Το είδος του λίπους έχει σημασία. Η μεσογειακή διατροφή είναι η απάντηση

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1 ΣΥΓΧΡΟΝΕΣ ΑΝΑΨΗΛΑΦΗΣΕΙΣ ΕΔΡΑΙΩΜΕΝΩΝ ΓΝΩΣΕΩΝ Λιπίδια και καρδιαγγειακά νοσήματα. Αναθεωρημένες απόψεις σχετικά με την υγιεινή διατροφή: Η μεγάλη διαμάχη Το είδος του λίπους έχει σημασία. Η μεσογειακή διατροφή είναι η απάντηση Αντωνία Τριχοπούλου Ελληνική Εταιρεία Καρδιαγγειακής Υγείας Αθήνα, 16 Ιανουαρίου

2 Athens, 1986

4 1993

5 Ελαιόλαδο και παχυσαρκία Τυχαιοποιημένη κλινική μελέτη σύγκρισης δύο ενεργειακά ισoδύναμων τύπων διατροφής Ομάδα Ι: Μεσογειακή διατροφή (35% της ενέργειας από λιπίδια) Ομάδα ΙΙ: Δίαιτα χαμηλή σε λιπαρά (20% της ενέργειας από λιπίδια) Μετά από 18 μήνες: Ομάδα Ι: Μέση μεταβολή βάρους - 4 kg (46% εγκατέλειψαν) Ομάδα ΙΙ: Μέση μεταβολή βάρους + 2 kg (88% εγκατέλειψαν) Η Μεσογειακή Διατροφή ενδέχεται να πλεονεκτεί για την απώλεια βάρους, και γιατί επιτρέπει τη μακροπρόθεσμη υιοθέτηση αυτής. Προϋπόθεση είναι η μείωση των καταναλισκόμενων θερμίδων και η σωματική άσκηση. Mc Manus et al. Int. J. Obes. 2001

7 Weight loss with different diets Shai et al., NEJM years trial: 233 moderately obese subject Three diets: low-carb, low-fat, Mediterranean

8 Weight loss with different diets Weight changes during 2 years according to diet Shai et al., NEJM 2008

9 Weight loss with different diets Mediterranean and low-carbohydrate diets may be effective alternatives to low-fat diets. More favorable effects on lipids (with the low-carbohydrate diet) and on glycemic control (with the Mediterranean diet). Shai et al., NEJM 2008

10 Ελαιόλαδο Σύσταση 1. Τριακυλγλυκερόλες (κυρίως μονοακόρεστων λιπαρών οξέων) και μικρό ποσοστό ελεύθερων λιπαρών οξέων 2. Ποικιλία μικροσυστατικών σε ποσοστό περίπου 1-2% (π.χ. φυτοστερόλες, φαινόλες, υδρογονάνθρακες, αρωματικές ουσίες)

11 Μονοακόρεστα λιπαρά του ελαιολάδου και στεφανιαία νόσος Κλινικές μελέτες συσχετίζουν την κατανάλωση των μονοακόρεστων λιπαρών οξέων του ελαιολάδου με μείωση των επιπέδων ολικής και κακής (LDL) χοληστερόλης. Jansen et al. 2000, Fuentes et al. 2001, Mata et al Kris-Etherton et al

12 Effects of oleate-rich and linoleate-rich diets on the susceptibility of low density lipoprotein to oxidative modification in mildly hypercholesterolemic subjects Oleate-rich LDL is less susceptible against oxidative modification than linoleate-rich LDL Reaven et al. J Clin Invest 1993

13 OLIVE OIL COMPONENTS Major components: Fatty acids Saturated (8-14%) Monounsaturated (oleic acid 55-83%) Polyunsaturated (4-20%) Minor components: Squalene, Sterols, triterpenes Vitamin E, Beta-carotene Phenolic compounds (tyrosol, hydroxytyrosol, oleuropeine, lignanes).

14 Main classes of antioxidant compounds reported to be present in virgin olive oil Chemical Class Subclass Phenolic acids Tyrosol, hydroxytyrosol and derivatives Phenolic compounds Lignans Flavonoids Tocopherols Closely related non-phenolic compounds Hydrocarbons Chlorophylls Carotenoids Triterpenes (mainly squalene) Chlorophyll and derivatives Carotenes (Hydrocarbons) Xanthophylls 1 Trichopoulou, A., & Dilis, V. (2007). Olive oil and longevity. Mol Nutr Food Res, 51,

15 Phenolic compounds in virgin and refined olive oils Olive oil phenolic compounds Extra virgin olive oil mg/ Kg (±SEM) Refined olive oil mg/ Kg (±SEM) Total olive oil phenolic compounds 232 (±15) 62 (±12) Owen et al. Lancet Oncol. 2000

16 Phenolic compounds in virgin olive oil have shown antioxidant and antiinflammatory properties prevention of lipoperoxidation induce favorable changes of the lipid profile improve endothelial function disclose antithrombotic properties

18 Vascular effects of the Mediterranean diet part I: anti-hypertensive and anti-thrombotic effects Substantial increase of FVII coagulant activity (FVIIc) occurs within 2-3h after a fatty meal and persists for several hours thereafter. When a background diet high in MUFA is consumed a lower post-prandial increase of FVIIc takes place Capurso C. Vascul Pharmacol. 2014

19 The effect of polyphenols in olive oil on heart disease risk factors: a randomized trial 200 healthy individuals from 6 Centres of 5 European countries OO low phenolic content OO medium phenolic content OO high phenolic content 2.7 mg/kg 164 mg/kg 366 mg/kg Covas MI et al. Ann Int Med. 2006

20 The increase in HDL cholesterol and the decrease in oxidative damage to lipids were observed in a dose-dependent manner with the phenolic content of the olive oil Covas MI et al. Ann Int Med

21 Olive oil and the haemostatic system A diet enriched in virgin olive oil reduce the sensitivity of platelets to aggregation decreasing von Willebrand and tromboxane B2 plasma levels Lopez-Miranda et al. Mol Nutr Food Res. 2007

22 Vascular effects of the Mediterranean diet part I: anti-hypertensive and anti-thrombotic effects Substantial increase of FVII coagulant activity (FVIIc) occurs within 2-3h after a fatty meal and persists for several hours thereafter. When a background diet high in MUFA is consumed a lower post-prandial increase of FVIIc takes place Capurso C. Vascul Pharmacol. 2014

23 Effect of virgin olive oil and thyme phenolic compounds on blood lipid profile: implications of human gut microbiota The ingestion of a PC-enriched virgin olive oil, containing a mixture of olive oil and thyme PC for 3 weeks decreases blood ox-ldl in hypercholesterolemic humans. This cardio-protective effect could be mediated by the increases in populations of bifidobacteria together with increases in PC microbial metabolites with antioxidant activities Martin-Pelaez S et al. Eur J Nutr. 2015

24 Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Total Mortality Estruch R. et al. NEJM 2013

25 Adherence to a Μediterranean diet and survival in a Greek population per 2-unit increase in Mediterranean diet score A higher degree of adherence to the Mediterranean diet was associated with a significant reduction in : total mortality adjusted mortality ratio 0.75 coronary heart disease adjusted mortality ratio 0.67 Trichopoulou et al. NEJM 2003 cancer adjusted mortality ratio 0.76

26 Mediterranean diet and survival of coronary patients: EPIC-Greece cohort a 2-unit increase in Mediterranean diet score was associated with 27 % reduction in overall mortality among individuals diagnosed as having coronary heart disease Trichopoulou et al. Arch Intern Med

27 Mediterranean diet and survival of coronary patients: EPIC-Greece cohort The reduced mortality amounted to 31% when only cardiac deaths were considered as the relevant outcome Trichopoulou et al. Arch Intern Med 2005

28 EFSA Scientific Opinion on the substantiation of health claims polyphenols in olive and protection of LDL particles from oxidative damage..in order to bear the claim, 5 mg of hydroxytyrosol and its derivatives (e.g. oleuropein complex and tyrosol) in olive oil should be consumed daily. These amounts, if provided by moderate amounts of olive oil, can be easily consumed in the context of a balanced diet. The concentrations in some olive oils may be too low to allow the consumption of this amount of polyphenols in the context of a balanced diet. 28

29 The benefits of olive oil consumption are becoming increasingly recognized 2004, FDA eating about 2 tablespoons (23 grams) of olive oil daily may reduce the risk of coronary heart disease source:

30 Ευχαριστώ για την προσοχή της

31 ΕΛΑΙΟΥΧΑ ΣΠΕΡΜΑΤΑ ΚΑΙ ΚΑΡΠΟΙ Πίεση / έκθλιψη (καρποί και σπέρματα με υψηλή περιεκτικότητα σε έλαιο όπως η ελιά, το σησάμι και το φιστίκι) Εκχύλιση με διαλύτη (π.χ σόγια) ΑΚΑΤΕΡΓΑΣΤΟ (CRUDE) ΛΙΠΟΣ Η ΕΛΑΙΟ Παρθένο Ελαιόλαδο και σησαμέλαιο 1. Αποκομμίωση (degumming) 2. Εξουδετέρωση (neutralization) 3. Αποχρωματισμός (bleaching) = Εξευγενισμός ή Ραφινάρισμα (refining) 4. Απόσμηση (deodorization) ΕΔΩΔΙΜΟ ΛΙΠΟΣ Η ΕΛΑΙΟ

ΠΟΣΟΣΤΑ ΛΙΠΩΝ ΚΑΙ ΕΛΑΙΩΝ (%) ΧΡΗΣΗ ΠΡΟΣΤΙΘΕΜΕΝΩΝ ΛΙΠΩΝ ΚΑΙ

76,2 70,0 69,6 66,3 ΒΟΥΤΥΡΟ 60,0 ΜΑΓΕΙΡΙΚΟ ΛΙΠΟΣ ΜΑΡΓΑΡΙΝΗ

ΠΡΟΣ/ΜΟΥ 30,0 20,0 10,0 0,0 22,9 17,0 16,0 7,5 0,2 3,6 4,2

33 ΠΟΣΟΣΤΑ ΛΙΠΩΝ ΚΑΙ ΕΛΑΙΩΝ (%) ΧΡΗΣΗ ΠΡΟΣΤΙΘΕΜΕΝΩΝ ΛΙΠΩΝ ΚΑΙ ΕΛΑΙΩΝ ΑΝΑ ΤΡΟΠΟ ΜΑΓΕΙΡΕΜΑΤΟΣ (%) 100,0 93,4 90,0 80,0 76,2 70,0 69,6 66,3 ΒΟΥΤΥΡΟ 60,0 ΜΑΓΕΙΡΙΚΟ ΛΙΠΟΣ ΜΑΡΓΑΡΙΝΗ 50,0 ΕΛΑΙΟΛΑΔΟ ΣΠΟΡΕΛΑΙΑ 40,0 ΑΝΕΥ.ΠΡΟΣ/ΜΟΥ 30,0 20,0 10,0 0,0 22,9 17,0 16,0 7,5 0,2 3,6 4,2 2,2 0,4 0,3 0,4 1,4 0,5 0,1 0,0 0,5 0,0 0,3 0,3 ΒΡΑΣΤΟ ΜΑΓΕΙΡΕΥΤΟ ΨΗΤΟ ΤΗΓΑΝΙΤΟ 17,0

34 Common Dietary Sources of Polyunsaturated Fatty Acid

35 Detailed Fatty Acid Composition of Dietary Fats Commonly Used in Experimental Studies Percent of total fatty acids" Fatty acid Name Butter fat (saturated) Corn oil ω-6) Salmon oil (ω-3) 4:0-12: :0 Myristic :0 Palmitic IS 16:1 ω-7 Palmitoleic 2 trace 6 18:0 Stearic :1ω9 Oleic :2 ω-6 Linoleic :3 ω-3 Linolenic 1 I 1 20:1 ω-9 Eicosenoic 10 20:4 ω-6 Arachidonic trace trace 20:5 ω-3 Eicosapentaenoic 9 22:1 ω-11 Cetoleic 9 22:5 ω-3 Docosapentaenoic 3 22:6 ω-3 Docosahexaenoic 8 Polyunsatu- rated/satura ted Iodine value *Trace = < 1%.

36 Major Families of Polyunsaturated Fatty Acids Family designation Parent fatty acid Major metabolites Characteristic strucutre Principal sources ω-9 C18:1 ω-9 oleic acid C20:30 ω-9* eicostrienoic acid H 3 C-C-C-C-C-C-C-C-C 9 = C-RCOOH Synthesis from acetate; animal and vegetable fats ω-6 C18:2 ω-6 linoleic acid C20:4 ω-6 arachidonic acid H 3 C-C-C-C-C-C-C 6 =C- R COOH Many vegatable oils ω-3 C18:3 ω-3 linoleic acid C20:5 ω-3 eicosapentaenoic acid H 3 C-C-C 3 =C-R COOH Some vegetable oils, leaves (18:3) C22:6 ω-3 docosahexaenoic Marine oils (20:5, 22:6) *Accamulates only in essential fatty acid deficiency

37 Typical Acid Composition of the Principal Vegetable Oils and Animal Fats* oil Oil or Fat Coconut Saturated 92 % of Total Fatty Acids+ Monounsaturated 6 Polyunsaturated 2 Palm kernel oil Butterfat Cocoa butter Palm oil Beef tallow Lard Cottonseed oil Olive oil Soybean oil Peanut oil Com oil Sunflower oil Safflower oil Low-erucic acid rapeseed oil (canola oil) * Adapted from Food Fats and Oils9 + Component fatty acids may not add to 100% because of rounding

38 Saturated Fatty Acid Composition of Some Vegetable Oils and Animal Fats* % of Total Fatty Acids Caproic Caprylic Capric Laurie Myristic Palmitic Steari c Oil or Fat (5)+ (8) (10) (12) (14) (16) (18) Beef tallow Coconut oil Corn oil Cottonseed oil Lard Palm oil Palm kernel oil * Adapted from Food Fats and Oils. + Numbers in parentheses indicate the number of carbon atoms.

39 Detailed Fatty Acid Composition of Dietary Fats Commonly Used in Experimental Studies Percent of total fatty acids* Fatty acid Name Butter fat (saturated) Corn oil (ω-6) Salmon oil (ω-3) 4:0-12: :0 16:0 Myristic Palmitic :1 ω-7 Palmitoleic 2 trace 6 18:0 Stearic :1 ω-9 Oleic :2ω-6 Linoleic :3ω-3 Linolenic :1 ω-9 Eicosenoic :4 ω-6 Arachidonic trace - trace :5 ω-3 22:1 ω-ll 22:5 ω-3 22:6 ω-3 Eicosapentaenoic Cetoleic Docosapentaenoic Docosahexaenoic Polyuns aturated/ saturated Iodine value * Trace = <1%

40 Typical Fatty Acid Composition ol the Princoal Vegetable Oils and Arwnaf Fats* Oil or Fat % o< Total Facy Aoctst Saturated Monounsaturated Polyu maturated Coconut oil Palm kernel oil Butterfat Cocoa butter Palm oil 50 4O 10 Beef tallow Lard Cottonseed oil Olive oil Soybean oil Peanut oil Com oil Sunflower oil Safftower oil Low-erucic acid rapeseed oil (canola oil) "Adapted Irom food Fats and Oils.' tcomponent fatty acids may not add to 100 because & rounding.

41 Saturated Fatty Acid Composition of Some Vegetable Oils and Animal Fats* % of Total Fatty Acids Oil or Fat Caproic (6) Capritic Capric (8) (10) Lauric (12) Myristic (14) Palmitic (18) Steari c (18) Beef tallow Coconut oil Comoii 11 2 Cortonseed oil Lard Palm oil Palm kernel oil... -_ Adapted from Food Fats and Oils9' tnumbers in parentheses indicate the number of carbon aoms. 694 JAMA, February 2,1990-Vc1263, No. 5 Vegetable Oils Council on Scientific Affairs

42 Olive Oil Polyphenols Decrease LDL Concentrations and LDL Atherogenicity in Men a Randomized Controlled Trial The consumption of olive oil polyphenols decreased plasma LDL concentrations and LDL atherogenicity in healthy young men. Hernaez A J Nutr.2015

43 Effects of Olive Oil on Markers of Inflammation and Endothelial Function -A Systematic Review and Meta-Analysis Olive oil might exert beneficial effects on endothelial function as well as markers of inflammation and endothelial function Heterogeneous study designs (olive oil given as a supplement or as part of dietary pattern, variations in control diets) conservative interpretation of the results is necessary Schwingshackl L. et al. Nutrients. 2015

44 New perspectives on OO research are needed aiming to clarify key mechanisms by which OO consumption exerts health benefits such as the use of urinary proteomic biomarkers 44

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