Mineral water fortified with folic acid, vitamins B6, B12, D and calcium improves folate status and decreases plasma homocysteine concentration in men and women.

OBJECTIVE: We investigated the effects of mineral water fortified with folic acid, vitamins B(6), B(12), D and calcium on folate concentrations in serum and erythrocytes, serum vitamin B(12) and plasma homocysteine concentrations in free-living subjects. In addition, we investigated the bioavailability of calcium added to mineral water by measuring urinary calcium excretion and serum alkaline phosphatase activity. DESIGN: Randomized, controlled, double-blinded, parallel design. SETTING: Outpatient dietary intervention with free-living subjects in Eastern Finland. SUBJECTS: Altogether, 66 subjects were recruited for the study. In all, 60 subjects completed the study. INTERVENTIONS: The study began with a 2-week run-in period followed by an 8-week intervention period. During the intervention study, subjects consumed mineral water fortified with folic acid (563 microg/day), vitamins B(6) (1 mg/day), B(12) (7.5 microg/day), cholecalciferol (0.6 microg/day) and calcium (563 mg/day) or placebo mineral water. RESULTS: The fortified mineral water increased serum and erythrocyte folate concentrations by 16.1+/-5.6 nmol/l (P<0.001) and 199+/-76 nmol/l (P<0.001), respectively, and decreased plasma homocysteine concentration by 1.6 micromol/l (P<0.001). Urinary calcium excretion and serum alkaline phosphatase activity for 24 h increased significantly (P<0.001 and P=0.01 respectively) in the intervention group. CONCLUSIONS: Mineral water fortified with folic acid, vitamins B(6), B(12) and D and calcium enhanced folate status and reduced plasma homocysteine concentration in normohomocysteinemic subjects without folate deficiency. Indirect measures of calcium and bone metabolism indicated that the calcium used in the fortification of the mineral water was bioavailable.

The effect of vegetable oil-based cheese on serum total and lipoprotein lipids.

OBJECTIVE: To investigate the effect of rapeseed oil-based cheese (milk-fat substituted by rapeseed oil) on serum total and lipoprotein lipid concentrations and blood pressure in reference to ordinary, milk-fat-based cheese in subjects with mildly to moderately elevated serum cholesterol concentration. DESIGN: Randomized, controlled, single-blind, cross-over clinical trial. SETTINGS: Outpatient dietary intervention with free-living subjects in Eastern Finland. INTERVENTIONS: The study began with a 2 week pre-trial period followed by two 4 week intervention periods. During the intervention study subjects replaced their ordinary cheese or cold cuts with 65 g of rapeseed oil-based or milk-fat-based control cheese. The type of test cheese was switched at 4 weeks of intervention. Altogether 31 subjects completed the study. RESULTS: Compared with the control cheese period the mean serum total cholesterol concentration was 6.7% (95% Cl -9.9 to -3.5%) lower after 2 weeks and 5.0% (95% Cl -7.5 to -2.5%) lower after 4 weeks of use of rapeseed oil-based cheese. Respectively, LDL cholesterol concentration was 7.0% (95% Cl -11.7 to -2.6%) lower after 2 weeks use and 6.4% (95% Cl -10.0 to -2.8%) lower after 4 weeks' use of rapeseed oil-based cheese. CONCLUSIONS: The present study showed that the rapeseed oil-based cheese reduces serum total and LDL cholesterol concentrations in mildly to moderately hypercholesterolemic subjects when replacing ordinary milk-fat-based cheese in the diet. SPONSORSHIP: Mildola Ltd, Tuusula, Finland and Kyrönmaan Juustomestarit Ltd, lsokyrö, Finland.

The impact of the leucine 7 to proline 7 polymorphism of the neuropeptide Y gene on postprandial lipemia and on the response of serum total and lipoprotein lipids to a reduced fat diet.

OBJECTIVE: The aim of the study was to examine the impact of the leucine7 to proline7 (Leu7Pro) polymorphism of the NPY gene on postprandial (PP) lipemia, post-heparin plasma lipoprotein lipase (LPL) and hepatic lipase (HL) activities, and the response of serum lipids to a reduced fat diet. DESIGN AND SUBJECTS: Seven middle-aged obese subjects with Leu7Pro genotype were matched with seven subjects with Leu7Leu genotype for gender, age, apolipoprotein E phenotype and BMI. These 14 subjects participated in the oral 8 h fat tolerance test. Sixty-eight slightly obese middle-aged subjects (10 with the Leu7Pro genotype) had participated in intervention studies and consumed a reduced fat diet for 8 weeks. RESULTS: There were no statistically significant differences in PP areas under the curve of plasma total triglycerides (TG), chylomicron TG, VLDL-TG or insulin between the genotype groups. The TG-to-cholesterol (C) ratio in VLDL was significantly lower in the subjects with Leu7Pro genotype compared to those with the Leu7Leu genotype at time points 30 min and 1 h in the fat tolerance test. Heparin-induced activities of LPL or HL or the response of serum total or LDL-C to the reduced fat diet did not differ between the groups. CONCLUSIONS: The NPY genotype neither affects the magnitude of postprandial lipemia induced by a fat tolerance test nor the response of serum total lipids or lipids in different lipoprotein classes to the reduced fat diet. However, this preliminary study suggests that there might be compositional differences in the lipoprotein particles between the genotype groups that affect postprandial lipid metabolism. SPONSORSHIP: The Council for Health Sciences of the Academy of Finland, Kuopio University Hospital and the National Technology Agency, Finland.

APOE polymorphism and the hypertriglyceridemic effect of dietary sucrose.

BACKGROUND: The E4 allele of the apolipoprotein gene (APOE) is associated with a greater serum cholesterol response to dietary changes in fat and cholesterol. However, less is known about the interaction between APOE polymorphism and other macronutrients in the diet. OBJECTIVE: We evaluated the interaction between APOE polymorphism and dietary fat and carbohydrate, particularly sucrose, in relation to serum lipid concentrations. DESIGN: A total of 284 men and 130 women with coronary artery disease (mean age: 61 y; range: 33-74 y) participated in the cross-sectional EUROASPIRE study. Serum lipids and fatty acids in cholesteryl esters (CEs) were measured and APOE genotypes were determined. Dietary intake was examined by using a 4-d food record. RESULTS: Patients were grouped by APOE genotype: E2 (E2/E2 and E2/E3; n = 21), E3 (E3/E3; n = 245), and E4 (E4/E2, E4/E3, and E4/E4; n = 148). Patients with the E2 allele had lower LDL-cholesterol concentrations and tended to have higher triacylglycerol concentrations than did patients with the E3 or E4 allele; concentrations were not significantly different between the last 2 groups. In regression analysis, significant predictors of serum triacylglycerol were the interaction between sucrose intake and the E2 allele, proportion of n-3 fatty acids in CEs, body mass index, and diabetes. A high sucrose intake was associated with high triacylglycerol concentrations only in patients with the E2 allele. Interaction between saturated fat intake and the E2 allele, proportion of linoleic acid in CEs, and fiber intake predicted serum cholesterol. CONCLUSION: Coronary artery disease patients with the E2 allele will likely have a greater triacylglycerol response to high dietary sucrose intakes than will patients with the E3 or E4 allele.

Insulin sensitivity after a reduced-fat diet and a monoene-enriched diet in subjects with elevated serum cholesterol and triglyceride concentrations.

BACKGROUND AND AIMS: To investigate the effect of a reduced-fat diet and a monoene-enriched diet (MUFA diet) on serum lipids, glucose and insulin metabolism in subjects with elevated cholesterol and triglyceride concentrations. METHODS AND RESULTS: Eighteen subjects with elevated serum cholesterol and triglyceride concentrations consumed the MUFA diet (39% of energy (E%) as fat and 21 E% monoenes) and the reduced-fat diet (34 E% fat, 16 E% monoenes) for 4 weeks according to a randomized cross-over design. Both periods were preceded by consumption of a standardized baseline diet for 2 weeks. Serum lipid and lipoprotein concentrations were determined at the beginning and end of each diet period. A frequently sampled intravenous glucose tolerance test was performed after the MUFA diet and the reduced-fat diet. Insulin sensitivity index (SI) was 40% higher after the reduced-fat diet than after the MUFA diet (2.42 +/- 0.42 vs 1.73 +/- 0.24 10(-4) min-1 U-1 ml-1, p = 0.018). This change in insulin sensitivity was seen in 13 subjects and was most evident in those who began with the MUFA diet. Compared to the baseline diet (high in saturated fat), both experimental diets lowered serum total and LDL cholesterol concentrations (6.6-6.9%, p < 0.05 and 7.4-8.0%, p < 0.05 respectively). CONCLUSIONS: Both diets were equally effective in lowering serum lipid concentrations, but the reduced-fat diet resulted in better insulin sensitivity.

Comparison of the effects of plant sterol ester and plant stanol ester-enriched margarines in lowering serum cholesterol concentrations in hypercholesterolaemic subjects on a low-fat diet.

OBJECTIVE: To investigate cholesterol-lowering effects of stanol ester (STAEST) and sterol ester (STEEST)-enriched margarines as part of a low-fat diet. DESIGN: According to a Latin square model randomized double-blind repeated measures design with three test margarines and three periods. SETTING: Outpatient clinical trial with free-living subjects. SUBJECTS: Thirty-four hypercholesterolaemic subjects completed the study. INTERVENTIONS: Subjects consumed three rapeseed oil-based test margarines (STAEST, STEEST and control (no added stanols or sterols)) as part of a low-fat diet each for 4 weeks. RESULTS: Mean daily intake of total plant sterols plus stanols was 2.01-2.04 g during the two test margarine periods. In reference to control, serum total cholesterol was reduced by 9.2 and 7.3% with the STAEST and STEEST margarine, respectively (P<0.001 for both). The respective reductions for low-density lipoprotein (LDL) cholesterol were 12.7 and 10.4% (P<0. 001). The cholesterol-lowering effects of the test margarines did not differ significantly. The presence of apolipoprotein E4 allele had a significant effect on LDL cholesterol response during the STAEST margarine only. Serum sitosterol and campesterol increased by 0.83 and 2.77 mg/l with the STEEST (P<0.001), respectively and decreased by 1.18 and 2.60 mg/l with the STAEST margarine (P<0.001). Increases of serum sitostanol and campestanol were 0.11 and 0.19 mg/l with the STAEST margarine (P<0.001), repsectively. No significant changes were found in serum fat-soluble vitamin and carotenoid concentrations when related to serum total cholesterol. CONCLUSIONS: STAEST and STEEST margarines reduced significantly and equally serum total and LDL cholesterol concentrations as part of a low-fat diet. SPONSORSHIP: Grant to the University of Kuopio by Raisio Benecol Ltd, Raisio, Finland.

Effects of a salt-restricted diet on the intake of other nutrients.

BACKGROUND: Salt restriction, recommended as the first-line treatment of hypertension, has been proposed to lead to deficiencies in intakes of some other nutrients. OBJECTIVE: The aim of this study was to investigate the effects of salt restriction for 20 wk on the intake of other nutrients in free-living subjects with mildly elevated blood pressure. DESIGN: Thirty-nine subjects (24 men, 15 women) aged 28-65 y with a mean daytime ambulatory diastolic blood pressure of 90-105 mm Hg and a diastolic blood pressure measured in a health care center of 95-115 mm Hg participated in the study. The subjects completed 4-d food records and their salt intake was measured by 24-h urinary sodium excretion. The subjects received both oral and written instructions from a clinical nutritionist on how to reduce their daily sodium chloride intake to <5 g/d but were instructed not to change their diet otherwise. The subjects were provided with low-salt bread during the salt-restriction period. RESULTS: Few changes were found in nutrient intakes. In men, total energy intake decreased by 1059 kJ/d and alcohol, potassium, and vitamin D intakes decreased, but there were no significant changes in energy-adjusted potassium and vitamin D intakes. In women, total potassium intake increased, but the potassium density of the diet remained unchanged. Total selenium intake and energy-adjusted intake of selenium both decreased significantly in women. CONCLUSIONS: Salt restriction can be undertaken in free-living hypertensive subjects without any untoward changes in the intake of other nutrients.

Plant stanol esters affect serum cholesterol concentrations of hypercholesterolemic men and women in a dose-dependent manner.

The effect of plant stanol ester on serum cholesterol is dose-dependent. However, it is not clear what the dose is beyond which no additional benefit can be obtained. Therefore, we determined the dose-response relationship for serum cholesterol with different doses of plant stanol ester in hypercholesterolemic subjects. In a single-blind design each of 22 men or women consumed five different doses of plant stanol [target (actual) intake 0 (0), 0.8 (0.8), 1.6 (1.6), 2.4 (2.3), 3.2 (3.0) g/d] added as plant stanol esters to margarine for 4 wk. The order of dose periods was randomly determined. Serum total cholesterol concentration decreased (calculated in reference to control) by 2.8% (P = 0.384), 6.8% (P < 0.001), 10.3% (P < 0.001) and 11.3% (P < 0.001) by doses from 0.8 to 3.2 g. The respective decreases for LDL cholesterol were 1.7% (P = 0. 892), 5.6% (P < 0.05), 9.7% (P < 0.001) and 10.4% (P < 0.001). Although the decreases were numerically greater with 2.4 and 3.2 g doses than with the 1.6 g dose, these differences were not significant (P = 0.054-0.516). Serum plant stanols rose slightly, but significantly with the dose (P < 0.001). Apolipoprotein B concentration was decreased significantly already at the dose of 0.8 g (8.7%, P < 0.001). Apolipoprotein E genotype did not affect the lipid responses. We conclude that significant reduction of serum total and LDL cholesterol concentrations is reached with the 1.6-g stanol dose, and increasing the dose from 2.4 to 3.2 g does not provide clinically important additional effect.

Effects of low-fat stanol ester enriched margarines on concentrations of serum carotenoids in subjects with elevated serum cholesterol concentrations.

OBJECTIVE: To investigate the effects of low-fat stanol ester margarines on concentrations of serum carotenoids. DESIGN: A randomized parallel double-blind study design consisting of a 4-week run-in (high-fat diet) and an 8-week experimental (low-fat, low-cholesterol diet) period. During the experimental diet period subjects consumed low-fat wood stanol ester (WSEM), vegetable oil stanol ester (VOSEM) or control (no stanol esters) margarine daily. The daily mean total stanol intake was 2.31 and 2.16 g in the WSEM and VOSEM groups, respectively. SETTING: Outpatient clinical trial with free-living subjects. SUBJECTS: Altogether, 60 hypercholesterolaemic subjects were selected for the study out of 91 originally screened. The study was completed by 55 subjects. MAIN OUTCOMES MEASURES: Serum alpha- and beta-carotene and lycopene determined by the HPLC. RESULTS: Serum alpha-carotene concentration did not change significantly in either of the experimental groups, whereas beta-carotene concentration decreased significantly in the WSEM and VOSEM groups (P<0.01), and the change differed significantly (P<0.05 and P <0.01, respectively) from that of the control group. Decrease in alpha+beta-carotene concentration was significantly greater (P <0.05) in both experimental groups than in the control group. However, the change in alpha-, beta- or alpha+beta-carotene/total cholesterol ratio did not differ significantly among the groups. No significant changes were found in serum lycopene or lycopene/total cholesterol ratio in both experimental groups. CONCLUSIONS: Low-fat stanol ester margarines appeared to have little effect on serum concentrations of alpha-, beta- or alpha + beta-carotene, or lycopene. SPONSORSHIP: Grant to the University of Kuopio by Raisio Benecol Ltd, Raisio, Finland.

Diet in relation to socioeconomic status in patients with coronary heart disease.

OBJECTIVES: Nutrient intake, food consumption and fatty acid profile of serum cholesteryl esters (CE) were investigated in relation to education in patients with coronary heart disease (CHD). DESIGN: A cross-sectional survey in CHD patients selected from hospital records at least six months after hospitalisation. Food record, a questionnaire on dietary fat and fatty acid profile of CE were used to examine diet composition. Years of education, divided into three categories, were used to indicate socioeconomic status. SETTING: The district of Kuopio University Hospital in Finland. SUBJECTS: One hundred and nine patients with coronary artery bypass surgery, 106 patients with coronary angioplasty, 101 patients with acute myocardial infarction and 99 patients with acute myocardial ischaemia aged 61 y (33-74 y) (mean (range)). RESULTS: Men with a low level of schooling had a higher intake of total and saturated fat, a lower consumption of vegetables and fruits, more frequently used butter or butter based spread and less frequently used oil compared to the diets of men with middle or high education. Men with low or middle education had a lower intake of alcohol than men with a high level of education. Highly-educated women had a lower proportion of myristic acid in CE than low-educated women and a similar trend between myristic acid and educational level was found in men. CONCLUSIONS: The educational level of men with CHD influenced their nutrient intake and food consumption, but in women with CHID its impact seemed to be weaker.

Dietary associates of serum total, LDL, and HDL cholesterol and triglycerides in patients with coronary heart disease.

BACKGROUND: Diet-lipid associations established in clinical trials have in general been weak or nonexistent in cross-sectional studies within a population. Our objective was to analyze the dietary associates of serum lipids in patients with coronary heart disease (CHD) not using lipid-lowering medication. METHODS: Patients with coronary bypass grafting (n = 49), balloon angioplasty (n = 46), acute myocardial infarction (n = 79), and acute myocardial ischemia (n = 79) participated in a survey (EUROASPIRE). Patients were selected from hospital records at least 6 months after hospitalization. Diet was assessed by a food record, a short questionnaire, and fatty acid composition of serum cholesteryl esters (CE). RESULTS: Neither the intake of total fat nor that of saturated, monounsaturated, or polyunsaturated fatty acids was associated with serum lipids. Use of soft margarine on bread (though not in cooking or baking) and high intake of fiber and cereal products were associated with low total cholesterol. Linoleic acid in CE was inversely associated with total cholesterol and triglycerides, and eicosapentaenoic acid was inversely associated with triglycerides and positively associated with HDL cholesterol. CONCLUSIONS: In the present study use of soft margarine on bread (though not in cooking or baking) and high intake of fiber and cereal products were associates of lowered serum cholesterol concentrations in CHD patients. Fatty acid composition of CE reflected dietary fatty acid intake involved in cholesterol lowering better than food records.

The effect of quality and amount of dietary fat on the susceptibility of low density lipoprotein to oxidation in subjects with impaired glucose tolerance.

OBJECTIVES: We examined the effects of a high fat diet rich in monounsaturated fat (MUFA-diet) and a moderate fat diet rich in polyunsaturated fat (PUFA-diet) on the susceptibility of LDL to oxidation. SUBJECTS: 29 subjects with impaired glucose tolerance. METHODS: After consuming a run-in diet [37% of energy (E%) fat, 18 E% saturated fat] for three weeks, subjects were randomly assigned either to a MUFA-diet (40 E% fat, 19 E% monounsaturated fatty acids) or a PUFA-diet (34 E% fat, 10 E% polyunsaturated fat) for eight weeks. The susceptibility of LDL to oxidation was measured by challenging LDL with hemin and H2O2 and measuring the time for the reaction to reach maximum velocity. Results are expressed as lag time to oxidation in minutes. RESULTS: In the PUFA-diet group (n = 15) lag time tended to decrease during the experimental diet (97 +/- 28 vs 90 +/- 25 min, mean +/- s.d., P = 0.073), whereas in the MUFA-diet group (n = 14) there was no significant change (lag time 96 +/- 24 vs 100 +/- 16 min, P = 0.408). The mean change in lag time was -7 +/- 14 min (-7.2%) in the PUFA-diet group and +4 +/- 16 min (+4.0%) in the MUFA-diet group (P = 0.029, PUFA-diet group vs MUFA-diet group). The alpha-tocopherol concentration in LDL increased significantly (P < 0.01) in both diet groups relative to the run-in diet period, but LDL particle score did not change in either of the diet groups during the dietary intervention. In subjects with impaired glucose tolerance a PUFA-rich diet with a moderate amount of fat tended to increase the susceptibility of LDL to oxidation as compared to a higher fat diet rich in MUFA. Furthermore, the negative mean change in lag time to oxidation found in the PUFA-diet group differed significantly from the slightly positive mean change found in the MUFA-diet group.

Fat-modified diets influence serum concentrations of cholesterol precursors and plant sterols in hypercholesterolemic subjects.

Serum noncholesterol sterols, cholesterol precursors and plant sterols, are indicators of cholesterol absorption and synthesis. Serum plant sterol concentrations correlate positively with cholesterol absorption, but have also been found to correlate with dietary unsaturated to saturated fatty acid ratios. We studied the concentration of serum noncholesterol sterols during four different fat-modified diets, (1) high-fat, saturated fat-enriched (control), (2) reduced-fat, sunflower oil-enriched (SO-enriched), (3) rapeseed oil-enriched (RO-enriched), and (4) reduced-fat, saturated fat-enriched (reduced-fat), followed for 6 months in hypercholesterolemic subjects in a parallel design. The proportion of lathosterol (micrograms per 100 mg cholesterol), a precursor of cholesterol synthesis, increased significantly (P < .05) in both SO-enriched (mean +/- SD 147 +/- 57 v 167 +/- 76, 0 v 6 months) and RO-enriched (147 +/- 54 v 157 +/- 52) groups, where the reduction in low-density lipoprotein (LDL) cholesterol was also significant. The proportion of sitosterol, a plant sterol, decreased significantly in the control group (137 +/- 48 v 122 +/- 42), and the proportion of another plant sterol, campesterol, increased in the RO-enriched group (280 +/- 141 v 333 +/- 162), reflecting changes in the use of vegetable oils in these two groups rather than increased cholesterol absorption. In the whole study population, the proportion of linoleic and alpha-linolenic acid (a marker of the use of RO) in cholesterol esters (CEs) correlated (P < .001) with the proportion of sitosterol (r = .43) and campesterol (r = .36) in serum at the end of the study. In conclusion, serum cholesterol precursors were found to be useful indicators of cholesterol metabolism, but changes in serum plant sterols reflected dietary changes rather than cholesterol metabolism during long-term dietary intervention with fat-modified diets.

Concordance of diet with the recommended cholesterol lowering diet in patients with coronary heart disease.

OBJECTIVE: The aim was to examine the concordance of diet with the recommended cholesterol lowering diet in Coronary Heart Disease (CHD) patients receiving usual care. DESIGN: CHD patients were selected for a survey from hospital records at least six months after hospitalization. Four patient groups divided according to the severity of disease were examined in cross-sectional setting. Food records and fatty acid composition of serum lipids were used to assess dietary intake. SUBJECTS: The study population consisted of 109 patients with coronary bypass grafting, 106 patients with balloon angioplasty, 101 patients with acute myocardial infarction and 99 patients with acute myocardial ischemia. RESULTS: Concordance of the diet with the cholesterol lowering diet was similar in the patient groups. One third of the patients achieved the recommended fat intake and only one fourth achieved the recommended saturated fat intake. Concordance was better in the patients who also used lipid lowering drugs, but previous myocardial infarction did not affect dietary intake of fat and saturated fat. Diabetic or obese patients tended to have a higher intake of saturated fat. Myristic acid in cholesterol esters, triglycerides and phospholipids and also palmitic and linoleic acids in triglycerides were markers of dietary saturated fat intake. CONCLUSIONS: Concordance of the diet with the recommended cholesterol lowering diet in CHD patients was moderate. Concordance was not affected by disease severity or previous myocardial infarction and was slightly worse in CHD patients who had diabetes or were obese or did not use lipid lowering drugs.

Lathosterol and other non-cholesterol sterols during treatment of hypercholesterolaemia with beta-glucan-rich oat bran.

OBJECTIVE AND SUBJECTS: Dietary fibre has been suggested to interfere with endogenous cholesterol synthesis in the liver. Therefore the effects of oat bran on the proportions of cholesterol synthesis precursors (squalene, delta(8-) cholesterol, desmosterol and lathosterol), cholestanol and plant sterols (campesterol and beta-sitosterol) to cholesterol were analysed in serum of 36 hypercholesterolaemic subjects. DESIGN: A randomized study of eight weeks duration when beta-glucan-rich oat bran (n = 20, subjects) or wheat bran (n = 16) was used as a part of a cholesterol lowering diet. Plant sterols and cholesterol synthesis precursors were analysed from frozen samples afterward. RESULTS: In the oat-bran group, but not in the wheat bran group, serum total cholesterol declined transiently. The proportions of plant sterols and cholesterol in serum, which reflect cholesterol absorption efficiency were unchanged. However, the proportions of squalene appeared to be transiently increased during the study. Subjects with apolipoprotein E 4 allele had higher serum campesterol and sitosterol levels (suggestive of efficient cholesterol absorption) than those with homozygous apolipoprotein E 3 allele. CONCLUSIONS: Since the cholesterol precursors in serum reflecting endogenous cholesterol synthesis remained almost unchanged the reduction in the serum cholesterol level by oat bran treatment can not be ascribed to an inhibition of the endogenous cholesterol synthesis.

Effects of dietary fat modification on fibrinogen, factor VII, and plasminogen activator inhibitor-1 activity in subjects with impaired glucose tolerance.

Our aim was to assess the impact of a monounsaturated fat-enriched (Mono) diet and a diet recommended by the National Cholesterol Education Program (NCEP) on plasma levels of fibrinogen and activities of factor VII (FVII:C) and plasminogen activator inhibitor-1 (PAI-1) and the impact of genetic polymorphisms of these variables (HaeIII, MspI, and 4G/5G polymorphisms, respectively) in 28 subjects with impaired glucose tolerance ([IGT] 17 men and 11 women; mean age, 55.6 +/- 5.5 years). A diet rich in fat and saturated fatty acids served as a baseline diet for 3 weeks. Thereafter, subjects were randomized for the next 8 weeks to either the Mono diet (n = 12) or NCEP diet (n = 18). Fibrinogen levels or PAI-1 activities did not change with either of the diets, but fibrinogen levels were higher (3.4 +/- 0.5 v 4.0 +/- 0.6 g/L, P = .007 at baseline) throughout the study in heterozygous subjects with respect to HaeIII polymorphism. This polymorphism and age accounted for 38% of the variation of fibrinogen levels. MspI polymorphism together with body mass index explained 51% of the variation of FVII:C, which was higher in subjects with the M1M1 genotype compared with M1M2/M2M2 genotypes (127% +/- 21% v 90% +/- 12%, P < .001). FVII:C showed a decrease with the NCEP diet (P < .05), but the decline was confined to M1M1 subjects. PAI-1 activity did not differ significantly between the genotypes. The insulin sensitivity index (SI) obtained by the minimal model method was the main explanatory variable of PAI-1 activity. To conclude, despite good compliance, the fat-modified diet did not alter plasma levels of fibrinogen or PAI-1 in white subjects with IGT. FVII:C levels decreased with the NCEP diet, but this was confined to subjects with the M1M1 genotype.

Different effects of palmitic and stearic acid-enriched diets on serum lipids and lipoproteins and plasma cholesteryl ester transfer protein activity in healthy young women.

The effects of palmitic and stearic acid-enriched diets on serum lipids, lipoproteins, apolipoproteins (apo) A-I and B, and plasma cholesteryl ester transfer protein (CETP) activity were examined in 12 healthy young women. Subjects followed the two experimental diets for 4 weeks according to a randomized crossover design. Both experimental diet periods were preceded by consumption of a baseline diet for 2 weeks. The diets provided 37% of total energy intake (E%) as fat, and differed only with respect to fatty acid composition. There was a substitution of 5E% of palmitic acid or stearic acid in the experimental diets for 5E% of monounsaturated fatty acids in the baseline diet. After the palmitic acid diet, serum total and high-density lipoprotein (HDL) cholesterol and apo A-I concentrations were higher (8%, P = .015, 9%, P = .040, and 11%,P = .011, respectively) and mean serum low-density lipoprotein (LDL) cholesterol concentration tended to be higher (8%, P = .077) as compared with values after the stearic acid diet. Plasma CETP activity increased in the palmitic acid diet as compared with the stearic acid diet (12%, P = .006). In conclusion, palmitic acid and stearic acid-enriched diets had different effects on serum lipids and lipoproteins and also on plasma CETP activity in young healthy women.

Long-term effects of four fat-modified diets on blood pressure.

The purpose of the present study was to examine the effects of four fat-modified diets on BP in 160 middle-aged subjects most of whom had mildly to moderately elevated serum total cholesterol levels and to analyse the relationship of BP to fatty acid composition of serum cholesterol esters. After screening, the subjects (74 men and 85 women) were randomised for the next six months into one of the four experimental diets: control diet (high in saturated fats) (35/14:10:4, indicating 35% of energy from total fat/14% from saturated, 10% from monoenes and 4% from polyenes in the actual diet), AHA (American Heart Association) type diet (32/10:8:8), monoene-enriched diet (34/11:11:5) and low-fat diet (30/12:8:3). Serum total cholesterol decreased significantly during the AHA type diet and monoene-enriched diet in both men and women. No significant changes were found in BP levels in any of the groups in the long-term when both sexes were analysed together but in men the AHA type diet resulted in a significant decline in SBP (-4.5 -7.9 mmHg, mean +/- SD) and a consistent reduction was also found in DBP (-2.1 +/- 8.4 mmHg). In contrast, control diet induced a significant rise (+5.5 +/- 14.3 mmHg) in both SBP and DBP (+3.4 +/- 8.4 mmHg) in men. In women, no persistent significant changes in BP levels were observed. An increase in the sum of proportions of myristic (C14:0), palmitic (C16:0) and palmitoleic acids (C16:1) of serum cholesterol esters was associated with the elevation of BP in men of the control group. Furthermore, at baseline, BP had significant positive correlations with C14:0, C16:0 and C16:1 of serum cholesterol esters in the entire study population whereas linoleic acid had an opposite effect on BP even after adjustment for body mass index and age.

Fatty acid composition of serum cholesterol esters, and erythrocyte and platelet membranes as indicators of long-term adherence to fat-modified diets.

Dietary adherence to four different fat-modified diets was examined in 160 subjects by determining the fatty acid composition of serum cholesterol esters (CEs) and erythrocyte (ER) and platelet (PT) membranes in addition to food records. Subjects were randomly assigned to one of the following diet groups: 1) high-sat--35/14:104 (% of energy from total/saturated:monounsaturated:polyunsaturated fatty acids in the actual diet) 2) AHA (American Heart Association) type--32/10:8:8 3) monoene-enriched--34/11:11:5, or 4) low-fat--30/12:8:3 for 6 mo. Decreases in the proportions of palmitic acid in CEs were found in the AHA-type and monoene-enriched-diet groups. An increased proportion of linoleic acid in CEs was found in the AHA-type group. The differences in the proportions of palmitic acid in CEs and linoleic and palmitoleic acids in PTs were significant in the AHA-type and monoene-enriched-diet groups compared with the high-sat group. An increase in alpha-linolenic acid in CEs was an indicator of the use of low erucic acid rapeseed oil, which was the main source of monoenes in the monoene-enriched-diet group.

Long-term effects of three fat-modified diets in hypercholesterolemic subjects.

Altogether 160 free living subjects (aged 30-60 years) most of whom had moderate hypercholesterolemia were randomised into the following diet groups to find out long-term effects of different fat-modified diets: (1) control diet 35/14:10:4 (energy percents from fat/saturated:monounsaturated:polyunsaturated fatty acids in actual diets); (2) AHA type diet 32/10:8:8; (3) monoene-enriched diet 34/11:11:5; (4) reduced-fat diet 30/12:8:3. LDL cholesterol fell equally with the AHA type diet (4.54 +/- 0.97 vs. 4.21 +/- 0.89 mmol/l (mean +/- S.D., 0 vs. 6 months), P = 0.001) and with the monoene-enriched diet (4.55 +/- 0.95 vs. 4.25 +/- 0.95 mmol/l, P = 0.004) during the 6-month study. Moderate amounts of polyenes or monoenes as part of natural diets did not decrease HDL cholesterol level in the long term. Serum lipid values remained unchanged with the reduced-fat diet. Analysis by apolipoprotein E phenotypes showed a decrease in LDL cholesterol only in subjects with phenotype 3/3 in the monoene-enriched group (-8.6 +/- 8.7 vs. +1.3 +/- 15.4, percent change in LDL cholesterol E 3/3 vs. E 4/3 + 4/4), but in the AHA type group LDL cholesterol decreased similarly in phenotypes E 3/3 and E 4/3 + 4/4 (-6.9 +/- 10.1 vs -6.9 +/- 16.5).