Grasa dietética y enfermedades no-

transmisibles: Excesos y posibles deficiencias

Hannia Campos, Ph.D.

Harvard T. H. Chan School of Public HealthCentro de Investigación e Innovación en Nutrición y Salud Traslacional

24 de agosto, 2016

nutrition science

Nutrient deficiencies

1900’s

1956

Basic 7 & 4Nutrient

minimum requiremen

ts

WWII

1941

Prevent nutrient deficiencies

Early dietary recommendations

1913

Cholesterol &

Atherosclerosis

Dietary fat &plasma cholesterol

1950’s

1960’s

Saturated fat and heart disease

Hypothesis

Cardiovascular disease becomes the major health concern in Europe and the United States

Diet and chronic diseases

Keys A. Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease. Cambridge, MA: Harvard University Press, 1980.

1913

Cholesterol &

Atherosclerosis

Dietary fat &plasma cholesterol

1950’s

1960’s

Saturated fat and CHD

Hypothesis

Diet and chronic diseases

Nutritional epidemiology

1980’s

Nutrition Epidemiology

Other

factors

Biomarkers

Diet

Chronic Disease

1913

Cholesterol &

Atherosclerosis

Dietary fat &plasma cholesterol

1950’s

1960’s

Saturated fat and CHD

Hypothesis

Nutritional epidemiology

1980’s

Evidence-based recommendations

1990’s

Nutrient deficiencies

1900’s

Nutrient minimum

requirements

WWII

1941

1956

Basic 7 & 4

1980

Dietary Guidelines

1992

Food guide pyramid(not evidence based)

CVD major health concern in Europe and the United States

X

Hu F, Stampfer MJ, Manson JE et al. Dietary fat intake and the risk of coronary heart disease in women. N Engl J Med 1997; 337:1491–9.

Fat & oils Use sparingly

< 30% calories from fat

USDA Diet Pyramid , 1992

Soybean Flaxseed

Rapeseed (Canola)

PerillaSpinach

Mustard seed

Walnut

Fish

7%52%

63% 9%

World Health Organization Recommendation

Coronary heart disease and ischaemicstroke

“These recommendations are likely to be unsustainable, as fish stocks are rapidly declining and likely to collapse in 40 years”

Jenkins, DJ CMAJ 2009

Fish consumption (1-2 s/wk)

~ 200-1000 mg of EPA and DHA

Omega-3 fatty acids

EPA

DHA

Long-chain

fatty acids

wAlpha-linolenic acid

18:3n-3

(ALA)

Methyl

RR (95% CI) 0.90 (0.81-0.99)

Dietary ALA (mainly from plants) is associated with a

modest reduction in prospective studies in CVD

Results from a meta-analysis

Pan A et al AJCN 2012

Adipose tissue sample collection

Costa Rica Heart Study

0.0

0.5

1.0

1.5

2.0

2.5

3.0

0.0 0.2 0.4 0.6 0.8 1.0 1.2

Deciles of adipose tissue α-linolenic

(% total fatty acids)

α-L

ino

len

ic i

nta

ke,

g/d

N=1816

Alpha-linolenic acid intake is strongly correlated

with its levels in adipose tissue in Costa Rica

r = 0.65, p trend <0.0001

0.36 0.55 0.70 0.88 1.04

p trend < 0.0001

Odds

ratio

- Linolenic acid in adipose tissue is associated

with reduced risk of MI in Costa Rica

N=3294

1.00

0.75

0.50

0.25

1.25

1.50

Deciles of adipose tissue -linolenic

Adipose

Campos H et al Circulation 2008

0.42 0.51 0.65 0.76 0.86

1.11 1.38 1.79 2.08 2.35Diet%E

g/d

L Fish < 1/wk

L ALA < 1% E

L Fish < 1/wk

H ALA > 1% EH Fish >1/wk

L ALA < 1% E

H Fish >1/wk

H ALA > 1% E

VL Fish < 1/m

VL ALA < 0.5%

Omega-3 fatty acid availability worldwide

Campos, Willett, PHN 2012

4,837 MI patients 60-

80 yr 78% men

18.8 gr margarine

40 m. follow-up

671 events

1,212

EPA-DHA, 400 mgs

ALA, 2 gr

1,192

EPA-DHA, 400 mgs

ALA placebo

1,197

EPA-DHA placebo

ALA 2 mg

1,236

EPA-DHA placebo

ALA placebo

Kromhout D et al. N Engl J Med 2010;363:2015-2026.

Alpha-Omega Trial

Kaplan–Meier Curves for Primary and Secondary End Points

Kromhout D et al. N Engl J Med 2010;363:2015-2026.

HR = 0.91

(0.78-1.05)

ALA

Placebo and EPA-DHA

Placebo

and ALA

EPA-DHA

0.36 0.55 0.70 0.88 1.04

Odds

ratio

ALA not associated with further benefit at ALA

adipose levels greater than 0.65%

N=3,294 P

trend <0.0001

1.00

0.75

0.50

0.25

1.25

1.50

Deciles of adipose tissue ALA

Adipose

Campos H et al Circulation 2008

0.42 0.51 0.65 0.76 0.86

1.11 1.38 1.79 2.08 2.35Diet%E

g/d

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

0 1 2 3 4 5 6 7

ALA availability (% total vegetable oil)

Ad

ipo

se

tis

su

e A

LA

(%

to

tal

fatt

y a

cid

s)

Bulgaria

Costa Rica

Netherlands

Switzerland

U.K.

U.S.A.

Germany

Spain

Israel

Russia

Finland

Norway

R=0.92

ALA consumption and in adipose tissue

in various countries

Campos, Willett, PHN 2012

0.36 0.55 0.70 0.88 1.04

Odds

ratio

ALA in adipose tissue is associated with

reduced risk of MI in Costa Rica

N=3294

1.00

0.75

0.50

0.25

1.25

1.50

Deciles of adipose tissue ALA

Adipose

Campos H et al Circulation 2008

0.42 0.51 0.65 0.76 0.86

1.11 1.38 1.79 2.08 2.35Diet%E

g/d

Bulgaria Costa Rica The Netherlands

-400

-350

-300

-250

-200

-150

-100

-50

0

0 0.5 1 1.5 2 2.5

Ch

an

ge

in

CH

D m

ort

ality

Increased intake of - linolenic acid is

associated with reduction in CHD mortality

1990-2002

Change in α-linolenic intake g/d

RussiaRomania

BulgariaSlovenia

Hungary

Estonia

Czech R+ Slovakia

Poland Lithuania

Latvia

Men 45-64 y

Zatonsky, Campos, Willett, EJE 2008

0

200

400

600

800

1000

1200

1400

1600

1800

0 1 2 3 4 5 6 7 8

Japan

Norway

U.S.A

Brazil

S. Korea

Austria

Netherlands

Spain

PhilippinesFrance Thailand

Italy

Costa Rica

Canada

PeruVenezuela

Malaysia

Ghana

AustraliaSri Lanka

Chile

Cambodia

Guatemala

Senegal

Greece

Portugal

Czech

Republic

Fis

h a

va

ilab

ilit

y (

gr

per

wk)

Haiti

Sweden

Germany

El Salvador

Paraguay

Denmark

Finland

U. Arab Emirates

Ireland

New Zealand

Panama

Uruguay

Jamaica Gambia

EstoniaTrinidad y Tobago

Gabon

Mauritius

Cyprus

Fiji Islands

Guyana

Cape

Verde

Solomon Islands

Suriname

Malta

Iceland

Barbados

Samoa

Santa Lucia

Grenada

Kiribati

Seychelles

AntiguaDominicaBermuda

St. Kitts

Dominican R.

Mexico

China

~ 1

.3 p

ort

ion

s

α-Linolenic acid availability (% total vegetable oil)

1.3 gr/d

Honduras

Bolivia

Argentina

Colombia

Nutrient deficiencies 1941

Nutrient minimum requirements

1900’s WWII

1956

Basic 4 1980

Dietary Guidelines 1992

Food guide pyramid(not evidence based)

1913

Nutritional epidemiology

Plasma cholesterol-Atherosclerosis

Dietary fat plasma cholesterol

1950’s

1960’s

Saturated fat Heart disease Hypothesis 1980’s

1990’s

Evidence-based recommendations

2011

My Plate 2016

Dietary Guidelines

World-wide recommendations

21st

Century1941

Formulaciones que contienen diferentes tipos de CLA se puede producir a partir de aceites ricos en ácido linoléico

El ácido linoléico conjugado (CLA) es un tipo de grasa que es producida por los rumiantes

trans-10, cis-12 18:2 CLA

cis-9, trans-11 18:2 CLA

Linoleic (18:2n-6)

DIETAC18:2C18:3

LECHECLA

La leche de vacas alimentadas con pasto tiene mayor contenido de CLA que la de vacas alimentadas con maíz

Maíz Pasto

5

4

3

2

1

0

5XCLA

El tejido adiposo refleja el consumo de CLA

Pro

bab

ilid

add

e ri

esgo

*

*

**

0.35 0.45 0.53 0.62 0.78

Infarto

0.34 0.47 0.55 0.42 0.83

CLA CLA

Un aumento en la ingesta de CLA podría tenerbeneficios en la salud

Smit L. et al Am J Clinical Nut 2010 Castro-Web et al Am J Clinical Nut 2012

Tejido adiposoTejido adiposo

Lácteos (porciones X día)

1.3 1.7 2.0 2.2 2.8

Diabetes1.3 1.7 2.0 2.2 2.8

Distribución de las fincas incluídas en el estudio

Epoca

CLA

(%

áci

do

sgr

aso

sto

tale

s)

Contenido de CLA en leche de acuerdo al tipo de pastoreo y época del año

1.291.23

1.131.12

P<0.001

1.50

1.41

1.261.22

1.18

1.07

0.950.93

0.84

0.60 0.59 0.59

0.460.44

0.37

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

% A

cid

os

gras

os

tota

les

Contenido de CLA en leche comercial de varios países

Evidencia

científica

Hábitos

saludables

Mejorar la

calidad de

vida?

Genera

hipótesis