Estimates of the direct and indirect cost savings associated with heart disease that could be avoided through dietary change in the United States.

AIMS: Diets high in saturated fat are associated with elevated risk of heart disease. This study estimates the savings in direct (medical care) costs and indirect (job absenteeism) costs in the US from reductions in heart disease associated with substituting monounsaturated fats (MUFA) for saturated fats. MATERIALS AND METHODS: A four-part model of the medical care cost savings from avoided heart disease was estimated using data on 247,700 adults from the 2000-2010 Medical Expenditure Panel Survey (MEPS). The savings from reduced job absenteeism due to avoided heart disease was estimated using a zero-inflated negative binomial model of the number of annual work loss days applied to data on 164,577 adults from the MEPS. RESULTS: Estimated annual savings in medical care expenditures resulting from a switch from a diet high in saturated fat to a high-MUFA diet totaled ∼ $25.7 billion (95% CI = $6.0-$45.4 billion) in 2010, with private insurance plans saving $7.9 billion (95% CI = $1.8-$14.0 billion), Medicare saving $9.4 billion (95% CI = $2.1-$16.7 billion), Medicaid saving $1.4 billion (95% CI = $0.2-$2.5 billion), and patients saving $2.2 billion (95% CI = $0.5-$3.8 billion). The annual savings in terms of reduced job absenteeism ranges from a lower bound of $600 million (95% CI = $100 million to $1.0 billion) to an upper bound of $1.2 billion (95% CI = $0.2-$2.1 billion) for 2010. LIMITATIONS: The data cover only the non-institutionalized population. Decreased costs due to any decreases in the severity of heart disease are not included. Cost savings do not include any reduction in informal care at home. CONCLUSIONS: Diets high in saturated fat impose substantial medical care costs and job absenteeism costs, and substantial savings could be achieved by substituting MUFA for saturated fat.

Modulation of plasma N-acylethanolamine levels and physiological parameters by dietary fatty acid composition in humans.

N-Acylethanolamines (NAEs) are endogenous lipid-signaling molecules involved in satiety and energetics; however, how diet impacts circulating NAE concentrations and their downstream metabolic actions in humans remains unknown. Objectives were to examine effects of diets enriched with high-oleic canola oil (HOCO) or HOCO blended with flaxseed oil (FXCO), compared with a Western diet (WD), on plasma NAE levels and the association with energy expenditure and substrate oxidation. Using a randomized controlled crossover design, 36 hypercholesterolemic participants consumed three isoenergetic diets for 28 days, each containing 36% energy from fat, of which 70% was HOCO, FXCO, or WD. Ultra-performance liquid chromatography-MS/MS was used to measure plasma NAE levels and indirect calorimetry to assess energy expenditure and substrate oxidation. After 28 days, compared with WD, plasma oleoylethanolamide (OEA) and alpha-linolenoyl ethanolamide (ALEA) levels were significantly increased in response to HOCO and FXCO (P = 0.002, P < 0.001), respectively. Correlation analysis demonstrated an inverse association between plasma OEA levels and percent body fat (r = -0.21, P = 0.04), and a positive association was observed between the plasma arachidonoyl ethanolamide (AEA)/OEA ratio and android:gynoid fat (r = 0.23, P = 0.02), respectively. Results suggest that plasma NAE levels are upregulated via their dietary lipid substrates and may modulate regional and total fat mass through lipid-signaling mechanisms.

Dietary oils and FADS1-FADS2 genetic variants modulate [13C]α-linolenic acid metabolism and plasma fatty acid composition.

BACKGROUND: Desaturation of dietary α-linolenic acid (ALA) to omega-3 (n-3) long-chain fatty acids (FAs) is mediated through FA desaturases (FADS1-FADS2) and may be influenced by dietary FA composition. OBJECTIVE: We investigated the effects of diets enriched in flaxseed oil (FXCO) or high-oleic acid canola oil (HOCO) compared with a Western diet (WD) and FADS1-FADS2 single nucleotide polymorphisms (SNPs) on plasma FAs and [U-(13)C]ALA metabolism. DESIGN: In a randomized crossover design, 36 hyperlipidemic subjects consumed 3 isoenergetic diets enriched in FXCO (20.6 g ALA/d), HOCO (2.4 g ALA/d), or WD (1.3 g ALA/d) for 4 wk. On day 27, blood was sampled 0, 24, and 48 h after the subjects (n = 26) consumed 45 mg [U-(13)C]ALA. The subjects were genotyped for 4 FADS SNPs. RESULTS: FXCO increased (P < 0.001) plasma ALA, EPA, and docosapentaenoic acid (DPA), with no change in DHA compared with the HOCO or WD diets. At 24 and 48 h, [U-(13)C]ALA recovered as plasma [(13)C]EPA and [(13)C]DPA were lower (P < 0.001) after the FXCO diet than after the HOCO and WD diets. No change in [(13)C]DHA was observed between diets. Minor allele homozygotes of rs174545, rs174583, rs174561, and rs174537 had lower (P < 0.05) plasma EPA, arachidonic acid (AA), EPA/ALA, and AA/linoleic acid compositions and lower (P < 0.05) plasma [(13)C]EPA enrichment at 24 and 48 h in comparison with carriers of the major allele after all diets. SNPs were not associated with plasma composition of DHA or [(13)C]DHA enrichment. CONCLUSION: An increase in ALA intake resulting in increased plasma EPA composition may be cardioprotective, especially in minor allele homozygotes. This trial was registered at www.clinicaltrials.gov as NCT00927199.

Effect of high-oleic canola and flaxseed oils on energy expenditure and body composition in hypercholesterolemic subjects.

OBJECTIVE: The fatty acid profile of dietary fats may contribute to its channelling toward oxidation versus storage, influencing energy and weight balance. Our objective was to compare the effects of diets enriched with high-oleic canola oil (HOCO), alone or blended with flaxseed oil (FXCO), on energy expenditure, substrate utilization, and body composition versus a typical Western diet (WD). MATERIALS/METHODS: Using a randomized crossover design, 34 hypercholesterolemic subjects (n=22 females) consumed 3 controlled diets for 28 days containing ~49% energy from carbohydrate, 14% energy from protein, and 37% energy from fat, of which 70% of fat was provided by HOCO rich in oleic acid, FXCO rich in alpha-linolenic acid, or WD rich in saturated fat. Indirect calorimetry measured energy expenditure and substrate oxidation. Body composition was analyzed by dual-energy x-ray absorptiometry. RESULT: After 28 days, resting and postprandial energy expenditure and substrate oxidation were not different after consumption of the HOCO or FXCO diets compared with a typical Western diet. No significant changes in body composition measures were observed between diets. However, the android-to-gynoid ratio tended to increase (P=.055) after the FXCO diet compared with the HOCO diet. CONCLUSIONS: The data suggest that substituting a typical Western dietary fatty acid profile with HOCO or FXCO does not significantly modulate energy expenditure, substrate oxidation or body composition in hypercholesterolemic males and females.

Dietary monounsaturated fatty acids are protective against metabolic syndrome and cardiovascular disease risk factors.

Over 50 years of research has sought to define the role dietary fat plays in cardiovascular disease (CVD) risk. Although optimal dietary fat quantity has been keenly pursued over past decades, attention has recently centered on the value of dietary fat quality. The purpose of the present review is to provide a critical assessment of the current body of evidence surrounding efficacy of dietary monounsaturated fatty acids (MUFA) for reduction of traditional risk factors defining metabolic syndrome (MetS) and CVD. Due to existing and emerging research on health attributes of MUFA rich diets, and to the low prevalence of chronic disease in populations consuming MUFA rich Mediterranean diets, national dietary guidelines are increasingly recommending dietary MUFA, primarily at the expense of saturated fatty acids (SFA). Consumption of dietary MUFA promotes healthy blood lipid profiles, mediates blood pressure, improves insulin sensitivity and regulates glucose levels. Moreover, provocative newer data suggest a role for preferential oxidation and metabolism of dietary MUFA, influencing body composition and ameliorating the risk of obesity. Mounting epidemiological and human clinical trial data continue to demonstrate the cardioprotective activity of the MUFA content of dietary fat. As the debate on the optimal fatty acid composition of the diet continues, the benefit of increasing MUFA intakes, particularly as a substitute for dietary SFA, deserves considerable attention.

High-oleic rapeseed (canola) and flaxseed oils modulate serum lipids and inflammatory biomarkers in hypercholesterolaemic subjects.

Recently, novel dietary oils with modified fatty acid profiles have been manufactured to improve fatty acid intakes and reduce CVD risk. Our objective was to evaluate the efficacy of novel high-oleic rapeseed (canola) oil (HOCO), alone or blended with flaxseed oil (FXCO), on circulating lipids and inflammatory biomarkers v. a typical Western diet (WD). Using a randomised, controlled, crossover trial, thirty-six hypercholesterolaemic subjects consumed three isoenergetic diets for 28 d each containing approximately 36% energy from fat, of which 70% was provided by HOCO, FXCO or WD. Dietary fat content of SFA, MUFA, PUFA n-6 and n-3 was 6, 23, 5, 1% energy for HOCO; 6, 16, 5, 7·5% energy for FXCO; 11·5, 16, 6, 0·5% energy for WD. After 28 d, compared with WD, LDL-cholesterol was reduced 15·1% (P < 0·001) with FXCO and 7·4% (P < 0·001) with HOCO. Total cholesterol (TC) was reduced 11% (P < 0·001) with FXCO and 3·5% (P = 0·002) with HOCO compared with WD. Endpoint TC differed between FXCO and HOCO (P < 0·05). FXCO consumption reduced HDL-cholesterol by 8·5% (P < 0·001) and LDL:HDL ratio by 7·5% (P = 0·008) v. WD. FXCO significantly decreased E-selectin concentration compared with WD (P = 0·02). No differences were observed in inflammatory markers after the consumption of HOCO compared with WD. In conclusion, consumption of novel HOCO alone or when blended with flaxseed oil is cardioprotective through lipid-lowering effects. The incorporation of flaxseed oil may also target inflammation by reducing plasma E-selectin.