3/8/17 1 The Role of Dietary Fats and Cardiovascular Disease & The Effect of Avocados March 20, 2017 Martha Gulati, MD, MS, FACC, FAHA, FASPC Professor of Medicine in the Division of Cardiology Chief, Section of Cardiology Editor-in-Chief, CardioSmart University of Arizona-Phoenix Phoenix, AZ Cardiovascular Disease Mortality trends for Males and Females (United States: 1979–2014). Benjamin, EJ et al. Circulation. 2017 Released January 25, 2017
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3/8/17
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The Role of Dietary Fats and Cardiovascular Disease & The Effect
of AvocadosMarch 20, 2017
Martha Gulati, MD, MS, FACC, FAHA, FASPCProfessor of Medicine in the Division of Cardiology
Chief, Section of CardiologyEditor-in-Chief, CardioSmart
University of Arizona-PhoenixPhoenix, AZ
Cardiovascular Disease Mortality trends for Males and Females (United States: 1979–2014).
Benjamin, EJ et al. Circulation. 2017 Released January 25, 2017
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AHA Life’s Simple 7: Health of the Nation (Adults)
Benjamin, EJ et al. Circulation. 2017 Released January 25, 2017
AHA Life’s Simple 7: Health of the Nation (Children)
Benjamin, EJ et al. Circulation. 2017 Released January 25, 2017
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1000
1250
1500
1750
2000
2250
2500
2750
Total Calories
1970 1980 1990 2000 2010
http://www.usda.gov/factbook/chapter2.pdf
Low fat = more added fat and sugar
0
25
50
75
100
Added Fats %
1970 1980 1990 2000 2010
http://www.usda.gov/factbook/chapter2.pdf
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http://www.usda.gov/factbook/chapter2.pdf
333 335 369 420 373
409 437540 596 581
346 372411
545 575
1970 1980 1990 2000 2010
Fat
Grain
Sugar
http://www.usda.gov/factbook/chapter2.pdf
129 123 132 141 126
50 46.1 57.3 57.4 71.5
67 7781 88 8116.4 17.4
20.7 20.8 2231.14 55.4674.38
87.84 96.25
1970 1980 1990 2000 2010
Cheese
Fish
Fruit
Nuts
Veg
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Diets and CAD: What’s the Evidence?
§ Dietary therapy can be an alternative to pharmacologic management of lipids in primary prevention
§ Important adjunctive therapy in secondary prevention
§ What is the best diet for CHD prevention?
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East Finland
Crete
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Adherence to Mediterranean Diet and Survival in a Greek Population
§ Prospective, population-based observational investigation of CHD mortality versus diet
§ 22,043 healthy adults in Greece§ 44-month follow-up§ Diet assessed by 10-point scale (0-9)
§ vegetables, legumes, fruits and nuts, cereals, fish, alcohol, monounsaturated/saturated fat ratio (+)
reduction§ 2-point increase in Mediterranean diet score
§ 25% reduction in total mortality§ 33% reduction in CHD mortality§ 24% reduction in cancer mortality
§ Adjusted for age, sex, WHR, energy expenditure, smoking, BMI, potato and egg consumption, and total caloric intake
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Diet-Heart Studies with OutcomesTrial N Year f/uEngland (Rose) 80 1965 2yMiddlesex 264 1965 5y Oslo 412 1966 5yLondon 393 1968 5ySydney 458 1978 5yDART 2033 1989 2yMoradabad 505 1992 1yLHT (invite) 48 1998 5yLyon 423 1999 4yPREDIMED 7447 2013 4.8y
Intervention control v corn oil v olive oilcontrol v low fatcontrol v low fat + PUFcontrol v soya-bean oilcontrol v low fat + PUFlow fat v fish v fiberlow fat v fruit/veg+fish+fibercontrol v ultra-low fatcontrol v MediterraneanControl v Med+EVOO or
nuts
Lifestyle Heart Trial
§ Randomized invitational design (recruitment in ~1987)
lower cholesterol§ Low glycemic index, especially if overweight§ Calorie control should be automatic
§ Low caloric density CHO’s§ Satiety from monounsaturated fats, proteins
§ Highly palatable§ Variety of foods and seasonings
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PREDIMED
Estruch R et al. N Engl J Med 2013;368:1279-90.
• 7447 people high CV risk• No known CVD• Randomized to
• Med diet + EVOO (1 L per week)• Med diet + nuts (30 grams per day)• Control (+ small food gifts)
• Followed median 4.8 years
PREDIMED
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Dietary QualityLowering Heart Disease Risk
Diet QualityEat more:
….Mediterranean Diet
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OVERVIEW:
§ Pilot study of 11 healthy men (18-35 years old)
§ The study investigated the effects of adding one-half of a fresh medium Hass avocado to a hamburger (90 percent lean) on peripheral arterial blood flow (the movement of blood to different parts of the body) and inflammation compared to a burger without avocado.
§ Eating one-half of a fresh medium Hass avocado with a burger (90 percent lean)
§ Reduced Inflammation within hours§ Reduced Narrowing of Blood Vessels within hours
§ When fresh avocado was eaten with a burger there was no increase in triglyceride levels beyond what was observed after eating the burger alone despite the extra calories and monounsaturated fat from the avocado.
Li et al. Food & Function. 2013
Avocados: What is the Evidence?
Avocados: What is the Evidence?
RCT, crossover, controlled feeding trial was conducted with 45 overweight or obese participants with LDL-C in the 25-90th percentile.
Participants consumed a typical American diet (34% fat, 51% carbohydrate and 17% protein) for two weeks prior to their baseline blood draw and randomization into one of three diets for five weeks each. Participants followed their normal eating pattern for two to three weeks in between each five week dietary intervention.Three cholesterol-lowering diets (6% to 7% SFA) were fed (5 weeks each):
§ a lower-fat diet (LF: 24% fat); 6-7% of saturated fat energy from the typical American diet was replaced with complex carbohydrates mainly from grains.
§ moderate-fat diets (34% fat)- Avocado Diet (one fresh Hass avocado (136 g) per day
§ moderate-fat diet (MF) mainly used high oleic acid oils (sunflower oil and canola oil) to match fatty acid content of one avocado.
Impact of avocado-enriched diets on plasma lipoproteins
Peou et al Journl of Clinical Lipidology 2016; 10;161-71
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Composition of an Avocado (1 ~ 140g)
Fresh Avocados – Love One Today® is proud to support the American Heart Association’s® Healthy for Good Movement§ National Recipe Host
§ The American Heart Association recommends an overall healthy eating pattern that emphasizes fruits and vegetables first. Fresh avocadoes can be a delicious part of this healthy eating pattern.