L eterno problema dei grassi. Franca Marangoni Nutrition Foundation of Italy Milano Brescia, 23 marzo 2012

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Aloisia Poletti
8 anni fa
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1 L eterno problema dei grassi Franca Marangoni Nutrition Foundation of Italy Milano Brescia, 23 marzo 2012

2 Fat intake as percentage of total calories in 134 countries FAO (FAOSTAT Food Supply section), 2011

3 Fat consumption world map ( ). World average was 78 g/person/day. no data < >165

4 Life expectancy world map

5 Hypothetical scheme of fat, fatty acid (ω-6, ω-3, trans and total) intake (as percent of calories from fat) and intake of vitamins E and C (mg/d). Data were extrapolated from crosssectional analyses of contemporary hunter-gatherer populations and from longitudinal observations and their putative changes during the preceding 100 years. Simopoulos, Biol Res 2004

Data were extrapolated from crosssectional analyses of contemporary hunter-gatherer

6 Grassi alimentari Visibili oli e grassi animali e vegetali lipidi semplici trigliceridi (93%) colesterolo (1%) Invisibili costituenti dei cibi lipidi complessi fosfolipidi (6%)

7 Acidi grassi della dieta Saturi: senza doppi legami si trovano nei prodotti animali (carni suine e bovine, latticini, oli di palma e cocco) Monoinsaturi: con un solo doppio legame (acido oleico) sono presenti nei grassi vegetali e animali Polinsaturi: con 2 o più doppi legami si classificano in base alla posizione del primo doppio legame a partire dal metile terminale.

(acido oleico) sono presenti nei grassi vegetali e animali Polinsaturi: con 2 o più doppi

8 Women Health Initiative Dietary Modification Trial Campione:48835 donne di età tra i 50 e i 79 anni in post-menopausa Al gruppo di intervento (40% delle partecipanti): è stato raccomandato di ridurre l apporto calorico giornaliero derivante dal consumo di grassi e di sostituirlo con almeno 5 porzioni di frutta e verdura e almeno6porzionidi cereali ridurre la quota lipidica dal 35-37% al25-29% dell introito calorico totale nessuna indicazione sul tipo di grassi da ridurre nessuna indicazione sull opportunità di perdere peso WHI, JAMA 2006

di sostituirlo con almeno 5 porzioni di frutta e verdura e almeno6porzionidi cereali ridurre la quota lipidica dal 35-37% al25-29% dell

9 Women Health Initiative Dietary Modification Trial End point: variazione di peso corporeo Perdita di peso dopo un anno nel gruppo di intervento = 2,2 kg (maggiore di 1,9 kg rispetto al gruppo di controllo) Differenza di peso tra i due gruppi al termine up di 7,5 anni = 0,4 kg del follow Howard VH et al, WHI, JAMA 2006

(maggiore di 1,9 kg rispetto al gruppo di controllo) Differenza di peso tra i

10 Women Health Initiative Dietary Modification Trial End-points: FR CV ed incidenza di nuovi eventi CV fatali e non fatali Follow-up: 6 anni Nel gruppo di intervento: LDL colesterolo: 3,5 mg/dl pressione diastolica: 0,3 mmhg livelli fattore VIIc 4,3% casi di CHD: HR 0,97 (0,90-1,06) Ictus: HR 1,02 (0,90-1,15) CVD: HR 0,98 (0,92-1,05) Howard BV et al, WHI, JAMA 2006

3,5 mg/dl pressione diastolica: 0,3 mmhg livelli fattore VIIc 4,3% casi di CHD: HR 0,97

11 Effects of SAT, trans MONO, cis MONO, and cis POLY Fatty Acids on LDL and HDL Cholesterol 0.4 Sat Trans 0.2 Mono Poly LDL chol HDL chol Values obtained by meta-analysis of 32 controlled dietary trials in humans Zock, 1997

12 Effects of SAT, trans MONO, cis MONO, and cis POLY Fatty Acids on LDL and HDL Cholesterol 0.4 Sat Trans 0.2 Mono Poly LDL chol HDL chol Values obtained by meta-analysis of 32 controlled dietary trials in humans Zock, 1997

13 Relative Risk of CHD according to quintiles of specific types of dietary fat in the Nurses Health Study 1,6 1,4 1,2 1 0,8 PUFA MUFA SFA TFA 0,6 0, Quintiles of intake Hu, 1997

14 Palmitic acid Oleic acid Linoleic acid

15 stearic acid oleic acid trans-elaidic acid

16 α linolenic acid Eicosapentaenoic acid Docosahexaenoic acid

17 Acidi Grassi Polinsaturi (AGP) nella catena alimentare Erbivori Carnivori Onnivori LA AGP-CC ALA Piante AA EPA+DHA Onnivori AGP-LC

18 RRs of CHD according to linoleic acid intake in the Nurses Health Study, Italian men (ibid) Italian population (Sofi et al, 2007) Italian women (ibid) Oh K, Am J Epidemiol 2005

19 Effect on coronary heart disease risk when 5% of energy intake of saturated fatty acids is replaced with polyunsaturated fatty acid

20 Circulating linoleic acid levels and CVD Author Population Specimen Observation for LA Iso, adults aged y Laaksonen, middle-aged men (15-y follow-up) Klein-Platat, 2005 Hodge, y-old adolescents (normaland overweight) 3737 adults aged y (4-y follow-up) Warensjo, y-old men (33.7-y follow-up) Steffen, 2008 Block, adolescents aged 15 y 768 incident cases (ACS) and 768 controls Serum total lipids Lower risk of stroke, particularly ischemic stroke Total serum esterified Lower mortality from CVD for men in the upper vs lower third Plasma PL and CE Plasma PL Serum CE Serum PL and CE Positive association with HDLcholesterol Negative association with the incidence of diabetes Positive association with decreased mortality Inverse relation to BMI, waist circumference and triglycerides Blood cell membranes Inverse association with ACS

7-y follow-up) Steffen, 2008 Block, 2008 264 adolescents aged 15 y 768 incident cases (ACS) and 768 controls Serum total lipids Lower risk of stroke, particularly ischemic stroke Total serum

21 RISCHIO DI MORTE IMPROVVISA E CONSUMO DI PESCE 1,2 Rischio Relativo 1 0,8 0,6 0,4 0,2 0 < 1/mese 5+/sett Consumo Hu, J Am Med Assoc, 2002

22 Relative Risk of CHD According to Quintiles of Omega-3 Fatty Acid Intake, Stratified by Omega-6/Omega-3 Ratio in the Nurses Health Study Quintiles of Omega-3 Fatty Acid Intake Low omega-6/omega-3 ratio (median=5.9) Cases, No Age-adjusted RR Multivariate RR High omega-6/omega-3 ratio (median=9.2) Cases,No Age-adjusted RR Multivariate RR All trend comparisons, calculated with the X 2 test, were significant (P<.001). the mean of omega-6/omega-3 ratio (7.6) was used as a cutoff to define low- and high-ratio groups. Omega-3 included α-linolenic acid and fish omega-3 fatty acids. JAMA, April 10,2002-Vol 287, No.14

23 Schema of Potential Dose Responses and Time Courses for Altering Clinical Events of Physiologic Effects of Fish or Fish Oil Intake Mozaffarian, JAMA 2006

24 Factors involved in cardiovascular risk that are affected by long chain n-3 fatty acids Factor Plasma triacylglycerol concentration (fasting and postprandial) Production of chemoattractants Production of growth factors Cell-surface expression of adhesion molecules Production of inflammatory eicosanoids Blood pressure Endothelial relaxation Thrombosis Cardiac arrhythmias Heart rate variability Atherosclerotic plaque stability Effect of long-chain n-3 PUFAs Calder, Clin Sci 2004

25 EPA+DHA levels and risk of death for CHD Greatest Protection GISSI-P and DART:~9.5% CHS:~8.9% SCIMO:8.3% PHS:~7.3% Seattle:6.5% PHS:~3.9% DART: Diet and Reinfarction T CHS: Cardiovascular Health Study) SCIMO: Study on the prevention of coronary Atherosclerosis by intervention with marine omega 3 FA PHS: Physicians Health Study SCIMO:3.4% Seattle:3.3% Lowest Protection Harris&von Schacky, Prev Med 2004

26 RISCHIO DI MORTE IMPROVVISA E CONSUMO DI NOCI 1,2 Rischio Relativo 1 0,8 0,6 0,4 0,2 0 raram./mai Consumo di noci 2+/sett. Albert, Arch Int Med, 2002

27 RISCHIO DI SVILUPPARE LA MALATTIA DIABETICA E CONSUMO DI NOCI: DATI DAL NHS 1,2 Rischio Relativo 1 0,8 0,6 0,4 0,2 0 raram./mai 1-4/sett. Consumo di noci 5+/sett. Jang, ADA meeting, 2003

28 Summary of Recommendations for Omega-3 Fatty Acid Intake Patients without documented CHD Eat a variety of (preferably oily) fish at least twice a week. Include oils and foods rich in -linolenic acid (flaxseed, canola, and soybean oils; flaxseed and walnuts) Patients with documented CHD Consume 1 g of EPA+DHA per day, preferably from oily fish. EPA+DHA supplements could be considered in consultation with the physician. Patients needing triglyceride lowering Two to four grams of EPA+DHA per day provided as capsules under a physician s care AHA Scientific Statement, Circulation 2002

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