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
