Pramod Khosla, PhD. Associate Professor, Dept. of Nutrition & Food Science, Wayne State University, Detroit, MI Cardiovascular disease.

Transcription

1 Palm Oil:...Health and Nutritional Benefits Pramod Khosla, PhD Associate Professor, Dept. of Nutrition & Food Science, Wayne State University, Detroit, MI 4822 Cognitive dec?????????????? Cardiovascular disease Exercise Fat Quality Chronic Disease Cancer Hypertension Diabetes Low calories: More fiber, grains, vegs. More fruits Control CHO & energy intake Lower sodium Osteoporosis Increased calcium Page 1

2 Fat quality Protein quality Fiber Antioxidants Phytochemicals Carbohydrate type Alcohol Diet and Lifestyle changes No smoking DIETARY FAT Maintain a healthy body weight Low to moderate intensity exercise 3-45 mins/day Per Capita Fat Consumption - g/day WHO recommendation Africa Asia CAmerica SAmerica REurope Oceania NAmerica EU15 Source : FAO website Page 2

3 RISK FACTORS FOR CHD Gender Increasing age Genetics: Family history of CHD High TC, LDL-C Low HDL-C Smoking Diabetes Obesity DIET Fat quality Protein quality Fiber Antioxidants Phytochemicals Carbohydrate type Alcohol Dietary fat composition: by fatty acid classes PUFA MUFA TFA SFA AAD 34%en 15:12:7 P/S.4 Fatty Acid Classes,% Coco PKO MilkF CoButt Tallow Pstear Palm POlein Lard Chick Olive hiosun Canola Soyb Corn Saff PUFA MUFA SFA Page 3

4 What about trans fatty acids? Unsaturated fatty acids - at least one trans double bond Partial hydrogenationof polyunsaturated oils -isomerization and migration of double bonds - distribution of cis and trans double bonds (margarines, shortenings, salad & cooking oils) Partial hydrogenationtfa. Full hydrogenation SFA Major tfa -elaidic acid (t9-18:1) Dairy and meats have t9-16:1 and t11-18:1 (vaccenic acid) what are the effects of fatty acid classes on lipoprotein cholesterol? Page 4

5 LDL S cm P tm.4.2 HDL S cm P tm MUFA & PUFA best. Trans worse than SFA TC/HDL S cm P tm Changes shown in mmol/l for LDL and HDL. Adapted from Mensink et al Am J Clin Nutr (23) 77: Effects on the TC/HDL-C C ratio S cm P tfa CHO FA S cm P tfa FA Am J Clin Nutr (23) 77: N Engl J Med (26) 344: Page 5

6 Ascherio et al, (1999 N Engl J Med 34: TC/HDL-C C adversely affected by the trans.. trans lowers HDL-C a trans increases TC/ HDL-C ratio Palmitate Trans % transfer (c.f. control) p =.3 16: Trans Khosla et al, (1997) Diet trans increases CETP Page 6

7 so what about effects on CVD? Dietary Fat intake and Risk of CHD and Type II Diabetes (TIID) in Women Effects of replacing 2%en from carbohydrates with trans fatty acids Effects of replacing 5%en from carbohydrates with specific fatty acids CHD data -Hu et al, (1997) N Engl J Med, 337: Type II Diabetes data -Salmeron et al, (21) Am J Clin Nutr 73: Page 7

8 Relative risk of CHD based on quintiles of dietary fatty acid intake (Multivariate analyses) 2 year follow-up data from the Nurses Health Study to 18% en 4.1 to 7.4% en Adverse effects with tfa Beneficial effects with PUFA 1.6 to 2.8% en SFA MUFA PUFA tfa fromoh et al (25) Am J Epidemiol, 161: Replacing SFA with different fatty 1.4 acids or carbohydrates Pooled analysis of 11 studies year follow-up Pooled RR evaluated in 344, 696 subjects (5, 249 coronary events, coronary deaths) Effect of 5% lower energy.8 intake from SFA with a simultaneous higher energy.6 intake from PUFA, carbs or MUFA is shown for coronory.4 events and coronory deaths.2 Jakobsen et al,(29) Am J Clin Nutr 89: 1425 PUFA Carbs MUFA Page 8

9 Exchanging 5% calories from SFA with carbs of different GI values Prospective cohort study. Median 12 year follow-up Hazard Ratio evaluated in 53, 644 subjects [1, 943 cases of incident myocardial infarction (MI)] For a 5% lower energy intake from SFA with a simultaneous higher energy intake from carbs with different GI values Singificant association with high GI carbs Jakobsen et al, (29) Am J Clin Nutr 89: Effects on CHD risk of consuming PUFA, carbs, or MUFA in place of SFA Predicted effects are based on changes in the TC:HDL-C ratio Evidence from a meta-analysis of eight randomized controlled trials Evidence for observed relationships of usual dietary habits with CHD events comes from a pooled analysis of 11 prospective cohort studies. Michaand and Mozaffarian, (21) Lipids. 45: Page 9

10 Meta-analysis analysis of 21 prospective epidemiologic studies showed no significant evidence for concluding SFA are associated with increased CHD risk 5-23 year follow-up Pooled RR evaluated in 347, 747 subjects (11, 6 developed CHD or stroke) SFA intake was not associated with CHD (Pooled RR 1.7; 95% CI , p=.22) Stroke (Pooled RR -.81; 95% CI , p=.11) CVD (Pooled RR -1.; 95% CI , p=.95) Siri-Tarino et al, (21 ) Am J Clin Nutr 91: Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Meta-analysisanalysis Chowdhuryet al, (214) Ann IntMed 16: Page 1

11 Figure Legend: Date of download: 3/18/214 Copyright American College of Physicians. All rights reserved. Skeaff and Miller, (29) Ann. Nutr. Metab. 55: Fatal CHD CHD events Total Fat C-NR C-NR TFA P C SFA/CHO P-NR P-NR MUFA/SFA PUFA/SFA C C Linoleic acid Alpha Linolenic n3 LCPUFA P C Dietary Fatty Acids and CHD: Summary of the Evidence C = Convincing evidence; P = Probable evidence; NR no relation; Reddenotes denotes increased risk while Green denotes decreased risk Page 11

12 what about individual saturated FA? Dietary fats comprised of individual fatty acids especially important for SFA 18:2 18: 18:3 C18:1 16: AAD 34%en 15:12:7 P/S.4 14: 12: 1: t18:1 6:+ 8: 16:1 Fatty Acid Classes Coco PKO MilkF CoaBut Tallow Pstear Palm pole Lard Chick Olive hiosun Canola Soyb Corn Saff 1/25 Page 12

13 Effects of individual SFA on lipoprotein cholesterol LDL L M P S HDL L M P S :, 16: no effect 18:, 12: beneficial TC/HDL L M P S Changes shown in mmol/l for LDL and HDL. Adapted from Mensink et al Am J Clin Nutr (23) 77: Nutritional attributes of Palm Oil and Palm Olein The global importance of palm oil Effects of palm oil on the ration of TC/HDL-C Replacement for trans fatty acids Variety of carotenoids -pro Vitamin A Vitamin E (tocopherols and tocotrienols) Page 13

14 the global importance of palm oil? Total Area Total Vegetable Oil Output million tonnes Soybean oil Palm oil 16. Rapeseed oil Net Importers China PR EU-27 Others India N Africa Pakistan Iran Bangladesh Mexico Japan Turkey South Africa South Korea Russia Nigeria Taiwan (x 1 ton 9.7 Sunflower oil 23.3 Animal Fats 7. Laurics Net Exporters 16.6 Others Others 4% Laurics 8% Animal Fats 7% Others 3% Coconut 4% Soybean oil 18% Sunflower oil 8% Rapeseed oil 3% Sunflower 1% Soybean 4% Rapeseed 12% 4 Global Exports Palm oil 52% Palm 4% Palm 29% Soybean 29% SBO Rapeseed 14% Tonnes/hectare/year SunflO RapSO Sunflower 8% Others 14% Laurics 6% Page 14

15 effects of palm oil on the ratio of TC/HDL-C? C? Palm Olein and MUFA-rich Oils exert similar effects on the ratio of Total cholesterol to HDL cholesterol (TC/HDL-C) C) in human subjects Page 15

16 Palm oil and blood lipid related markers of cardiovascular disease: a systematic review and meta-analysis analysis of dietary intervention trials Fattoreet et al,, (214) Am J. Clin Nutr. doi: /ajcn Synopsis of meta-analysisanalysis 51 studies; 1526 volunteers (2/3 men); ages 16-7 y Studies from Australia, Canada, China, Denmark, Finland, France, India, Malaysia, Netherlands, Norway, Scotland, South Africa, Spain, Thailand, USA Feeding times 2 to 16 wks Studies in healthy volunteers who were normocholesterol-emic, hypercholesterolemic as well as n/h subjects Dietary fat content 28% to 53% of total calories (test fat 4% to 43% of total calories) Page 16

17 Effects on plasma lipoproteins ofsubstituting various fatty acids with palm oil TC LDL VLDL apob HDL ApoAI TG Lp(a) LDL / HDL Stearic I I N I I I N N I N TC / HDL Lauric+ Myristic D N N N D D N N N MUFA I I N I I N N N N N PUFA I N N I I I N N N N transfa N N N D I I D N N D I-increase, D decrease and N no significant change Adpatedfrom Fattoreet al, (214). Am J ClinNutr99: palm oil as a replacement for trans fat? Page 17

18 . practical aspects SFA vs tfa not a realistic comparison Look at specific fats/oils replacing PHVO containing tfa CHD risk based not just on changes in plasma lipoproteins. Report of Mozaffarian and Clarke (29) is of interest Also risk assessment papers (Barraj et al 28, Mente et al 29) so how much palm oil in the diet? Page 18

19 conservative --based on current recommendations for restricting SFA--can calculate the amount of palm oil in a prudent diet that satisfies various dietary guidelines Khosla (26) J Agro Food Ind. 17: Hayes and Khosla, Eur J Lipid Sci Tech (27) 19: can readily replace trans by blending palm with local vegetable oils? Page 19

20 Dietary fat composition: by fatty acid classes PUFA MUFA TFA SFA AAD 34%en 15:12:7 P/S.4 RD 3%en 1:1:1 P/S 1. Coco PKO CoButt Pstear Palm Polein Olive Sun Canola Soy Corn Saff Dietary fat composition: by fatty acid classes Palm/Soy 1:1 mix PUFA MUFA TFA SFA AAD 34%en 15:12:7 P/S.4 Coco PKO CoButt Pstear Palm Polein Olive PO/SBO Canola Soy Corn Saff RD 3%en 1:1:1 P/S 1. Page 2

21 Nutritional attributes of Palm Oil and Palm Olein The global importance of palm oil Effects of palm oil on the ration of TC/HDL-C Replacement for trans fatty acids Variety of carotenoids -pro Vitamin A Vitamin E (tocopherols and tocotrienols) Vitamin A activity of red palm oil RE Per 1 g Relative quality (Times <red palm oil Red Palm 3, - Oil Carrots 2, 15 Leafy Vegetables Apricots Tomatoes 1 3 Bananas 3 1 Orange Juice 8 3,75 Phytoene 2.% Phytofluene 1.2% Cis-β- Carotene.8% β Carotene 47.4% α- Carotene 37.% Cis- α- Carotene 6.9% ζ- Carotene 1.3% δ -Carotene.6% γ -Carotene.5% Neurosporene Tr β - Zeacarotene.5% α - Zeacarotene.3% Lycopene 1.5% Numerous human studies showing efficacy of red palm oilin in fighting Vitamin A deficiency Page 21

22 studies have adopted different methods to provide Vitamin A naturally Children fed traditional Indian sweets made with redpo School children fed biscuits baked with redpo School children given 5 1 ml redpo daily Cooking green leafy vegetables in redpo Also Vitamin A status improved by feeding redpo to pregnant mothers at various stages of pregnancy. Also lactating mothers Numerous human studies showing efficacy of red palm oil in fighting Vitamin A deficiency Nutritional attributes of Palm Oil and Palm Olein The global importance of palm oil Effects of palm oil on the ration of TC/HDL-C Replacement for trans fatty acids Variety of carotenoids -pro Vitamin A Vitamin E (tocopherols and tocotrienols) Page 22

23 Nutritional attributes of Palm Oil & Palm Olein Variety of carotenoids (Vitamin A) Vitamin E (tocopherols and tocotrienols) Oil Tocopherols(ppm) αt βt γt δt Tocotrienols(ppm) αt3 βt3 γt3 δt3 Ppm T+T3 Red Palm Oil Soyabean Cornoil Groundnut Safflower Sunflower Numerous in vitro studies showing efficacy of tocotrienolsin in inhibiting cancer cellproliferation and decreasing neurodegeneration. A pilot human breast cancer clinical trial was not definitive A series of studies show efficacy against lung cancer and Phase I human studies are the next logical step Ongoing human stroke prevention trial is recruiting subjects. An earlier study from our lab helped establish the dose Evidence that tooctrienolsmay lower blood lipids and possible synergy with statin drugs has been suggested?? Recent Phase I study in dialysis patients from our laboratory. Page 23

24 Tocotrienol effects on white matter lesions Mean white matter lesion volume - change from baseline of tocotrienol and placebo treated groups (1 and 2 yrs) Gopalan et al. Stroke, 214 Pathophysiology of CVD in CKD/ESRD Renal Function Dialytic Factors Co-morbidities Clearance of cytokine of uremic toxins Bioincompatibility Vascular access Protein catabolizers Chronic infections Diabetes mellitus Congestive heart failure Anorexia protein & energy antioxidant intake Inflammation Energy expenditure Dyslipidemia Delayed catabolism of TG-rich lipoprotein HDL Oxidative Stress CVD PEW Adapted from: Ikizler et al 24; Libetta et al 211 Page 24

25 Exclusion criteria: < 3 months on HD treatment < 18 years old Vit. E supplement Stay in nursing home On interdialytic PN Screened for eligibility (n=118) Randomization (n=81) Excluded (n=37) Did not met inclusion criteria (n=3) Declined to participate (n=7) Allocated to TRF (n=41) Allocated to Placebo (n=4) Excluded (catheter dysfunction) (n=1) Week 1 Baseline Week 8 Week 3 1 pt c/o diarrhea but willing to continue the study Died (n=1) (Cardiac arrest) Underwent transplantation (n=1) Week 12 Week 12 Died (n=1) (Cardiac arrest) Analyzed (n=4) Week 16 Analyzed (n=37) Daud et al. Vasc. Health Risk Manag, 213 Lipid changes during the course of the study Triglyceride HDL-cholesterol Placebo TRF *P<.5 (P=.7) * p<.1 *p<.5 Week-8 Week-12 Week-16 Daud et al. Vasc. Health Risk Manag, 213 Page 25

26 Oil Palm Phenolics the exciting future Oil palm fruit water soluble phenolics -scaled production First nutrition studies reported starting in 211 Neuroprotective, anti-atherogenic, anti-diabetic and anti-cancer effects Summary Diet and Lifestyle changes first line of defense can have profound effect on chronic disease (prevention) Alcohol, smoking and lack of physical activity major drivers Numerous dietary changes shown to be effective Palm Oil serves a multitude of nutritional needs Supply of palm oil makes it theimportant player globally and is an important factor in global food security Fatty acid profile of palm eliminates need for hydrogenation Minor components (antioxidant/phytochemicals) help alleviate micronutrient deficiencies using food-based approach AND show promise for preventative route in certain chronic disease Additional details: J. Am. Coll. Nutr. (21), 29 (3S) Page 26