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In this slide deck I demonstrate the effects of carbohydrate restriction on different lipoproteins such as HDL, LDL, non-HDL-cholesterol and apolipoprotein B (apoB). The effect of butter and saturated fat as such are compared to unsaturated fat and especially to canola oil. Meta-analysis by Mensink et al. 2003 is the primary reference for the analysis.
Citation preview
Changes in apoB, LDL, non-HDL-cholesterol, HDL and LDL particles when carbohydrates are replaced
by different fatty acids
Scientific evidence
Registered dietitian, M.Sc, MBAReijo Laatikainen
www.twitter.com/pronutritionist
Page 1
2
Is butter really healthy for your heart?
3
Why this slide deck?• It’s rather widely accepted that apoB, non-HDL-cholesterol and
total cholesterol:HDL –ratio are better predictors of coronary heart disease (CHD) risk than LDL-C alone. The importance of LDL particle number (LDL-P) and high share of small dense LDL is yet to be confirmed in meta-analyses vs apoB etc.
• Some proponents of the low carb diet maintain that saturated fat is either beneficial or neutral in regards to these risk factors and that “… saturated fat has nothing to do with heart disease”. Point seem to be that if you reduce carbohydrate intake substantially, all the key risk factors will settle within the optimal range
• In some occasions media has declared butter heart healthy
• What is actually known about lipoproteins when carbohydrates (“carbs”) are replaced by different fatty acid classes?
Page 4
Source
Meta-analysis of 60 randomized studies in weight stable situation
by Mensink et al 2003
5
Lipoprotein changes when 1% of daily energy from carbs is replaced by fats
Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55
Page 6
Part 1, summary
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Direction of effects when only 1 E% of carbs is replaced by fatty acids
HDL LDL T-Chol:HDL-ratio
apoB Non-HDL-C
Carbs→SFA
+/- 0 +/- 0 Not calculated in the original paper. I’ve done the math (ie. red text previous slide)
Carbs→MUFA
Carbs→PUFA
Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55
Green arrow= beneficial change in a risk factor, red/striped arrow=negative change, +/-0= not statistically significant change
Page 8
Part 2, practical example
Potatoes (200 kcal) → Butter (200 kcal)or
Potatoes (200 kcal) → Canola oil (200 kcal)
9
Effects of replacing potatoes by butter or canola oil in an isocaloric situation
?
10
Carbohydrate Protein* PUFA MUFA SFA
-12.0 %
-10.0 %
-8.0 %
-6.0 %
-4.0 %
-2.0 %
0.0 %
2.0 %
4.0 %
6.0 %
8.0 %
-9.3 %
-0.7 %0.4 %
2.8 %
6.8 %
Change in macronutrient intake when 10% of daily energy as carbs (boiled potatoes) is replaced by animal fat (butter)
Changes in macronutrient intake when butter replaces potatoes
*Protein is considered neutral in the following calculations (no data in Mensink). Therefore actual amount of carbs replaced is 9.3 E%-0.7 E%= 8.6 E%. It follows that the ‘replaceable’ fat intake is also reduced by 0.7 E%, and this reduction is splitted to all 3 fatty acid classes in the following calcutions.
11
Changes in macronutrient intake when canola oil replaces potatoes
Carbohydrate Protein PUFA MUFA SFA
-12.0 %
-10.0 %
-8.0 %
-6.0 %
-4.0 %
-2.0 %
0.0 %
2.0 %
4.0 %
6.0 %
8.0 %
-9.3 %
-0.7 %
2.8 %
6.4 %
0.7 %
Change in macronutrient intake when 10% of daily energy as carbs (boiled potatoes) is replaced by canola oil
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Change in LDL
Carbs replaced by butter Carbs replaced by canola oil
-0.15
-0.1
-0.05
0
0.05
0.1
0.15
0.20.1808
-0.0883
Change in LDL (mmol/L)mmol/L (For mg/DL multiply by 38.67)
Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55 (calculated from Table 1)
13
Change in HDL
Carbs replaced by butter Carbs replaced by canola oil0
0.01
0.02
0.03
0.04
0.05
0.06
0.07
0.08
0.09
0.1
0.087
0.0694
Change in HDL (mmol/L)mmol/L (For mg/DL multiply by 38.67)
Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55 (calculated from Table 1)
14
Change in total cholesterol:HDL –ratio
Carbs replaced by butter Carbs replaced by canola oil
-0.3
-0.25
-0.2
-0.15
-0.1
-0.05
0
-0.0545
-0.2403
Change in TOT CHOL:HDL -ratio
Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55 (calculated from Table 1)
15
Change in non-HDL-cholesterol
Carbs replaced by butter Carbs replaced by canola oil
-0.2
-0.15
-0.1
-0.05
0
0.05
0.1
0.15 0.1272
-0.1426
Change in non-HDL-Cholesterol (mmol/L)mmol/L (For mg/DL multiply by 38.67)
Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55 (calculated from Table 1)
16
Change in apoB
Carbs replaced by butter Carbs replaced by canola oil
-60
-50
-40
-30
-20
-10
0
10
2.88
-48
Change in apoB (mg/L)mg/L
Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55 (calculated from Table 1)
Page 17
Part 2
125 grams (25 E%) of carbs → SFAor
125 grams (25 E%) of carbs → MUFAor
125 grams (25 E%) of carbs → PUFA
Page 18
The following calculations are theoretical because edible fats are
mixtures of different fatty acids. However, calculations
demonstrate the direction of the change with given fatty acids.
Page 19
25 E% of carbs
all replaced by SFA
25 E% of carbs
all replaced by MUFA
25 E% of carbs
all replaced by PUFA
3 scenariosin weight stable situation
1
2
3
?
?
?
20
Change in HDL
Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55 (calculated from Table 1)
by SFA by MUFA by PUFA 0.00
0.05
0.10
0.15
0.20
0.25
0.30
0.25
0.20
0.15
Change in HDL (mmol/l) when 25 % of energy from carbs is replaced by different fatty acid classes
mmol/L (For mg/DL multiply by 38.67)
21
Change in apoB
Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55 (calculated from Table 1)
by SFA by MUFA by PUFA
-250.00
-200.00
-150.00
-100.00
-50.00
0.00
50.00
100.00
65.00
-120.00
-192.50
Change in Apo-B (mg/L) when 25 % of energy from carbs is replaced by different fatty acid classes
mg/L
22
Change in non-HDL-cholesterol
Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55 (calculated from Table 1)
by SFA by MUFA by PUFA
-0.80
-0.60
-0.40
-0.20
0.00
0.20
0.40
0.60
0.800.65
-0.35
-0.68
Change in Non-HDL (mol/L) when 25% of energy from carbs is replaced by different fatty acid classes
mmol/L (For mg/DL multiply by 38.67)
23
Change in total cholesterol:HDL -ratio
by SFA by MUFA by PUFA
-1.000
-0.800
-0.600
-0.400
-0.200
0.000
0.2000.075
-0.65
-0.80
Change in Tot Cholesterol:HDL -ratio when 25% of energy from carbs is replaced by different fatty acid
classes
Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55 (calculated from Table 1)
24
Change in LDL-C
Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55 (calculated from Table 1)
by SFA by MUFA by PUFA
-0.60
-0.40
-0.20
0.00
0.20
0.40
0.60
0.80
1.00
0.80
-0.23
-0.48
Change in LDL (mmol/L) when 25% of energy from carbs is replaced by different fatty acid classes
mmol/L (For mg/DL multiply by 38.67)
25
Changes in LDL-particle size, LDL pattern B or number (LDL-P)
No data available in Mensink’s meta-analysis or in any other currently available meta-analysis
Conclusion • Replacing carbohydrates by PUFA/MUFA compared to SFA induces
more beneficial changes in the key CHD risk factors, ie. apoB, non-HDL-cholesterol and total cholesterol:HDL ratio, in addition to LDL-C.
• All fatty acids in place of carbohydrates increase HDL cholesterol
• When carbohydrates are replaced by SFA, apoB and total cholesterol:HDL ratio seem to change little or not at all. This may partly explain why replacing saturated fat by carbohydrates has not been associated with improved CHD outcomes in prospective cohorts (Jakobsen et al. 2009)
• Favouring food items rich in MUFA and PUFA instead of SFA is likely to be beneficial to cardiovascular health when “going low carb”
26
27
Healthy switch
28
Unhealthy switch
Disclaimer
This analysis focuses on lipoprotein changes only in weight stable situation.
Other diet related factors (such as protein quality, fiber, vitamins, minerals,
phytochemicals, healthy weight etc.) may also play a critical role in preserving
cardiovascular health
29
Page 30
What about morbidity and mortality trials and prospective
cohorts? Visit my other slide deck on butter
http://www.slideshare.net/pronutritionist/margine-or-butter
Page 31
What about LDL-particle size or LDL-P?
Visit my upcoming slide deck (due before September 2014)
Wellcome aboard!
http://twitter.com/pronutritionisthttp://www.facebook.com/pronutritionist
http://www.pronutritionist.net
Reijo Laatikainen, RD, MBA
Images bought and licensed from BigStockPhoto. Snapshots from papers and sites referred to.
Page 32
Back up slides
Calculations behind the substitutions
34
Change in LDL when canola oil replaces potatoes
POtatoes replaced by SFA (0.5 E%)
Carbs replaced by MUFA (6.1 E%)
Carbs replaced by PUFA (2.6 E%)
Net change (sum)
-0.1
-0.08
-0.06
-0.04
-0.02
0
0.02
0.04
0.016
-0.0549-0.0494
-0.0883
Change in LDL cholesterol (mmol/L)
35
Change in HDL when canola oil replaces potatoes
Carbs replaced by SFA (0.5 E%)
Carbs replaced by MUFA (6.1 E%)
Carbs replaced by PUFA (2.6 E%)
Net change (sum)0
0.01
0.02
0.03
0.04
0.05
0.06
0.07
0.08
0.005
0.0488
0.0156
0.0694
Change in HDL cholesterol (mmol/L)
36
Change in total cholesterol:HDL –ratio when canola oil replaces potatoes
Carbs replaced by SFA (0.5 E%)
Carbs replaced by MUFA (6.1 E%)
Carbs replaced by PUFA (2.6 E%)
Net change (sum)
-0.3
-0.25
-0.2
-0.15
-0.1
-0.05
0
0.05
0.0015
-0.1586
-0.0832
-0.2403
Change in Tot Chol:HDL -ratio
37
Change in non-HDL-cholesterol when canola oil replaces potatoes
Carbs replaced by SFA (0.5 E%)
Carbs replaced by MUFA (6.1 E%)
Carbs replaced by PUFA (2.6 E%)
Net change (sum)
-0.16
-0.14
-0.12
-0.1
-0.08
-0.06
-0.04
-0.02
0
0.02
0.04
0.013
-0.0854
-0.0702
-0.1426
Change in non-HDL-Cholesterol
38
Change in apoB when canola oil replaces potatoes
Carbs replaced by SFA (0.5 E%)
Carbs replaced by MUFA (6.1 E%)
Carbs replaced by PUFA (2.6 E%)
Net change (sum)
-60
-50
-40
-30
-20
-10
0
10
1.3
-29.28
-20.02
-48.00
Change in Apo B (mg/L)
39
Change in LDL when butter replaces potatoes
Carbs replaced by SFA (6.5 E%)
Carbs replaced by MUFA (2.6 E%)
Carbs replaced by PUFA (0.2 E%)
Net change (sum)
-0.05
0
0.05
0.1
0.15
0.2
0.25
0.208
-0,0234
-0,0038
0.1808
Change in LDL cholesterol (mmol/L)
40
Change in HDL when butter replaces potatoes
Carbs replaced by SFA (6.5 E%)
Carbs replaced by MUFA (2.6 E%)
Carbs replaced by PUFA (0.2 E%)
Net change (sum)0
0.01
0.02
0.03
0.04
0.05
0.06
0.07
0.08
0.09
0.1
0.065
0.0208
0.0012
0.087
Change in HDL cholesterol (mmol/L)
41
Change in total cholesterol:HDL –ratio when butter replaces potatoes
Carbs replaced by SFA (6.5 E%)
Carbs replaced by MUFA (2.6 E%)
Carbs replaced by PUFA (0.2 E%)
Net change (sum)
-0.08
-0.06
-0.04
-0.02
0
0.02
0.04
0.0195
-0.0676
-0.0064
-0.0545
Change in Tot Chol:HDL -ratio
42
Change in non-HDL-cholesterol when butter replaces potatoes
Carbs replaced by SFA (6.5 E%)
Carbs replaced by MUFA (2.6 E%)
Carbs replaced by PUFA (0.2 E%)
Net change (sum)
-0.05
0
0.05
0.1
0.15
0.2
0.169
-0.0364
.-0,0054
0.1272
Change in non-HDL-Cholesterol
43
Change in apoB when butter replaces potatoes
Carbs replaced by SFA (6.5 E%)
Carbs replaced by MUFA (2.6 E%)
Carbs replaced by PUFA (0.2 E%)
Net change (sum)
-15
-10
-5
0
5
10
15
20
16.9
-12.48
-1.54
2.88
Change in Apo B (mg/L)