CHO oxidation but
did not alter plasma glucose oxidation during exercise. By contrast, the
estimated rates of muscle glycogen and lactate oxidation were lower after the
HFD-CHO diet. The HFD-CHO treatment was also associated with improved TT times
(29.5 +/- 2.9 min vs. 30.9 +/- 3.4 min for HFD-CHO and CTL-CHO, p <.05).
High-fat feeding for 10 days prior to CHO-loading was associated with an
increased reliance on fat, a decreased reliance on muscle glycogen, and improved
time trial performance after prolonged exercise.
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25) Effects of dietary
fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and
on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials
Ronald P Mensink, Peter L
Zock, Arnold DM Kester, and Martijn B Katan, Am J Clin Nutr 2003;77:1146–55.
ABSTRACT
Background: The effects of dietary fats on the risk of coronary artery
disease (CAD) have traditionally been estimated from their effects on LDL
cholesterol. Fats, however, also affect HDL cholesterol, and the ratio of total
to HDL cholesterol is a more specific marker of CAD than is LDL cholesterol. Objective: The objective was to evaluate the effects of individual fatty
acids on the ratios of total to HDL cholesterol and on serum lipoproteins. Design: We performed a meta-analysis of 60 selected trials and calculated
the effects of the amount and type of fat on total:HDL cholesterol and on other
lipids. Results: The ratio did not change if carbohydrates replaced
saturated fatty acids, but it decreased if cis unsaturated fatty acids replaced
saturated fatty acids. The effect on total:HDL cholesterol of replacing trans
fatty acids with a mix of carbohydrates and cis unsaturated fatty acids was
almost twice as large as that of replacing
saturated fatty acids. Lauric acid greatly increased total cholesterol, but much
of its effect was on HDL cholesterol. Consequently, oils rich in lauric acid
decreased the ratio of total to HDL
cholesterol. Myristic and palmitic acids had little effect on the ratio, and
stearic acid reduced the ratio slightly. Replacing fats with carbohydrates
increased fasting triacylglycerol concentrations. Conclusions: The
effects of dietary fats on total:HDL cholesterol may differ markedly from their
effects on LDL. The effects of fats on these risk markers should not in
themselves be considered to reflect changes in risk but should be confirmed by
prospective observational studies or clinical trials. By that standard, risk is
reduced most effectively when trans fatty acids and saturated fatty acids are
replaced with cis unsaturated fatty acids. The effects of carbohydrates and of
lauric acid–rich fats on CAD risk remain uncertain.
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26) Dietary
cholesterol, cholesterol absorption, postprandial lipemia and atherosclerosis,
Can J Clin Pharmacol. 2003 Winter;10 Suppl A:26A-32A (Review)
Huff MW.
Vascular Biology Group, Robarts Research Institute, University of Western
Ontario, London. mhuff@uwo.ca
The relationship among dietary cholesterol, cholesterol absorption, the
metabolism of cholesterol-rich chylomicron remnants and atherosclerosis is
complex; however, recent advances have provided insight into the mechanisms
involved. Although dietary cholesterol is an independent risk factor for
atherosclerosis, the attributable risk is low compared with dietary variables
such as the amount and type of fat. Clinical studies have demonstrated that in
humans consuming a typical Western-type diet, decreasing the amount of dietary
cholesterol intake results in only small changes in low-density lipoprotein (LDL)-cholesterol
and little or no change in the ratio of total cholesterol to high-density
lipoprotein cholesterol. These findings are better appreciated when all sources
of cholesterol entering the intestinal lumen are considered. Only a third of
intestinal cholesterol per day is derived from the diet. Cholesterol from
endogenous sources, including the bile and intestinal epithelial cells,
represents the majority of cholesterol absorbed and subsequently formed into
chylomicrons and secreted into the circulation. There is increasing evidence
that postprandial lipoproteins are atherogenic, in particular, cholesterol-rich
chylomicron remnants. These lipoproteins have the capacity to enter the arterial
wall and promote atherogenesis at several stages of development, including the
induction of smooth muscle cells and macrophage foam cell formation.
Furthermore, enhanced delivery of chylomicron remnants to the liver decreases
hepatic LDL-receptor expression, resulting in increased plasma LDL
concentrations. Therefore, the inhibition of cholesterol absorption has become
an attractive therapeutic target. There is growing genetic and biochemical
evidence that intestinal cholesterol absorption is carrier-mediated, which has
facilitated the development and characterization of small molecule inhibitors of
this process. Ezetimibe, the first of these new compounds, inhibits intestinal
absorption of dietary and biliary cholesterol and lowers total and LDL-cholesterol
concentrations in plasma. By inhibiting cholesterol absorption, and possibly by
reducing the cholesterol content of chylomicrons, ezetimibe may decrease the
atherogenic potential of chylomicron remnants.
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27) Paleolithic
nutrition: what can we learn from the past?, Asia Pac J Clin Nutr.
2004;13(Suppl):S17
Mann NJ
Department of Food
Science, RMIT University, Melbourne, 3001, Australia
Background -
Anthropologists and some nutritionists have long recognised that the diets of
Paleolithic and recent hunter-gatherers (HG) may represent a reference standard
for modern human nutrition and a model for defense against certain western
lifestyle diseases. Boyd Eaton of Emory University (Atlanta) has spent over 20
years reconstructing prehistoric diets from anthropological evidence and
observations of surviving HG societies, put this succinctly: "We are the heirs
of inherited characteristics accrued over millions of years, the vast majority
of our biochemistry and physiology are tuned to life conditions that existed
prior to the advent of agriculture some 10,000 years ago. Genetically our bodies
are virtually the same as they were at the end of paleolithic some 20,000 years
ago. The appearance of agriculture and domestication of animals some 10,000
years ago and the Industrial Revolution some 200 years ago introduced new
dietary pressures for which no adaptation has been possible in such a short time
span. Thus an inevitable discordance exists between our dietary intake and that
which our genes are suited to". This discordance hypothesis postulated by Eaton,
could explain many of the chronic "diseases of civilisation". But what did
hunter-gatherer populations actually eat?
Review - The lines of investigation used by anthropologists to deduce the
evolutionary diet of hominids include the study of: (i) changes in cranio-dental
features, (ii) isotopic chemical tracer methods, including carbon isotope
(13C/12C), strontium isotope (87Sr/86Sr) and trace element Sr/Ca ratios in
enamel and bone of fossils,(iii) comparative gut morphology of modern humans and
other mammals, (iv) the energetic requirements of a developing a large
brain:body size ratio, (v) optimal foraging theory and food selection, (vi) the
study of dietary patterns of surviving hunter-gatherer societies. Findings show
clear cranio-dental changes including, a decrease in molar teeth size,
jaws/skull became more gracile and front teeth became well-buttressed, all
indicative of less emphasis on grinding course foliage and more on biting and
tearing. Carbon isotope studies indicate the dietary intake of C4 grasses,
undoubtedly in the form of herbivorous animals, at a level which increased
substantially during the progression of our genus from A. aferensis to H.
sapiens. Even as far back as 3.5 million years, the Sr/Ca ratio falls in between
those typical for herbivores and carnivores. Gut morphology studies indicate a
closer structural analogy with carnivores than the folivorous or frugivorous
mammals. Energetic requirements of a relatively enlarged brain have been
balanced by reduction in size and energy requirement of the digestive system, a
phenomena requiring a high quality diet. Investigation of food procurement
habits of hunter-gatherer societies indicates the advantage of hunting of game
animals compared with plant foraging in terms of energy gain versus expenditure.
Study of macronutrient energy proportions in the diet of HG societies (n=229)
show a relatively high protein intake 19-35%, highly variable fat intake 28-47%
and low carbohydrate level 22-40%. Conclusions - It is postulated that changes
in food staples and food processing procedures introduced during the Neolithic
and Industrial era have fundamentally altered seven crucial nutritional
characteristics of our ancestral diet: (i) glycaemic load, (ii) fatty acid
balance, (iii) macronutrient balance, (iv) trace nutrient density, (v) acid-base
balance, (vi) sodium-potassium balance, (vii) fiber content.
(naar boven)
28) The paradoxical
nature of hunter-gatherer diets: meat-based, yet non-atherogenic.
Cordain L, Eaton SB, Miller JB, Mann N, Hill K.
Department of Health and Exercise Science, Colorado State University, Fort
Collins, Colorado, USA. cordain@cahs.colostate.edu
OBJECTIVE: Field studies of twentieth century hunter-gathers (HG) showed
them to be generally free of the signs and symptoms of cardiovascular disease (CVD).
Consequently, the characterization of HG diets may have important implications
in designing therapeutic diets that reduce the risk for CVD in Westernized
societies. Based upon limited ethnographic data (n=58 HG societies) and a single
quantitative dietary study, it has been commonly inferred that gathered plant
foods provided the dominant energy source in HG diets. METHOD AND RESULTS: In this review we have analyzed the 13 known quantitative dietary
studies of HG and demonstrate that animal food actually provided the dominant
(65%) energy source, while gathered plant foods comprised the remainder (35%).
This data is consistent with a more recent, comprehensive review of the entire
ethnographic data (n=229 HG societies) that showed the mean subsistence
dependence upon gathered plant foods was 32%, whereas it was 68% for animal
foods. Other evidence, including isotopic analyses of Paleolithic hominid
collagen tissue, reductions in hominid gut size, low activity levels of certain
enzymes, and optimal foraging data all point toward a long history of meat-based
diets in our species. Because increasing meat consumption in Western diets is
frequently associated with increased risk for CVD mortality, it is seemingly
paradoxical that HG societies, who consume the majority of their energy from
animal food, have been shown to be relatively free of the signs and symptoms of
CVD. CONCLUSION: The high reliance upon animal-based foods would not have
necessarily elicited unfavorable blood lipid profiles because of the
hypolipidemic effects of high dietary protein (19-35% energy) and the relatively
low level of dietary carbohydrate (22-40% energy). Although fat intake (28-58%
energy) would have been similar to or higher than that found in Western diets,
it is likely that important qualitative differences in fat intake, including
relatively high levels of MUFA and PUFA and a lower omega-6/omega-3 fatty acid
ratio, would have served to inhibit the development of CVD. Other dietary
characteristics including high intakes of antioxidants, fiber, vitamins and
phytochemicals along with a low salt intake may have operated synergistically
with lifestyle characteristics (more exercise, less stress and no smoking) to
further deter the development of CVD.
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29)
LDL size: does it matter?, Swiss Med Wkly 2004;134:720–724
Berneis K, Rizzo M.
The atherogenic
lipoprotein phenotype is characterised by a moderate
increase in plasma triglycerides, a decrease in high density
lipoprotein cholesterol and the prevalence of smaller denser
low density lipoprotein particles. The prevalence of this
partially inheritable phenotype is approximately 30% and is
a feature of the metabolic syndrome associated with an
increased risk for cardiovascular events. The predominance
of small dense LDL has been accepted as an emerging
cardiovascular risk factor by the adult treatment panel
(ATP) III. Key words: small dense LDL; atherogenic
lipoprotein
phenotype; coronary heart disease; diabetes
(naar boven)
30)
Relation of lipoprotein subclasses as measured by
Proton Nuclear Magnetic Resonance Spectroscopy to coronary artery disease.
Arteriosler Thromb Vasc Biol. 1998;18:1046-1053
Freedman DS et al.
Division of Nutrition, Centers for
Disease Control and Prevention, Atlanta, GA 30341-3724, USA.
Dxfl@cdc.gov
Although each of the major lipoprotein fractions is composed
of various subclasses that may differ in atherogenicity, the
importance of this heterogeneity has been difficult to
ascertain owing to the labor-intensive nature of subclass
measurement methods. We have recently developed a procedure,
using proton nuclear magnetic resonance (NMR) spectroscopy,
to simultaneously quantify levels of subclasses of very low
density (VLDL), low density (LDL), and high density (HDL)
lipoproteins; subclass distributions determined with this
method agree well with those derived by gradient gel
electrophoresis. The objective of the current study of 158
men was to examine whether NMR-derived lipoprotein subclass
levels improve the prediction of arteriographically
documented coronary artery disease (CAD) when levels of
lipids and lipoproteins are known. We found that a global
measure of CAD severity was positively associated with
levels of large VLDL and small HDL particles and inversely
associated with intermediate size HDL particles; these
associations were independent of age and standard lipid
measurements. At comparable lipid and lipoprotein levels,
for example, men with relatively high (higher than the
median) levels of either small HDL or large VLDL particles
were three to four times more likely to have extensive CAD
than were the other men; the 27 men with high levels of both
large VLDL and small HDL were 15 times more likely to have
extensive CAD than were men with low levels. In contrast,
adjustment for levels of triglycerides or HDL cholesterol
greatly reduced the relation of small LDL particles to CAD.
These findings suggest that large VLDL and small HDL
particles may play important roles in the development of
occlusive disease and that their measurement, which is not
possible with routine lipid testing, may lead to more
accurate risk assessment.
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31) Effect of mineral oil, sunflower oil,
and coconut oil on prevention of hair damage. J Cosmet Sci.
2003 Mar-Apr;54(2):175-92.
Rele AS, Mohile RB.
Research and Development Department, Nature Care Division,
Marico Industries Ltd., Mumbai, India.
Previously published results showed that both in vitro and
in vivo coconut oil (CNO) treatments prevented combing
damage of various hair types. Using the same methodology, an
attempt was made to study the properties of mineral oil and
sunflower oil on hair. Mineral oil (MO) was selected because
it is extensively used in hair oil formulations in India,
because it is non-greasy in nature, and because it is
cheaper than vegetable oils like coconut and sunflower oils.
The study was extended to sunflower oil (SFO) because it is
the second most utilized base oil in the hair oil industry
on account of its non-freezing property and its odorlessness
at ambient temperature. As the aim was to cover different
treatments, and the effect of these treatments on various
hair types using the above oils, the number of experiments
to be conducted was a very high number and a technique
termed as the Taguchi Design of Experimentation was used.
The findings clearly indicate the strong impact that coconut
oil application has to hair as compared to application of
both sunflower and mineral oils. Among three oils, coconut
oil was the only oil found to reduce the protein loss
remarkably for both undamaged and damaged hair when used as
a pre-wash and post-wash grooming product. Both sunflower
and mineral oils do not help at all in reducing the protein
loss from hair. This difference in results could arise from
the composition of each of these oils. Coconut oil, being a
triglyceride of lauric acid (principal fatty acid), has a
high affinity for hair proteins and, because of its low
molecular weight and straight linear chain, is able to
penetrate inside the hair shaft. Mineral oil, being a
hydrocarbon, has no affinity for proteins and therefore is
not able to penetrate and yield better results. In the case
of sunflower oil, although it is a triglyceride of linoleic
acid, because of its bulky structure due to the presence of
double bonds, it does not penetrate the fiber, consequently
resulting in no favorable impact on protein loss.
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32) A randomized double-blind controlled
trial comparing extra virgin coconut oil with mineral oil as
a moisturizer for mild to moderate xerosis. Dermatitis. 2004
Sep;15(3):109-16
Agero AL, Verallo-Rowell VM.
Department of Dermatology, Makati Medical Center, Makati
City, Philippines.
BACKGROUND: Xerosis is a common skin condition (1)
characterized by dry, rough, scaly, and itchy skin, (2)
associated with a defect in skin barrier function, and (3)
treated with moisturizers. People in the tropics have
effectively used coconut oil as a traditional moisturizer
for centuries. Recently, the oil also has been shown to have
skin antiseptic effects. A moisturizer with antiseptic
effects has value, but there are no clinical studies to
document the efficacy and safety of coconut oil as a skin
moisturizer. OBJECTIVE: This study aimed to determine the
effectivity and safety of virgin coconut oil compared with
mineral oil as a therapeutic moisturizer for mild to
moderate xerosis. METHODS: A randomized double-blind
controlled clinical trial was conducted on mild to moderate
xerosis in 34 patients with negative patch-test reactions to
the test products. These patients were randomized to apply
either coconut oil or mineral oil on the legs twice a day
for 2 weeks. Quantitative outcome parameters for effectivity
were measured at baseline and on each visit with a
Corneometer CM825 to measure skin hydration and a Sebumeter
SM 810 to measure skin lipids. For safety, transepidermal
water loss (TEWL) was measured with a Tewameter TM210, and
skin surface hydrogen ion concentration (pH) was measured
with a Skin pH Meter PH900. Patients and the investigator
separately evaluated, at baseline and at each weekly visit,
skin symptoms of dryness, scaling, roughness, and pruritus
by using a visual analogue scale and grading of xerosis.
RESULTS: Coconut oil and mineral oil have comparable effects.
Both oils showed effectivity through significant improvement
in skin hydration and increase in skin surface lipid levels.
Safety was demonstrated through no significant difference in
TEWL and skin pH. Subjective grading of xerosis by the
investigators and visual analogue scales used by the
patients showed a general trend toward better (though not
statistically evident) improvement with coconut oil than
with mineral oil. Safety for both was further demonstrated
by negative patch-test results prior to the study and by the
absence of adverse reactions during the study. CONCLUSION:
Coconut oil is as effective and safe as mineral oil when
used as a moisturizer.
(naar boven)
33) Influence of supplementary vitamins,
minerals and essential fatty acids on the antisocial
behaviour of young adult prisoners. Randomised,
placebo-controlled trial. Br J Psychiatry. 2002
Jul;181:22-8.
Gesch CB
et al.
BACKGROUND: There is evidence that offenders consume diets
lacking in essential nutrients and this could adversely
affect their behaviour. AIMS: To test empirically if
physiologically adequate intakes of vitamins, minerals and
essential fatty acids cause a reduction in antisocial
behaviour. METHOD: Experimental, double-blind,
placebo-controlled, randomised trial of nutritional
supplements on 231 young adult prisoners, comparing
disciplinary offences before and during supplementation.
RESULTS: Compared with placebos, those receiving the active
capsules committed an average of 26.3% (95% CI 8.3-44.33%)
fewer offences (P=0.03, two-tailed). Compared to baseline,
the effect on those taking active supplements for a minimum
of 2 weeks (n=172) was an average 35.1% (95% CI 16.3-53.9%)
reduction of offences (P<0.001, two-tailed), whereas
placebos remained within standard error. CONCLUSIONS:
Antisocial behaviour in prisons, including violence, are
reduced by vitamins, minerals and essential fatty acids with
similar implications for those eating poor diets in the
community.
Publication Types:
* Clinical Trial
* Randomized Controlled Trial
Free full
tekst versie op:
http://bjp.rcpsych.org/cgi/content/full/181/1/22
Omega-3 fatty acids in the treatment of psychiatric
disorders. Drugs. 2005;65(8):1051-9
Peet M, Stokes C.
The importance of omega-3 fatty acids for physical health is
now well recognised and there is increasing evidence that
omega-3 fatty acids may also be important to mental health.
The two main omega-3 fatty acids in fish oil,
eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)
have important biological functions in the CNS. DHA is a
major structural component of neuronal membranes, and
changing the fatty acid composition of neuronal membranes
leads to functional changes in the activity of receptors and
other proteins embedded in the membrane phospholipid. EPA
has important physiological functions that can affect
neuronal activity. Epidemiological studies indicate an
association between depression and low dietary intake of
omega-3 fatty acids, and biochemical studies have shown
reduced levels of omega-3 fatty acids in red blood cell
membranes in both depressive and schizophrenic patients.Five
of six double-blind, placebo-controlled trials in
schizophrenia, and four of six such trials in depression,
have reported therapeutic benefit from omega-3 fatty acids
in either the primary or secondary statistical analysis,
particularly when EPA is added on to existing psychotropic
medication. Individual clinical trials have suggested
benefits of EPA treatment in borderline personality disorder
and of combined omega-3 and omega-6 fatty acid treatment for
attention-deficit hyperactivity disorder. The evidence to
date supports the adjunctive use of omega-3 fatty acids in
the management of treatment unresponsive depression and
schizophrenia. As these conditions are associated with
increased risk of coronary heart disease and diabetes
mellitus, omega-3 fatty acids should also benefit the
physical state of these patients. However, as the clinical
research evidence is preliminary, large, and definitive
randomised controlled trials similar to those required for
the licensing of any new pharmacological treatment are
needed.
Publication Types: Review
(naar boven)
Eicosapentaenoic acid in the treatment
of schizophrenia and depression: rationale and preliminary
double-blind clinical trial results. Prostaglandins Leukot
Essent Fatty Acids. 2003 Dec;69(6):477-85.
Peet M.
It has been hypothesised that polyunsaturated fatty acids (PUFA)
play an important role in the aetiology of schizophrenia and
depression. Evidence supporting this hypothesis for
schizophrenia includes abnormal brain phospholipid turnover
shown by 31P Magnetic Resonance Spectroscopy, increased
levels of phospholipase A2, reduced niacin skin flush
response, abnormal electroretinogram, and reduced cell
membrane levels of n-3 and n-6 PUFA. In depression, there is
strong epidemiological evidence that fish consumption
reduces risk of becoming depressed and evidence that cell
membrane levels of n-3 PUFA are reduced. Four out of five
placebo-controlled double- blind trials of eicosapentaenoic
acid (EPA) in the treatment of schizophrenia have given
positive findings. In depression, two placebo-controlled
trials have shown a strong therapeutic effect of ethyl-EPA
added to existing medication. The mode of action of EPA is
currently not known, but recent evidence suggests that
arachidonic acid (AA) if of particular importance in
schizophrenia and that clinical improvement in schizophrenic
patients using EPA treatment correlates with changes in AA.
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Bipolar disorder and cell membrane
dysfunction. Progress toward integrative management. Altern
Med Rev. 2004 Jun;9(2):107-35.
Kidd PM.
Bipolar disorder (BD) is characterized by periods of
abnormally elevated mood (mania) that cycle with abnormally
lowered mood (depression). Multiple structural, metabolic,
and biochemical abnormalities are evident in the brain's
cortex, subcortex, and deeper regions. This disorder is
highly genetically conditioned but also highly susceptible
to environmental stressors: prenatal or perinatal insults,
childhood sexual or physical abuse, challenging life events,
substance abuse, and other toxic chemical exposures. Its
high morbidity, lost productivity, and suicide risk place a
great toll on society. Since World War II, BD has been
steadily worsening with earlier age of onset, greater
intensity of symptoms, and development of drug resistance.
Incidence in children is rising and misdiagnosis is common.
Disciplined management of the many risk factors is
essential, including cognitive psychotherapy and support
from family and community. Lithium has been the foundational
treatment, followed by valproate and other mood stabilizers,
antidepressants, and anticonvulsants. Several
single-nutrient and multinutrient supplements have also
proven beneficial. Controlled, double-blind trials show
multinutrient combinations of vitamins, minerals,
orthomolecules, herbals, and the omega-3 fatty acids EPA and
DHA to be effective monotherapy. The molecular action of
lithium and valproate converge with nutrients on the level
of the cell membrane and its molecular signal transduction
systems. This emergent, unified rationale presages effective
integrative management of bipolar disorder.
Publication Types: Review
(naar boven)
Omega-3 fatty acids in psychiatry: a review. Ann Clin
Psychiatry. 2000 Sep;12(3):159-65.
Freeman MP.
Omega-3 fatty acids are long-chain, polyunsaturated fatty
acids found in plant and marine sources. Unlike saturated
fats, which have been shown to have negative health
consequences, omega-3 fatty acids are polyunsaturated fatty
acids that have been associated with many health benefits.
Omega-3 fatty acids may prove to be efficacious in a number
of psychiatric disorders. Mood disorders have been
associated with abnormalities in fatty acid composition.
Several lines of evidence suggest that diminished omega-3
fatty acid concentrations are associated with mood
disorders. Clinical data are not yet available regarding
omega-3 fatty acids in the treatment of major depression.
However, one double-blind treatment trial has been conducted
in bipolar disorder. Also, substantial evidence does exist
supporting a potential role of omega-3 fatty acids in
schizophrenia, although treatment data are needed. A case
has been reported in which a patient with schizophrenia was
successfully treated with omega-3 fatty acids. Controlled
studies are necessary to explore the potential treatment of
schizophrenia with omega-3 fatty acids. Omega-3 fatty acids
may also be helpful in the treatment of dementia.
Furthermore, omega-3 fatty acids may prove to be a safe and
efficacious treatment for psychiatric disorders in pregnancy
and in breastfeeding.
Publication Types: Review
(naar boven)
Lipids, depression and suicide. Encephale. 2003
Jan-Feb;29(1):49-58.
Colin A, Reggers J, Castronovo V, Ansseau M.
Polyunsatured fatty acids are made out of a hydrocarbonated
chain of variable length with several double bonds. The
position of the first double bond (omega) differentiates
polyunsatured omega 3 fatty acids (for example: alpha-linolenic
acid or alpha-LNA) and polyunsatured omega 6 fatty acids
(for example: linoleic acid or LA). These two classes of
fatty acids are said to be essential because they cannot be
synthetised by the organism and have to be taken from
alimentation. The omega 3 are present in linseed oil, nuts,
soya beans, wheat and cold water fish whereas omega 6 are
present in maize, sunflower and sesame oil. Fatty acids are
part of phospholipids and, consequently, of all biological
membranes. The membrane fluidity, of crucial importance for
its functioning, depends on its lipidic components.
Phospholipids composed of chains of polyunsatured fatty
acids increase the membrane fluidity because, by bending
some chains, double bonds prevent them from compacting
themselves perfectly. Membrane fluidity is also determined
by the phospholipids/free cholesterol ratio, as cholesterol
increases membrane viscosity. A diet based on a high
proportion of essential polyunsatured fatty acids (fluid)
would allow a higher incorporation of cholesterol (rigid) in
the membranes to balance their fluidity, which would
contribute to lower blood cholesterol levels. Brain
membranes have a very high content in essential
polyunsatured fatty acids for which they depend on
alimentation. Any dietary lack of essential polyunsatured
fatty acids has consequences on cerebral development,
modifying the activity of enzymes of the cerebral membranes
and decreasing efficiency in learning tasks. EPIDEMIOLOGICAL
DATA: The prevalence of depression seems to increase
continuously since the beginning of the century. Though
different factors most probably contribute to this
evolution, it has been suggested that it could be related to
an evolution of alimentary patterns in the Western world, in
which polyunsatured omega 3 fatty acids contained in fish,
game and vegetables have been largely replaced by
polyunsatured omega 6 fatty acids of cereal oils. Some
epidemiological data support the hypothesis of a relation
between lower depression and/or suicide rates and a higher
consumption of fish. These data do not however prove a
relation of causality. CHOLESTEROL AND DEPRESSION: Several
cohort studies (on nondepressed subjects) have assessed the
relationship between plasma cholesterol and depressive
symptoms with contradictory results. Though some results
found a significant relationship between a decrease of total
cholesterol and high scores of depression, some other did
not. Studies among patients suffering from major depression
signalled more constantly an association between low
cholesterol and major depression. Besides, some trials
showed that clinical recovery may be associated with a
significant increase of total cholesterol. CHOLESTEROL AND
SUICIDAL BEHAVIOR: The hypothesis that a low cholesterol
level may represent a suicidal risk factor was discovered
accidentally following a series of epidemiological studies
which revealed an increase of the suicidal risk among
subjects with a low cholesterol level. Though some
contradictory studies do exist, this relationship has been
confirmed by several subsequent cohort studies. These
findings have challenged the vast public health programs
aimed at promoting the decrease of cholesterol, and even
suggested to suspend the administration of lipid lowering
drugs. Recent clinical studies on populations treated with
lipid lowering drugs showed nevertheless a lack of
significant increase of mortality, either by suicide or
accident. In addition, several controlled studies among
psychiatric patients revealed a decrease of the
concentrations of plasma cholesterol among patients who had
attempted suicide in comparison with other patients.
POLYUNSATURATED FATTY ACID AND DEPRESSION: In major
depression, all studies revealed a significant decrease of
the polyunsaturated omega 3 fatty acids and/or an increase
of the omega 6/omega 3 ratio in plasma and/or in the
membranes of the red cells. In addition, two studies found a
higher severity of depression when the level of
polyunsaturated omega 3 fatty acids or the ratio omega
3/omega 6 was low. Parallel to these modifications, other
biochemical perturbations have been reported in major
depression, particularly an activation of the inflammatory
response system, resulting in an increase of the
pro-inflammatory cytokines (interleukins: IL-1b, IL-6 and
interferon g) and eicosanoids (among others, prostaglandin
E2) in the blood and the CSF of depressed patients. These
substances cause a peroxidation and, consequently a
catabolism of membrane phospholipids, among others those
containing polyunsaturated fatty acids. The cytokines and
eicosanoids derive from polyunsaturated fatty acids and have
opposite physiological functions according to their omega 3
or omega 6 precursor. Arachidonic acid (omega 6) is, among
others, precursor of pro-inflammatory prostaglandin E2
(PGE2), whereas polyunsaturated omega 3 fatty acids inhibit
the formation of PGE2. It has been shown that a dietary
increase of polyunsaturated omega 3 fatty acids reduced
strongly the production of IL-1 beta, IL-2, IL-6 and TNF-alpha
(tumor necrosis factor-alpha). In contrast, diets with a
higher supply of linoleic acid (omega 6) increased
significantly the production of pro-inflammatory cytokines,
like TNF-alpha. Therefore, polyunsaturated omega 3 fatty
acids could be associated at different levels in the
pathophysiology of major depression, on the one hand through
their role in the membrane fluidity which influences diverse
steps of neurotransmission and, on the other hand, through
their function as precursor of pro-inflammatory cytokines
and eicosanoids disturbing neurotransmission. In addition,
antidepressants could exhibit an immunoregulating effect by
reducing the release of pro-inflammatory cytokines, by
increasing the release of endogenous antagonists of
pro-inflammatory cytokines like IL-10 and, finally, by
acting like inhibitors of cyclo-oxygenase. THERAPEUTIC USE
OF FATTY ACIDS: Data available concerning the administration
of supplements of DHA (docosahexanoic acid) or other
polyunsaturated fatty acids omega 3 are limited. In a double
blind placebo-controlled study on 30 patients with bipolar
disorder, the addition of polyunsaturated omega 3 fatty
acids was associated with a longer period of remission.
Moreover, nearly all the other prognosis measures were
better in the omega 3 group. Very recently, a controlled
trial showed the benefits of adding an omega 3 fatty acid,
eicosopentanoic acid, among depressed patients. After 4
weeks, six of the 10 patients receiving the fatty acid were
considered as responders in comparison with only one of the
ten patients receiving placebo. CONCLUSIONS: Some
epidemiological, experimental and clinical data favour the
hypothesis that polyunsaturated fatty acids could play a
role in the pathogenesis and/or the treatment of depression.
More studies however are needed in order to better precise
the actual implication of those biochemical factors among
the various aspects of depressive illness.
Publication Types: Review
(naar boven)
Omega-3 fatty acids and neuropsychiatric disorders. Reprod
Nutr Dev. 2005 Jan-Feb;45(1):1-28.
Young G, Conquer J.
Human Biology and Nutritional Sciences, University of Guelph,
Guelph, Ontario, Canada.
Epidemiological evidence suggests that dietary consumption
of the long chain omega-3 fatty acids eicosapentaenoic acid
(EPA) and docosahexaenoic acid (DHA), commonly found in fish
or fish oil, may modify the risk for certain
neuropsychiatric disorders. As evidence, decreased blood
levels of omega-3 fatty acids have been associated with
several neuropsychiatric conditions, including Attention
Deficit (Hyperactivity) Disorder, Alzheimer's Disease,
Schizophrenia and Depression. Supplementation studies, using
individual or combination omega-3 fatty acids, suggest the
possibility for decreased symptoms associated with some of
these conditions. Thus far, however, the benefits of
supplementation, in terms of decreasing disease risk and/or
aiding in symptom management, are not clear and more
research is needed. The reasons for blood fatty acid
alterations in these disorders are not known, nor are the
potential mechanisms by which omega-3 fatty acids may
function in normal neuronal activity and neuropsychiatric
disease prevention and/or treatment. It is clear, however,
that DHA is the predominant n-3 fatty acid found in the
brain and that EPA plays an important role as an
anti-inflammatory precursor. Both DHA and EPA can be linked
with many aspects of neural function, including
neurotransmission, membrane fluidity, ion channel and enzyme
regulation and gene expression. This review summarizes the
knowledge in terms of dietary omega-3 fatty acid intake and
metabolism, as well as evidence pointing to potential
mechanisms of omega-3 fatty acids in normal brain
functioning, development of neuropsychiatric disorders and
efficacy of omega-3 fatty acid supplementation in terms of
symptom management.
Publication Types: Review
(naar boven)
Omega 3 Fatty Acids in Bipolar Disorder Arch Gen Psychiatry.
1999;56:407-412.
A Preliminary Double-blind, Placebo-Controlled Trial
Stoll AL et al
Background. 3
Fatty acids may inhibit neuronal signal transduction
pathways in a manner similar to that of lithium carbonate
and valproate, 2 effective treatments for bipolar disorder.
The present study was performed to examine whether 3 fatty
acids also exhibit mood-stabilizing properties in bipolar
disorder. Methods. A 4-month, double-blind,
placebo-controlled study, comparing 3 fatty acids (9.6 g/d)
vs placebo (olive oil), in addition to usual treatment, in
30 patients with bipolar disorder. Results. A
Kaplan-Meier survival analysis of the cohort found that the
3 fatty acid patient group had a significantly longer period
of remission than the placebo group (P=.002; Mantel-Cox). In
addition, for nearly every other outcome measure, the 3
fatty acid group performed better than the placebo group.
Conclusion 3 Fatty acids were well tolerated and improved
the short-term course of illness in this preliminary study
of patients with bipolar disorder.
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Two
double-blind placebo-controlled pilot studies of
eicosapentaenoic acid in the treatment of schizophrenia.
Schizophr Res. 2001 Apr 30;49(3):243-51.
Peet M, Brind J, Ramchand CN, Shah S, Vankar GK.
Academic Department of Psychiatry, Northern General
Hospital, The Longley Centre, Norwood Grange Drive, S5 7JT,
Sheffield, UK. m.peet@sheffield.ac.uk
Evidence that the metabolism of phospholipids and
polyunsaturated fatty acids (PUFA) is abnormal in
schizophrenia provided the rationale for intervention
studies using PUFA supplementation. An initial open label
study indicating efficacy for n-3 PUFA in schizophrenia led
to two small double-blind pilot studies. The first study was
designed to distinguish between the possible effects of two
different n-3 PUFA: eicosapentaenoic acid (EPA) and
docohexaenoic acid (DHA). Forty-five schizophrenic patients
on stable antipsychotic medication who were still
symptomatic were treated with either EPA, DHA or placebo for
3 months. Improvement on EPA measured by the Positive and
Negative Syndrome Scale (PANSS) was statistically superior
to both DHA and placebo using changes in percentage scores
on the total PANSS. EPA was significantly superior to DHA
for positive symptoms using ANOVA for repeated measures. In
the second placebo-controlled study, EPA was used as a sole
treatment, though the use of antipsychotic drugs was still
permitted if this was clinically imperative. By the end of
the study, all 12 patients on placebo, but only eight out of
14 patients on EPA, were taking antipsychotic drugs. Despite
this, patients taking EPA had significantly lower scores on
the PANSS rating scale by the end of the study. It is
concluded that EPA may represent a new treatment approach to
schizophrenia, and this requires investigation by
large-scale placebo-controlled trials.
Publication Types: Clinical Trial, Randomized Controlled
Trial
(naar boven)
Membrane phospholipid composition, alterations in
neurotransmitter systems and schizophrenia. Prog
Neuropsychopharmacol Biol Psychiatry. 2005 Jul;
29(6):878-88.
du Bois TM, Deng C, Huang XF.
This review addresses the relationship between modifications
in membrane phospholipid composition (MPC) and alterations
in dopaminergic, serotonergic and cholinergic
neurotransmitter systems in schizophrenia. The main evidence
in support of the MPC hypothesis of schizophrenia comes from
post-mortem and platelet studies, which show that in
schizophrenia, certain omega-3 and omega-6 polyunsaturated
fatty acid (PUFA) levels are reduced. Furthermore,
examination of several biochemical markers suggests abnormal
fatty acid metabolism may be present in schizophrenia.
Dietary manipulation of MPC with polyunsaturated fatty acid
diets has been shown to affect densities of dopamine,
serotonin and muscarinic receptors in rats. Also,
supplementation with omega-3 fatty acids has been shown to
improve mental health rating scores, and there is evidence
that the mechanism behind this involves the serotonin
receptor complex. This suggests that a tight relationship
exists between essential fatty acid status and normal
neurotransmission, and that altered PUFA levels may
contribute to the abnormalities in neurotransmission seen in
schizophrenia.
Review
(naar boven)
Omega-3 fatty acids in inflammation and autoimmune diseases.
J Am Coll Nutr. 2002 Dec;21(6):495-505.
Simopoulos AP.
The Center for Genetics, Nutrition and Health, Washington,
DC 20009, USA. cgnh@bellatlantic.net
Among the fatty acids, it is the omega-3 polyunsaturated
fatty acids (PUFA) which possess the most potent
immunomodulatory activities, and among the omega-3 PUFA,
those from fish oil-eicosapentaenoic acid (EPA) and
docosahexaenoic acid (DHA)--are more biologically potent
than alpha-linolenic acid (ALA). Some of the effects of
omega-3 PUFA are brought about by modulation of the amount
and types of eicosanoids made, and other effects are
elicited by eicosanoid-independent mechanisms, including
actions upon intracellular signaling pathways, transcription
factor activity and gene expression. Animal experiments and
clinical intervention studies indicate that omega-3 fatty
acids have anti-inflammatory properties and, therefore,
might be useful in the management of inflammatory and
autoimmune diseases. Coronary heart disease, major
depression, aging and cancer are characterized by an
increased level of interleukin 1 (IL-1), a proinflammatory
cytokine. Similarly, arthritis, Crohn's disease, ulcerative
colitis and lupus erythematosis are autoimmune diseases
characterized by a high level of IL-1 and the
proinflammatory leukotriene LTB(4) produced by omega-6 fatty
acids. There have been a number of clinical trials assessing
the benefits of dietary supplementation with fish oils in
several inflammatory and autoimmune diseases in humans,
including rheumatoid arthritis, Crohn's disease, ulcerative
colitis, psoriasis, lupus erythematosus, multiple sclerosis
and migraine headaches. Many of the placebo-controlled
trials of fish oil in chronic inflammatory diseases reveal
significant benefit, including decreased disease activity
and a lowered use of anti-inflammatory drugs.
Publication Types:
• Review
(naar boven)
The
importance of the ratio of omega-6/omega-3 essential fatty
acids. Biomed Pharmacother. 2002 Oct;56(8):365-79.
Simopoulos AP.
The Center for Genetics, Nutrition and Health, Washington,
DC 20009, USA. cgnh@bellatlantic.net
Several sources of information suggest that human beings
evolved on a diet with a ratio of omega-6 to omega-3
essential fatty acids (EFA) of approximately 1 whereas in
Western diets the ratio is 15/1-16.7/1. Western diets are
deficient in omega-3 fatty acids, and have excessive amounts
of omega-6 fatty acids compared with the diet on which human
beings evolved and their genetic patterns were established.
Excessive amounts of omega-6 polyunsaturated fatty acids (PUFA)
and a very high omega-6/omega-3 ratio, as is found in
today's Western diets, promote the pathogenesis of many
diseases, including cardiovascular disease, cancer, and
inflammatory and autoimmune diseases, whereas increased
levels of omega-3 PUFA (a low omega-6/omega-3 ratio) exert
suppressive effects. In the secondary prevention of
cardiovascular disease, a ratio of 4/1 was associated with a
70% decrease in total mortality. A ratio of 2.5/1 reduced
rectal cell proliferation in patients with colorectal cancer,
whereas a ratio of 4/1 with the same amount of omega-3 PUFA
had no effect. The lower omega-6/omega-3 ratio in women with
breast cancer was associated with decreased risk. A ratio of
2-3/1 suppressed inflammation in patients with rheumatoid
arthritis, and a ratio of 5/1 had a beneficial effect on
patients with asthma, whereas a ratio of 10/1 had adverse
consequences. These studies indicate that the optimal ratio
may vary with the disease under consideration. This is
consistent with the fact that chronic diseases are
multigenic and multifactorial. Therefore, it is quite
possible that the therapeutic dose of omega-3 fatty acids
will depend on the degree of severity of disease resulting
from the genetic predisposition. A lower ratio of omega-6/omega-3
fatty acids is more desirable in reducing the risk of many
of the chronic diseases of high prevalence in Western
societies, as well as in the developing countries, that are
being exported to the rest of the world.
Publication Types:
• Review
(naar boven)
The
Mediterranean diets: What is so special about the diet of
Greece? The scientific evidence. J Nutr. 2001 Nov;131(11
Suppl):3065S-73S.
Simopoulos AP.
The Center for Genetics, Nutrition and Health, Washington,
DC, USA. cgnh@bellatlantic.net
The term "Mediterranean diet," implying that all
Mediterranean people have the same diet, is a misnomer. The
countries around the Mediterranean basin have different
diets, religions and cultures. Their diets differ in the
amount of total fat, olive oil, type of meat and wine
intake; milk vs. cheese; fruits and vegetables; and the
rates of coronary heart disease and cancer, with the lower
death rates and longer life expectancy occurring in Greece.
Extensive studies on the traditional diet of Greece (the
diet before 1960) indicate that the dietary pattern of
Greeks consists of a high intake of fruits, vegetables (particularly
wild plants), nuts and cereals mostly in the form of
sourdough bread rather than pasta; more olive oil and olives;
less milk but more cheese; more fish; less meat; and
moderate amounts of wine, more so than other Mediterranean
countries. Analyses of the dietary pattern of the diet of
Crete shows a number of protective substances, such as
selenium, glutathione, a balanced ratio of (n-6):(n-3)
essential fatty acids (EFA), high amounts of fiber,
antioxidants (especially resveratrol from wine and
polyphenols from olive oil), vitamins E and C, some of which
have been shown to be associated with lower risk of cancer,
including cancer of the breast. These findings should serve
as a strong incentive for the initiation of intervention
trials that will test the effect of specific dietary
patterns in the prevention and management of patients with
cancer.
Publication Types:
• Review
(naar boven)
N-3
fatty acids and human health: defining strategies for public
policy. Lipids. 2001;36 Suppl:S83-9.
Simopoulos AP.
The Center for Genetics, Nutrition and Health, Washington,
DC 20009, USA. cgnh@bellatlantic.net
The last quarter of the 20th century was characterized by an
increase in the consumer's interest in the nutritional
aspects of health. As a result, governments began to develop
dietary guidelines in addition to the traditional
recommended dietary allowances, which have been superseded
now by dietary reference intakes. In addition to governments,
various scientific societies and nongovernmental
organizations have issued their dietary advice to combat
chronic diseases and obesity. Human beings evolved on a diet
that was balanced in n-6 and n-3 essential fatty acid
intake, whereas Western diets have a ratio of n-6/n-3 of
16.74. The scientific evidence is strong for decreasing the
n-6 and increasing the n-3 intake to improve health
throughout the life cycle. This paper discusses the reasons
for this change and recommends the establishment of a
Nutrition and Food Policy, instead of a Food and Nutrition
Policy, because the latter subordinates the nutritional
aspects to the food policy aspects. Nutrition and food
planning comprise a tool of nutrition and food policy, whose
objectives are the achievement of the adequate nutrition of
the population as defined by nutritional science. The
scientific basis for the development of a public policy to
develop dietary recommendations for essential fatty acids,
including a balanced n-6/n-3 ratio is robust. What is needed
is a scientific consensus, education of professionals and
the public, the establishment of an agency on nutrition and
food policy at the national level, and willingness of
governments to institute changes. Education of the public is
essential to demand changes in the food supply.
Publication Types:
• Review
(naar boven)
Diet and disease--the Israeli paradox: possible dangers of a
high omega-6 polyunsaturated fatty acid diet. Isr J Med Sci.
1996 Nov;32(11):1134-43.
Yam D, Eliraz A, Berry EM.
Department of Membrane Research and Biophysics, Weizmann
Institute of Science, Rehovot, Israel.
Israel has one of the highest dietary polyunsaturated/saturated
fat ratios in the world; the consumption of omega-6
polyunsaturated fatty acids (PUFA) is about 8% higher than
in the USA, and 10-12% higher than in most European
countries. In fact, Israeli Jews may be regarded as a
population-based dietary experiment of the effect of a high
omega-6 PUFA diet, a diet that until recently was widely
recommended. Despite such national habits, there is
paradoxically a high prevalence of cardiovascular diseases,
hypertension, non-insulin-dependent diabetes mellitus and
obesity-all diseases that are associated with
hyperinsulinemia (HI) and insulin resistance (IR), and
grouped together as the insulin resistance syndrome or
syndrome X. There is also an increased cancer incidence and
mortality rate, especially in women, compared with western
countries. Studies suggest that high omega-6 linoleic acid
consumption might aggravate HI and IR, in addition to being
a substrate for lipid peroxidation and free radical
formation. Thus, rather than being beneficial, high omega-6
PUFA diets may have some long-term side effects, within the
cluster of hyperinsulinemia, atherosclerosis and
tumorigenesis.
Publication Types:
• Review
(naar boven)
Dietary fats, carbohydrate, and
progression of coronary atherosclerosis in postmenopausal
women. Am J Clin Nutr. 2004 Nov;80(5):1175-84
Mozaffarian D, Rimm EB, Herington DM.
Channing Laboratory, Department of Medicine, Brigham and
Women's Hospital and Harvard Medical School, Harvard School
of Public Health, Boston, Massachusetts, USA. dmozaffa@hsph.harvard.edu
BACKGROUND: The influence of diet on atherosclerotic
progression is not well established, particularly in
postmenopausal women, in whom risk factors for progression
may differ from those for men. OBJECTIVE: The
objective was to investigate associations between dietary
macronutrients and progression of coronary atherosclerosis
among postmenopausal women. DESIGN: Quantitative coronary
angiography was performed at baseline and after a mean
follow-up of 3.1 y in 2243 coronary segments in 235
postmenopausal women with established coronary heart
disease. Usual dietary intake was assessed at baseline. RESULTS: The mean (+/-SD) total fat intake was 25 +/- 6%
of energy. In multivariate analyses, a higher saturated fat
intake was associated with a smaller decline in mean minimal
coronary diameter (P = 0.001) and less progression of
coronary stenosis (P = 0.002) during follow-up. Compared
with a 0.22-mm decline in the lowest quartile of intake,
there was a 0.10-mm decline in the second quartile (P =
0.002), a 0.07-mm decline in the third quartile (P = 0.002),
and no decline in the fourth quartile (P < 0.001); P for
trend = 0.001. This inverse association was more pronounced
among women with lower monounsaturated fat (P for
interaction = 0.04) and higher carbohydrate (P for
interaction = 0.004) intakes and possibly lower total fat
intake (P for interaction = 0.09). Carbohydrate intake was
positively associated with atherosclerotic progression (P =
0.001), particularly when the glycemic index was high.
Polyunsaturated fat intake was positively associated with
progression when replacing other fats (P = 0.04) but not
when replacing carbohydrate or protein. Monounsaturated and
total fat intakes were not associated with progression. CONCLUSIONS: In postmenopausal women with relatively low
total fat intake, a greater saturated fat intake is
associated with less progression of coronary
atherosclerosis, whereas carbohydrate intake is associated
with a greater progression.
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