Cholesterol-saturated Fat Index Research Articles

Investigation of the interaction between genetic risk score (GRS) and fatty acid quality indices on metabolic syndrome among overweight and obese women

Background and aimMetabolic syndrome is one of the major public-health challenges, affecting one-quarter of the world population. Fatty acid quality indices are novel determinants of this disease and their interactions with genetic factors may have an impact on metabolic syndrome risk. Therefore, we aimed to investigate the interaction between genetic risk score (GRS) and fatty acid quality indices with metabolic syndrome (MetS) among overweight and obese women.MethodsIn the present cross-sectional study, 279 overweight and obese women (18–48 years old) were included. Several anthropometric measurements such as weight, height, body mass index (BMI), waist circumference (WC), and body fat percent (BF%) were measured. Also, systolic and diastolic blood pressure (SBP and DBP) were measured. Biochemical determination was performed for fasting blood glucose (FBS), triglyceride (TG), and high-density lipoprotein (HDL). MetS was determined according to National Cholesterol Education Program (NCEP ATP III) criteria. Dietary intake was evaluated by a validated and reliable 147-item semi-quantitative food frequency questionnaire. Cholesterol-saturated fat index (CSI) and the ratio of omega-6/omega-3 (ω-6/ω-3) essential fatty acids were considered as fat quality indices. The salting-out method was used to extract the total DNA. The unweighted GRS was calculated using the risk alleles of the three single nucleotide polymorphisms. The total average GRS value was 2 and the sum of the risk alleles of the 3 polymorphisms was 6.ResultThe results of our analysis showed that after controlling for age, energy intake, BMI, and physical activity, there was a positive interaction between T2 of GRS and T2 of N6/N3 ratio on WC (β = 7.95, 95%CI = 0.83,15.08, P = 0.029), T3 of GRS and T2 of N6/N3 ratio on DBP (β = 5.93, 95%CI= -0.76,12.63, P = 0.083), and FBS (β = 6.47, 95%CI = 0.59,13.53, P = 0.073), T3 of GRS and T3 of N6/N3 ratio on TG (β = 54.42, 95%CI = 1.76,107.08, P = 0.043), and T3 of GRS and T3 of CSI on BF% (β = 3.55, 95%CI= -0.35,7.45, P = 0.075). Also T2 of GRS in the interaction with T3 of CSI leads to an decrease − 8.35 mg/dl in HDL level after adjustment in (β= -8.35, 95%CI= -17.34,0.62, P = 0.068).ConclusionIt seems the interaction of GRS and fatty acid quality indices is positively associated with several components of metabolic syndrome such as WC, TG and BF%. Our findings are of importance to public health, considering the high consumption of foods that are high on fatty acids. Conflicting evidence of many previous studies regarding the effect of fat intake and obesity and cardiovascular diseases could be because of the gene-diet interactions and genetic heterogeneity across various ethnic groups. Hence, the synergism effect of genetic and dietay intakes should be considered in future studies.

The interaction between MALAT1 and TUG1 with dietary fatty acid quality indices on visceral adiposity index and body adiposity index

We aimed to investigate the interaction between the transcript levels of taurine-upregulated gene 1 (TUG1) and metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) and the Cholesterol-Saturated Fat Index (CSI) in relation to the visceral adiposity index (VAI) and body adiposity index (BAI). This cross-sectional study involved 346 women classified as obese and overweight, aged between 18 and 48 years. Dietary intake and the quality of dietary fat were assessed using a validated and reliable 147-item semi-quantitative food frequency questionnaire, with the Cholesterol-Saturated Fat Index (CSI) used as an indicator. Transcription levels of MALAT1 and TUG1 were evaluated through real-time polymerase chain reaction following the criteria outlined in the Minimum Information for Publication of Quantitative standards. Serum profiles were measured using standard protocols. We observed a positive association between transcription level of MALAT1 and VAI in both crude (β = 3.646, 95% CI 1.950–5.341, p < 0.001) and adjusted (β = 8.338, 95% CI 6.110–10.566, p < 0.001) models. Furthermore, after adjusting for confounders, a significant positive interaction was noted between MALAT1 expression and CSI on BAI (β: 0.130, 95% CI 0.019, 0.240, p = 0.022), with a marginal positive interaction observed on VAI (β: 0.718, 95% CI − 0.028, 1.463, p = 0.059). It seems that there may be a positive interaction between MALAT1 transcription level and CSI on VAI and BAI among overweight and obese women. However, no associations were seen between TUG1 mRNA level and the above-mentioned outcomes. Further functional studies are still required to elucidate this concept.

The association between cholesterol-saturated fat index with risk of glioma: A Case-control study

The association between cholesterol-saturated fat index with risk of glioma: A Case-control study

The association between cholesterol/saturated fat index (CSI) and quality of sleep, and circadian rhythm among overweight and obese women: a cross-sectional study

BackgroundThe decline in sleep quality is one of the main public health problems affecting the global population. Some studies have shown that a high-fat diet may be linked to changes in circadian rhythm and sleep quality. The cholesterol/saturated fatty acid index (CSI) determines the amount of cholesterol and saturated fatty acid (SFA) in people's dietary patterns and can affect the quality of sleep and circadian rhythm. However, to date, no studies have investigated the effect of this index on these two variables. Therefore, our aim was to investigate the relationship between CSI on circadian rhythm and sleep quality in obese and overweight women.MethodThis cross-sectional study included 378 adult women who were obese or overweight. Using accepted techniques, anthropometric measurements, blood pressure readings, and biochemical variables were evaluated. A validated and trustworthy semi-quantitative food frequency questionnaire (FFQ 147 items) was used to gauge dietary intake. The CSI was measured to find out how much cholesterol and saturated fats were in the diet. Additionally, to assess circadian rhythm and sleep quality, respectively, the valid morning-evening questionnaire (MEQ) and Pittsburgh sleep quality index (PSQI) questionnaires were utilized.ResultThe results of the multinomial logistic regression model of our analysis showed that a significant association was observed between circadian rhythm status with CSI score, and participants with one higher unit of CSI had a 7.3% more chance of being in the eveningness group than being in morningness category in the crude model (OR: 1.07; 95% CI 1.00, 1.14; P = 0.026). This association remains marginally significant when adjusting for age, energy intake, BMI, job status, thyroid, and smoking status (OR = 1.08; 95% CI 1.00, 1.16; P = 0.051). The binary logistic regression model showed that after controlling for potentially confounding variables, there was no significant association between sleep quality with CSI score, however, those with one higher unit of CSI had 1.6% more chance of having sleep problems (OR: 1.01; 95% CI 0.96, 1.06; P = 0.503).ConclusionOur results indicated a direct marginally significant association between CSI with evening type in overweight and obese women. Future studies are needed to clarify the precise link between circadian rhythm and sleep behavior with fatty acid quality index.

Investigation the interaction of dietary fat quality indices and the MC4R gene in metabolically healthy and unhealthy overweight and obese women

Obesity has become a common global problem. Some obese people can be metabolically healthy. Gene-environment interaction can be important in this context. This study aimed to assess the interaction between dietary fat quality indices and the Melanocortin 4 receptor (MC4R) gene in metabolically healthy and unhealthy overweight and obese women. This cross-sectional study was conducted on 279 women with overweight and obesity. The definition of metabolically healthy and unhealthy phenotypes was done according to Karelis criteria. Dietary assessment was done using a 147-item validated semi-quantitative food frequency questionnaire and dietary fat quality was assessed by cholesterol-saturated fat index (CSI) and the ratio of omega-6/omega-3 (N6/N3) essential fatty acids. MC4R was genotyped by polymerase chain reaction-restriction fragment length polymorphism technique. A generalized linear model was used to evaluate the interaction between dietary fat quality indices and the MC4R gene in both crude and adjusted models. Study subjects with higher ratio of N6/N3 had higher homeostatic model assessment for insulin resistance (HOMA IR) index (P = 0.03) and other variables showed no difference according to the tertile of CSI and N6/N3. Participants with the C allele of MC4R rs17782313 had lower height (P < 0.001) and higher HOMA index (P = 0.01). We found that the CC genotype of MC4R interacts with the N6/N3 ratio on the metabolically unhealthy phenotype in the crude model (β = 9.94, CI 2.49–17.39, P = 0.009) and even after adjustment for all confounders (β = 9.002, CI 1.15–16.85, P = 0.02, β = − 12.12, CI 2.79–21.46, P = 0.01). The data of this study can justify one inconsistency observed in society, regarding dietary recommendations about metabolic health status. Those with CC genotype, are more likely to have an unhealthy phenotype with an increase in N6/N3 as one fat quality indices than those who do not have CC genotype. We found the interaction of dietary fat quality indices such as N6/N3 and the MC4R gene in metabolically unhealthy overweight and obese women.

The association between fatty acid quality indices and quality of life among overweight and obese women: A cross-sectional study.

Reduced quality of life (QOL) is a major public health challenge affecting the global population. Fatty acid quality indices (FAQIs) are novel determinants of QOL and may impact various aspects of QOL. Prior research has established a significant link between dietary habits and QOL. However, the association between FAQIs and specific dimensions of QOL has not been established. Therefore, we aimed to investigate the association between FAQIs and QOL in overweight and obese women. In total, 378 adult overweight or obese women participated in this cross-sectional study. Several anthropometric indices, systolic and diastolic blood pressure, and biochemical factors were measured using standard protocols. Dietary intake was assessed using a validated and reliable semi-quantitative food frequency questionnaire (the FFQ, 147 items). The cholesterol-saturated fat index (CSI) and the ratio of omega-6/omega-3 (N6/N3) essential fatty acids consumed were employed as FAQIs. The SF-36 questionnaire was administered to measure QOL. Linear logistic regression was used, in the form of raw and adjusted models, to evaluate the associations between FAQIs and QOL. The study sample consisted of 279 participants for whom ω-6/ω-3 ratio was measured and 378 participants for whom CSI was measured. The mean (±SD) age of participants was 36.65 ± 9.07 years. Linear logistic regression, with adjustment for potential confounders, such as age, energy intake, body mass index, employment, and thyroid status, indicated that ω-6/ω-3 intake ratio was negatively and marginally significantly associated with general health (β = -139.94, 95% CI: [-286.54, 6.66]; p = 0.061) and physical role limitations (β= -337.68, 95% CI: [-679.99, 1.61]; p = 0.051). A significant negative association was observed between ω-6/ω-3 intake ratio and social functioning (β = -247.54, 95% CI: [-458.14, -36.94]; p = 0.021), which indicates that obese and overweight women with a higher ω-6/ω-3 intake ratio obtained lower scores on social functioning. It was found that FAQI scores were negatively associated with certain QOL measures among overweight and obese Iranian women, suggesting that a higher consumption of fatty acids, especially trans and saturated fatty acids, may be associated with lower QOL.

Fatty Acids and Nutraceutical Properties of Lipids in Fallow Deer (Dama dama) Meat Produced in Organic and Conventional Farming Systems.

The aim of the study was to assess the fatty acid profile and nutraceutical properties of lipids contained in fallow deer (Dama dama) meat produced in organic and conventional farming systems. Longissimus lumborum (LL) and semimembranosus (SM) muscles from 24 fallow deer carcasses were selected for the study. The fallow deer meat from the organic farming system was characterized by significantly lower intramuscular fat content. The fatty acid profile in the organic meat was characterized by a particularly high proportion (p < 0.0001) of conjugated linoleic acid—CLA (LL—2.29%, SM—2.14%), alpha-linolenic acid—ALA (LL—4.32%, SM—3.87%), and docosahexaenoic acid—DHA (LL—2.83%, SM—2.60%). The organic system had a beneficial effect (p < 0.0001) on the amount of polyunsaturated fatty acids (PUFAs), including n-3 PUFAs, which resulted in a more favorable n-6 PUFA (polyunsaturated fatty acid)/n-3 PUFA ratio. The significantly higher nutritional quality of organic meat lipids was confirmed by such nutraceutical indicators as the thrombogenic index (TI), ∆9-desaturase C16, elongase, and docosahexaenoic acid+eicosapentaenoic acid (DHA+EPA) in the LL and SM and cholesterol index (CI), and the cholesterol-saturated fat index (CSI) indices in the SM. LL was characterized by higher overall quality.

The correlation between dietary fat quality indices and lipid profile with Atherogenic index of plasma in obese and non-obese volunteers: a cross-sectional descriptive-analytic case-control study

Background and aimAbnormalities in lipid metabolism are commonly observed in patients who were obese. Alongside dyslipidemia, one of the markers in predicting the risk of cardiovascular disease is the Atherogenic Index of Plasma (AIP), which is related to dietary intake. Healthy fat quality indices might affect on AIP. The purpose of this study is to find the possible relationship between dietary fat quality, and AIP and comparison of these indices among obese and non-obese volunteers.MethodsThis study was a cross-sectional descriptive-analytic case-control study with 157 normal and overweight and obese volunteers (n = 71 normal, Age: 38.90 ± 10.976 vs n = 86 overweight/obese, Age: 38.60 ± 9.394) in the age range of 18–65 years. Food intake was measured using FFQ, anthropometric indices (weight, height, body mass index and waist to hip ratio), body composition (visceral fat level, total body water, body fat mass), and lipid profile were measured.ResultsBased on the present results, comparable biochemical parameters including TC (P = 0.580), TG (P = 0.362), LDL (P = 0.687) and HDL (P = 0.151) among overweight/obese volunteers as compared to normal ones were noticed. Effects of dietary fat quality, including Atherogenicity (AI) and Thrombogenicity (TI) hypo/hypercholesterolemic ratio (h/H), the Cholesterol-Saturated Fat Index (CSI) showed significantly higher AI (P = 0.012) in the overweight/obese group as compared to the normal group. Whereas, h/H (P = 0.034) and ω-6/ω-3 ratio (P = 0.004) were significantly higher in normal-weight volunteers. There was a positive correlation between AI, TI, CSI, SFA, MUFA, PUFA and ω-6/ω-3 ratio with AIP and negative correlation between h/H with AIP in both groups. Despite the significances of these correlations no strong relation was observed by doing multiple regression among normal and overweight/obese groups (R2 = 0.210, R2 = 0.387).ConclusionsIn summary, the present work proposes a direct relationship between dietary fat quality, increased BMI, and lipid abnormalities with AIP. Nevertheless, further large-scale studies are required to sustain a clear conclusion in this wish.

Beneficios dietéticos asociados a la ingesta habitual de dosis moderadas de fitoesteroles presentes de forma natural en los alimentos

BackgroundRecently it has been shown that the regular intake of moderate amounts of naturally-occurring phytosterols affects whole-body cholesterol metabolism giving rise to lower serum levels. The aim of the study was to describe the dietary pattern of a population from the region of Aragon (Spain) with a moderate consumption of phytosterols, to identify the major food groups involved, and to investigate the relationship between phytosterol intake and several dietary factors related to cardiovascular health. MethodsA total of 85 healthy volunteers were studied as regards their dietary habits (using a validated food frequency questionnaire). Subjects were classified into tertiles of phytosterol intake and differences regarding foods, nutrients and other dietary components affecting cardiovascular health consumption as well as the adherence degree to the Mediterranean diet pattern were assessed. ResultsA higher phytosterols intake was associated with a higher consumption of fresh fruits and nuts, vegetables and vegetable oils, and lower in meat and pre-cooked meals. Furthermore, it was associated with higher level of unsaturated fat, total fibre intake, antioxidant capacity of the diet and phytosterols/cholesterol ratio, as well as a lower of cholesterol intake and cholesterol-saturated fat index. Finally, phytosterols intake correlated positively with the degree of adherence to the Mediterranean diet. ConclusionThe regular intake of moderate amounts of naturally-occurring phytosterols, besides having cholesterol lowering benefits per se, is associated with other dietetic factors related to the prevention of cardiovascular disease. The recommendation of increasing the regular intake of phytosterols source foods is completely justified.

Lipid, fatty acid and carotenoid content of edible egg yolks from avian species: A comparative study

A comparative study has been conducted of the major lipid classes composition, as well as the fatty acid and carotenoid content in the yolk of conventional eggs from five avian species (ostrich, turkey, quail, duck and goose); the nutritional indices were calculated. The neutral lipids were the major yolk fractions but their proportions varied among species. All yolks and especially ostrich’s yolk were found to be an excellent source of dietary lecithin. Quail yolk displayed the lowest fat and cholesterol content and the lowest values for the cholesterol index (CI) and cholesterol-saturated fat index (CSI). It is therefore more appropriate for a healthier diet. Turkey and goose yolks contained significantly ( P < 0.05) higher ω-3 fatty acid proportion and ω-6/ω-3 ratio. The turkey yolk was characterised by the lowest AI and TI values, which are recommended for a healthy diet. Quail yolk lipids contained a favourable PUFA/SFA ratio. All the examined yolks contained highly bioavailable functional nutrients, such as lutein and zeaxanthin.

Low levels of cholesterol/saturated fat index (CSI) in a Japanese–Brazilian diet

PurposeDifferences in dietary patterns constitute a major component of the environmental changes experienced by immigrant populations, and have been associated with several diseases with contrasting prevalence rates in the USA and Japan. The Japanese preparations present very colorful dishes, with a wide variety of vegetables with little or no cooking, which preserves the nutritive value of vitamins. The present study was carried out to determine the cholesterol/saturated fat index (CSI) levels of some Japanese dishes using the following equation, developed to calculate the ratio between cholesterol and dietary saturated fatty acids: CSI=(1.01 × saturated fatty acids in g)+(0.05 × cholesterol in mg).Design/methodology/approachFifteen Japanese recipes consumed by Japanese immigrants in São Paulo (Brazil) were prepared and analyzed for chemical composition by AOAC methods, for fatty acids profile (gas chromatography) and cholesterol (colorimetric method).FindingsTotal lipid content (g/100g) ranged from 0.10 to 16.40, with mean±SD values of 2.83±4.10. Cholesterol (mg/100g) ranged from 0 to 166.5, with mean values of 36.90±45.61. CSI values ranged from 0.0 to 9.87, with mean values of 2.76±3.19.Orginality/valueThe habitual intake of Japanese foods available in São Paulo could be useful to achieve a limit of 30 per day for dietary CSI.

Dietary Intake Is Predictive Of C-reactive Protein In 205 Adult Women

C-reactive protein (CRP) is one of best indicators of vascular inflammation and atherosclerosis. In fact, CRP has been shown to be a better predictor of coronary heart disease (CHD) than serum cholesterol levels. PURPOSE To assess the extent to which dietary intake is predictive of serum CRP levels in 205 adult women. An ancillary objective was to evaluate the influence of body fat percentage (BF%) on the diet and CRP relationship. METHODS All subjects were non-smokers and non-obese (BMI <30) with an average (± SD) age of 43.1 ± 3.0 years. Diet was measured using 7-day weighed food records. Each subject was taught how to operate an electronic scale that weighed foods to the nearest gram. Plastic food models were used to instruct participants concerning how to weigh and record everything they consumed. The 7-day food records were analyzed using ESHA software. Dietary intake was indexed using the ADA Exchange Lists, and the Cholesterol-Saturated Fat Index (CSI). Subjects were instructed to refrain from exercise for at least 48 hours prior to having their blood drawn, and to wait until fully recovered from any possible injury or illness. CRP was measured using the solid phase ELISA, manufactured by Alpha Diagnostics International, Inc. (Kit no. 1000). Assays were performed in duplicate and the average of the two measures was used to index CRP. The relationship between dietary intake and CRP was analyzed using multiple regression and the GLM technique. To aid interpretation, subjects were divided into quartiles based on CRP levels and the middle-two quartiles were collapsed forming three groups. RESULTS Average and median CRP levels were 1.28 ± 1.70 and 0.68 mg/L, respectively. Mean servings for the ADA diet categories were: Bread-Starch (6.9 ± 2.9), Carbs-Sugar (6.2 ± 2.8), Protein (2.0 ± 1.9), Meat (2.7 ± 1.5), Fruit (2.4 ± 1.6), Vetgetables (1.6 ± 1.0), Milk (1.1 ± 0.9), and Fat (10.3 ± 3.6). Average CSI was 34.4 ± 13.2. Servings of Meat (F=12.2, p=0.0006), Fat (F=8.5, p=0.004), and the CSI (F=11.7, p=0.0008) were directly related to CRP levels. Servings from the other ADA Exchange categories were unrelated to CRP levels. After adjusting for differences in BF%, the associations between servings of Meat and CRP (F=6.5, p=0.012), Fat and CRP (F=3.3, p=0.069), and CSI and CRP (F=3.0, p=0.050) were weakened, although Meat and CSI remained significant predictors of CRP. CONCLUSION Servings of Meat, Fat, and the Cholesterol-Saturated Fat Index are predictive of CRP concentrations in women. After controlling for differences in BF%, Meat intake and the CSI remain significant predictors of CRP levels.

Behavior change outcomes in an outpatient cardiac rehabilitation program

Objective To evaluate the effectiveness of nutrition education within an outpatient cardiac rehabilitation program. Design Subjects were assigned, according to participation in cardiac rehabilitation programs in two community hospitals within an integrated healthcare system, to either a treatment (n=54), or a control group (n=50). Subjects/setting One hundred four men and women, age range 35 to 85 years, participating in a 6-week cardiac rehabilitation program. Most were men (80%) and overweight. The majority presented with the diagnosis of myocardial infarction followed by coronary artery bypass surgery or percutaneous transluminal coronary angiography procedure. Intervention Subjects in the control group received usual nonindividualized nutrition education from cardiac rehabilitation therapists. Subjects in the treatment group attended two group nutrition education classes and one individual diet counseling session, all led by the same dietitian. Main outcome measures Changes in fat, saturated fat, cholesterol, and carbohydrate intake, and restaurant eating habits as assessed by the Diet Habit Survey; changes in cardiac diet self-efficacy; and changes in health-related quality of life. Statistical analyses performed Group-by-time analysis of variance with repeated measures, χ 2 test. Results The treatment group had greater improvement in Restaurant and Recipes scores on the Diet Habit Survey (2.6 vs 1.0) and a greater cardiac diet self-efficacy mean score (4.3) compared with the control group (3.8), with the greatest change in items related to eating in restaurants, away from home, or when alone. From entry into the program to discharge, the cholesterol-saturated fat index decreased significantly in the control group (from 57 to 48), and in the treatment group (from 51 to 42). The percent of energy from carbohydrate increased significantly in the control group (from 51% to 55%) and in the treatment group (from 53% to 57%). There were no differences between groups over the 3 time periods (baseline, 6 weeks, and 3-month follow-up) (n=39 for control group and n=47 for treatment group for all 3 time periods). Applications/conclusions Nutrition education within an outpatient cardiac rehabilitation program can improve dietary choices at restaurants and boost self confidence in the ability to adhere to a lipid-lowering diet. J Am Diet Assoc. 2002; 102:664-671.

A comparison of atherogenic potential of diets between Asian and Hispanic college students and their parents

The purpose of this study was to examine the differences in energy intake, body mass index (BMI), and atherogenic potential of the diets between male and female Asian and Hispanic college students and between their respective parents. By doing this, we hope to unveil the dietary patterns that can lead to diet-related diseases, such as obesity, diabetes and cardiovascular problems, while there is still time for intervention. We assessed the three-day dietary records and heights and weights of 71 Asian and 81 Hispanic American students and their genetic parents (71 Asian parents and 81 Hispanic parents) living in the same household. Diets were analyzed for mean differences in calories, cholesterol, fiber, total fat, saturated fat, polyunsaturated fat, percent total fat, percent saturated fat, percent polyunsaturated fat, body mass indices (BMI) and atherogenic potential of the diets, namely, Keys score (KS), Hegsted score (HS), polyunsaturated fat-to-saturated fat ratio (PS), cholesterol index (CI) and cholesterol-saturated fat index (CSI) by the computer program Nutritionist III (V7) and statistically analyzed by SPSS. Asians consumed more calories and Kcal/kg than Hispanics, however, they possessed lower BMI than Hispanics. In both Asian and Hispanic groups, BMI increased with advancing age. The diets of the young and old Asian males possessed less atherogenic potential and saturated fat than the diets of the young and old Hispanic males. Between older females, however, no differences were found in dietary nutrients and atherogenic potential. Young female Asians had higher intakes of cholesterol and atherogenic potential than did the young female Hispanics. No differences in neither dietary nutrients nor atherogenic potential were found between the young male groups. These findings suggest that Asians and Hispanics are abandoning their traditional diets and are consuming a more Western diet. Using BMI and atherogenic potential of the diets, we found that older Hispanic males and young Asian females are at increased risk for diet-related diseases, such as obesity, non-insulin-dependent diabetes mellitus (NIDDM) and coronary heart disease. It is important and necessary to provide dietary counseling to both young Hispanic and young Asian students to decrease any potential risk of disease.

Lipaemia and lipoproteinaemia in a Spanish male nonsmoker population consuming sunflower oil.

The aim of this study was to assess the prevalence of altered levels of serum lipids, lipoproteins and apolipoprotein (Apo) B in very active, 20 to 65 year-old, Spanish male nonsmokers who consumed sunflower oil. Among the 169 participants, total serum cholesterol (TC), triglycerides (TG), LDL-C, and TC/HDL-C were found to be age-dependent variables. A detailed study over a 12-day period showed that this population displayed a Mediterranean dietary pattern, with the exception of the substitution of sunflower for olive oil Saturated, monounsaturated and polyunsaturated fatty acids represented 9.9%, 12.7% and 8.8% of the total amount of energy, respectively. The cholesterol-saturated fat index of the average diet was 19.2 per 1000 kcal, whereas the Keys index of the diet was 27.1. Daily intakes of fibre, ascorbic acid and vitamin E were 25.1 g, 89.6 mg and 28.3 mg, respectively. The calcium/magnesium ratio of the average diet was 1.54. The low percentage of individuals with high TC levels (5.4% with TC > or = 6.49 mmol/L), high TG levels (3.7% with TG > or = 2.25 mmol/L), high Apo B levels (3.0% with > or = 1.5 g/L), low levels of HDL-C (0.7% with < or = 0.91 mmol/L), high LDL-C levels (1.4% with > or = 4.94 mmol/L or a high TC/HDL-C ratio (2.8% with > or = 5.0) suggest a reasonable protection against coronary heart disease in this Spanish population.

Development and Validation of the Cholesterol-Saturated Fat Index (CSI) Scorecard: A Dietary Self-Monitoring Tool

Objective The Cholesterol-Saturated Fat Index (CSI) Scorecard was developed and tested as a self-monitoring tool for patients consuming a cholesterol-lowering diet. Subjects/design Twelve nutritionists used the CSI Score-card to estimate the CSI score of the same five food records. Subsequently, using a revised tool, 12 subjects with hyper-cholesterolemia estimated the CSI score of their 4-day food records and 11 participated in evaluation meetings. Statistical analyses Two-tailed, one-sample t tests and the Spearman p correlation test were used, respectively, to compare CSI Scorecard estimates of nutritionists and participants to CSI scores obtained from computer calculations. Results The CSI scores estimated by the nutritionists were close to the computed scores at the 25th and 75th food record percentiles. The correlation of the estimated CSI scores of participants to the computed scores was r s=.8 (P<.05). Application The CSI Scorecard is a new, simple, quick, and accurate dietary self-monitoring tool patients can use in research centers and primary care settings. By numerically illustrating the saturated fat and cholesterol content of foods, the CSI Scorecard facilitates dietary self-monitoring and, thus, self-efficacy in the adoption and maintenance of a cholesterol-lowering dietary pattern. J Am Diet Assoc. 1996; 96:132-136.

Low fat diet behavior changes in a phase II cardiac rehabilitation program at a large midwestern teaching hospital

Low fat diet habit patterns in outpatient (Phase II) Cardiac Rehabilitation participants were studied in relation to nutrition class attendance or independent learning. A nonprobability convenience sampling of 81 patients (126 candidates) included two independent groupings (treatment n = 47 and control, n = 34). Patients choosing classes formed the treatment group, independent study the control group. Two separate surveys adapted with permission by authors, pilot-tested for validity and reliability were completed by subjects at program baseline and exit. Subjects were ages 32 – 82 yrs, 94% white (6% black), 73% male (27% female) with 77% having received low fat low cholesterol diet instructions prior. Paired t test findings showed improvements (Food Habits Survey) in treatment (P = .001) and control groups (typically P = .01) concerning dietary fat habit changes for five subscales tested. Cholesterol-Saturated Fat Index (CSI) Survey scoring revealed significant mean per cent of energy as fat consumption changes baseline/exit: 29.8/24.4% in the treatment group (P =.001) and 29.1/24.3% in the control group (P = .001). Independent t test measures comparing treatment and control group dual survey outcomes revealed insignificant evidence to support differences related to class attendance. In conclusion, both sample groups demonstrated significantly reduced dietary fat intakes and related habits within groups.

Differences in coronary mortality can be explained by differences in cholesterol and saturated fat intakes in 40 countries but not in France and Finland. A paradox.

For decades, the coronary heart disease (CHD) mortality rate has been four or more times higher in Finland than in France despite comparable intakes of dietary cholesterol and saturated fat. A potential answer to this paradox is provided by this study of 40 countries and the analyses of other nutrients in the diets besides cholesterol and saturated fat. CHD death rates for men aged 55 to 64 years were derived from the World Health Organization annual vital statistics. Dietary intakes were gathered from the Food and Agriculture Organization of the United Nations database. Forty countries at various levels of economic development and 40 dietary variables were investigated, including a lipid score that combined the intakes of cholesterol and saturated fat (Cholesterol-Saturated Fat Index [CSI]). The CSI was significantly and positively related to CHD mortality in the 40 countries. The countries with low CSIs had low CHD death rates. Countries with high CSIs had a wide range of CHD death rates. France, Finland, and other Western industrialized countries had similar CSIs. After adjusting for cholesterol and saturated fat, milk and many components of milk (butterfat, milk protein, calcium from milk, and riboflavin) and total calcium remained positively related to CHD mortality for all 40 countries. There were differences in the consumption of these foods and nutrients in France and Finland. Milk and butterfat (fat from milk, cream, cheese, and butter) consumption was higher in Finland than in France. The consumption of plant foods, recently shown to be protective against CHD (vegetables and vegetable oils containing monounsaturated and polyunsaturated fatty acids), was greater in France than in Finland. Over the years, France and Finland, with similar intakes of cholesterol and saturated fat, consistently have had very different CHD mortality rates. This paradox may be explained as follows. Given a high intake of cholesterol and saturated fat, the country in which people also consume more plant foods, including small amounts of liquid vegetable oils, and more vegetables (more antioxidants) had lower rates of CHD mortality. On the other hand, milk and butterfat were associated with increased CHD mortality, possibly through their effects on thrombosis as well as on atherosclerosis.

Importance of diet in the treatment of familial hypercholesterolemia

The principal goal of dietary treatment of heterozygous familial hypercholesterolemia (hFH) is the reduction of the plasma low density lipoprotein (LDL) cholesterol. This is best accomplished by enhancing the activity of LDL receptors and, at the same time, depressing liver synthesis of cholesterol. Both cholesterol and saturated fat down-regulate the LDL receptor and inhibit the removal of LDL from the plasma by the liver. Saturated fat down-regulates the LDL receptor, especially when cholesterol is concurrently present in the diet. The total amount of dietary fat is also important. The greater the flux of chylomicron remnants into the liver, the greater is the influx of cholesterol ester. In addition, factors that affect LDL synthesis could be important. These include excessive calories (obesity) that enhance very low density lipoprotein (VLDL) and, hence, LDL synthesis, and weight loss and ω-3 fatty acids, which depress synthesis of VLDL and LDL The optimal diet for treatment of children and adults has the following characteristics: cholesterol (100 mg/day), total fat (20% of kcal, 6% saturated with the balance from ω-3 and ω-6 polyunsaturated and monounsaturated fat), carbohydrate (65% kcal, 67% from starch), and protein (15% kcal). This low-fat, high-carbohydrate diet can lower the plasma cholesterol 18–21%. A new concept, the Cholesterol-Saturated Fat Index, allows people to evaluate any foodstuff for its potential to elevate the plasma LDL cholesterol level. It is an antithrombotic diet, thrombosis being another major consideration in preventing coronary heart disease. Also, it contains significant amounts of antioxidants and fiber. Dietary therapy is the mainstay of treatment of hFH to which various drug therapies can be added.

The cholesterol-saturated fat index for coronary prevention: Background, use, and a comprehensive table of foods

The potential of a food or a diet to raise the plasma level of total and low-density-lipoprotein cholesterol and to promote atherosclerosis is directly related to its cholesterol and saturated fat content. A new formula that indicates the concentrations of cholesterol and saturated fat in foods, termed the cholesterol-saturated fat index (CSI), has been devised. A low CSI indicates low saturated fat and/or cholesterol content and thus hypocholesterolemic and low atherogenic potential. Guidelines are provided for using the CSI to evaluate or plan low-fat diets, for comparing a food or a mixed dish with others, and for evaluating a day's food intake. A comprehensive table of foods is presented.