Effects of margarine enriched with plant sterol esters from rapeseed and tall oils on markers of endothelial function, inflammation and hemostasis.

BACKGROUND AND AIMS: The sterol profile of rapeseed oil differs from that of tall oil with higher contents of campesterol and brassicasterol. We previously found that margarines providing 2 g/day of sterols from rapeseed or tall oil resulted in similar reductions in LDL cholesterol of 8-9%. The aim of the present study was to investigate whether the consumption of these margarines affected markers of endothelial function, inflammation and hemostasis. METHODS: Blood samples were collected from 58 hypercholesterolemic volunteers who completed a double-blinded, randomized, crossover trial. Subjects consumed each of the two sterol margarines and a control non-sterol margarine for 4 weeks separated by one-week washout periods. All the margarines had the same fatty acid composition. Concentrations of vascular cell adhesion molecule-l (VCAM-1), E-selection, circulating tumor necrosis factor α (TNFα) and plasminogen activator inhibitor-1 (total, tPAI-1; active, PAI-1) were quantified. RESULTS: Rapeseed-sterol margarine reduced E-selection concentrations compared to the control margarine (p = 0.012) while tall-sterol margarine had no effect. The rapeseed-sterol margarine also reduced tPAI-1 (p = 0.008) compared to the tall-sterol margarine. No significant changes were observed in TNFα and VCAM-1. No association was found between LDL reduction and changes in E-selection and tPAI-1. CONCLUSION: Rapeseed-sterol margarine demonstrated favorable effects on vascular risk markers.

Intake of trans fatty acids from partially hydrogenated vegetable and fish oils and ruminant fat in relation to cancer risk.

Intake of trans fatty acids (TFA) may influence systemic inflammation, insulin resistance and adiposity, but whether TFA intake influences cancer risk is insufficiently studied. We examined the association between TFA intake from partially hydrogenated vegetable oils (PHVO-TFA), partially hydrogenated fish oils (PHFO-TFA), and ruminant fat (rTFA) and cancer risk in the Norwegian counties study, a large cohort study with a participation rate >80%. TFA intake was assessed three times in 1974-1988 by questionnaire. A total of 77,568 men and women were followed up through 2007, during which time 12,004 cancer cases occurred. Hazard ratios (HRs) and confidence intervals (CIs) were estimated with Cox regression for cancer sites with ≥150 cases during follow-up. Significantly increased or decreased risks were found when comparing the highest and lowest intake categories (HRs, 95% CIs) for PHVO-TFA and pancreatic cancer in men (0.52, 0.31-0.87) and non-Hodgkin lymphoma (NHL) in both genders (0.70, 0.50-0.98); PHFO-TFA and rectal cancer (1.43, 1.09-1.88), prostate cancer (0.82, 0.69-0.96), and multiple myeloma (2.02, 1.24-3.28); and rTFA and all cancers (1.09, 1.02-1.16), cancer of the mouth/pharynx (1.59, 1.08-2.35), NHL (1.47, 1.06-2.04) and multiple myeloma (0.45, 0.24-0.84). Furthermore, positive trends were found for PHFO-TFA and stomach cancer (p(trend) = 0.01) and rTFA and postmenopausal breast cancer (p(trend) = 0.03). Inverse trends were found for PHVO-TFA and all cancers (p(trend) = 0.006) and cancer of the central nervous system in women (p(trend) = 0.005). PHFO-TFA, but not PHVO-TFA, seemed to increase cancer risk. The increased risks observed for rTFA may be linked to saturated fat.

A prospective study of intake of trans-fatty acids from ruminant fat, partially hydrogenated vegetable oils, and marine oils and mortality from CVD.

Trans-fatty acids (TFA) have adverse effects on blood lipids, but whether TFA from different sources are associated with risk of CVD remains unresolved. The objective of the present study was to evaluate the association between TFA intake from partially hydrogenated vegetable oils (PHVO), partially hydrogenated fish oils (PHFO) and ruminant fat (rTFA) and risks of death of CVD, CHD, cerebrovascular diseases and sudden death in the Norwegian Counties Study, a population-based cohort study. Between 1974 and 1988, participants were examined for up to three times. Fat intake was assessed with a semi-quantitative FFQ. A total of 71,464 men and women were followed up through 2007. Hazard ratios (HR) and 95 % CI were estimated with Cox regression. Energy from TFA was compared to energy from all other sources, carbohydrates or unsaturated cis-fatty acids with different multivariable models. During follow-up, 3870 subjects died of CVD, 2383 of CHD, 732 of cerebrovascular diseases and 243 of sudden death. Significant risks, comparing highest to lowest intake category, were found for: TFA from PHVO and CHD (HR 1.23 (95 % CI 1.00, 1.50)) and cerebrovascular diseases (HR 0.65 (95 % CI 0.45, 0.94)); TFA from PHFO and CVD (HR 1.14 (95 % CI 1.03, 1.26)) and cerebrovascular diseases (HR 1.32 (95 % CI 1.04, 1.69)); and rTFA intake and CVD (HR 1.30 (95 % CI 1.05, 1.61)), CHD (HR 1.50 (95 % CI 1.11, 2.03)) and sudden death (HR 2.73 (95 % CI 1.19, 6.25)) in women. These associations with rTFA intake were not significant in men (P interaction ≥ 0.01). The present study supports that TFA intake, irrespective of source, increases CVD risk. Whether TFA from PHVO decreases risk of cerebrovascular diseases warrants further investigation.

Metabolic effects of krill oil are essentially similar to those of fish oil but at lower dose of EPA and DHA, in healthy volunteers.

The purpose of the present study is to investigate the effects of krill oil and fish oil on serum lipids and markers of oxidative stress and inflammation and to evaluate if different molecular forms, triacylglycerol and phospholipids, of omega-3 polyunsaturated fatty acids (PUFAs) influence the plasma level of EPA and DHA differently. One hundred thirteen subjects with normal or slightly elevated total blood cholesterol and/or triglyceride levels were randomized into three groups and given either six capsules of krill oil (N = 36; 3.0 g/day, EPA + DHA = 543 mg) or three capsules of fish oil (N = 40; 1.8 g/day, EPA + DHA = 864 mg) daily for 7 weeks. A third group did not receive any supplementation and served as controls (N = 37). A significant increase in plasma EPA, DHA, and DPA was observed in the subjects supplemented with n-3 PUFAs as compared with the controls, but there were no significant differences in the changes in any of the n-3 PUFAs between the fish oil and the krill oil groups. No statistically significant differences in changes in any of the serum lipids or the markers of oxidative stress and inflammation between the study groups were observed. Krill oil and fish oil thus represent comparable dietary sources of n-3 PUFAs, even if the EPA + DHA dose in the krill oil was 62.8% of that in the fish oil.

Calcium from salmon and cod bone is well absorbed in young healthy men: a double-blinded randomised crossover design.

BACKGROUND: Calcium (Ca) - fortified foods are likely to play an important role in helping the consumer achieve an adequate Ca intake, especially for persons with a low intake of dairy products. Fish bones have a high Ca content, and huge quantities of this raw material are available as a by-product from the fish industry. Previously, emphasis has been on producing high quality products from fish by-products by use of bacterial proteases. However, documentation of the nutritional value of the enzymatically rinsed Ca-rich bone fraction remains unexplored. The objective of the present study was to assess the bioavailability of calcium in bones of Atlantic salmon (oily fish) and Atlantic cod (lean fish) in a double-blinded randomised crossover design. METHODS: Ca absorption was measured in 10 healthy young men using 47Ca whole body counting after ingestion of a test meal extrinsically labelled with the 47Ca isotope. The three test meals contained 800 mg of Ca from three different calcium sources: cod bones, salmon bones and control (CaCO3). RESULTS: Mean Ca absorption (+/- SEE) from the three different Ca sources were 21.9 +/- 1.7%, 22.5 +/- 1.7% and 27.4 +/- 1.8% for cod bones, salmon bones, and control (CaCO3), respectively. CONCLUSION: We conclude that bones from Atlantic salmon and Atlantic cod are suitable as natural Ca sources in e.g. functional foods or as supplements.

Dairy products and metabolic effects in overweight men and women: results from a 6-mo intervention study.

BACKGROUND: Some epidemiologic studies have suggested inverse relations between intake of dairy products and components of the metabolic syndrome. OBJECTIVE: The objective was to investigate the effects of an increased intake of dairy products in persons with a habitually low intake on body composition and factors related to the metabolic syndrome. DESIGN: Middle-aged overweight subjects (n = 121) with traits of the metabolic syndrome were recruited in Finland, Norway, and Sweden and randomly assigned into milk or control groups. The milk group was instructed to consume 3-5 portions of dairy products daily. The control group maintained their habitual diet. Clinical investigations were conducted on admission and after 6 mo. RESULTS: There were no significant differences between changes in body weight or body composition, blood pressure, markers of inflammation, endothelial function, adiponectin, or oxidative stress in the milk and the control groups. There was a modest unfavorable increase in serum cholesterol concentrations in the milk group (P = 0.043). Among participants with a low calcium intake at baseline (<700 mg/d), there was a significant treatment effect for waist circumference (P = 0.003) and sagittal abdominal diameter (P = 0.034). When the sexes were analyzed separately, leptin increased (P = 0.045) and vascular cell adhesion molecule-1 decreased (P = 0.001) in women in the milk group. CONCLUSIONS: This study gives no clear support to the hypothesis that a moderately increased intake of dairy products beneficially affects aspects of the metabolic syndrome. The apparently positive effects on waist circumference and sagittal abdominal diameter in subjects with a low calcium intake suggest a possible threshold in relation to effects on body composition.

Vitamin D requirement and setting recommendation levels - current Nordic view.

At the latitude of the Nordic countries, where there is almost no dermal formation of vitamin D during winter, dietary intake is required to avoid deficiency. Dietary intake is of the order of 4-5 microg/day but varies widely. The lowest intake is seen among adolescents. Low levels of serum 25(OH)D have been found in population groups in all Nordic countries. The drop in 25(OH)D during the winter months may be considerable, falling below acceptable levels (50 nmol/L) in one half of the population. To ensure an acceptable vitamin D status is maintained in the population and to diminish the seasonal drop in 25(OH)D, the Nordic Nutrition Recommendations 2004 increased the vitamin D recommendation for the age group 2-60 years by 50% from 5 microg/day to 7.5 microg/day. To attain such an intake at the population level, public health actions, including information dissemination and increased fortification of foods, are necessary.

[Model for estimation of cardiovascular risk in Norway]. / Modell for estimering av kardiovaskulaer risiko i Norge.

BACKGROUND: Guidelines for prevention of cardiovascular disease (CVD) include calculation of total risk. A new risk model based on updated Norwegian data is needed, as the European SCORE function overestimates the risk of fatal CVD in Norway. NORRISK for 10-year CVD mortality is presented. It includes gender, age and smoking and levels of systolic blood pressure and serumtotal cholesterol. MATERIAL AND METHODS: NORRISK is based on national age- and sex specific mortality rates from Statistics Norway (1999-2003), mean levels of risk factors from Norwegian Health Surveys (2000-03) and relative risks from mortality follow-up of Norwegian Cardiovascular Screenings (1985-2002). The model is adjusted to the mortality level in the period 1999-2003 and is compared with the SCORE model. RESULTS: 10-year risk estimates calculated from NORRISK fall between SCORE high- and low-risk estimates and increase strongly with age. Very few persons below 50 years of age have a 10-year risk above 5% (European limit for high risk). More than half of men aged 60 years have estimated risks above this limit, while only 7% of 60-year-old women exceed the limit. Even if the risk limit is reduced to 1% for younger age groups, very few women below 50 years of age have risks above the limit. INTERPRETATION: NORRISK is more adapted to the current situation in Norway than the SCORE model and may be a useful and relevant tool in Norwegian clinical practice.

Intake of dairy fat and dairy products, and risk of myocardial infarction: a case-control study.

The role of dairy fat in the aetiology of myocardial infarction (MI) is controversial. The aim of this study was to evaluate the association between intake of dairy fat and dairy products, and risk of a first acute MI. A total of 111 MI patients with a first acute MI and 107 population controls (men and women, age 45 75 years) were studied. Diet was assessed using a 180-item food frequency questionnaire. The MI cases had higher intake of total fat, but lower intake of saturated fat and dairy fat than the control persons. No effect of dairy fat or saturated fat on the odds ratio for MI was observed, however. A significant inverse trend in odds of MI for intake of cheese was observed, but the trend was no longer significant after adjustment for smoking. The results suggest that intake of fat from dairy products may not be associated with increased risk of having a first MI. The healthy control persons had a diet that differed from the diet of the MI patients in many aspects, and dairy products were a part of this diet. This may have protected them from having a first MI.

The ability of the SCORE high-risk model to predict 10-year cardiovascular disease mortality in Norway.

AIMS: To evaluate the predictive accuracy of the Systematic Coronary Risk Evaluation (SCORE) project high-risk function in Norway. METHODS AND RESULTS: We included 57 229 individuals screened in 1985-1992 from two population-based surveys in Norway (age groups 40-49, 50-59, and 60-69 years). The data have been linked to the Norwegian Cause of Death Registry. The SCORE high-risk algorithm for the prediction of 10-year cardiovascular disease (CVD) mortality was applied, and the risk factors entered into the model were age, sex, total cholesterol, systolic blood pressure, and smoking (yes/no). The number of expected events estimated by the SCORE model (E) was compared with the observed numbers (O). The SCORE low-risk algorithm was studied for comparison. In men, the observed number of CVD deaths was 718, compared with 1464 estimated by the SCORE high-risk function (O/E ratios 0.53, 0.53 and 0.45, for age groups 40-49, 50-59 and 60-69, respectively). In women, the observed and expected numbers were 226 and 547. The O/E ratios decreased with age (ratios 0.60, 0.45 and 0.37, respectively), i.e. the overestimation increased with age. The low-risk function predicted reasonably well for men (ratios 0.85, 0.92 and 0.79, respectively), whereas an overestimation was found for women aged 50-59 and 60-69 years (ratios 0.69 and 0.56, respectively). CONCLUSION: The SCORE high-risk model overestimated the number of CVD deaths in Norway. Before implementation in clinical practice, proper adjustments to national levels are required.

Dietary patterns, food groups and myocardial infarction: a case-control study.

Certain dietary patterns may be related to the risk of CVD. We hypothesised that a plant-centred dietary pattern would be associated with a reduced risk of first myocardial infarction (MI). A case-control study of Norwegian men and postmenopausal women (age 45-75 years) was performed. A FFQ was administered, generally within 3 d after incident MI (n 106 cases). Controls (n 105) were frequency matched on sex, age and geographic location. On the FFQ, 190 items were categorised into thirty-five food groups and an a priori healthy diet pattern score was created. We estimated OR using logistic regression with adjustment for energy intake, family history of heart disease, marital status, current smoking, education and age. Among food groups, the risk of MI was significantly higher per SD of butter and margarine (OR 1.66 (95 % CI 1.12, 2.46)), and lower per SD of tomatoes (OR 0.53 (95 % CI 0.35, 0.79)), high-fat fish (OR 0.57 (95 % CI 0.38, 0.86)), wine (OR 0.58 (95 % CI 0.41, 0.83)), salad (OR 0.59 (95 % CI 0.40, 0.87)), whole grain breakfast cereals (OR 0.64 (95 % CI 0.45, 0.90)), cruciferous vegetables (OR 0.66 (95 % CI 0.47, 0.93)) and non-hydrogenated vegetable oil (OR 0.68 (95 % CI 0.49, 0.95)). An abundance of cases were found to have a low a priori healthy diet pattern score. A dietary pattern emphasising nutrient-rich plant foods and high-fat fish and low in trans fatty acids was associated with decreased risk of MI among Norwegians.

The SCORE risk model applied to recent population surveys in Norway compared to observed mortality in the general population.

AIMS: To compare the predictions of the Systematic Coronary Risk Evaluation (SCORE) high- and low-risk functions applied to a recent population study with observed cardiovascular disease (CVD) mortality estimated from annual official mortality statistics in Norway. METHODS: Data were obtained from large epidemiological surveys conducted in five Norwegian counties in 2000-2003. RESULTS: A total of 32 251 men and women were investigated (aged 30-31, 40-41, 45-46, and 59-61). For men aged >or=59, more than 75% qualified for preventive treatment by having a 10-year risk >or=5%. Few women and practically no men younger than 46 years can be considered at high risk according to the SCORE risk prediction models. For men, the high-risk function overestimated and the low-risk model underestimated the CVD mortality as compared to the 10-year risks calculated from official mortality statistics (1999-2003). For women, however, both functions underestimated mortality in young individuals, whereas in the elderly an overestimation was observed. CONCLUSIONS: The risk predictions depended strongly on age and gender. The SCORE high-risk function overestimates the risk of fatal CVD for men in Norway, and before implementation in clinical practice, proper adjustments to national levels are required.

[Trans fatty acids in the Norwegian diet]. / Transfettsyrer i norsk kosthold.

BACKGROUND: Intake of trans fatty acids and saturated fatty acids should be limited, as high intakes may increase the risk of coronary heart disease. There is no up-to-date information on intake of trans fatty acids in the Norwegian population. MATERIAL AND METHODS: Information on trans fatty acid content in foods in 2003 from a survey among Norwegian food manufacturers and importers, together with data from the Norwegian Food Composition data base, is used to estimate the content of trans fatty acids in food groups. Intake of trans fatty acids is calculated on the basis of food intake reported in a national dietary survey among adults in 1997. RESULTS: Mean intake of trans fatty acids was 1.6 gram/person/day, corresponding to 0.6 percent of total energy intake. Trans fatty acids contributed with less than 1% of energy intake among 97 percent of the participants; differences in intake related to gender, age and length of education were small. Main contributors of trans fatty acids were dairy products 50%, meat products 18%, buns and cakes 8% and bread products 7%. Food groups containing partially hydrogenated fats contributed totally approximately 30%. For several food groups the content has been reduced since 2003. INTERPRETATION: The calculated intake of trans fatty acids among Norwegians in 2003 was lower than earlier estimates based on household consumption surveys in 2001, and at the same level as reported for Mediterranean countries in the 1990s. Mean intake is now in accordance with the recommendation from World Health Organization: intake should be limited to less than 1 % total energy intake. Our calculations imply that intake of trans fatty acids no longer represents a public health concern in Norway.

Palm oil versus hydrogenated soybean oil: effects on serum lipids and plasma haemostatic variables.

The purpose of this study was to test if replacement of trans fatty acids by palmitic acid in an experimental margarine results in unfavourable effects on serum lipids and haemostatic factors. We have compared the effects of three different margarines, one based on palm oil (PALM-margarine), one based on partially hydrogenated soybean oil (TRANS- margarine) and one with a high content of polyunsaturated fatty acids (PUFA-margarine), on serum lipids in 27 young women. In nine of the participants fasting levels and diurnal postprandial levels of haemostatic variables on the 3 diets were compared. The sum of 12:0, 14:0, 16:0 provided 11% of energy (E%) in the PALM diet, the same as the sum of 12:0, 14:0, 16:0 and trans fatty acids in the TRANS-diet. Oleic acid provided 10-11E% in all three diets, while PUFA provided 5.7, 5.5 and 10.2 E%, respectively. Total fat provided 30-31% and the test margarines 26% of total energy in all three diets. Each of the diets was consumed for 17 days in a crossover design. There were no significant differences in total cholesterol, LDL-cholesterol and apoB between the TRANS- and the PALM-diet. HDL-cholesterol and apoA-I were significantly higher on the PALM-diet compared to the TRANS-diet while the ratio of LDL- to HDL-cholesterol was lower, although not significantly (P = 0.077) on the PALM-diet. Total cholesterol, LDL-cholesterol and apoB were significantly lower on the PUFA-diet compared to the two other diets. HDL-cholesterol was not different on the PALM- and the PUFA-diet while it was significantly lower on the TRANS-diet compared to the PUFA-diet. Triglycerides and Lp(a) were not different among the three diets. The diurnal postprandial state level of tissue plasminogen activator (t-PA) activity was significantly decreased on the TRANS-diet compared to the PALM-diet. t-PA activity was also decreased on the PUFA-diet compared to PALM-diet although not significantly (P=0.07). There were no significant differences in neither fasting levels or in circadian variation of t-PA antigen, PAI-1 activity, PAI-1 antigen, factor VII coagulant activity or fibrinogen between the three diets. Our results suggest that dietary palm oil may have a more favourable effect on the fibrinolytic system compared to partially hydrogenated soybean oil. We conclude that from a nutritional point of view, palmitic acid from palm oil may be a reasonable alternative to trans fatty acids from partially hydrogenated soybean oil in margarine if the aim is to avoid trans fatty acids. A palm oil based margarine is, however, less favourable than one based on a more polyunsaturated vegetable oil.