Sarcopenic obesity and associations with mortality in older women and men - a prospective observational study.

BACKGROUND: The combined effect of sarcopenia and obesity, i.e., sarcopenic obesity, has been associated with disability and worse outcomes in older adults, but results are conflicting. The objectives of this study were to describe the prevalence of sarcopenic obesity (SO) in older adults, and to examine how the risk of mortality is associated with SO and its various components. METHODS: Data were obtained from two Swedish population studies, the Gothenburg H70 Birth Cohort Studies of 521 women and men at the age of 75, and the Uppsala Longitudinal Study of Adult Men (ULSAM), which included 288 men aged 87 years. Sarcopenia was defined using the recently updated EWGSOP2 definition. Obesity was defined by any of three established definitions: body mass index ≥30 kg/m2, fat mass > 30%/ > 42% or waist circumference ≥ 88 cm/≥102 cm for women and men, respectively. The Kaplan-Meier survival curve and the Cox proportional hazard model were used for 10-year and 4-year survival analyses in the H70 and ULSAM cohorts, respectively. RESULTS: SO was observed in 4% of the women and 11% of the men in the H70 cohort, and in 10% of the ULSAM male cohort. The 75-year-old women with SO had a higher risk (HR 3.25, 95% confidence interval (1.2-8.9)) of dying within 10 years compared to those with a "normal" phenotype. A potential similar association with mortality among the 75-year-old men was not statistically significant. In the older men aged 87 years, obesity was associated with increased survival. CONCLUSIONS: SO was observed in 4-11% of community-dwelling older adults. In 75-year-old women SO appeared to associate with an increased risk of dying within 10 years. In 87-year-old men, the results indicated that obesity without sarcopenia was related to a survival benefit over a four-year period.

"Feeling More Self-Confident, Cheerful and Safe". Experiences from a Health-Promoting Intervention in Community Dwelling Older Adults - A Qualitative Study.

OBJECTIVES: Studies show that regular exercise in combination with nutritional support can be effective in managing sarcopenia, which is age-related involuntary loss of skeletal muscle mass and strength. Qualitative investigations of participants' experiences from interventions in this domain are scarce. In this study, we explored older persons' experiences from an intervention designed to prevent sarcopenia, with the aim of capturing the participants' thoughts and opinions. DESIGN: A qualitative study embedded in the multicenter randomized clinical trial The Vitality and Vigor in the Elderly study, VIVE2. Focus group interviews were conducted. Manifest and latent content analyses were performed. PARTICIPANTS: Community dwelling older adults (n=20) 71-86 years of age with minor limitations in mobility. RESULTS: The experiences from the intervention were categorized and interpreted in one overall theme "Feeling more self-confident, cheerful and safe". The theme encompasses the categories psychological effects of participating in the intervention, physical effects of participating in the intervention, the importance of social support and the importance of a tailored set-up. The participants described their motives for participating in the intervention as being based on concerns regarding the negative health effects of continuing a sedentary lifestyle, difficulties of getting started on their own and lack of confidence in accomplishing change on their own. Participants also expressed that one main objective for participating was to lose weight. CONCLUSION: In this study we have captured the experiences of older adults with minor mobility limitations who participated in a lifestyle intervention. The experiences are interpreted in one overall theme "Feeling more self-confident, cheerful and safe". The central understanding of the participants' experiences was that the intervention affected them in several ways, both psychologically and physically, and that supporting factors included the social support, which became a prerequisite for success. A noticeable finding was the discrepancy between the motive of the participants, to lose weight, and the aim of the study, to improve muscle function. The expectation to lose weight seems to reflect what is commonly known as to be healthy. To our knowledge, at least in Sweden, there are no campaigns or public information highlighting the risks of sarcopenia and the complex issue of if, and when weight loss is desirable for older individuals. This finding highlights the importance of providing such information to this target group. The findings in this study provide valuable knowledge for research teams, practitioners and decision makers when designing and setting objectives for health-promoting interventions for older individuals.

Physical Performance and Serum 25(OH)vitamin D Status in Community Dwelling Old Mobility Limited Adults: A Cross-Sectional Study.

OBJECTIVES: To examine the potential association between serum 25(OH) vitamin D and the performance on the Short Physical Performance Battery (SPPB) including the sub-components; five repeated chair stands test, 4 meters walk test and balance in older mobility-limited community-dwelling men and women. DESIGN: A cross sectional study was performed in American and Swedish subjects who were examined for potential participation in a combined exercise and nutrition intervention trial. Logistic regression analysis and linear regression analyses were performed to evaluate the association for 25(OH)D with the overall score on the SBBP, chair stand, gait speed and balance. PARTICIPANTS: Community-dwelling (mean age 77.6 ± 5.3 years) mobility limited American (n=494) and Swedish (n=116) females (59%) and males. MEASUREMENTS: The SPPB (0-12 points) includes chair stand (s), gait speed (m/s) and a balance test. Mobility limitation i.e., SPPB score ≤ 9 was an inclusion criterion. A blood sample was obtained to measure serum 25(OH)vitamin D concentrations. RESULTS: No clear association of 25(OH)D with SPPB scores was detected either when 25(OH)D was assessed as a continuous variable or when categorized according to serum concentrations of <50, 50-75 or <75 nmol/L. However, when analyzing the relationship between 25(OH)D and seconds to perform the chair stands, a significant quadratic relationship was observed. Thus, at serum levels of 25(OH)D above 74 nmol/L, higher concentrations appeared to be advantageous for the chair stand test, whereas for serum levels below 74 nmol/L this association was not observed. CONCLUSION: This cross- sectional study lacked clear association between serum 25(OH)D and physical performance in mobility limited adults. A potentially interesting observation was that at higher serum levels of 25(OH)D a better performance on the chair stand test was indicated.

Incomplete descriptions of oral nutritional supplement interventions in reports of randomised controlled trials.

BACKGROUND & AIMS: The effects of oral nutritional supplements (ONS) have been evaluated in several clinical trials and more studies have been requested. To facilitate replication, support accurate evaluations of research results and avoid research waste, high quality reporting of interventions in clinical trials is needed. The aim of this study is to assess the quality of reporting of interventions in publications describing randomised controlled trials of ONS in populations with malnutrition or at nutritional risk. METHODS: The PubMed database was searched for articles describing ONS trials published between January 2002 and December 2015. The quality of intervention descriptions was evaluated using the Template for Intervention Description and Replication (TIDieR) checklist and guide, which contains twelve items. Articles published before and after 2011 were compared. RESULTS: Of 76 articles identified, only 3% reported all TIDieR items in sufficient detail. The most frequently missing elements were descriptions of the intervention procedures (e.g. how the ONS were to be taken and if participants were given a choice of flavours), which were adequately presented in only 26% of the articles. Less than half of the articles included a description of the intervention provider and sufficient information about the location(s) for the intervention. Information about adherence and mode of delivery was reported in 60-65% of the articles. Most frequently reported, in >70% of the articles, were items regarding the brief name of the intervention, the rationale for the intervention and the materials used (i.e. information about the specific ONS product(s) administered). The reporting quality for two of the items (materials and provider) was higher in articles published after 2011. CONCLUSIONS: The quality of reporting of ONS interventions was found to be poor. The descriptions mostly lacked information about intervention procedures, provider and location(s). A moderately higher reporting quality was observed in articles published after 2011. These findings imply that an improvement in the descriptions of ONS interventions is required in future clinical trials of malnutrition treatment.

Effect of Structured Physical Activity and Nutritional Supplementation on Physical Function in Mobility-Limited Older Adults: Results from the VIVE2 Randomized Trial.

OBJECTIVES: The interactions between nutritional supplementation and physical activity on changes in physical function among older adults remain unclear. The primary objective of this study was to examine the impact of nutritional supplementation plus structured physical activity on 400M walk capacity in mobility-limited older adults across two sites (Boston, USA and Stockholm, Sweden). DESIGN: All subjects participated in a physical activity program (3x/week for 24 weeks), involving walking, strength, balance, and flexibility exercises. Subjects were randomized to a daily nutritional supplement (150kcal, 20g whey protein, 800 IU vitamin D) or placebo (30kcal, non-nutritive). SETTING: Participants were recruited from urban communities at 2 field centers in Boston MA USA and Stockholm SWE. PARTICIPANTS: Mobility-limited (Short Physical Performance Battery (SPPB) ≤9) and vitamin D insufficient (serum 25(OH) D 9 - 24 ng/ml) older adults were recruited for this study. MEASUREMENTS: Primary outcome was gait speed assessed by the 400M walk. RESULTS: 149 subjects were randomized into the study (mean age=77.5±5.4; female=46.3%; mean SPPB= 7.9±1.2; mean 25(OH)D=18.7±6.4 ng/ml). Adherence across supplement and placebo groups was similar (86% and 88%, respectively), and was also similar across groups for the physical activity intervention (75% and 72%, respectively). Both groups demonstrated an improvement in gait speed with no significant difference between those who received the nutritional supplement compared to the placebo (0.071 and 0.108 m/s, respectively (p=0.06)). Similar effects in physical function were observed using the SPPB. Serum 25(OH)D increased in supplemented group compared to placebo 7.4 ng/ml versus 1.3 ng/ml respectively. CONCLUSION: Results suggest improved gait speed following physical activity program with no further improvement with added nutritional supplementation.

Quality Indicators of Nutritional Care Practice in Elderly Care.

OBJECTIVES: The aim is to explore the effects of antecedent, structural and process quality indicators of nutritional care practice on meal satisfaction and screened nutritional status among older adults in residential care homes. DESIGN: Data for this Swedish cross-sectional study regarding older adults living in residential care homes were collected by i) a national questionnaire, ii) records from the quality registry Senior Alert, iii) data from an Open Comparison survey of elderly care in 2013/2014. The data represented 1154 individuals in 117 of 290 Swedish municipalities. MEASUREMENTS: Meal satisfaction (%) and adequate nutritional status, screened by the Mini Nutritional Assessment Short Form (MNA-SF), were the two outcome variables assessed through their association with population density of municipalities and residents' age, together with 12 quality indicators pertaining to structure and process domains in the Donabedian model of care. RESULTS: Meal satisfaction was associated with rural and urban municipalities, with the structure quality indicators: local food policies, private meal providers, on-site cooking, availability of clinical/community dietitians, food service dietitians, and with the process quality indicators: meal choice, satisfaction surveys, and 'meal councils'. Adequate nutritional status was positively associated with availability of clinical/community dietitians, and energy and nutrient calculated menus, and negatively associated with chilled food production systems. CONCLUSION: Municipality characteristics and structure quality indicators had the strongest associations with meal satisfaction, and quality indicators with local characteristics emerge as important for meal satisfaction. Nutritional competence appears vital for residents to be well-nourished.

Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients.

BACKGROUND & AIMS: Malnutrition is a well-recognized problem in geriatric patients. Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients. The objective of this study was to investigate routines regarding dietary prescriptions and monitoring of food intake in geriatric patients and to see how well the prescribed diet conforms to the patients' nutritional status and ability to eat. A further aim was to identify the most common reasons and factors interacting with patients not finishing a complete meal. METHODS: This study combines two methods using both qualitative and quantitative analysis. Patients (n = 43; 82.5 ± 7.5 yrs; 60% females) at four geriatric wards performed a two-day dietary record, assisted by a dietician. Nurses and assistant nurses at each ward participated in a semi-structured interview regarding prescription of diets and portion size for the patients. RESULTS: The prescribed diet differed significantly (P < 0.01) from a diet based upon the patient's nutritional status and ability to eat. Only 30% of the patients were prescribed an energy-enriched diet in contrast to 60% that was in need of it. The most common reason for not finishing the meal was lack of appetite. Diet prescription for the patient was based upon information about eating difficulties identified in the Mini Nutritional Assessment-Short Form (MNA-SF) at admission and the type of diet that was prescribed on a previous ward. Monitoring of the patients' food intake was described as a continuous process discussed daily between the staff. CONCLUSION: Patients' nutritional status and to what extent they were able to eat a complete meal was not routinely considered when prescribing food and monitoring food intake in this study. By making use of this information the diet could be tailored to the patients' needs, thereby improving their nutritional treatment.

Cluster analysis of fruit and vegetable-related perceptions: an alternative approach of consumer segmentation.

BACKGROUND: Audience segmentation optimises health communication aimed to promote healthy dietary habits, such as fruit and vegetable (F&V) consumption. The present study aimed to segment respondents into clusters based on F&V-related perceptions, and to describe these clusters with respect to F&V consumption and sex. METHODS: The cross-sectional study was conducted using a semi-structured questionnaire. The respondents were randomly selected among Swedish adults (n = 1304; response rate 51%; 56% women). A two-step cluster analysis was conducted followed by a binary logistic regression with cluster membership as a dependent variable. The clusters were compared using t-tests and chi-squared tests. P < 0.05 (two-sided) was considered statistically significant. The respondents' open-ended answers of determinants of F&V consumption were used as a descriptive support for the conducted multivariate analysis. RESULTS: Of the two identified clusters, the Positive cluster (n = 476) was older and consumed more vegetables (both sexes) and fruit (women only), whereas men in the Indifferent cluster (n = 715) consumed more juice. Indifferent cluster reported more F&V consumption preventing factors, such as storage and preparation difficulties and low satisfaction with F&V selection and price. Not liking or not having a habit of F&V consumption, laziness, forgetting and a lack of time were mentioned as main barriers to F&V consumption. CONCLUSIONS: The Indifferent cluster reports more practical and life-style related difficulties. The Positive cluster consumes more vegetables, perceives fewer F&V-related difficulties, and looks for more dietary information. The findings confirm that cluster analysis is an appropriate way of identifying consumer subgroups for targeted health and nutrition communication.

Agreement between different methods of measuring height in elderly patients.

BACKGROUND: The present study aimed to examine the agreement between measurements of standing height and self-reported height, height measured with a sliding caliper, and height estimated from either demispan or knee height in elderly patients. METHODS: Fifty-five patients (mean age 79 years) at a Swedish hospital were included in this observational study. The participants' heights were evaluated as the standing height, self-reported height, height measured in a recumbent position with a sliding caliper, and height estimated from the demispan or knee height. RESULTS: The measurements made with a sliding caliper in the recumbent position agreed most closely with the standing height. Ninety-five percent of the individuals' differences from standing height were within an interval of +1.1 to -4.8 cm (limits of agreement). Self-reported height and height estimated from knee height differed relatively strongly from standing height. The limits of agreement were +5.2 to -9.8 cm and +9.4 to -6.2 cm, respectively. The widest distribution of differences was found in the height estimated from the demispan, with limits of agreements from +11.2 to -9.3 cm. CONCLUSIONS: When measuring the height of patients who find it difficult to stand upright, a sliding caliper should be the method of choice, and the second choice should be self-reported height or the height estimated from knee height. Estimating height from the demispan should be the method of last resort.

Five-day food intake in elderly female outpatients with Parkinson's disease, rheumatoid arthritis or stroke.

AIM: The aim of this study was to describe and analyse the intake of food, energy and selected nutrients in elderly outpatients, i.e. women with Parkinson's disease, rheumatoid arthritis or stroke. SUBJECTS AND METHODS: Sixty-three elderly women aged 64-88 years participated in the study. For assessing dietary intake, a repeated 24-h recall and an estimated food diary for three consecutive days were used. RESULTS: The mean age was 73.4 +/- 6.6 years. Mean reported daily energy intake was 6.4 +/- 1.7 MJ, i.e. lower than reference figures for all groups. However, looking at nutrient density, only intakes of vitamin E and folate were below recommended levels. The most frequently consumed food groups were bread, coffee, milk products, buns and cookies, and spreads. CONCLUSION: The reported energy intake among the elderly female outpatients was low. This might be explained by actual low intake and/or under-reporting. However, the intake of most vitamins and minerals, i.e. nutrient density, was adequate, with the exception of vitamin E and folate intake, which was below recommended levels. Food intake showed large variation and good diet composition, and there was a tendency towards high consumption of food items that are easily prepared and eaten.

Meals and snacks among elderly self-managing and disabled women.

AIM: The aim of this study was to describe the frequency and distribution of self-managing and disabled elderly women's eating events, as well as to investigate which definition/names the women had given their different eating events and to categorise these into meals and snacks. An additional aim was to study the composition of meals and snacks, and analyse the nutritional significance of these eating events in terms of energy and macronutrients. SUBJECTS: Elderly women, both self-managing (n=139) and disabled (n=63; with Parkinson's disease, rheumatoid arthritis or stroke), aged 64-88 years, and living at home participated. METHODS: A repeated 24 h recall and an estimated food diary for three consecutive days were used. RESULTS: The eating events defined by the women that were categorised as meals contributed 74% of the total daily energy intake, while snacks contributed 22-23%. The meals that the women had defined as dinner, was the most energy dense meal. The frequency of eating events not defined by the women, was 30-34%, but contributed only 3-4% of the total daily energy intake. The disabled women had a significantly lower energy content in meals and most snacks, compared to the self-managing women. CONCLUSION: The main conclusion was that elderly women still living at home had their meals distributed during the day and that these meals were characterised by individuality and flexibility.

Achievement of dietary fatty acid intakes in long-term controlled intervention studies: approach and methodology.

OBJECTIVE: To describe the calculations and approaches used to design experimental diets of differing saturated fatty acid (SFA) and monounsaturated fatty acid (MUFA) compositions for use in a long-term dietary intervention study, and to evaluate the degree to which the dietary targets were met. DESIGN, SETTING AND SUBJECTS: Fifty-one students living in a university hall of residence consumed a reference (SFA) diet for 8 weeks followed by either a moderate MUFA (MM) diet or a high MUFA (HM) diet for 16 weeks. The three diets were designed to differ only in their proportions of SFA and MUFA, while keeping total fat, polyunsaturated fatty acids (PUFA), trans-fatty acids, and the ratio of palmitic to stearic acid, and n-6 to n-3 PUFA, unchanged. RESULTS: Using habitual diet records and a standardised database for food fatty acid compositions, a sequential process of theoretical fat substitutions enabled suitable fat sources for use in the three diets to be identified, and experimental margarines for baking, spreading and the manufacture of snack foods to be designed. The dietary intervention was largely successful in achieving the fatty acid targets of the three diets, although unintended differences between the original target and the analysed fatty acid composition of the experimental margarines resulted in a lower than anticipated MUFA intake on the HM diet, and a lower ratio of palmitic to stearic acid compared with the reference or MM diet. CONCLUSIONS: This study has revealed important theoretical considerations that should be taken into account when designing diets of specific fatty acid composition, as well as practical issues of implementation.

Reasons among older Swedish women of not participating in a food survey.

OBJECTIVES: To (a) examine participation rate as a function of municipality, age group and living status; and (b) investigate the main reasons for exclusion and declining as stated by the women themselves. DESIGN: Analysis of participation rate and content analysis of statements given in phone calls explaining exclusion or declination from a project in which 24 h recalls and food-diaries were used. SUBJECTS: Self-managing Swedish women (n=505) were systematically selected from a stratified random sample covering single living and cohabiting women aged 64-68, 74-78 and 84-88 y living in three municipalities. RESULTS: No significant differences were found among included and declining women when municipalities and living status was analysed, but significantly more women in the oldest group were excluded (P>0.01). Among those in their 80s living at home, the usual reasons for exclusion were illness, disability or dementia, and many lived in institutions for old people. The four most used explanations to decline participation were 'lack of time', 'tired, fragile, sick or having bad memory', 'not willing to participate in scientific studies' and 'too old and nothing to contribute'. CONCLUSIONS: The participation rate was, compared with other food surveys in the older generation, fairly good, especially among those in their 80s. However, the most active and the very ill and disabled did not participate. SPONSORSHIP: The Swedish Council for Social Research, the Swedish Council for Forestry and Agricultural Research, the Swedish Foundation for Health and Care Sciences and Allergy Research and Uppsala University.

Meals and energy intake among elderly women--an analysis of qualitative and quantitative dietary assessment methods.

OBJECTIVE: The objective of this study was to analyse whether a qualitative method, in relation to traditional dietary assessment methods, was adequate to establish sufficient energy intake and energy content in separate meals in a population of elderly women. METHODS: One hundred and thirty-five elderly women, aged 63-88 years, living at home from three communities in mid-eastern Sweden participated in the present study. The quantitative methods used were a combination of repeated 24-h recall and a 3-day estimated food diary. The qualitative method used was the Food-Based Classification of Eating episodes model (FBCE). RESULTS: The mean intake of energy estimated by the 5-day registration was 6.8 +/- 1.9 MJ. The total number of eating events was 5.22 +/- 1.04 per day. On a group level, FBCE was useful to describe the diet among a group of elderly women; however, on an individual level, some complete meals were low or very low in energy, due to small portion sizes. CONCLUSION: The main conclusion was that a qualitative method, such as FBCE, must be supplemented with a dietary assessment method giving the energy intake to ensure that it is sufficient, especially when studying groups at risk for malnutrition.

Similar effects of rapeseed oil (canola oil) and olive oil in a lipid-lowering diet for patients with hyperlipoproteinemia.

OBJECTIVE: To compare the metabolic effects of a lipid-lowering diet containing either low erucic rapeseed (canola) oil or olive oil. METHODS: Twenty-two hyperlipidemic patients participated in a cross-over study comprising two consecutive 3.5-week treatment periods. The participants were free-living throughout the study period, visiting the metabolic clinic initially and at the end of each treatment period for weighing and blood sampling. All food was prepared daily and weighed out for each individual appropriate to his/her energy requirement. RESULTS: Total serum cholesterol, low-density lipoprotein and the ratio between low-density and high-density lipoprotein cholesterol decreased to the same extent on the two diets tested, as did the apolipoproteins B, A-I and Lp(a). After adjustment for body weight changes, most of the reported effects remained virtually unaltered. However, there was a slightly greater decrease in low-density lipoprotein cholesterol with the diet containing rapeseed oil (-17%, p < 0.001) than with the olive oil diet (-13%, p < 0.01) with p < 0.04 for the difference between diets. Also, the intravenous glucose tolerance improved to a similar extent on both diets. CONCLUSIONS: The results indicate that lipid-lowering diets containing either rapeseed oil or olive oil have similar effects on serum lipoprotein concentration and glucose tolerance in hyperlipidemic subjects.

Effects of a simplified programme for dietary treatment of hyperlipdaemia in primary health care.

OBJECTIVE: To evaluate a model for dietary treatment of hyperlipidaemia in primary health care. DESIGN: The participating men received their initial dietary instructions from a dietitian, in a group, together with their wives. Thereafter the nurses used a checklist to evaluate dietary compliance throughout the year. The participants completed a simplified food frequency questionnaire six times during the study period. RESULTS: Throughout the year the total body weight, body mass index (BMI), total cholesterol, LDL cholesterol and LDL/HDL cholesterol ratio decreased significantly. HDL cholesterol was significantly increased after one year. SETTING: The Industrial Health Care Centre, Ovansiljans Företagshälsovård AB in Mora, Sweden. PARTICIPANTS: 35 men, aged 39-63 years (mean 51), with hyperlipidaemia, discovered at a health survey of persons attending an industrial health care centre. CONCLUSION: A simplified model for treatment of hyperlipidaemic patients can improve the dietary habits in the long term.

A diet rich in monounsaturated rapeseed oil reduces the lipoprotein cholesterol concentration and increases the relative content of n-3 fatty acids in serum in hyperlipidemic subjects.

The effects of 3 wk on a diet rich in monounsaturated rapeseed oil were compared with those of a diet containing sunflower oil within a lipid-lowering diet. Ninety-five subjects with moderate hyperlipoproteinemia were randomly assigned to one of the two well-controlled diets prepared at the hospital kitchen. Total serum, low-density- and high-density-lipoprotein cholesterol concentrations decreased by 15%, 16%, and 11% (P < 0.001), respectively, on the rapeseed oil diet and by 16%, 14%, and 13% (P < 0.001) on the sunflower oil diet. Serum triglycerides decreased more markedly (by 29%, P < 0.001) on the sunflower oil than on the rapeseed oil diet (14%, P < 0.01). The n-3 fatty acids (20:5 and 22:5) in the serum phospholipids increased significantly on the rapeseed oil diet but decreased on the sunflower oil diet. There was an increase in the alpha-tocopherol concentrations after both diets. The findings indicate that low erucic acid rapeseed oil can replace oils and fats rich in polyunsaturated fatty acids in a lipid-lowering diet.

Similar serum lipoprotein cholesterol concentrations in healthy subjects on diets enriched with rapeseed and with sunflower oil.

A double-blind cross-over study was conducted during two 3-week periods to compare the effects of rapeseed oil and sunflower oil, enriching a normal diet, on the lipoprotein and fatty acid composition in healthy subjects. It was carried out in randomized order at residential schools, comprising 101 persons (mean age 29.2 years). The dietary fats used for cooking and as table margarine were prepared from rapeseed oil during one period and from sunflower oil during the other. No changes were made in the total fat content or other dietary nutrients. During both treatment periods the serum cholesterol (-4%, P < 0.001), LDL cholesterol (-5% to -7%, P < 0.01 and 0.001) and apolipoprotein B (-5%, P < 0.001) concentrations decreased significantly and to the same extent, while serum triglycerides, HDL cholesterol, apolipoprotein A-1 and lipoprotein (a) remained virtually unchanged. The content of 18:2 n-6 serum phospholipids was increased after the sunflower oil-enriched diet, and the contents of oleic acid (18:1 n-9), alpha-linolenic acid (18:3 n-3), and eicosapentaenoic acid (20:5 n-3) were increased after the rapeseed oil-enriched diet. The concentration of alpha-tocopherol increased and gamma-tocopherol decreased after the sunflower oil-enriched diet, less so after the rapeseed oil-enriched diet. It is concluded that substitution of mono- and polyunsaturated fats for saturated fats without any other dietary changes causes a significant improvement of the lipoprotein profile in healthy subjects. The rapeseed oil and sunflower oil fats were equally effective in this respect. The results also indicate that humans have a certain capacity to elongate and desaturate alpha-linolenic acid to 20:5 n-3 in vivo. Dietary fats based on rapeseed oil seem to be attractive alternatives to the more commonly used oils and fats rich in linoleic acid. Financial support from the Swedish Council for Forestry and Agricultural Research and the Swedish Margarine Industrial Association for Nutritional Physiological Research is gratefully acknowledged.

Lipid-lowering diets enriched with monounsaturated or polyunsaturated fatty acids but low in saturated fatty acids have similar effects on serum lipid concentrations in hyperlipidemic patients.

The aim of this study was to compare the effects of a diet enriched with monounsaturated (MUFAs) with one enriched with polyunsaturated (PUFAs) fatty acids on the serum lipoprotein composition in patients with hyperlipidemia. A new model for conducting controlled dietary treatment studies in free-living hyperlipidemic patients was tested. Twenty-six patients with an average age of 51 y participated in a crossover study during two consecutive 3.5-wk treatment periods. The mean serum cholesterol and LDL cholesterol decreased by 17% and 19%, respectively, on the MUFA diet. The corresponding figures on the PUFA diet were 19% and 23%, respectively. The HDL-cholesterol concentration was significantly decreased after both dietary periods. No significant differences in any of the variables studied were found between the diets. It is concluded that MUFAs and PUFAs, within a diet with a restricted content of saturated fat and total fat, are interchangeable with regard to lipid-lowering effects among free-living hyperlipidemic patients.

Effects of lipid-lowering diets enriched with monounsaturated and polyunsaturated fatty acids on serum lipoprotein composition in patients with hyperlipoproteinaemia.

Controlled comparisons of the effects of monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA) as a part of lipid-lowering diets in persons with hyperlipoproteinaemia are sparse. The present study was carried out at a metabolic ward. Forty hyperlipidaemic patients (25 hypercholesterolaemic and 15 hypertriglyceridaemic) were given a 3-week diet rich in either MUFA (saturated fatty acids 7.3 energy% (E%), MUFA 14.6 E%, PUFA 4.8 E%) or PUFA (saturated fatty acids 7.8 E%, MUFA 8.4 E%, PUFA 10.4 E%), but otherwise with an identical composition. The mean serum cholesterol reduction on the MUFA diet was 12% (P < 0.001), with a low density lipoprotein cholesterol reduction of 11% (P < 0.001). The corresponding reductions on the PUFA diet were 15% (P < 0.001) and 16% (P < 0.001). The serum apolipoprotein B and A-I concentrations decreased highly significantly by 13% and 11% on the MUFA diet and by 14% and 11% on the PUFA diet. None of these changes differed between the two diets. Neither were there any differences between the diets regarding the effects on blood glucose, serum insulin and plasma fibrinogen, but there was a significant decrease in serum insulin with a significant reduction of the insulin/glucose ratio after the MUFA diet. The results of this study indicate that MUFA and PUFA are interchangeable within the given frames in lipid lowering diets even in patients with hyperlipidaemia.