Hyperlipidemias: Tapsell LC

Jacobs DR, Gross MD, Tapsell LC. · School of Public Health, University of Minnesota, Minneapolis, MN, USA. · Am J Clin Nutr. · Pubmed #19279083 No free full text.

Abstract: Research and practice in nutrition relate to food and its constituents, often as supplements. In food, however, the biological constituents are coordinated. We propose that "thinking food first"' results in more effective nutrition research and policy. The concept of food synergy provides the necessary theoretical underpinning. The evidence for health benefit appears stronger when put together in a synergistic dietary pattern than for individual foods or food constituents. A review of dietary supplementation suggests that although supplements may be beneficial in states of insufficiency, the safe middle ground for consumption likely is food. Also, food provides a buffer during absorption. Constituents delivered by foods taken directly from their biological environment may have different effects from those formulated through technologic processing, but either way health benefits are likely to be determined by the total diet. The concept of food synergy is based on the proposition that the interrelations between constituents in foods are significant. This significance is dependent on the balance between constituents within the food, how well the constituents survive digestion, and the extent to which they appear biologically active at the cellular level. Many examples are provided of superior effects of whole foods over their isolated constituents. The food synergy concept supports the idea of dietary variety and of selecting nutrient-rich foods. The more we understand about our own biology and that of plants and animals, the better we will be able to discern the combinations of foods, rather than supplements, which best promote health.

Patch CS, Tapsell LC, Williams PG, Gordon M. · National Centre of Excellence in Functional Foods, Northfields Avenue, University of Wollongong, New South Wales, Australia. · Vasc Health Risk Manag. · Pubmed #17319460 links to  free full text

Abstract: Plant sterol-enriched foods are an effective dietary adjuvant in reducing cardiovascular risk by lowering total cholesterol and low density lipoprotein-cholesterol (LDL-C) in serum by up to approximately 15%. The mechanism of action of plant sterols is different from those of 3-hydroxy-3-methylglutaryl coenzyme A inhibitors (statins) and thus their effect is additive. Combining plant sterols with other dietary components known to reduce cholesterol in a portfolio approach has proven to be most effective for reduction of hypercholesterolemia and provide an alternative treatment option for clinicians. Plant sterol-enriched foods provides clinicians with a relatively cheap, safe, and effective way to help patients manage their cardiovascular risk.

Patch CS, Tapsell LC, Williams PG. · Smart Foods Centre, University of Wollongong, NSW 2522, Australia. · J Am Diet Assoc. · Pubmed #15635344 No free full text.

Abstract: OBJECTIVE: To determine the effectiveness of prescribing 2 g plant sterols/stanols per day as an addition to standard practice in a dietary outpatient clinic. DESIGN: A randomized parallel design of comparative 12-week interventions. SUBJECTS/SETTING: Patients referred by a general practitioner to a dietary outpatient clinic for the management of hyperlipidemia were eligible. Twenty-five patients (15 women and 10 men) completed the study. INTERVENTION: Counseling regarding diet for hyperlipidemia was based on the National Cholesterol Education Program guidelines. The intervention group was instructed to incorporate approximately 25 g/day of margarine, containing plant sterols/stanols, which delivered approximately 2 g plant sterols/stanols. MAIN OUTCOME MEASURE: Changes in diet, body weight, and serum total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides were measured. STATISTICAL ANALYSIS PERFORMED: Changes in dietary and biochemical outcomes were assessed using Student's t test. For nonnormally distributed data, Wilcoxon signed rank test was used, and Mann-Whitney U tests were conducted to determine the proportion of subjects reaching defined goals. The number needed to treat index was used to report effectiveness of the intervention. RESULTS: Five of 14 subjects in the intervention group compared with 0 of 11 in the control group achieved a reduction in serum cholesterol of >/=15% ( P <.05). Using the number needed to treat index, for each 2.8 patients counseled with routine prescription of plant sterols/stanols, one additional patient would obtain a reduction in cholesterol by >/=15% compared with conventional management. This was achieved without any detrimental effects on the dietary fatty acid profile. CONCLUSIONS: Routine prescription of margarine containing plant sterol/stanol is an effective strategy in the management of hypercholesterolemic patients in the clinical setting.

Meyer BJ, Larkin TA, Owen AJ, Astheimer LB, Tapsell LC, Howe PR. · Department of Biomedical Science and Smart Foods Centre, University of Wollongong, NSW, Australia. · Ann Nutr Metab. · Pubmed #14679315 No free full text.

Abstract: AIM: To examine cardiovascular health benefits of foods containing a whole soybean extract. METHODS: The study design was a randomized, placebo-controlled crossover trial of consuming soy-based milk and yoghurt (treatment) or equivalent dairy products (control) for 5 weeks each. Twenty-six mildly hypercholesterolaemic and/or hypertensive volunteers were recruited from the community as study volunteers, of which 23 completed. Main outcome measures included clinic and ambulatory blood pressure, arterial compliance, lipids, fatty acids and isoflavones in fasted blood and 24-hour urinary isoflavone excretion. Nutrient intakes were assessed initially and after each 5-week period. Multiple regression analyses were used to determine predictor variables in statistical models; order effects were tested by repeated measures ANOVA. Changes in Lp(a) were determined by Wilcoxon signed ranks tests; other differences between treatment and control were assessed by t tests. RESULTS: Plasma and urinary isoflavones were markedly increased by whole soy supplementation but there were no overall differences in plasma lipids, blood pressure or arterial compliance between the soy and dairy diets. However, in 8 equol-positive subjects (equol detected in either plasma or urine), retrospective analysis revealed significant reductions in total cholesterol (8.5%), LDL cholesterol (10%), LDL:HDL ratio (13.5%), plasma triglycerides (21%) and lipoprotein(a) (11%) with the soy diet. These reductions were independent of changes in polyunsaturated fat and other macronutrient intakes. CONCLUSIONS: Regular consumption of whole soybean milk and yogurt products had no effect on plasma lipids, blood pressure or arterial compliance in at-risk subjects, despite substantially increasing isoflavone levels in blood and urine. Retrospective analysis suggests that improvement of plasma lipids may have been limited to equol-positive subjects.

Patch CS, Tapsell LC, Mori TA, Meyer BJ, Murphy KJ, Mansour J, Noakes M, Clifton PM, Puddey IB, Beilin LJ, Annison G, Howe PR. · National Centre of Excellence in Functional Foods, University of Wollongong, New South Wales, Australia. · J Am Diet Assoc. · Pubmed #16321598 No free full text.

Abstract: OBJECTIVE: To evaluate the effect of consuming a variety of foods enriched in long-chain n-3 fatty acids in low fish eaters. DESIGN: Evaluation of reported dietary intakes in a 6-month, double-blind, randomized, controlled parallel design trial. SUBJECTS/SETTING: Eighty-five men and women with overweight and mildly elevated triglyceride levels who have a low habitual intake of fish. INTERVENTION: Subjects were randomized to consume foods either enriched in long-chain n-3 fats or control foods (not enriched). Subjects were asked to consume eight portions per day (equivalent to approximately 1 g/day long-chain n-3 fatty acid if randomized to the intervention). MAIN OUTCOME MEASURE: Reported energy, macronutrient, and fatty acid intakes were measured by diet history, 3-day food records, and body weight. STATISTICAL ANALYSES: Repeated measures analysis of variance, Kruskall-Wallis test, Pearson's correlation coefficient, and Bland-Altman plots were conducted. RESULTS: The two groups did not differ in mean dietary intake of long-chain n-3 fatty acid intake at baseline (258 mg and 313 mg for the intervention and control groups, respectively). At 6 months the intervention group members increased their intake of long-chain n-3 fats 4.5-fold compared with baseline and with the control group (P<.001). The data from the diet histories correlated well with the food records for all reported macronutrient and fatty acid values. Food pattern analysis showed that milk (13.8%), cereal (12.1%), and bread (11.3%) contributed the most to the overall long-chain n-3 fatty acid intake in the intervention group. CONCLUSIONS: This long-term study in free-living subjects indicates that population intakes of long-chain n-3 fatty acids could be substantially increased through the availability of a variety of n-3 fatty acid-enriched processed foods.