Fats and Lipids in

Nutrition
http://www.cwu.edu/~geed/fcsn245.htm
Dr. David L. Gee
FCSN 245 - Basic Nutrition
 Fats and Lipids
 Definition
 Classes of Fats
–Triglycerides
–Phospholipids
–Cholesterol and other Sterols
Functions of Triglycerides
Energy storage
Physical & thermal
insulator
Carrier of fat soluble
vitamins
 Triglyceride Chemistry
©2001 Brooks/Cole, a division of Thomson Learning, Inc. Thomson Learning™ is a trademark used herein under license.
 Phospholipid Chemistry
 Very similar to triglycerides
– Glycerol
– TWO fatty acids
– Phosphate + nitrogen-containing
compound
 Structure with two distinct parts
– Fat soluble part (FA’s)
– Water soluble part (phosphate + N-
compound)
Functions of Phospholipids
Cell membrane
structure
Emulsifier
– fat digestion
– fat transport in blood
Cholesterol Chemistry
©2001 Brooks/Cole, a division of Thomson Learning, Inc. Thomson Learning™ is a trademark used herein under license.
Functions of Cholesterol
 Cellmembrane structure
 Precurser for:
– Bile acids
– Steroid hormones
– Vitamin D
 Sources:
– Animal fats only
– Made in liver (non-dietary essential)
©2001 Brooks/Cole, a division of Thomson Learning, Inc. Thomson Learning™ is a trademark used herein under license.
 Triglycerides
Structure
Mono- & Di- glycerides
Fatty Acids
©2001 Brooks/Cole, a division of Thomson Learning, Inc. Thomson Learning™ is a trademark used herein under license.
 Fatty Acids
 Chain length
 Long chain ( C12 - C22 )
– most vegetable fats
– most animal fats
 Medium chain ( C6 - C10 )
– butter fat
– coconut oil
– liquids/very soft at room T
 Fatty Acids
Degree of saturation
 Saturatedfatty acids (SFA)
 Monounsaturated (MUFA)
 Polyunsaturated (PUFA)
© 2002 Wadsworth Publishing / Thomson Learning™
 The problem with
Saturated Fatty Acids
 Raises blood cholesterol
– Raises LDL-cholesterol (bad)
– Lowers activity of LDL-receptor
 What are lipoproteins?
 Particles in the blood for
transporting fat.
 Structure
– Outer coat
» Phospholipids, cholesterol,
proteins
– Core
» Fats: triglycerides, cholesterol-FA
esters
 Types of lipoproteins
 Triglyceride carriers
– Chylomicrons (dietary TGs)
– Very Low Density lipoproteins (VLDL,
TGs made in the body)
 Cholesterol carriers
– LDL ( delivers cholesterol to tissues )
– HDL ( removes cholesterol from tissues for
excretion in liver)
©2001 Brooks/Cole, a division of Thomson Learning, Inc. Thomson Learning™ is a trademark used herein under license.
© 2002 Wadsworth Publishing / Thomson Learning™
 Saturated Fatty Acids
 Raises blood cholesterol
– Raises LDL-cholesterol (bad)
 Solid at room temperature
–High in animal fats
–Tropical plant fats
» coconut oil, palm oil, cocoa oil
Mono Unsaturated Fats
 Lowers blood cholesterol
– Lowers LDL - cholesterol
– No effect on HDL - cholesterol
 Liquid at room temperature
 Olive oil, canola oil, peanut oil
 Major Types of Human
Nutrition Research
 Anecdotal & Case Studies
– Individual or small # subjects
– Not controlled
– Not considered reliable research
 Epidemiological
Research
 Randomized Controlled Trials
 Nutritional Epidemiological
Studies
 Studies:
– Prevalence of disease/disorder in a population
– Association with nutritional factors
 Observational
 Time
– cross-sectional studies
– Retrospective studies
– Prospective studies
 Nutritional Epidemiological
Studies
 Strengths
– Significant endpoints
» mortality
» morbidity
– Free living populations
– Prospective studies over long periods of
time
 Magnesium Intake and Reduced
Risk of Colon Cancer in a
Prospective Study of Women
American Journal of Epidemiology 2006 163(3):232-235

 http://aje.oxfordjournals.org/cgi/content/abstract/163/3/232?
maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&title=magnesium+colon+cancer&an
dorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=11388224460
01_2635&FIRSTINDEX=0&sortspec=relevance&journalcode=amjepid
 Nutritional Epidemiological
Studies
 Does not prove cause and effect
– Suggests possible relationships
between nutrition and disease
 Well known epidemiological studies
– Framingham Studies
– Physician’s Health Studies
– Nurse’s Health Studies
 Randomized Controlled Trials
(RCT)
 Experimental
 Groups assigned randomly
 All other factors (other than
experimental factor) controlled
 Single and double blind experiments
 Strongest evidence proving cause and
effect
 Modification of lymphocyte DNA
damage by carotenoid supplementation
in postmenopausal women.
American Journal of Clinical Nutrition, Vol. 83, No. 1, 163-
169, January 2006

http://www.ajcn.org/cgi/content/abstract/83/1/163
 Randomized Controlled Trials
 Limitations
– Short period of time
» Clinical trials can be longer, but more
difficult to control
– Subjects not free-living
» # subjects small
– Endpoints measured related to, but
does not measure morbidity or mortality
Mono Unsaturated Fats
 Lowers blood cholesterol
– Lowers LDL - cholesterol
– No effect on HDL - cholesterol
 Liquid at room temperature
 Olive oil, canola oil, peanut oil
 Mediterranean Diet
Protection Against Heart Disease?
 High in Olive Oil (MUFA)
 French Paradox
– Northern vs Southern France
 But other possible contributing factors:
– High Red Wine consumption
– Rich in fiber, fruits, vegetables
– More active lifestyle
– Recent changes in diet and lifestyle 
Polyunsaturated Fats
 Lowers LDL-cholesterol
–But also lowers HDL-
cholesterol
 Dietary Sources
–Vegetable oils
–Fish oils
©2001 Brooks/Cole, a division of Thomson Learning, Inc. Thomson Learning™ is a trademark used herein under license.
 Essential Fatty Acids
 PUFA’s required in diet
 Two classes of EFA’s
– Omega-6 PUFA’s
»Linoleic acid
– Omega-3 PUFA’s
»Linolenic acid
 3-6 g/day (1 tsp veg. oil)
© 2002 Wadsworth Publishing / Thomson Learning™
 Essential Fatty Acids
 Deficiency Syndrome
– Rare
» fat malabsorption in infants
– Dermatitis, hair loss, poor wound
healing
 Bigger concerns of relative
amounts of w-3 & w-6 in US diet
 Essential Fatty Acids
 Functions
 Component of phospholipids in cell
membranes
 Synthesis of Eicosanoids
– Potent hormone-like chemicals
» Prostaglandins
» Leukotrienes
 Eicosanoid Functions:
role in heart disease
 Regulates
– smooth muscle contractions
» blood pressure
 Omega-3 eicosanoids tend to lower BP
 Omega-6 tend to increase BP
– blood clotting
 Omega-3 eicosanoids tend to inhibit blood
clotting
 Omega-6 tend to increase blood clotting
 Intake of Fish and Omega-3
Fatty Acids and Risk of Stroke in
Women
 JAMA, Jan. 2001
 Nurses’ Health Study
– Prospective epidemiological study
 14 year follow up on 79,839 women
 574 strokes
 Relative Risk related to fish consumption
 Risk of Stroke on Fish
Consumption
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
<1/mo 1-3/mo 1/wk 2-4/wk >4/wk
Stroke and Fish Intake (cont.)
 Risk of ischemic stroke 49% in
women consuming fish > 2/wk
 Risk related to intake of omega-3
PUFA
 No association between fish intake
or omega-3 intake with
hemorrhagic stroke
Dietary Effects on Eicosanoids
 Omega-6 PUFA (Veg Oils)
– Produce eicosanoids that tend to:
»increase blood clotting
»increase blood pressure
–May tend to increase risk of
heart disease
Dietary Effects on Eicosanoids
 Omega -3 PUFA’s (fish oils,
canola)
– Produce eicosanoids that tend to:
»decreases blood clotting
»decreases blood pressure
»decreases blood viscosity
– decreases risk of heart disease
 Essential Fatty Acids and
Inflammation
 Inflammation: injury that results in
increased immune system activity and
blood flow
 Inflammation may play a role in heart
disease and cancer
 Omega-3 PUFA may reduce
inflammatory response
Hydrogenation of UFA
 Conversion of PUFA to MUFA &
SFA
 Process
 Purposes:
– Produce solid fats from oils
– Produce more chemically stable fats
(resists oxidation, rancidity)
©2001 Brooks/Cole, a division of Thomson Learning, Inc. Thomson Learning™ is a trademark used herein under license.
 Hydrogenation of UFA
 “cis”and “trans” UFA
 ‘trans’ formed as a side/reverse
reaction of hydrogenation
 Trans fats mainly found in foods
with partially hydrogenated fats
– Trace amounts in milk fat & tallow
– Current average intake ~2.6% of calories
©2001 Brooks/Cole, a division of Thomson Learning, Inc. Thomson Learning™ is a trademark used herein under license.
 Health Concerns of Trans Fatty Acids
 Epidemiological Studies
– Several show association between consumption of
trans fats and risk of coronary heart disease
 Randomized Controlled Trials
– Several show that increased consumption of trans
fats increase LDL-C, possibly by decreasing LDL
receptor activity
 FDA requires Trans fat labeling containing >
0.5g/serving (Jan. 2006)
– Currently, trans fats are included with all
unsaturated fats
Diet and Heart Disease
 Incidence
 Leading cause of death
 1,250,000 myocardial
infarctions/yr
 750,000 MI deaths/yr
 Diet and Heart Disease
Incidence of early heart disease
(under age 65)
 Males:
– 300/100,000 fatal MI
– 80/1,000 MI
 Female:
– 125/100,000 fatal MI
– 45/1,000 MI
 History of a Heart Attack
Initiation
 Fatty Streaks
–Initiated by:
»hypertension
»cigarette smoke
»Inflammation
 C-reactive Protein: a marker for
chronic inflammation (CRP)
»other causes?
 Low-grade Systemic
Inflammation in Overweight
Children
 Pediatrics, Jan. 2001
 cross-sectional epidemiological study
 3,561 children, 8-16 yrs old
 C-reactive protein
– Associated with inflammation
– linked with development of heart disease in
overweight adults
C-reactive Protein in Overweight
Children
 History of a Heart Attack
Atherosclerotic Plaque Development
 Macrophages attach
 LDL-cholesterol accumulates
 Fibrous cells grow
 Calcification
© 2002 Wadsworth Publishing / Thomson Learning™
 History of a Heart Attack:
End-Stage: Symptoms Appear
 Myocardial Infarction
– Heart attack
 Angina
– Chest pain
 Thrombosis:
– growth of stationary clot
 Embolism:
– sudden closure by loose clot
 Ischemia
– Lack of blood flow and oxygen delivery to tissue
 History of a Heart Attack
 Warning signs
– Angina & shortness of breath
– Often no warning!
 Treatment
– Angiogram
– Angioplasty
– Coronary bypass surgery
 Treatment of late-stage CHD
Secondary Prevention of CHD
 Testing
– Stress test
– Angiogram
 Angioplasty
– Balloon angioplasty
– stents
 Coronary Bypass Surgery
– Grafting of healthy veins around diseased coronary
arteries
Primary Prevention of CHD
 Know your risk factors
 Make dietary changes
 Start/continue exercise
 Stop smoking
 Stress reduction
 Use medication if necessary
 CHD Risk Factors
( * modifiable)
 High LDL-cholesterol *
 Low HDL-cholesterol *
 High blood pressure *
 Family history of early CHD
 Current cigarette smoking *
 Diabetes *
 (Obesity *)
Risk Factors for CHD
 High Total Blood Cholesterol
– >200 mg/dl: borderline high risk
– >240 mg/dl: high risk
 High LDL-C
– >130 mg/dl: borderline high
– >160 mg/dl: high risk
 Lowering your LDL-C
 Decrease dietary saturated fat
– < 10% calories (Step 1)
– < 7% calories (Step 2)
 Decrease dietary cholesterol
– < 300 mg/day (Step 1)
– < 200 mg/day (Step 2)
 Lowering your LDL-C
 Replacing dietary SFA with
MUFA
–Canola oil, olive oil
 Increase dietary fiber
–Whole grains, oats, fruits,
vegetables
 Lowering your LDL-C
 Decrease dietary Trans-FA
– hydrogenated fats
 Medication
– Plant stanols/sterols
– “Statin” drugs
– Bile acid binding resins
– Niacin (pharmacological doses)
Risk Factors for CHD
Low HDL-C
–< 40mg/dl : high risk
–> 65mg/dl : protective
Increasing your HDL-C
 Exercise
 Alcohol

–1-2 servings/d males

–1 serving/d females
 2nd Exam
Tuesday, Feb 13, 2005

 The Lipids: Fats and Oils

– Chapter 5
 Nutrition and Disease Prevention
– Chapter 11
» Cardiovascular Disease
» Hypertension and Stroke
» Nutrition and Cancer Prevention
 Nutrition Research
– Chap 1: 11-14
Risk Factors for CHD
 Hypertension
 Cigarette smoking
– quit/don’t start
 Diabetes

– lose weight if overweight (type 2)

– control blood sugar
 Non-modifiable Risk Factors
 Age
– males over 45
– female post-menopause
 Family History
– premature CHD
»males under 55
»females under 65
 Risk Reduction
100

80
smoke, hiBP, hiTC
60
hiBP, hiTC
hiTC
40
none
20

0
Reversal of Heart Disease ?
 Heart Disease Reversal Program
 Dean Ornish, MD
 Semi-vegetarian
– NF dairy
– egg whites
 <10% cal from fat
Reversal of Heart Disease ?
 JAMA 1998
 5 year study - mod-severe CHD
 20 patients on Ornish diet
 15 patients on AHA Step 2 diet
 Average % stenosis
– Ornish - 8% improved
– AHA - 28% worse
Reversal of Heart Disease ?
 Cardiac Events
– heart attacks
– angioplasty
– coronary bypass surgery
 Ornish - 25 events in 5 years
 AHA - 45 events in 5 years
 More CHD regression, half the number
of cardiac events