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									fatty acid
expert roundtable
Key statements about fatty acids
fatty acid expert roundtaBle

key statements aBout fatty acids

•	   Cardiovascular	disease	(CVD)	remains	a	leading	cause	of	death	and	disability.
•	   Clinical	guidelines	and	pharmaceutical	development	have	focused	on	the	reduction	of	LDL	
     cholesterol	(LDL-C)	as	a	main	goal	for	reducing	CVD,	but	other	lipoproteins,	including	HDL	
     cholesterol	(HDL-C),	triglycerides,	and	LDL-particle	size	may	also	be	important.
•	   Saturated	fatty	acid	consumption	(grams	or	percent	calories)	increases	LDL-C	and	HDL-C,		
     but	tends	to	lower	triglycerides.		
•	   When	substituted	isocalorically	for	carbohydrate,	any	of	the	three	classes	of	fatty	acids		
     (i.e.,	poly,	mono,	saturated)	results	in	increases	in	HDL-C	and	decreases	in	serum	triglycerides	levels.	
•	   Dietary	guidelines	from	the	American	Heart	Association	and	other	agencies	recommend	that		

     <1%,	with	the	remainder	from	monounsaturated	and	polyunsaturated	fats.		
     total	fat	account	for	<25-35%	of	total	daily	caloric	intake;	saturated	fat,	<7%;	and	trans	fat,		

•	   A	2005	estimate	of	the	average	American	diet	found	that	trans	fatty	acid	intake	contributed		
     2.5%	of	total	calories.
•	   Changes	in	carbohydrate	intake	must	be	taken	into	account	when	considering	the	effect		
     of	changes	in	fatty	acid	metabolism	in	human	physiology.				

considerations for replacing trans fats when a solid fat
is required for food functionality and staBility
•	   Trans	fatty	acids	increase	LDL-C	and	decrease	HDL-C	levels.
•	   Public	health	officials	and	policy	makers	are	recommending	that	trans	fatty	acids		
     to	be	eliminated	from	the	American	diet.
•	   Efforts	to	reduce	or	eliminate	trans	fatty	acids	in	baked	goods	forces	manufacturers		
     to	make	one	of	several	changes	in	food	manufacturing:
     1.	 Substituting	saturated	fat	such	as	palm	oil	for	trans	fat
     2.	 Substituting	interesterified	fat	for	trans	fat
     3.	 Substituting	carbohydrate	for	trans	fat
•	   Each	choice	adds	additional	complexity	to	“improving”	our	manufactured	food	supply.
•	   Finding	a	suitable	fat	with	desirable	functionality,	taste	and	shelf	life	similar	to	a	hydrogenated		
     fat	presents	a	challenge	for	food	manufacturers.	Solid	fats	(saturated	fatty	acids)	are	more	readily	
     adaptable	for	food	preparation	processes.
•	   If	half	of	trans	fatty	acids	are	replaced	by	polyunsaturated	fat	or	monounsaturated	fat,	and	half	
     replaced	with	saturated	fatty	acids,	it	is	expected	that	the	saturated	fat	component	in	the	diet	will	
     increase	approximately	1	to	1.5%	of	total	fat	calories	(composed	of	primarily	palmitic	and/or	stearic	acid).	

The	overall	public	health	goal	in	regard	to	trans	fatty	acids	is	to	prevent	adverse	health	effects	
associated	with	exposure	to	them.	The	preferred	option	would	be	to	replace	them	with	unsaturated	
fatty	acids,	or	when	necessary	for	structural	or	functionality	purposes,	a	natural	or	modified	saturate.	
A	further	consideration	is	that	“healthier”	baked	goods	with	no	trans	fats	should	be	consumed	in	the	
context	of	an	overall	diet	containing	fruit,	vegetables,	dairy	products	and	grains.

fat replacement options for food manufacturers
An	example	of	replacing	trans	fatty	acids	with	saturated	fatty	acids	required	for	functionality	might	be	
formulated	as	follows:

            Medium Muffin                      With Trans Fat                       No Trans Fat
  Total	Fat                                           10.3g                            10.3g
  Trans	Fat                                           0.7g                               0g
  Saturated	Fat                                       	1.5g                             2.2g
  Monounsaturated	Fat                                 2.4g                              2.4g
  Polyunsaturated	Fat                                 5.7g                              5.7g

Currently	available	technology	offers	two	major	options:
1.	 Replace	partially	hydrogenated	fatty	acids	with	a	saturated	fatty	acid	that	is	mostly	palmitic	acid	
    from	natural	fat(s).
2.	 Replace	partially	hydrogenated	fat	with	a	specifically	designed,	interesterified	fat	containing	more	
    saturated	fatty	acids	made	up	mostly	of	stearic	acid.

The	pros	and	cons	of	each	of	these	choices	are	outlined	in	the	table	below.		

                                                            Fully Hydrogenated
            Issue            Palmitic Acid Option         Interesterified Stearic      Trans Fatty Acid
                                                                Acid Option

 Reasonable Evidence

                            Naturally	occurring	          Fully	hydrogenated	       Partially	hydrogenated	
                            saturated	fatty	acid
                                                          Fatty	acid	is	placed	     Fatty	acid	is	placed	
 Fat	type
                            Fatty	acid	is	placed	         randomly	at	the	1,2	      randomly	at	the	1,2	
                            at	the	1,3	position	on	       and	3	position	on	the	    and	3	position	on	the	
                            triglyceride	molecule         triglyceride	molecule     triglyceride	molecule

                            Neutral	to	increase	in	       Neutral	to	increase		     Increases	LDL	
 Effects	on	LDL             LDL	depending	on	level	       in	LDL	depending		        depending	on	level		
                            of	intake                     on	level	of	intake        of	intake

                            Neutral	to	moderate	          Neutral	to	decrease		
 Effects	on	HDL                                                                     Decrease	in	HDL
                            increase	in	HDL               in	HDL	at	high	intakes

                                                                    Fully Hydrogenated
            Issue                  Palmitic Acid Option           Interesterified Stearic         Trans Fatty Acid
                                                                        Acid Option

  Exploratory Evidence

  Effects	on		                    Relatively	neutral	to	          Tends	to	increase		
                                                                                               Increases	ratio	(typically)
  LDL:	HDL	ratio                  slight	decrease	in	ratio        ratio	at	high	levels

                                                                                               One	study	found	increase	
                                  One	study	found	                One	study	found	
                                                                                               in	postprandial	glucose	
  Effect	on	postprandial	         increase	in	postprandial	       increase	in	postprandial	
                                                                                               (under	the	curve)	more	
  glucose	(area	under		           glucose	(under	the	             glucose(under	the	curve)	
                                                                                               than	palmitic	acid,	but	
  the	curve)	                     curve),	but	less	than	          more	than	palmitic	acid	
                                                                                               less	than	interesterified	
                                  stearic	acid	and	trans	fat      and	trans	fat	
                                                                                               stearic	acid

                                  When	combined	with	                                          Increased	fibrinogen,	
                                                                  Increased	fibrinogen	
  Effect	of	high	levels	on	       myristic	and	lauric		                                        but	at	lower	levels		
                                                                  over	control	
  inflammatory	markers            acids	has	similar		                                          than	stearic	acid		
                                                                  carbohydrate	group
                                  effect	as	carbohydrates                                      and	control	group

  Effect	on	myocardial	
                                  Neutral	effect		                Increases	risk	of	MI	        Neutral	effect	compared	
  infarction	risk	through	
                                  compared	to	control             compared	to	control          to	control
  fibrinogen	increase

a third option for food manufacturers—increase carBohydrate
energy component
A	third	option	for	replacing	trans	fatty	acids	(still	within	FDA	guidelines	for	<0.5g	TFA/serving)	would	
be	to	reduce	them	to	less	than	0.5g	without	replacing	the	fat.	Therefore,	the	carbohydrate	and	protein	
levels	would	not	change,	but	they	would	represent	a	greater	percentage	of	the	total	energy	in	the	

	An	example	for	a	hypothetical	muffin	follows:

           Medium Muffin                              With Trans Fat                          No Trans Fat*
   Total	Fat                                                 10.3g                                  10g
   Trans	Fat                                                   0.7g                                0.4g
   Saturated	Fat                                              	1.5g                                1.5g
   Monounsaturated	Fat                                         2.4g                                2.4g
   Polyunsaturated	Fat                                         5.7g                                5.7g
*Based	on	FDA	labeling	that	states	less	than	0.5	g	can	be	defined	as	“no	trans	fat”

key consensus statements
•	     Where	possible,	the	selection	of	oils	or	fats	to	replace	trans	fatty	acids	should	favor	polyunsaturated	
       or	monounsaturated	fatty	acids.		
•	     Where	a	solid	fat	is	required	for	product	taste	and	functionality,	the	only	saturated	fatty	options	
       currently	available	to	replace	trans	fatty	acids	are	palm	oil	or	interesterified	stearic	acid.	
•	     Replacing	trans	fats	with	either	palmitic	acid	or	interesterified	stearic	acid	is	expected	to	reduce	
       cardiovascular	risk	factors.		
•	     How	future	changes,	including	the	introduction	of	fats	from	genetically	modified	crops	and	the	
       availability	of	interesterified	diets	richer	in	stearic	acid,	will	alter	fatty	acid	consumption	of	
       consumers,	and	hence,	cardiovascular	risk,	remains	unclear.
•	     Consumption	of	a	variety	of	fats—including	polyunsaturated	(both	omega-3	and	omega-6),	
       monounsaturated,	and	saturated	fatty	acids—is	preferable	to	over-reliance	on	any	one	fatty	acid.	
•	     A	one-to-one	exchange	of	saturated	fatty	acids	for	trans	fatty	acids	is	expected	to	raise	the	former	
       to	a	level	consistent	with	reduced	cardiovascular	risk	(assuming	no	other	shift	in	macronutrient	
       composition	or	total	amount	of	fats	in	the	average	diet).
•	     Before	any	policies	are	made	related	to	trans	fatty	acids	and	potential	replacement	fats,	further	
       interventional	and	observational	studies	should	be	completed	to	fully	understand	the	tradeoffs	
       inherent	in	the	solution.

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       Blood	Institute;	American	Heart	Association;	World	Heart	Federation;	International	Atherosclerosis	Society;	
       and	International	Association	for	the	Study	of	Obesity.	Circulation.	2009;Epub	Ahead	of	Print(Oct	5).
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3.	    American	Heart	Association.	Stearic	acid.	www.americanheart.org/presenter.jhtml?identifier=4747.
4.	    Baer	DJ,	et	al.	Dietary	fatty	acids	affect	plasma	markers	of	inflammation	in	healthy	men	fed	controlled	diets:	
       a	randomized	crossover	study1–3.	Am	J	Clin	Nutr	2004;79:969	–73.
5.	    Denke	MA	and	Grundy	SM.	Comparison	of	effects	of	lauric	acid	and	palmitic	acid	on	plasma	lipids	and	
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       1994	Dec;60(6	Suppl):1023S-1028S.
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       randomized	controlled	trial.	Behav	Res	Ther	2009;	47	(8),	685-691.
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       weight	loss.	Nutrition	&	Metabolism	2006,	3:24.	www.nutritionandmetabolism.com/content/3/1/24
10.	   Ford	ES,	Li	C,	Zhao	G,	Pearson	WS,	Capewell	S.	Trends	in	the	prevalence	of	low	risk	factor	burden	for	
       cardiovascular	disease	among	United	States	adults.	Circulation.	Sep	29	2009;120(13):1181-1188.
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       nutrition	guidelines:	a	scientific	statement	from	the	American	Heart	Association	Nutrition	Committee	
       of	the	Council	on	Nutrition,	Physical	Activity	and	Metabolism,	Council	on	Cardiovascular	Disease	in	the	
       Young,	Council	on	Arteriosclerosis,	Thrombosis	and	Vascular	Biology,	Council	on	Cardiovascular	Nursing,	
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12.	   Harvard	www.health.harvard.edu/books/lowering_your_cholesterol.htm
13.	   High	blood	cholesterol:	what	you	need	to	know.	NHLBI.	www.nhlbi.nih.gov/health/public/heart/chol/wyntk.htm.
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15.	   Institute	of	Medicine,	“Dietary	Reference	Intakes	for	Energy,	Carbohydrate,	Fiber,	Fat,	Fatty	Acids,	
       Cholesterol,	Protein,	and	Amino	Acids.”	September	2002.	Chapter	11:	Macronutrients	and	Healthful	Diets.

16.	   Jakobsen	MJ,	O’Reilly	EJ,	et	al.	Major	types	of	dietary	fat	and	risk	of	coronary	heart	disease:	a	pooled	analysis	
       of	11	cohort	studies.	Am	J	Clin	Nutr	2009;89:1425-1432.
17.	   Judd	JT,	et	al.	Dietary	cis	and	trans	Monounsaturated	and	Saturated	FA	and	Plasma	Lipids	and	Lipoproteins	
       in	Men.	Lipids	2002;37:123-131.
18.	   Katan	MB,	Zock	PL,	Mensink	RP.	Effects	of	fats	and	fatty	acids	on	blood	lipids	in	humans:	an	overview.		
       Am	J	Clin	Nutr	1994;60(suppl):1017S-22S.
19.	   Kellens	M.	Interesterification:	process	conditions.	Society	of	Chemical	Industry.	2000.	www.soci.org/SCI/
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       cholesterol	and	on	serum	lipids	and	apolipoproteins:	a	meta-analysis	of	60	controlled	trials.	Am	J	Clin	Nutr	
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       cardiovascular	risk	factors	from	childhood	to	adulthood:	the	Cardiovascular	Risk	in	Young	Finns	Study.	Br	J	
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29.	   Sundram	K,	Karupaiah	T,	Hayes	KC.	Stearic	acid-rich	interesterified	fat	and	trans-rich	fat	raise	the	LDL/HDL	
       ratio	and	plasma	glucose	relative	to	palm	olein	in	humans.	Nutrition	&	Metabolism	2007,	4:3.
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taBle Background
•	 Baer	DJ,	et	al.	Dietary	fatty	acids	affect	plasma	markers	of	inflammation	in	healthy	men	fed	
   controlled	diets:	a	randomized	crossover	study1–3.	Am	J	Clin	Nutr	2004;79:969	–73.
   -	 LMP	diet,	8%	of	energy	enrichment	with	saturated	fatty	acids	as	the	sum	of	lauric	(L),	myristic	
      (M),	and	palmitic	(P)	acids	(ratio	of	L	to	M	to	P	of	0.3:1.4:8.3);	stearic	acid	(STE)	diet,	8%	of	
      energy	enrichment	with	stearic	acid;	trans	fatty	acid	(TFA)	diet,	8%	of	energy	enrichment	in	
      TFAs	(spectrum	of	trans	18:1	positional	isomers	similar	to	that	in	the	US	food	supply).
   -	 Inflammatory	Marker	Data:		In	both	stearic	acid	enriched	diet	and	stearic	acid/trans	fat	
      enriched	diet	fibrinogen	increased.	In	stearic	acid	only,	was	4.4%	higher	than	control	
      carbohydrate	group.	Consumption	of	the	diet	enriched	in	stearic	acid	resulted	in	higher	
      concentrations	of	fibrinogen	than	did	consumption	of	all	other	diets	except	the	TFA/STE	diet.

Concentrations	of	plasma	markers	of	inflammation	after	5	wk	of	consumption	of	each	diet:

                                    diet                            mean (g/l)
                                CHO	(control)                           2.74
                                     OL                                 2.71
                                    TFA                                 2.74
                                 TFA	+	STE                              2.75
                                    STE                                 2.86
                                    LMP                                 2.68

•	   van	der	Bom	JG,	de	Maat	MP,	Bots	ML,	et	al.	Elevated	plasma	fibrinogen:	cause	or	consequence		
     of	cardiovascular	disease?	Arterioscler	Thromb	Vasc	Biol	1998;18:621–5.
     -	 Myocardial	Infarction	Risk:	A	rise	in	fibrinogen	of	1	g/L	was	associated	with	a	45%	increased	
         risk	(odds	ratio	adjusted	for	age,	sex,	and	smoking,	1.45;	95%	CI,	1.12	to	1.88).	Lowering	
         fibrinogen	levels	is	not	associated	with	a	lower	risk	of	myocardial	infarction.

•	   Sundram	K,	Karupaiah	T,	Hayes	KC.	Stearic	acid-rich	interesterified	fat	and	trans-rich	fat	raise	the	LDL/
     HDL	ratio	and	plasma	glucose	relative	to	palm	olein	in	humans.	Nutrition	&	Metabolism	2007,	4:3.
     -	 One	test	fat	rotation	was	based	on	palm	olein	(POL)	and	provided	12.0	percent	of	energy	(%en)	
        as	palmitic	acid	(16:0);	a	second	contained	trans-rich	partially	hydrogenated	soybean	oil	
        (PHSO)	and	provided	3.2	%en	as	trans	fatty	acids	plus	6.5	%en	as	16:0,	while	the	third	used	an	
        interesterified	fat	(IE)	and	provided	12.5	%en	as	stearic	acid	(18:0).	
     -	 Effects	on	LDL:	Dietary	fat	also	affected	absolute	change	in	LDL-C,	with	the	concentration	after	
        the	PHSO	being	7%	greater	than	POL	(P	< 0.05).	The	IE	diet	effect	was	intermediate	and	not	
        significantly	different	from	either	POL	or	PHSO.
     -	 Effects	on	HDL:	After	adjusting	for	multiple	comparisons	between	dietary	treatments,	plasma	
        HDL-C	was	significantly	lower	(p	<	0.001)	both	during	the	PHSO	(-8%)	and	IE	(-9%)	diet	
        treatments	compared	to	POL.
     -	 Effects	on	LDL:HDL	ratio:	The	LDL-C/HDL-C	ratio	was	similarly	increased	by	the	PHSO	and	IE	
        diets,	with	differences	being	about	15%	greater	than	the	POL	diet	(P	<	0.001).
     -	 Glucose	Data:	After	four	weeks	on	each	test	fat,	the	rise	was	3%	for	POL,	9%	for	PHSO,	and	22%	for	IE.

•	    Judd	JT,	et	al.	Dietary	cis	and	trans	Monounsaturated	and	Saturated	FA	and	Plasma	Lipids	and	
      Lipoproteins	in	Men.	Lipids	2002;37:123-131.
      -	 The	six	diets	were	planned	to	vary	by	8	en%	as	follows:	diet	CHO,	8.5	en%	reduction	in	fat	
          (approximately	equivalent	to	8	en%	reduction	in	FA)	replaced	by	digestible	carbohydrate;	diet	
          OL,	8	en%	enrichment	in	oleic	acid;	diet	LMP,	8	en%	enrichment	with	saturated	FA	as	the	sum	
          of	lauric	(L),	myristic	(M),	and	palmitic	acids	(P)	(LMP)	with	the	ratio	of	L/M/P	of	0.3:1.4:8.3;	diet	
          STE,	8	en%	enrichment	with	stearic	acid;	diet	TFA:	8	en%	enrichment	in	TFA	with	a	spectrum	
          of	trans	18:1	positional	isomers	similar	to	that	in	the	U.S.	food	supply;	and	diet	TFA|STE,	a	
          combined	enrichment	with	4	en%	TFA	and	4	en%	STE.	
      -	 Dietary	fatty	acid	levels	prior	to	enrichment	were	targeted	at	levels	within	the	range	of	typical	
          U.S.	diets	with	the	exception	that	saturated	FA	were	to	be	about	10	en%	with	STE	excluded.	
          Otherwise,	the	diets	before	enrichment	were	targeted	to	have	2.5	en%	STE,	4	en%	linoleic	acid,	
          10	en%	OL,	10	en%	LMP	FA,	and	2.5	en%	other	FA.

Plasma	Lipid,	Lipoprotein	Cholesterol,	and	Apolipoprotein	Concentrations	and	Ratios	of	Total	and	LDL	
Cholesterol	to	HDL	Cholesterol	of	50	Adult	Men	After	5	wk	Consumption	of	Each	Dieta

expressed as mg/dl

           Medium Muffin                 CHO              OL              TFA         TFA/STE     STE      LMP
     Triglycerides                      91b,c           78a             91b,c          94b,	c	   101c     86a,b
     Total	Cholesterol                  184a,b          179a            195d           194d      175b     193c,d
     LDL                                119a,b          115a            131e           129d,e    121b,c   125c,d
     HDL                                47b             48c             45a,b          46a,b     45a      51d

Diets	labeled	with	different	roman	superscripts	are	significantly	different	at	P	<	0.01.
     TC/HDL	(ratio)                     4.1b            3.9a            4.5d           4.4c,d    4.3c     4.0a,b


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