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We compared the effects on blood pressure (BP) of three isocaloric diets with reduced total fat and saturated fatty acid (SAFA) contents but with different proportions of monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA). Diet LF (low fat) provided 20 en% fat (7.9% SAFA, 7.8% MUFA, 3.0% PUFA); diet HP (high PUFA) 26 en% fat (7.5% SAFA, 8.2% MUFA, 8.1% PUFA), and diet HM (high MUFA) 26 en% fat (7.3% SAFA, 14.1% MUFA, 3.2% PUFA). The diets were consumed for 8 weeks (intervention) preceded by 2 weeks and followed by 8 weeks on a habitual diet (baseline/ switchback) with 33-34 en% fat (13-14% SAFA, 12% MUFA, 6% PUFA). Forty-five free-living couples were randomly allocated into the three diet groups, and 43 men and 44 women completed the study. BP was measured weekly with an automatic device. Compliance to diet was monitored by repeated food records, serum fatty acid compositions, and weekly visits to a nutritionist. Both systolic BP (SBP) and diastolic BP (DBP) remained unchanged throughout the study in all three groups. The weight-adjusted mean (s.e.m.) BP values showed changes in SBP of +1.7 (1.8), -0.4 (1.7), and +1.9 (1.9) mm Hg on the LF, HP, and HM diets, respectively (difference NS), and DBP of +0.1 (1.0), +0.6 (1.0), and -0.3 (1.0) mm Hg, respectively (difference NS) between the last 2 weeks of the baseline and intervention periods. The expected fatty acid intakes were achieved, and there were no between-group differences in change of body weight, intake of dietary fibre and potassium, and 24-h sodium excretion. A reduction in total fat and SAFA intake and changes in the proportions of dietary MUFA and PUFA did not affect the BP levels of this normotensive population with an adequate intake of PUFA at baseline.

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OBJECTIVE: To compare the effects on serum lipoproteins of three isocaloric diets with reduced total fat and saturated fatty acid (SFA) contents but with different proportions of monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA). DESIGN: A low-fat diet (LF) provided 20 en% fat, 7.9% SFA, 7.8% MUFA, 3.0% PUFA; a high-PUFA diet (HP) 26 en% fat, 7.5% SFA, 8.2% MUFA, 8.1% PUFA; and a high-MUFA diet (HM) 26 en% fat, 7.3% SFA, 14.1% MUFA, 3.2% PUFA. Diets were consumed for 8 weeks in a parallel design, after 2 weeks on a habitual diet with 33-34 en% fat, 13-14% SFA, 12% MUFA, 6% PUFA, and followed by an 8-week period on habitual diet. Compliance to diet was monitored by repeated food records and weekly visits to a nutritionist. SUBJECTS: 45 free-living, middle-aged couples who were randomly allocated into the three diet groups; 43 men and 44 women completed the study. RESULTS: During the diet periods, a small but significant reduction in body weight of 0.4-1.0 kg was observed in all groups. Similar and significant reductions of mean weight-adjusted serum total cholesterol (4-8%), low-density lipoprotein (LDL) cholesterol (7-11%), and high-density lipoprotein (HDL) cholesterol (8-11%) were observed during the diets. HDL2-cholesterol and apoprotein (apo) A-I levels were reduced whereas HDL3-cholesterol and apoA-II increased. ApoB was significantly decreased during the HM diet only. Serum triglycerides increased significantly during diets LF (25%, P < 0.01) and HP (19%, P < 0.05) but not during diet HM (5%, NS). CONCLUSIONS: Reduction in the intake of total fat and saturated fatty acids reduced serum LDL-cholesterol and HDL2-cholesterol concentrations irrespective of the relative proportions of MUFA and PUFA in the diets. The results suggest that there might be some advantage in increasing the proportion of MUFA in low-fat diets, since the HM diet rich in MUFA reduced apoB and slightly attenuated the increase in serum triglycerides that is commonly associated with dietary fat reduction.

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Ten middle-aged males participated in a crossover study to determine the cholesterolemic effect of high amounts of stearic acid in a natural diet. They consumed a 20-d stabilization diet followed by two 40-d intervention diets containing either 1.5% of energy as stearic (18:0) acid and 7.3% of energy as palmitic (16:0) acid (low stearate: LS) or 2.4% of energy as 16:0 and 7.3% of energy as 18:0 (high stearate: HS). The experimental diets also contained approximately 10% of energy each as saturated and monounsaturated fatty acids and 7.2-8% of energy as polyunsaturated fatty acids. The primary source of 18:0 in the HS diet was sheanut oil (commercially referred to as shea butter) and palm oil and butter in the LS diet. Plasma total, low-density-lipoprotein, and high-density-lipoprotein cholesterol were significantly lower with the HS than with the LS diet. Total fecal fatty acid excretion was higher throughout the HS period. Apparent digestibility of the major dietary fatty acids showed that all of the selected fatty acids, except 18:0, were > or = 95% absorbed. These data demonstrate that feeding diets containing about two times the usual amount of stearic acid consumed in the United States, contributed to an increase in plasma lipoprotein concentrations at 40 d from an earlier decrease at 20 d. The time required to achieve stable cholesterol concentrations appears to vary depending on the kind of saturated fatty acids present in the diet.

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Ten male subjects were fed a diet rich in stearic acid while they were contained to a metabolic ward. There were three study periods: a 20-d baseline period followed by two 40-d intervention periods. The baseline diet contained 4.4% of energy from stearic acid; one intervention diet was high in stearic acid (7.3% of energy) and the other intervention diet was low in stearic acid (1.6% of energy). The energy contribution of protein, carbohydrate, and fat (16%, 54%, and 30%, respectively) was identical for the two diets. The fat content was distributed equally among saturated, monounsaturated, and polyunsaturated fatty acids. Urinary excretions of thromboxane B2, 2,3-dinor-thromboxane B2, 6-oxo-prostaglandin F1 alpha, and 2,3-dinor-6-oxo-prostaglandin F1 alpha were not significantly different during the two different intervention periods. This suggests that changes in dietary stearic acid do not affect in vivo thromboxane A2 or prostacyclin biosynthesis.

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We examined the effect of dietary alpha-linolenic acid (ALA) on the indices of lipid and coagulation status and on the fatty acid composition of serum and peripheral blood mononuclear cell (PBMNC) lipids in ten healthy men (age 21-37 yr) who consumed all their meals at the Western Human Nutrition Research Center for 126 d. There was a stabilization period of 14 d at the start when all 10 subjects consumed the basal diet (BD) containing 23.4 energy percent (en%) fat and two intervention periods of 56 d each. During the first intervention period, 5 subjects consumed the BD containing 23.4 en% fat, and 5 subjects consumed a diet providing 6.3% calories from alpha-linolenic acid [flaxseed oil (FSO) diet containing 28.8 en% fat]. Diets were crossed over between the two groups during the second intervention period. Feeding the FSO diet did not significantly alter serum triglycerides, cholesterol, high-density lipoproteins, low-density lipoproteins, apoprotein A-I and apoprotein B when compared to the corresponding values in the subjects fed the BD, nor was there any effect of the FSO diet on the bleeding time, prothrombin time and partial prothrombin time for these subjects. Feeding the ALA-containing diet did cause a significant increase in ALA concentration in serum (P < 0.001) and PBMNC lipids (P < 0.05). It also caused a significant increase (P < 0.05) in the eicosapentaenoic and docosapentaenoic acid contents of PBMNC lipids, and a decrease (P < 0.01) in linoleic and eicosatrienoic acid contents of serum lipids.(ABSTRACT TRUNCATED AT 250 WORDS)

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A group of women were fed two separate diets in a crossover study and urinary eicosanoids were quantified. One diet contained 3.1% of total energy (en%) as polyunsaturated fatty acids (3.0 en% linoleic acid) and the other contained 8.4 en% polyunsaturated fatty acids (8.3 en% linoleic acid). Carbohydrate replaced fat in the low-polyunsaturated-fat diet. No changes were observed in the urinary excretion of 6-oxo-prostaglandin F1 alpha, its 2,3-dinor metabolite or thromboxane B2 by subjects on either of the diets. Urinary 2,3-dinor-thromboxane B2 excretion was lower (206.5 ng/24 h) when subjects were fed the high-omega 6 polyunsaturated fatty acid diet when compared with the lower-omega 6 polyunsaturated fatty acid diet (275.3 ng/24 h). Conversely, urinary prostaglandin E2 was higher (139.2 ng/g creatinine) during the higher-omega 6 polyunsaturated fatty acid diet when compared with the lower-omega 6 polyunsaturated fatty acid diet (94.4 ng/g creatinine).

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We examined the effect of the dietary concentration of total fat and n-6 polyunsaturated fatty acids (PUFA) on the immune status of seven healthy women (age 30-65 years) who lived at our metabolic suite. During the first 20 days all subjects consumed a stabilization diet that contained 5.2 energy percent (en%) PUFA and 41.1 en% fat. For the next 40 days, three subjects consumed a diet with 3.2 en% PUFA and 26.1 en% fat, while the remaining four subjects consumed a diet with 9.1 en% PUFA and 31.1 en% fat. For the next 40 days, the diets of the two groups were crossed over. Blastogenesis of peripheral blood mononuclear cells cultured with phytohemagglutinin, concanavalin A, protein A, and pokeweed, and the serum concentrations of complement fractions C3 and C4 were significantly increased upon the feeding of both low fat (26.1 or 31.1 en%) diets compared to the values when the high fat (41.1 en%) diet was fed. None of the indices tested were different when the high PUFA (9.1 en%) and low PUFA (3.1 en%) diets were compared. Our results indicate that low fat diets improve some of the indices of human immune status and that a moderate increase in the level of n-6 PUFA in an otherwise low fat diet does not suppress the human immune system.

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The effect of concentrations of linoleic acid (LA) on platelet aggregation was measured in seven healthy adult males. Subjects were randomly divided into two groups; these groups were fed natural food diets of identical composition except that one was high in LA (11.5% of energy) and low in oleic acid (OA) (7.4% of energy), the other was low in LA (4.5% of energy) and high in OA (15.7% of energy). The thresholds of ADP- and collagen-induced platelet aggregation were increased significantly by the high LA diet even though the intake of total fat and saturated fatty acids did not differ in these diets.

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Low-fat, natural diets were fed to 11 middle-aged, healthy male subjects for two 40-d periods to determine effects on plasma lipoproteins. The diets were designed to maintain saturated and monounsaturated fatty acids at 10 en% and linoleic acid (LA) at 3.8 and 10.8 en%. When compared with baseline concentrations, total cholesterol decreased 10% at the end of the lower LA diet and 15% at the end of the higher LA diet. Low-density-lipoprotein cholesterol (LDL-C) decreased 18% and 22%, respectively, during the same periods. Plasma high-density-lipoprotein cholesterol (HDL-C) at the end of each dietary period was not significantly different but the midpoint values were lower by 12.5% on the lower LA diet and 7.3% on the higher LA diet. Apolipoprotein B decreased 27% at the end of the lower LA diet and 37% at the end of the higher LA diet whereas apolipoprotein A-I increased 18% and 24%, respectively. HDL-C was not reduced by dietary LA over a 6-wk period.

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We examined the effect of dietary alpha-linolenic acid (ALA) on the indices of immunocompetence in 10 healthy free-living men (age 21-37 y) who consumed all meals at the Western Human Nutrition Research Center for 126 d. There was a stabilization period of 14 d at the start when all 10 subjects consumed basal diet (BD) and there were two intervention periods of 56 d each. Five of the subjects consumed the basal diet and the other five consumed flax-seed-oil diet (FD) during each intervention period. Feeding of FD suppressed the proliferation of peripheral blood mononuclear cells when they were cultured with phytohemagglutinin-P (P = 0.041) and concanavalin A (P = 0.054) and the delayed hypersensitivity response to seven recall antigens (NS). Concentrations of immunoglobulins in serum, C3, C4, salivary IgA, the numbers of helper cells, suppressor cells, and total T and B cells in the peripheral blood were not affected by the diets.

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Red blood cell membranes (RBCM) were used to estimate human red blood cell lability to lipid peroxidation in vitro. RBCM were prepared from blood collected from humans fed diets with either 3 or 15% polyunsaturated fatty acids for 80 days. RBCM were isolated by centrifugation, and oxidative stress was induced by in vitro incubation with 0.1 or 0.5 mM tert-butyl hydroperoxide (t-BOOH) in the presence of 0.5 mg added hemoglobin. Lipid Peroxidation was evaluated by measurement of thiobarbituric acid-reactive substances (TBARS). Lipid peroxidation correlated with the protein content of RBCM in both noninduced and t-BOOH-induced lipid peroxidation systems. TBARS production was dependent on the amount of t-BOOH added to the RBCM. The production of TBARS by RBCM incubated with 0.5 mM t-BOOH was correlated with arachidonic acid content in the red blood cells (RBC) from which RBCM were prepared. The methodology developed was useful for comparative estimations of the lability of RBCM to lipid peroxidation.

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The regulation of blood pressure by dietary means represents an important approach toward the reduction of morbidity and mortality of heart disease. The results of our dietary intervention studies demonstrated that a lowered saturated fat, higher polyunsaturated fat diet had a lowering effect on both systolic and diastolic blood pressure, and a lowering effect on blood lipids. These beneficial effects were accomplished without drastic changes in the typical Western diet. The amount of meat, dairy products, fish and eggs was not altered from the usual intake, while the intake of fruits, vegetables and grains increased. As a consequence of altering the diet, we have found that the blood pressure lowering effect appears to be mediated through linoleic acid (n-6). It is evident from these results that the role of diet must be given serious consideration for the control of blood pressure.

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A significant reduction in blood pressure has been observed during low-fat high poly unsaturated fattyacids/saturated fattyacid--ratio diets in a series of studies conducted in the U.S. and Finland. The results suggest the active role of linoleic acid but the effects of decreased intake of saturated fats and the concomitant changes in the intake of other dietary components cannot be ruled out.

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When the fat content of the typical US diet was reduced from 40 to 44% of total energy (en %) to approximately 25 en % there was a marked improvement in the overall nutrient content of the diet. Cholesterol, saturated fatty acid, and monounsaturated fatty acid intake were decreased and the polyunsaturated fatty acid content was moderately increased. This kind of dietary change was achieved without changing the usual intake of meats, dairy products, fish, and eggs. As the amount of fat was decreased, carbohydrates in the form of grains, fruits, and vegetables were increased, providing an improvement in the vitamin and mineral content of the diet. Vitamin C, thiamin, riboflavin, niacin, B-6, B-12, and folates increased in the 25 en % diet. Potassium, calcium, magnesium, phosphorus, iron, zinc, and copper intake also increased when the dietary fat decreased.

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Three controlled dietary intervention studies were carried out in 1981-1983 in North Karelia, Finland, to asses the impact of dietary fat intake modification on blood pressure (BP). All these studies involved middle-aged men and women in rural or semirural areas and comprised a baseline period, a six week (or 12 weeks in the third study) intervention period and a four to six week return to baseline. During the intervention period the total fat intake was reduced from 39% to 24% of energy and the polyunsaturated/saturated (P/S) ratio increased from 0.2 to 0.4-1.2. In all groups energy intake was kept constant. For the present report data from the three studies were pooled for a series of stepwise regression analyses to predict changes in BP with different dietary changes. For both systolic (SBP) and diastolic (DBP) blood pressure, change in polyunsaturated fatty acid intake was the strongest dietary predictor of BP change. Changes in body weight, total fat intake, urinary sodium and potassium did not have significant predictive power in any of the analyses. The findings support the hypothesis that modification of dietary fat intake is a significant predictor of change in BP.

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This article reviews data obtained from a series of dietary intervention studies conducted in the United States, Finland, and Italy. The objectives were to determine the effects of reducing animal fat consumption while moderately increasing polyunsaturated fatty acid (PUFA), on blood pressure and lipoproteins. Although the diet was modified to improve risk factors related to cardiovascular disease, it is apparent that the dietary intervention would also apply to cancer. The results obtained for men and women, ages 35-65 years, indicate that plasma total cholesterol and low-density and high-density lipoprotein cholesterol were reduced; blood pressure was reduced among both normotensives and hypertensives; daily intake of meat and dairy products were not reduced but were much lower in fat; carbohydrates were substituted as fruits, vegetables, and grains, which provided more vitamins and minerals; and salt intake was maintained at a level of 8-12 g per day. From the data obtained for lowering blood pressure, it would appear that the requirement for PUFA is between 5 and 10 en%, which is somewhat higher than the recommended dietary allowances but lower than that recommended by health agencies. The results of these studies give support to current dietary recommendations to reduce the risk of cardiovascular disease as well as cancer by dietary intervention.

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