1. Fats Lisa Lachenmayr June 2006 FSNE Nutrition Workshop

4. Dietary Guidelines Key Recommendations  Adults: 20-35% of calories Children 4-18 years old: 25-35% of calories Children 2-3 years old: 30-35% of calories  Less than 10% of calories from saturated fatty acids  Less than 300 mg/day of cholesterol  Keep trans fatty acids as low as possible

5. Fats in Foods  Phospholipids  Sterols  Triglycerides –Common names: Fats and Oils –95% of the fat in food –9 kcal/gram –Glycerol backbone + 3 Fatty Acids

6. Different Types of Fatty Acids  Polyunsaturated –Essential –Omega-6 –Omega-3  Monounsaturated  Saturated  Trans

7. Fatty Acids in Foods  Mixed Triglycerides –Length (Number of carbons in a chain) –Degree of saturation  Food contains a mixture of fatty acids  Foods classified based on predominant fatty acid

9. Polyunsaturated Fatty Acids  Dietary Guidelines –“Keep total fat intake between 20-35% of calories, with most coming from sources of polyunsaturated and monounsaturated fatty acids…”  Primarily found in vegetable oils  Decreased risk of CHD associated with replacing dietary saturated fats with polyunsaturated fats while maintaining a low intake of trans fatty acids  Good source of essential fatty acids and Vitamin E

10. Polyunsaturated Fatty Acids Omega-6  Sources: Vegetable oils such as soybean, corn and safflower  High in Western Diet  Essential Omega-6 FA: Linoleic Acid

11. Polyunsaturated Fatty Acids Omega-3  Alpha linolenic –Plant source such as soybean and canola oil, walnuts and flaxseed –Essential Omega-3 FA  DHA and EPA –Animal sources such as fish and shellfish –Especially high in fatty fish including salmon, lake trout, tuna and herring

12. Dietary Guidelines – EPA and DHA  General Population: –Limited evidence suggestions consumption of FA in fish and decreased mortality from CVD  Previous Cardiac Event: –Evidence suggests consuming 2 servings of fish per week decreases risk of heart disease –EPA and DHA decreases risk of mortality from CVD

13. Fish Consumption Concerns  Mercury –Discussed in Dietary Guidelines –Heavy metal toxin found in varying levels in nearly all fish and shellfish –Not a health concern for general population –EPA and FDA recommend following special consumption guidelines for certain populations: - Woman of childbearing age who may become pregnant - Pregnant women - Nursing mothers - Young children

14. Mercury in Fish – Guidelines for Special Populations High Levels – AvoidLow Levels - Consume Shark Swordfish King Mackerel Tilefish Locally Caught Fish - Check local advisories and avoid if recommended - Consume only 6 ounces per week Shrimp Canned Light Tuna* Salmon Pollock Catfish Fish sticks and processed fish sandwiches * Albacore (white) tuna has more mercury than canned light tuna. You may eat up to 6 ounces of albacore tuna per week (one average meal) and 6 ounces of tuna steaks per week.

15. Salmon – Farmed vs. Wild  Farm Raised –Higher levels of contaminants (Including PCBs and dioxins) –Where fish is farmed matters –Recommendations of 1-2 meals (8 ounces) per month based on EPA guidelines  Wild –Lower levels of contaminants –Recommendations of up to 8 meals per month  Labels –“Fresh” – Does not mean wild-caught –“Atlantic” – Almost always farmed

16. American Heart Association – DHA and EPA  Decrease risk of arrhythmias  Decreased blood clots  Decrease triglyceride levels  Decrease growth of plaque  Lower blood pressure (slightly)

17. AHA Recommendations – DHA and EPA PopulationRecommendation Without CHD-Eat a variety of fish (preferably fatty) at least 2 times per week - Include oils and foods rich in alpha-linolenic* With CHD-Eat 1g of EPA + DHA per day preferably from fatty fish - Consult doctor about supplements Need to lower triglycerides-Eat 2-4 grams of EPA+ DHA per day via supplements (consult doctor) - High intakes of EPA and DHA could cause excessive bleeding - High-quality omega-3 fatty acid supplements *Alpha-linolenic acid can be converted to DHA and EPA in the body. This conversion is modest and controversial. Alpha-linolenic acid is found in flaxseed and flaxseed oil, canola and soybean oils and walnuts.

18. EPA and DHA Health Claim  FDA Allowed Health Claim (2004) –Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease. One serving of [name of food] provides [x] grams of EPA and DHA omega-3 fatty acids. [See nutrition information for total fat, saturated fat and cholesterol content.]

19. DHA - Infants  Visual and cognitive development in infants  Found in breast milk –Higher if a mother's diet is high in fish  FDA approved addition of DHA and Arachidonic acid (ARA) to infant formula in 2002 –FDA indicating “safe”  Limited research on benefit of addition of DHA and ARA

20. Monounsaturated Fatty Acids  Dietary Guidelines –“Keep total fat intake between 20-35% of calories, with most coming from sources of polyunsaturated and monounsaturated fatty acids…”  Primarily found in canola and olive oils, some nuts and avocados  Decreased risk of CHD associated with replacing dietary saturated fats with monounsaturated fats while maintaining a low intake of trans fatty acids  Decreases Total and LDL Cholesterol

21. Olive Oil Health Claim  FDA Allowed Health Claim (2004) –Limited and not conclusive scientific evidence suggests that eating about 2 tablespoons (23 grams) of olive oil daily may reduce the risk of coronary heart disease due to the monounsaturated fat in olive oil. To achieve this possible benefit, olive oil is to replace a similar amount of saturated fat and not increase the total number of calories you eat in a day. One serving of this product [Name of food] contains [x] grams of olive oil.

22. Saturated Fatty Acids  Dietary Guidelines –Consume less than 10% of calories from saturated fatty acids…  Primarily found in animal products and tropical oils  Increases risk of CHD –Increases LDL cholesterol –Number one dietary link to high blood cholesterol –Decreasing consumption appears to significantly decrease risk of mortality (esp. CVD mortality) in persons with diabetes  Americans consume 4-5 times as much saturated fat as trans fat

25. Maximum Daily Amount of Saturated Fat  Amount keep levels below 10% of total calories  Rounded to nearest 5 grams to be consistent with Nutrition Facts Panel  Table 8 and Table 9 of Dietary Guidelines Total Calorie IntakeLimit on Saturated Fat Intake 1,60018 g or less 2,00020 g or less 2,20024 g or less 2,50025 g or less 2,80031 g or less

26. Nutrition Facts Label – Saturated Fat  % Daily Value for Saturated Fat  5% or less is low  20% or more is high

27. Dietary Guidelines Recommendation – Adults with Elevated LDL  Less than 7% of calories from saturated fat  Less than 200mg/day from cholesterol  Should be under care of physician

28. Trans Fatty Acids  Dietary Guidelines –“…..keep trans fatty acid consumption as low as possible”  Primarily found in processed foods and oils and animal products –Partially hydrogenated oils and foods containing partially hydrogenated oils  Reasons for hydrogenating –Shelf stable –Withstands repeated heatings without breaking down –Oil becomes solid at room temperature

29. Trans Fatty Acids & Heart Disease  Increases risk of CHD –Increases LDL cholesterol –Lowers HDL cholesterol –Increases tendency of blood platelets to clump  Harvard University study estimates that replacing partially hydrogenated fat with healthy unsaturated vegetable oils would prevent at least 30,000 premature deaths from heart disease each year

30. Trans Fat in the American Diet  Americans consume 4-5 times as much saturated fat as trans fat  Average intake = 5.84 grams  2.6% of total calories (estimated at 4-7% in early 1990’s)  80% is from processed foods and oils compared to 20% from animal sources (naturally occurring trans fat)  FDA once estimated that 95% of prepared cookies, 100% of crackers and 80% of frozen breakfast products contained trans fat  Trans fat in processed foods has changed and is likely to continue to change as the industry reformulates products

31. Trans Fat in the American Diet* Food GroupContribution (% of total trans fat consumed) Cakes, cookies, crackers, pies, bread, etc.40 Animal products21 Margarine17 Fried Potatoes8 Table 11 *Data collected 1994-1996

32. McDonald’s French Fries SizeTrans fat (g) Small3.5 Medium5 Large8 Ingredients: Potatoes, partially hydrogenated soybean oil, natural flavor (beef, wheat and dairy sources), dextrose, sodium acid pyrophosphate (to preserve natural color). Cooked in partially hydrogenated vegetable oils (may contain partially hydrogenated soybean oil and/or partially hydrogenated corn oil and/or partially hydrogenated canola oil and/or cottonseed oil and/or sunflower oil and/or corn oil).

33. Nutrition Facts Label – Trans Fat  As of January 1, 2006 the FDA requires on Nutrition Facts Label  No %DV for trans fat  Choose products with little or no trans fat When comparing products:  Add grams of saturated fat and trans fat

35. McDonald’s French Fries SizeSaturated Fat (g)Trans fat (g) Small2.53.5 Medium45 Large68 Ingredients: Potatoes, partially hydrogenated soybean oil, natural flavor (beef, wheat and dairy sources), dextrose, sodium acid pyrophosphate (to preserve natural color). Cooked in partially hydrogenated vegetable oils (may contain partially hydrogenated soybean oil and/or partially hydrogenated corn oil and/or partially hydrogenated canola oil and/or cottonseed oil and/or sunflower oil and/or corn oil).

36. Trans Free Products Soon to Limit Trans Fat….

37. Cholesterol  Dietary Guidelines –“ Consume less than 300mg/day of cholesterol….” –“Because men tend to have higher intakes of dietary cholesterol, it is especially important for them to meet this recommendation.” –Individuals with elevated LDL should consume less than 200mg/day of cholesterol  ONLY found in animal products –Often found in animal products high in saturated fat  Linked to increased LDL cholesterol and CHD

39. Women’s Health Initiative Study Reducing Total Fat Intake  Study the effect of low-fat, high fruit, vegetable, and grain diet on breast cancer, colorectal cancer and heart disease in postmenopausal women  Diet NOT designed for weight loss  Women followed 8.1 years  48,000 postmenopausal woman –No intervention – 60% of participants –Intervention (dietary change) – 40% of participants

40. WHI - Dietary Change Group Goals  Decrease fat intake to 20% of total calories  Increase fruits and vegetables to 5 or more servings/day  Increase grains to 6 or more servings/day Methods for dietary change-  Attended group sessions (included education) –18 time in year one –4 times in year 2-8  Self-monitoring

41. WHI - % Calories from Fat  2.9% decrease saturated fat  3.3% decrease monounsaturated fat  1.5% decrease polyunsaturated fat Dietary Change Group No Intervention Difference Study Goal20% Baseline35% 0% At 1 year24%35%11% At 6 years29%37%8%*

42. WHI – Fruits and Vegetables and Grains  Fruits and Vegetables –Dietary Change Group 3.5 to 5 servings at year 1 and year 6 –Comparison Group 3.5 to 4 servings at year 1 and year 6  Grains –4.5 servings at baseline for both groups –Very little change in either group over time

43. WHI – Breast Cancer  9% lower rate in women in Dietary Change group which was not quite statistically significant  Women who had higher levels of dietary fat intake at the start of the study had a greater reduction in fat and a greater reduction in risk (15-20%)  Women who most strictly adhered to 20% fat intake had 15-20% risk reduction  Low fat diet reduced blood estradiol (estrogen) by 15% (breast cancer risk factor)  30% risk reduction for a certain subtype of breast cancer –Progesterone-receptor negative tumors (rare)

44. WHI – Breast Cancer Possible Explanations  Insufficient follow-up time  Dietary fat not low enough (did not meet the goal)

45. WHI – Colorectal Cancer  Did not reduce risk  9% lower reporting of polyps in Dietary Change group  No benefit found in those that adhered to low-fat goal  No benefit found in those that had greatest decrease in fat  Possible benefit due to decrease polyps if followed for longer period of time

46. WHI – Heart Disease  Did not reduce risk of heart disease (look at heart attacks and death from heart disease)  Small but significant improvements in risk factors including: –Body weight –LDL –Diastolic blood pressure –Factor VII C (a blood clotting factor)  Women who reached lowest levels of saturated and trans fat and highest level of fruits and vegetables had greater reductions in LDL (but lower sample size)

47. WHI – Heart Disease Explanations  Dietary pattern reduced ALL types of fat since trying for low fat diet to determine impact on breast cancer  Diet designed for heart disease would focus on reducing saturated and trans fat  Relied on food frequency questionnaires which rely heavily on memory*  Length of study*  Participants started the study late in life*

48. Key Lessons  Greatest changes in fats were made by decreasing added fats  Dietary change and maintaining change strongly associated with attending nutritionist-led groups and self- monitoring food intake  Results show it is feasible to reduce fat intake to below 30%  Low-fat, high carbohydrate diet does not increase body weight, blood triglycerides, or indicators of increased risk of diabetes such as blood glucose or insulin levels