HEALTH BENEFIT OF MONOUNSATURATED FATS: FOOD-BASED RESEARCH ON MUFAs





Penny Kris-Etherton

Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA



Significant progress has been made to reduce the incidence of cardiovascular disease (CVD) in the U.S. However, CVD remains the leading cause of death, accounting for more deaths than the other leading causes of death collectively. Thus, there is still a pressing need to develop effective intervention strategies to further reduce CVD morbidity and mortality markedly. Diet remains a cornerstone in prevention and treatment efforts. It is without question that lowering dietary saturated fatty acids (SFA), trans fatty acids and cholesterol are essential to lower LDL cholesterol levels, a major CVD risk factor. There is a growing literature that indicates that monounsaturated fatty acids (MUFA) have beneficial effects (when substituted for SFA) on other CVD risk factors beyond lowering LDL cholesterol levels. Compared with a low fat diet, a moderate fat diet low in SFA and high in MUFA decreases triglyceride (TG) levels and attenuates the HDL cholesterol, and in particular, the HDL(2) decrease. A blood cholesterol-lowering diet high in MUFA favorably affects hemostatic factors, including fibrinogen and coagulation factors VIIc, XIIc, XIIa, and Xc. There is evidence that MUFA diets also significantly improve insulin sensitivity compared with a high SFA diet, providing that total fat does not exceed 37-38% of calories. A limited body of evidence indicates that MUFA reduces blood pressure. There also is emerging evidence that following a MUFA diet lowers chylomicron remnant particle response to a high fat meal. Finally, there is exciting evidence that a calorie restricted, moderate fat diet high in MUFA favorably affects weight loss and maintenance of reduced body weight compared with a low fat diet. Despite the numerous beneficial effects of MUFA on multiple risk factors for CVD, there is some evidence of potentially adverse effects. In monkeys fed a high MUFA atherogenic diet for five years, coronary artery atherosclerosis was comparable to that of monkeys fed an atherogenic diet high SFA; atherosclerosis was minimal in animals fed a similar diet high in polyunsaturated fatty acids. In addition, in human studies a high MUFA fat load decreases flow mediated dilation (FMD) in the brachial artery. However, this response is markedly attenuated when antioxidants are included in the fat load. In summary, a diet that emphasizes MUFA has many attributes that could reduce CVD mortality especially within the context of a diet that has other cardioprotective nutrients/components. Because of the worrisome monkey data, however, an intervention study assessing atherosclerosis in humans is needed to conclusively resolve the role of MUFA in a cardioprotective diet. Nonetheless, even without these data, MUFA can be included in moderation in a heart healthy diet that is rich in many cardioprotective nutrients. This position is consistent with our current thinking that there are many diverse diets that can be designed to prevent CVD.




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