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Olive oil and veggies help the heart

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It's no secret that eating well is good for both body and mind, so it may not come as a surprise that a new study finds women who eat more olive oil and leafy vegetables such as salads and cooked spinach are significantly less likely to develop heart disease.A group of Italian researchers found that women who ate at least 1 serving of leafy vegetables per day were more than 40 percent less likely to develop heart disease over an average of eight years, relative to women who ate two or fewer portions of those vegetables each week. Women who downed at least 3 tablespoons of olive oil daily – such as in salad dressing – were also 40 percent less likely to be diagnosed with heart disease, compared to women who ate the least olive oil.

It's not exactly clear why specifically leafy vegetables and olive oil may protect the heart, said study author Dr. Domenico Palli of the Cancer Research and Prevention Institute in Florence. “Probably the mechanisms responsible for the protective effect of plant-origin foods on cardiovascular diseases involve micronutrients such as folate, antioxidant vitamins and potassium, all present in green leafy vegetables.” Folate reduces blood levels of homocysteine, Palli explained, which is thought to increase the risk of cardiovascular disease by damaging the inner lining of arteries. Other studies have shown people who eat more potassium have lower blood pressure, which can protect the cardiovascular system. Virgin olive oil may be particularly effective at lowering heart disease risk because of its high level of antioxidant plant compounds, he added.

This is not the first study to link olive oil or vegetables to good heart health. Most famously, the traditional Mediterranean diet — rich in vegetables and monounsaturated fats from olive oil and nuts, but low in saturated fat from meat and dairy — has been tied to a decreased risk of heart disease. Mediterranean-style eating has also been credited with lowering risk for some cancers, diabetes, and, more recently, with slowing brain aging. Cardiovascular disease is a major killer, responsible for 30 percent of all deaths worldwide and the leading cause of death for both men and women in the U.S.

To look more closely at the role of foods in protecting against heart disease, Palli and colleagues reviewed dietary information collected from nearly 30,000 Italian women participating in a large national health study. Researchers followed the women, whose mean age was 50 at the beginning of the study, for an average of 8 years, noting who developed heart disease. In that time, the women experienced 144 major heart disease-related events, such as heart attack or bypass surgery, the authors report in the American Journal of Clinical Nutrition. Women who ate at least one daily serving (about two ounces) of leafy vegetables – such as raw lettuce or endives, or cooked vegetables like spinach or chard — had a 46 percent lower risk of developing heart disease than women who ate at most two portions per week. Consuming at least an ounce of olive oil per day lowered their risk by 44 percent relative to women who consumed a half-ounce or less daily, the authors found.

The women's intake of other types of vegetables, such as roots and cabbages, and their consumption of tomatoes or fruit did not seem to be linked to their risk for major heart events. Both fruits and vegetables have been associated with heart benefits in past studies conducted elsewhere in Europe and in North America. The authors caution that the apparent lack of positive effect from high fruit consumption in their results may have something to do with a different attitude toward fruit in Italy. It is cheap, varied and easily available, so eating a lot of fruit is a widespread habit but it does not necessarily signal that the rest of someone's diet is as healthy, the authors wrote. Another issue with the study, Palli noted, is that women had to report how much they ate of various items, and some may not have remembered their diets accurately, or may have changed their eating habits during the study period. In addition, people sometimes over-estimate their healthy behaviors, believing they eat healthier than they really do.

SOURCE: American Journal of Clinical Nutrition, published online December 22, 2010.

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Stroke deaths higher where fried fish aplenty

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The steep rate of death from stroke in a swath of Southern states often referred to as America's “stroke belt” may be linked to a higher consumption of fried fish in that region, new research suggests. A study published in the journal Neurology shows people living in the stroke belt — which comprises North Carolina, South Carolina, Georgia, Alabama, Mississippi, Tennessee, Arkansas and Louisiana — eat more fried fish and less non-fried fish than people living in the rest of the country, and African-Americans eat more fried fish than Caucasians. “Differences in dietary fish consumption, specifically in cooking methods, may be contributing to higher rates of stroke in the stroke belt and also among African Americans,” says study author Fadi Nahab, medical director for the Stroke Program at Emory University Hospital in Atlanta.

The research, part of a large government-funded study, Reasons for Geographic and Racial Differences in Stroke (REGARDS), involved 21,675 participants from across the country; the average age was 65. Of the participants, 21% were from the “stroke buckle,” the coastal plain region of North Carolina, South Carolina and Georgia where stroke mortality rates are even higher than they are in the rest of the stroke belt. Another 34% were from the rest of the stroke belt and 44% were from the other states.

Participants were interviewed by phone and then given an in-home physical exam. The questionnaire asked how often they ate oysters, shellfish, tuna, fried fish and non-fried fish. The American Heart Association recommends people eat fish high in omega-3 fatty acids—essential fatty acids humans get through their diet—at least twice a week, baked or grilled but not fried. Fewer than one in four overall ate two or more servings of non-fried fish a week. Stroke belt residents were 32% more likely to eat two or more servings of fried fish each week than those in the rest of the country.

African-Americans were more than 3.5 times more likely to eat two or more servings of fried fish each week than Caucasians, with an overall average of about one serving per week of fried fish compared with about half a serving for Caucasians. When it came to eating non-fried fish meals, stroke belt residents ate an average of 1.45 servings per week, compared with 1.63 servings eaten by people elsewhere.

“This is good stuff. It's a well-done study, but I think one thing to bear in mind is that it's not specifically a study of stroke risk. You're looking at a community and seeing how it's behaving on the whole,” says Daniel Labovitz, a stroke neurologist at Montefiore Medical Center in the Bronx. “This study can't tell you causation. It can't tell you there's a direct link between one thing and another, it just tells you they're associated,” says stroke neurologist Victor Urrutia, an assistant professor at Johns Hopkins University School of Medicine.

How might eating fried fish impact stroke?

It could be that frying the fish leaches out the omega-3s, says Jeremy Lanford, stroke director at Scott & White Healthcare in Roundrock, Texas. Or the increased fat calorie content from the frying oil may contribute to stroke, says author Nahab. He also notes that fish used for frying, such as cod and haddock, tend to be the types lower in healthy fats. More research is needed to tease out whether cooking methods affect stroke risk, Labovitz says. “In other words, is fried fish a problem, or is it another red herring?” he says.

The study was supported by the National Institute of Neurological Disorders and Stroke, the National Institutes of Health, and the Department of Health and Human Services. Funding was provided by General Mills for coding of the food frequency questionnaire.

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Replace Saturated Fat with Polyunsaturated Dat

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Over the past several decades, the food industry has reduced the amount of saturated fat in many products, and the public has reduced the amount of saturated fat in their diet. However, there has been a wide variation in the types of nutrients that have replaced this saturated fat. For example, in many products saturated fats were replaced with trans fats, which have since been determined to be detrimental; and in the overall American diet saturated fat was generally replaced with increased consumption of refined carbohydrates and grains.

“The specific replacement nutrient for saturated fat may be very important,” said lead author Dariush Mozaffarian, assistant professor in the department of epidemiology at HSPH and the department of medicine at Harvard Medical School. “Our findings suggest that polyunsaturated fats would be a preferred replacement for saturated fats for better heart health.”

Results from prior individual randomized controlled trials of saturated fat reduction and heart disease events were very mixed, with most showing no significant effects. Other trials focused only on blood cholesterol levels, which are an indirect marker of risk. Large observational studies have also generally shown no relationship between saturated fat consumption and risk of heart disease events; for example, earlier this month in the American Journal of Clinical Nutrition, researchers from HSPH and Children's Hospital Oakland Research Institute performed a pooled meta-analysis of prior observational studies and found no evidence that overall consumption of saturated fat was related to risk of coronary heart disease or stroke events.

Some of these mixed findings may relate to absence of prior focus on the specific replacement nutrient for saturated fat; in other words, was saturated fat replaced primarily with carbohydrate, monounsaturated fats such as in olive oil, or polyunsaturated fats such as in most vegetable oils?

Mozaffarian and his HSPH colleagues, Renata Micha and Sarah Wallace, performed a systematic review and meta-analysis of all randomized controlled trials through June 2009 in which participants specifically increased their polyunsaturated fat consumption as a replacement for saturated fat and in which coronary heart disease events were documented. Eight trials met the inclusion criteria, totaling 13,614 participants with 1,042 coronary heart disease events.

The meta-analysis of the trials showed that increasing polyunsaturated fat consumption as a replacement for saturated fat reduced the risk of coronary heart disease events by 19%. For every 5% increase (measured as total energy) in polyunsaturated fat consumption, coronary heart disease risk was reduced by 10%. This is now just the second dietary intervention–consuming long-chain omega-3 fatty acids is the first — to show a reduction in coronary heart disease events in randomized controlled trials.

Currently, the Institute of Medicine guidelines recommend that a range of 5%-10% energy consumption come from polyunsaturated fats. In addition, some scientists and organizations have recently suggested that consumption of polyunsaturated fats (largely “omega-6” fatty acids) should actually be reduced due to theoretical concerns that such consumption could increase coronary heart disease risk.

The results from this study suggest that polyunsaturated fats from vegetable oils may be an optimal replacement for saturated fats, an important finding for dietary guidelines and for when food manufacturers and restaurants are making decisions on how to reduce saturated fat in their products. The findings also suggest that an upper limit of 10% energy consumption from polyunsaturated fats may be too low, as the participants in these trials who reduced their risk were consuming about 15% energy from polyunsaturated fats.

Support for this study was provided by the National Heart, Lung, and Blood Institute, NIH and a Searle Scholar Award from the Searle Funds at the Chicago Community Trust.

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Trans Fats Interfere with Blood Flow

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Trans fats are made through hydrogenation, which involves bubbling hydrogen through hot vegetable oil, changing the arrangement of double bonds in the essential fatty acids in the oil and “saturating” the “unsaturated” carbon chain with hydrogen. Because double bonds are rigid, altering them can straighten or twist fat molecules into new configurations that give the fats their special qualities, such as the lower melting point of margarine that makes it creamy at room temperature.

Kummerow, 94, has spent nearly six decades studying lipid biochemistry, and is a long-time advocate for a ban on trans fats in food.

While the body can use trans fats as a source of energy for maintenance and growth, Kummerow said, trans fats interfere with the body's ability to perform certain tasks critical to good health. Because these effects are less obvious, many researchers have missed the underlying pathologies that result from a diet that includes trans fats, he said.

Trans fats displace – and cannot replace – the essential fatty acids linoleic acid (omega-6) and linolenic acid (omega-3), which the body needs for a variety of functions, including blood flow regulation. Studies have shown that trans fats also increase low-density lipoproteins (LDLs) in the blood, a factor which some believe contributes to heart disease.

Trans fats are associated with increased inflammation in the arteries. And trans fats have been found to change the composition of cell membranes, making them more leaky to calcium. Inflammation, high LDL cholesterol and calcified arteries are the signature ingredients of atherosclerosis.

Trans fats also were shown to interfere with an enzyme that converts the essential fatty acid linoleic acid into arachidonic acid, which is needed for the production of prostacyclin (a blood-flow enhancer) and thromboxane (which regulates the formation of blood clots needed for wound healing). While some in the food oil industry believed this problem could be overcome simply by adding more linoleic acid to partially hydrogenated fats, in 2007 Kummerow's team reported that extra linoleic acid did not overcome the problem.

“Trans fats inhibited the synthesis of arachidonic acid from linoleic acid, even when there was plenty of linoleic acid available,” he said.

The new study reports that in addition to interfering with the production of arachidonic acid from linoleic acid, trans fats also reduce the amount of prostacyclin needed to keep blood flowing. Thus blood clots may more easily develop, and sudden death is possible.

According to the American Heart Association, each year more than 330,000 people in the U.S. die from coronary heart disease before reaching a hospital or while in an emergency room. Most of those deaths are the result of sudden cardiac arrest, the Heart Association reports.

“This is the first time that trans fatty acids have been shown to interfere with yet another part of the blood-flow process,” Kummerow said. This study adds another piece of evidence to a long list that points to trans fats as significant contributors to heart disease, he said.

Kummerow believes the U.S. Food and Drug Administration's new requirement (begun in 2006) that trans fats be included on food labels is inadequate and misleading. Anything less than one-half gram of trans fats per serving can be listed as zero grams, Kummerow said, so people are often getting the mistaken impression that their food is trans fat-free.

“Go to the grocery store and compare the labels on the margarines,” he said. “Some of them say zero trans fat. That's not true. Anything with partially hydrogenated oils in it contains trans fat.”

“Partially hydrogenated fats can be made trans fat-free,” Kummerow said. “The industry would be helped by an FDA ban on trans fat that would save labeling costs, medical costs and lives.”

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