Effects of Full-Fat and Fermented Dairy Products on Cardiometabolic Disease: Food Is More Than the Sum of Its Parts.

Current dietary recommendations to limit consumption of saturated fat are largely based on early nutrition studies demonstrating a direct link between dietary saturated fat, elevated blood cholesterol levels, and increased risk of cardiovascular disease. As full-fat dairy products are rich in saturated fat, these dietary guidelines recommend consumption of fat-free or low-fat dairy products in place of full-fat dairy. However, dairy products vary greatly in both their nutrient content and their bioactive ingredients, and research increasingly highlights the importance of focusing on whole foods (i.e., the food matrix) as opposed to single nutrients, such as saturated fat. In fact, the weight of evidence from recent large and well-controlled studies, systematic reviews, and meta-analyses of both observational studies and randomized controlled trials indicates that full-fat dairy products, particularly yogurt and cheese, do not exert the detrimental effects on insulin sensitivity, blood lipid profile, and blood pressure as previously predicted on the basis of their sodium and saturated fat contents; they do not increase cardiometabolic disease risk and may in fact protect against cardiovascular disease and type 2 diabetes. Although more research is warranted to adjust for possible confounding factors and to better understand the mechanisms of action of dairy products on health outcomes, it becomes increasingly clear that the recommendation to restrict dietary saturated fat to reduce risk of cardiometabolic disease is getting outdated. Therefore, the suggestion to restrict or eliminate full-fat dairy from the diet may not be the optimal strategy for reducing cardiometabolic disease risk and should be re-evaluated in light of recent evidence.

Análisis de la energía y nutrientes de las raciones individuales de combate y su adecuación a una dieta saludable / Analysis of energy and nutrients of individual portions in combat and their appropriateness to a healthy diet

INTRODUCCIÓN Y OBJETIVOS: Se realizó este estudio para valorar si las raciones individuales de combate cumplen con el valor energético y contenido en macronutrientes exigidos en el pliego de prescripciones técnicas de su contrato y para conocer si una dieta elaborada exclusivamente con ellas cubre las necesidades nutricionales del personal militar durante un día de trabajo intenso. MATERIAL Y MÉTODOS: se analizó, por duplicado, el contenido en macronutrientes y sodio de los cinco módulos diferentes de desayuno, comida A y comida B, los módulos A1 y B1 preparados para musulmanes y el pan-galleta. Se calculó su valor energético y para su evaluación se asumió que el soldado ingiere todos los alimentos incluidos en cada módulo. RESULTADOS: los cinco tipos de menú estándar y el musulmán cubren de manera adecuada las necesidades energéticas del personal militar. Se han encontrado diferencias significativas en algunos módulos entre el valor real de proteínas y lípidos y las cantidades establecidas en el pliego de prescripciones técnicas. El contenido de sodio es muy elevado, llegando a triplicar la ingesta diaria recomendada. DISCUSIÓN Y CONCLUSIONES: las raciones individuales de combate cubren satisfactoriamente las necesidades energéticas del personal militar español en misiones y maniobras, habiendo considerado el escenario más exigente, con un reparto razonable de la ingesta energética a lo largo del día. No obstante, existe margen de mejora mediante la reducción del contenido de lípidos, la disminución de la cantidad de sal añadida y el incremento del contenido de hidratos de carbono complejos

INTRODUCTION AND OBJECTIVES: This study was conducted to assess whether the individual combat rations meet the energy and macronutrient content required in the technical specifications of the contract and to know whether a diet made exclusively from combat rations covers the nutritional needs of military personnel during a day of intense work. MATERIAL AND METHODS: we analyzed, twice, macronutrient and sodium content of five different modules of breakfast, lunch and dinner, items prepared for Muslims and bread-biscuit. Energy value was calculated and it was assumed that soldiers eat all foods included in each module. RESULTS: the five types of standard menu and the Muslim adequately cover the energy needs of military personnel. We found significant differences in some modules between the real value of proteins and lipids and amounts specified in the technical specifications. The sodium content is very high; almost three times the recommended daily intake. DISCUSSION AND CONCLUSIONS: individual combat rations satisfactorily cover the energy needs of the Spanish soldiers in missions and maneuvers, having considered the most demanding case, with a reasonable distribution of energy intake throughout the day. However, there is room for improvement by reducing the lipid content, reducing the amount of added salt and increasing the content of complex carbohydrates

Evidence-Based Guideline of the German Nutrition Society: Fat Intake and Prevention of Selected Nutrition-Related Diseases.

As nutrition-related chronic diseases have become more and more frequent, the importance of dietary prevention has also increased. Dietary fat plays a major role in human nutrition, and modification of fat and/or fatty acid intake could have a preventive potential. The aim of the guideline of the German Nutrition Society (DGE) was to systematically evaluate the evidence for the prevention of the widespread diseases obesity, type 2 diabetes mellitus, dyslipoproteinaemia, hypertension, metabolic syndrome, coronary heart disease (CHD), stroke, and cancer through the intake of fat or fatty acids. The main results can be summarized as follows: it was concluded with convincing evidence that a reduced intake of total and saturated fat as well as a larger intake of polyunsaturated fatty acids (PUFA) at the expense of saturated fatty acids (SFA) reduces the concentration of total and low-density lipoprotein cholesterol in plasma. Furthermore, there is convincing evidence that a high intake of trans fatty acids increases risk of dyslipoproteinaemia and that a high intake of long-chain polyunsaturated n-3 fatty acids reduces the triglyceride concentration in plasma. A high fat intake increases the risk of obesity with probable evidence when total energy intake is not controlled for (ad libitum diet). When energy intake is controlled for, there is probable evidence for no association between fat intake and risk of obesity. A larger intake of PUFA at the expense of SFA reduces risk of CHD with probable evidence. Furthermore, there is probable evidence that a high intake of long-chain polyunsaturated n-3 fatty acids reduces risk of hypertension and CHD. With probable evidence, a high trans fatty acid intake increases risk of CHD. The practical consequences for current dietary recommendations are described at the end of this article.

High-fat diet action on adiposity, inflammation, and insulin sensitivity depends on the control low-fat diet.

Animal studies using a high-fat diet (HFD) have studied the effects of lipid overconsumption by comparing a defined HFD either with a natural-ingredient chow diet or with a defined low-fat diet (LFD), despite the dramatic differences between these control diets. We hypothesized that these differences in the control diet could modify the conclusions regarding the effects that an increase of fat in the diet has on several metabolic parameters. For 11 weeks, C57bl6/J mice were fed a low-fat chow diet (8% energy from fat), a typical semisynthetic LFD (12%), or a semisynthetic HFD (sy-HF) (40%). Conclusions about the effect of sy-HF on body weight gain, subcutaneous adipose tissue, insulin sensitivity, and adipose tissue inflammation were modified according to the control LFD. Conversely, conclusions about epididymal and retroperitoneal adipose tissue; fat intake effects on liver and muscular lipids, cholesterol, free fatty acids, and markers of low-grade inflammation; and of adipose tissue macrophage infiltration were the same regardless of the use of low-fat chow diet or semisynthetic LFD. For some physiological outcomes, conflicting conclusions were even reached about the effects of increased fat intake according to the chosen low-fat control. Some deleterious effects of sy-HF may not be explained by lipid overconsumption but rather by the overall quality of ingredients in a semisynthetic diet. According to the control LFD chosen, conclusions on the lipid-related effects of HFDs must be formulated with great care because some end points are profoundly affected by the ingredient composition of the diet rather than by fat content.

Cholesterol: where science and public health policy intersect.

Current US guidelines for cholesterol recommend limiting intake of cholesterol to <300 mg/day for the general population and <200 mg/day for individuals with elevated low-density lipoprotein cholesterol. These recommendations, however, are at odds with international (e.g., Canada, United Kingdom, and Australia) guidelines that provide no specific numerical recommendation, but instead recommend reducing total fat intake and shifting fat consumption away from saturated and trans fats to unsaturated fats. A conference was held on December 3, 2008, to evaluate the data supporting current US nutrition policy recommendations to limit dietary cholesterol and analyze the consequences of this policy on the eating patterns and health of the US population. This review is a summary of the information and perspectives presented by conference speakers and discussed by conference participants.

A healthful options food station can improve satisfaction and generate gross profit in a worksite cafeteria.

The objectives of this study were to determine customer satisfaction with a healthful options food station offered in a worksite cafeteria and document the financial contribution of such a station. The healthful options station featured daily entrées with fewer than 500 calories and less than 30% of calories from fat. Questionnaires from 655 (24.5% response) employees and students provided data on satisfaction with and usage of the station. The majority of the respondents who had purchased from the healthful options station were female (77.3%), white (51.6%), aged 30 to 50 years (52.0%), and had annual incomes of $60,000 to $100,000 (29.3%) or $20,000 to $39,999 (22.2%). Sales and gross profit from the healthful options station were compared to those of the comfort station. Customers were satisfied with attributes of the healthful options station (means >3 on a 5-point scale). Results of paired t tests suggested that customers who had purchased from the healthful options station rated the station significantly (P<0.001) higher for healthfulness of entrées, food presentation, food quality, overall quality of the cafeteria, length of line, and food choices available compared to their ratings for the cafeteria in general. The healthful options station generated average daily sales of $458 and gross profit of $306. However, the sales and gross profit were significantly (P<0.05) less than the comparison comfort station.

Low-fat or low-carbohydrate diet for cardiovascular health.

Obesity is a major, modifiable risk factor for cardiovascular disease. Climbing obesity rates are leaving Canadians at increased risk for disability, disease and premature death. This has led to increased interest in dietary interventions to control weight and reduce obesity. While a low-fat diet has been promoted for more than 20 years to reduce cardiovascular risk, recently there has been a proliferation of new diets that promise fast, successful weight loss. The marketing strategies of diet promoters have led consumers and health care professionals to consider the benefits and risks of these diets for cardiovascular health. The purpose of this paper is to compare the traditional low-fat diet with one such dietary innovation -- the low-carbohydrate diet. Research studies are reviewed to provide some evidence for practice in assisting patients to improve cardiovascular health through weight loss.

Nonalcoholic fatty liver disease as a feature of the metabolic syndrome.

The main criteria of the metabolic syndrome are obesity, insulin resistance and disturbed lipid metabolism. The same disturbances are regarded to be involved into the pathomechanism of nonalcoholic fatty liver disease which is shown by epidemiological studies and animal models. Thus NAFLD can be regarded a specific feature of the metabolic syndrome and it should be looked for in high risk populations.

Nutrient adequacy of a very low-fat vegan diet.

This study assessed the nutrient adequacy of a very low-fat vegan diet. Thirty-nine men (mean age=65 years) with early stage prostate cancer who chose the "watchful waiting" approach to disease management, were instructed by a registered dietitian and a chef on following a very low-fat (10%) vegan diet with the addition of a fortified soy protein powdered beverage. Three-day food diaries, excluding vitamin and mineral supplements, were analyzed and nutrient values were compared against Dietary Reference Intakes (DRI). Mean dietary intake met the recommended DRIs. On the basis of the Adequate Intake standard, a less than adequate intake was observed for vitamin D. This demonstrates that a very low-fat vegan diet with comprehensive nutrition education emphasizing nutrient-fortified plant foods is nutritionally adequate, with the exception of vitamin D. Vitamin D supplementation, especially for those with limited sun exposure, can help assure nutritional adequacy.

Niño y lípidos / Children and lipids

La aterosclerosis es una enfermedad que se inicia en edades tempranas de la vida, de modo que conocer y controlar aspectos relacionados con el riesgo cardiovascular en el niño tendrá repercusión en la incidencia de la enfermedad cardiovascular en la edad adulta. En nuestra población infantil los valores plasmáticos de colesterol total y colesterol ligado a lipoproteínas de baja densidad son elevados y, aunque los valores de colesterol ligado a lipoproteínas de alta densidad son también elevados, es preocupante observar que se asocian con una dieta, además de hipercalórica, muy rica en grasa, especialmente grasa saturada. No debemos olvidar, sin embargo, que los valores de lípidos a lo largo de la edad infantil van a ser el resultado de complejas interacciones de la dieta con determinantes genéticos y factores hormonales (AU)

Atherosclerosis is a disease that begins early in life. Therefore, knowledge and control of factors related to cardiovascular risk in children will affect the incidence of cardiovascular disease in adults. In our pediatric population, plasma levels of total and low-density lipoprotein cholesterol are high and, although high-density lipoprotein cholesterol levels are also high, the association between these levels and a high-calorie diet, rich in fats, especially saturated fats, is a cause of concern. However, lipid levels throughout childhood are the result of complex interactions between the diet, genetic determinants and hormonal factors (AU)

An ad libitum, very low-fat diet results in weight loss and changes in nutrient intakes in postmenopausal women.

OBJECTIVES: To determine whether a very low-fat diet (<15% of energy intake) consumed ad libitum during an 8-month period can achieve weight loss of 5% to 10% of initial body weight while still providing adequate intakes of other essential nutrients. DESIGN: Longitudinal, 8-month, ad libitum, free living, very low-fat diet trial. SUBJECTS: Fifty-four of the sixty-four healthy postmenopausal women recruited completed the entire study (age 59+/-8 years, BMI=29.6+/-6.3). Twenty-four of these women used hormone replacement therapy, thirty women did not. INTERVENTION: Weekly sessions aimed at teaching and reinforcing a very low-fat intake diet for eight months. MAIN: outcome measures Body weight, percent body fat, waist-to-hip ratio, resting energy expenditure, respiratory quotient, and nutrient intakes derived from 7-day food records at the beginning and at 2, 4, 6, and 8 months of the study. Statistical analysis performed Repeated measures analysis of variance and Tukey post hoc analysis were used to analyze significant differences in mean data (P<.05). RESULTS: Fat intake decreased from 33.2+/-7.5% to 11+/-4% over the 8-month intervention period (P<.00001). Weight loss was 6.0 kg+/- 4.2 kg (P<.000038), an 8% weight change, and decrease in percent body fat of 2.7%+/-0.2% (P< or =.000046). Weight correlated better with the self-reported fat intake (r=0.321, P<.01) than the energy intake (r=0.263, P<.05) at baseline. Fiber intake increased from 16 g+/-0.6 g to 23 g+/-0.2 g (P<.0005). All micronutrient intakes remained at or above preintervention ranges, except for a decrease in vitamin E intake from 8.1 mg+/-4.0 mg to 3.7 mg+/-1.1 mg (P<.0005) on the very low-fat diet and linoleic acid from 6.3%+/-1.5% to 2.5%+/-0.7% (P<.000001) with no significant reduction in linolenic acid. Hormone replacement was not associated with the amount of weight loss. APPLICATIONS: This study demonstrates that adherence to a very low-fat diet consumed ad libitum causes weight loss in the 5% to 10% range and a reduction of body fat. These reductions, along with the observed decreases in fat intake, are associated with improved health outcomes. Because of the decreased vitamin E and n-3 fatty acid intake, emphasis on foods high in these nutrients may need to be encouraged for those consuming a very low-fat diet.

Selected lower-fat foods positively impact nutrient quality in diets of free-living Americans.

OBJECTIVE: To compare nutrient profiles of Continuing Survey of Food Intake by Individuals (CSFII) respondents who reported use of regular and lower-fat versions of selected foods with those not reporting intake of these foods. SUBJECTS: American children (ages 2 to 19) and adults completing two days of recalls for the 1994 to 1996 CSFII. DESIGN: Dietary intakes were reviewed for selected foods for which regular (high) and modified-fat versions were available. Foods included added table fats (eg, salad dressings, margarine, creams), desserts, snacks, cheeses, and yogurts. Respondents were divided into non-users (none of these foods reported), mixed users (lower-fat and high-fat foods), and high-fat (only) users. STATISTICAL ANALYSES PERFORMED: Weighted data were used for descriptive analyses. Unweighted data were used for reported nutrient intake, nutrient density, fat intakes, and Food Guide Pyramid comparisons. A P value of < or =.01 was selected to determine whether group differences were statistically significant. Post hoc analyses were conducted to identify where differences were found. RESULTS: Respondents reporting inclusion of any selected lower-fat food had significantly lower fat intake (P<.01) than exclusive high-fat users (male respondents: 31.5% vs 35.1%; female respondents: 30.3% vs 34.4%; children: 30.6% vs 33.4%). In general, mixed users had higher micronutrient intakes than high-fat users. Specifically, mixed users reported higher intakes of most B vitamins; vitamins A, C, and folate; the minerals calcium, phosphorus, magnesium, iron, and zinc; and fiber. These differences were associated with higher intakes of milk, fruits, and grains. APPLICATIONS/CONCLUSIONS: This research supports the "all foods can fit" paradigm and validates recommending lower-fat foods (including snacks, desserts, cheeses, yogurt, and added table fats) to American consumers to reduce total fat to moderate levels while ensuring adequacy for most micronutrients.

Lipid responses to plant-sterol-enriched reduced-fat spreads incorporated into a National Cholesterol Education Program Step I diet.

BACKGROUND: Plant sterol esters reduce cholesterol absorption and lower circulating blood cholesterol concentrations when incorporated into the habitual diet. OBJECTIVE: This randomized, double-blind, 3-group parallel, controlled study evaluated the influence of esterified plant sterols on serum lipid concentrations in adults with mild-to-moderate primary hypercholesterolemia. DESIGN: Subjects incorporated a conventional 50%-fat spread into a National Cholesterol Education Program Step I diet for a 4-wk lead-in period, followed by a 5-wk intervention period of the diet plus either a control reduced-fat spread (40% fat; n = 92) or a reduced-fat spread enriched with plant sterol esters to achieve intakes of 1.1 g/d (n = 92; low-sterol group) or 2.2 g/d (n = 40; high-sterol group). RESULTS: Subjects in the low- and high-sterol groups who consumed > or = 80% of the scheduled servings (per-protocol analyses) had total cholesterol values that were 5.2% and 6.6% lower, LDL-cholesterol values that were 7.6% and 8.1% lower, apolipoprotein B values that were 6.2% and 8.4% lower, and ratios of total to HDL cholesterol that were 5.9% and 8.1% lower, respectively, than values for the control group (P < 0.001 for all). Additionally, triacylglycerol concentrations decreased by 10.4% in the high-sterol group. Serum concentrations of fat-soluble vitamins and carotenoids were generally within reference ranges at baseline and postintervention. Serum plant sterol concentrations increased from baseline (0.48% of total sterol by wt) to 0.64% and 0.71% by wt for the low- and high-sterol groups, respectively (P < 0.05 compared with control). CONCLUSION: A reduced-fat spread containing plant sterol esters incorporated into a low-fat diet is a beneficial adjunct in the dietary management of hypercholesterolemia.

[Dietary recommendations for dyslipidemic individuals]. / Recommandations diététiques aux dyslipidémiques.

Diet prescription is a fundamental first-line element in the management of patients with dyslipidemia. Weight loss should be a primary goal for all overweight patients. A 5 to 10% weight loss is often sufficient to obtain a significant improvement in lipid levels. Dietary fat should not provide more than 30% of total calorie intake. Saturated fatty acids should not exceed 7% and polyunsaturated fatty acids should also be limited to 7 to 10%. For monounsaturated fatty acids the dietary allowance can be a bit wider, up to 15% of total calorie intake. Carbohydrates, particularly complex carbohydrates, should replace the fat calories. Dietary fiber (more than 20g/d) as well as soy protein or phyto-sterols can be helpful in reducing LDL-cholesterol by about 10%. Consumption of fruits and vegetables should also be encouraged because they provide antioxidants that have effects on other cardiovascular risk factors. Long-term education is needed to encourage the patient to comply with this type of diet. Psycho-behavioral strategies can be useful here.

Assessment of the effect of fat-modified foods on diet quality in adults, 19 to 50 years, using data from the Continuing Survey of Food Intake by Individuals.

Fat-reduction strategies and the role of fat-modified foods in the US diet were assessed using a nationally representative survey: the 1996 US Department of Agriculture Continuing Survey of Food Intakes by Individuals. A sample of 878 men and 853 women was included. The sample was divided into low fat and high fat based on the Dietary Guideline's cutoff poin of 30% or less of energy from total fat. The survey sample was further stratified in nonusers, low-users or high-users of fat-modified foods. Approximately 10% of 7,000 foods were classified as fat-modified. There was a 400 to 500 kcal difference in energy intake of individuals consuming low-fat compared with high-fat diets. Adults who were users of fat-modified foods consumed more nutrient-dense diets, with higher intakes of vitamin A, folate, and iron. Not all fat-reduction strategies were equally effective in reducing fat and maintaining nutrient intake. Nonusers of fat-modified foods who consumed a low-fat diet tended to do so by substituting carbohydrate, in part from carbonated beverages, for fat. Both men and women consuming a low-fat diet had lower average BMIs; this difference between individuals consuming low-fat vs high-fat diets was significant for women who were high-users of fat-modified foods. The data suggest that a low-fat diet with high use of fat-modified foods may be one strategy for achieving adequate nutrient intake while maintaining weight in the desirable BMI range of 19 to 25.

Technical constraints in the development of reduced-fat bakery products.

The present study was funded by the Ministry of Agriculture, Fisheries and Food, its aim being to identify the technical barriers to the development of reduced-fat alternatives for bakery products. Using National Food Survey (Ministry of Agriculture, Fisheries and Food, 1998) statistics on dietary consumption within the home, biscuits, cakes and pastries were identified as contributing significant amounts of fat to the population's dietary intake. Face-to-face interviews were conducted with contacts in the technical community of the baking industry, who were usually working in technical and new-product development functions. A discussion guide was developed to cover the main lines of enquiry. The companies selected were ingredient suppliers (eight), manufacturers (twelve) and retailers (four) and so represented each step of the food supply chain. In brief, results showed that current labelling rules were too stringent, and constrained development of reduced-fat bakery products. Products with lower fat levels are harder to make due to altered handling and processing properties. Their quality is usually poorer than standard products, particularly for flavour, texture and mouthfeel. The perception of freshness is reduced and product shelf-life may consequently be shorter. For the product developer, there are relatively few ingredients that can be used in place of fat, and knowledge of how they work is limited, which inhibits product development. There is no identifiable source of technical knowledge in this field. Consumers perceive reduced-fat bakery products to be of lower quality and are generally unwilling to pay higher prices than for standard products.