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Original Research Communication |
1 From the Departments of Human Biology (RPM) and Methodology and Statistics (ADMK), Maastricht University, Maastricht, Netherlands, and the Wageningen Centre for Food Sciences and Division of Human Nutrition and Epidemiology, Wageningen University, Wageningen, Netherlands (PLZ and MBK).
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 ratis 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.
Key Words: Diet • fatty acids • carbohydrates • serum lipoproteins • coronary artery disease risk
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T. Tholstrup, M. Raff, S. Basu, P. Nonboe, K. Sejrsen, and E. M Straarup Effects of butter high in ruminant trans and monounsaturated fatty acids on lipoproteins, incorporation of fatty acids into lipid classes, plasma C-reactive protein, oxidative stress, hemostatic variables, and insulin in healthy young men Am. J. Clinical Nutrition, February 1, 2006; 83(2): 237 - 243. [Abstract] [Full Text] [PDF]
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 A. D. Mooradian, M. J. Haas, and N. C. W. Wong The Effect of Select Nutrients on Serum High-Density Lipoprotein Cholesterol and Apolipoprotein A-I Levels Endocr. Rev., February 1, 2006; 27(1): 2 - 16. [Abstract] [Full Text] [PDF]
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M. S. Itskowitz, J. L. Pollock, M. B. Katan, Y. Xie, N. O. Davidson, D. Ashen, and R. S. Blumenthal Low HDL cholesterol levels. N. Engl. J. Med., January 26, 2006; 354(4): 417 - 419. [Full Text] [PDF]
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P. L. L. Goyens and R. P. Mensink The Dietary {alpha}-Linolenic Acid to Linoleic Acid Ratio Does Not Affect the Serum Lipoprotein Profile in Humans J. Nutr., December 1, 2005; 135(12): 2799 - 2804. [Abstract] [Full Text] [PDF]
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L. J. Appel, F. M. Sacks, V. J. Carey, E. Obarzanek, J. F. Swain, E. R. Miller III, P. R. Conlin, T. P. Erlinger, B. A. Rosner, N. M. Laranjo, et al. Effects of Protein, Monounsaturated Fat, and Carbohydrate Intake on Blood Pressure and Serum Lipids: Results of the OmniHeart Randomized Trial JAMA, November 16, 2005; 294(19): 2455 - 2464. [Abstract] [Full Text] [PDF]
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B. Fletcher, K. Berra, P. Ades, L. T. Braun, L. E. Burke, J. L. Durstine, J. M. Fair, G. F. Fletcher, D. Goff, L. L. Hayman, et al. Managing Abnormal Blood Lipids: A Collaborative Approach Circulation, November 15, 2005; 112(20): 3184 - 3209. [Abstract] [Full Text] [PDF]
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 T. J. Little, K. L. Feltrin, M. Horowitz, A. J. P. M. Smout, T. Rades, J. H. Meyer, A. N. Pilichiewicz, J. Wishart, and C. Feinle-Bisset Dose-related effects of lauric acid on antropyloroduodenal motility, gastrointestinal hormone release, appetite, and energy intake in healthy men Am J Physiol Regulatory Integrative Comp Physiol, October 1, 2005; 289(4): R1090 - R1098. [Abstract] [Full Text] [PDF]
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M. A Thijssen and R. P Mensink Small differences in the effects of stearic acid, oleic acid, and linoleic acid on the serum lipoprotein profile of humans Am. J. Clinical Nutrition, September 1, 2005; 82(3): 510 - 516. [Abstract] [Full Text] [PDF]
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P. Verhoef, T. van Vliet, M. R Olthof, and M. B Katan A high-protein diet increases postprandial but not fasting plasma total homocysteine concentrations: a dietary controlled, crossover trial in healthy volunteers Am. J. Clinical Nutrition, September 1, 2005; 82(3): 553 - 558. [Abstract] [Full Text] [PDF]
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M. L. Fernandez and K. L. West Mechanisms by which Dietary Fatty Acids Modulate Plasma Lipids1 J. Nutr., September 1, 2005; 135(9): 2075 - 2078. [Abstract] [Full Text] [PDF]
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A. L. Lock, C. A. M. Horne, D. E. Bauman, and A. M. Salter Butter Naturally Enriched in Conjugated Linoleic Acid and Vaccenic Acid Alters Tissue Fatty Acids and Improves the Plasma Lipoprotein Profile in Cholesterol-Fed Hamsters J. Nutr., August 1, 2005; 135(8): 1934 - 1939. [Abstract] [Full Text] [PDF]
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P. T Williams, P. J Blanche, R. Rawlings, and R. M Krauss Concordant lipoprotein and weight responses to dietary fat change in identical twins with divergent exercise levels 1 Am. J. Clinical Nutrition, July 1, 2005; 82(1): 181 - 187. [Abstract] [Full Text] [PDF]
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J. B. Keogh, J. A. Grieger, M. Noakes, and P. M. Clifton Flow-Mediated Dilatation Is Impaired by a High-Saturated Fat Diet but Not by a High-Carbohydrate Diet Arterioscler Thromb Vasc Biol, June 1, 2005; 25(6): 1274 - 1279. [Abstract] [Full Text] [PDF]
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G. Bos, J. M Dekker, E. J. Feskens, M. C Ocke, G. Nijpels, C. D. Stehouwer, L. M Bouter, R. J Heine, and H. Jansen Interactions of dietary fat intake and the hepatic lipase -480C->T polymorphism in determining hepatic lipase activity: the Hoorn Study Am. J. Clinical Nutrition, April 1, 2005; 81(4): 911 - 915. [Abstract] [Full Text] [PDF]
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 K. Oh, F. B. Hu, J. E. Manson, M. J. Stampfer, and W. C. Willett Dietary Fat Intake and Risk of Coronary Heart Disease in Women: 20 Years of Follow-up of the Nurses' Health Study Am. J. Epidemiol., April 1, 2005; 161(7): 672 - 679. [Abstract] [Full Text] [PDF]
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C. Bellido, J. Lopez-Miranda, L. M. Blanco-Colio, P. Perez-Martinez, F. J. Muriana, J. L. Martin-Ventura, C. Marin, P. Gomez, F. Fuentes, J. Egido, et al. Butter and walnuts, but not olive oil, elicit postprandial activation of nuclear transcription factor {kappa}B in peripheral blood mononuclear cells from healthy men Am. J. Clinical Nutrition, December 1, 2004; 80(6): 1487 - 1491. [Abstract] [Full Text] [PDF]
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S. Desroches, M.-E. Paradis, M. Perusse, W. R. Archer, J. Bergeron, P. Couture, N. Bergeron, and B. Lamarche Apolipoprotein A-I, A-II, and VLDL-B-100 metabolism in men: comparison of a low-fat diet and a high-monounsaturated fatty acid diet J. Lipid Res., December 1, 2004; 45(12): 2331 - 2338. [Abstract] [Full Text] [PDF]
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L. C. Tapsell, L. J. Gillen, C. S. Patch, M. Batterham, A. Owen, M. Bare, and M. Kennedy Including Walnuts in a Low-Fat/Modified-Fat Diet Improves HDL Cholesterol-to-Total Cholesterol Ratios in Patients With Type 2 Diabetes Diabetes Care, December 1, 2004; 27(12): 2777 - 2783. [Abstract] [Full Text] [PDF]
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J B. German and C. J Dillard Saturated fats: what dietary intake? Am. J. Clinical Nutrition, September 1, 2004; 80(3): 550 - 559. [Abstract] [Full Text] [PDF]
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M.-P. St-Onge, I. Janssen, and S. B. Heymsfield Metabolic Syndrome in Normal-Weight Americans: New definition of the metabolically obese, normal-weight individual Diabetes Care, September 1, 2004; 27(9): 2222 - 2228. [Abstract] [Full Text] [PDF]
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M. U. Jakobsen, K. Overvad, J. Dyerberg, M. Schroll, and B. L. Heitmann Dietary Fat and Risk of Coronary Heart Disease: Possible Effect Modification by Gender and Age Am. J. Epidemiol., July 15, 2004; 160(2): 141 - 149. [Abstract] [Full Text] [PDF]
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N. R. Matthan, F. K. Welty, P. H. R. Barrett, C. Harausz, G. G. Dolnikowski, J. S. Parks, R. H. Eckel, E. J. Schaefer, and A. H. Lichtenstein Dietary Hydrogenated Fat Increases High-Density Lipoprotein apoA-I Catabolism and Decreases Low-Density Lipoprotein apoB-100 Catabolism in Hypercholesterolemic Women Arterioscler Thromb Vasc Biol, June 1, 2004; 24(6): 1092 - 1097. [Abstract] [Full Text]
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K. Meksawan, D. R. Pendergast, J. J. Leddy, M. Mason, P. J. Horvath, and A. B. Awad Effect of Low and High Fat Diets on Nutrient Intakes and Selected Cardiovascular Risk Factors in Sedentary Men and Women J. Am. Coll. Nutr., April 1, 2004; 23(2): 131 - 140. [Abstract] [Full Text] [PDF]
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 M. M. Mello, E. B. Rimm, and D. M. Studdert The McLawsuit: The Fast-Food Industry And Legal Accountability For Obesity Health Aff., November 1, 2003; 22(6): 207 - 216. [Abstract] [Full Text] [PDF]
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