M. de Lorgeril

Farmed and wild fish in the prevention of cardiovascular diseases: assessing possible differences in lipid nutritional values.

AIM The consumption of fish and fish-derived products is recommended as a means of preventing cardiovascular and other diseases, and has considerably increased over recent decades. However, as the worlds wild fish stocks are limited, consumers are now being proposed farmed fish as an alternative. The aim of this study was to compare the fat composition of farmed and wild fish in order to estimate whether the expected health effects of the former (especially in relation to cardiovascular diseases) are potentially the same as those of the latter. DATA SUMMARY The data presented in this paper were collected from the recently published literature. The lipid composition of farmed fish is more constant and less affected by seasonal variations than that of wild fish because, as it is largely dependent on the fatty acid composition of their feed, it can be customised by adjusting dietary intakes. Vegetable food is increasingly replacing fishmeal in fish feeds, and may induce a relative decrease in n-3 polyunsaturated fatty acids (PUFAs), expressed as a percentage of total fatty acids. However, as farmed fish generally have higher total lipid levels than wild fish, 100 g of farmed fish fillet can provide a higher amount of n-3 PUFAs (especially EPA and DHA) than 100 g of wild fish. Furthermore, quite high levels of (alpha-tocopherol in farmed fish can theoretically provide better EPA and DHA protection against peroxidation. Sensory analyses by trained consumer panels have not revealed any significant differences between wild and farmed fish. Moreover, fresh fish storage conditions (including the time from slaughtering to consumer sales) are more easily verifiable in the case of farmed fish, in which the content of potentially toxic heavy metals (a major health concern in certain areas) is also theoretically more easily controlled. CONCLUSIONS Provided that they are raised under appropriate conditions, the nutritional content of farmed fish is at least as beneficial as that of wild fish (particularly in terms of the prevention of cardiovascular diseases), and they also have the advantages of freshness and apparent non-toxicity.

Alpha-linolenic acid and coronary heart disease

AIM To summarize our present knowledge about vegetable omega-3 fatty acids. DATA SYNTHESIS Alpha-linolenic acid (ALA) is one of the two essential fatty acids in humans. Epidemiological studies and dietary trials strongly suggest that this fatty acid is important in relation with the pathogenesis (and prevention) of coronary heart disease. Like other n-3 fatty acids from marine origin, it may prevent cardiac arrhythmias and sudden cardiac death. The optimal dietary intake of alpha-linolenic acid seems to be about 2 g per day or 0.6 to 1% of total energy intake. Obtaining an optimal ratio of the two essential fatty acids, linoleic and alpha-linolenic acids--ie a ratio of less than 4 to 1 in the diet--is a major issue. The main sources of alpha-linolenic acid for the European population should be canola oil (and canola-oil based margarine if available), nuts (English walnut), ground linseeds and green leafy vegetables such as purslane. CONCLUSIONS Epidemiological studies and dietary trials in humans suggest that alpha-linolenic acid is a major cardio-protective nutrient.

Blood lipids among young children in Europe: results from the European IDEFICS study.

Background:Measurement of cholesterol and triglyceride (TG) fractions in blood has become standard practice in the early detection of atherosclerotic disease pathways. Considerable attention is given nowadays to the presence of these risk factors in children and to start preventive campaigns early in life. In this context, it is imperative to have valid comparative frameworks for interpretation of lipid levels. The aim of this study is to present sex- and age-specific reference values on blood lipid levels in European children aged 2.0–10.9 years.Methods:Fasting blood was obtained via either venipuncture or capillary sampling. In 13 579 European non-obese children (50.3% boys), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), TG and TC/HDL-C ratio levels were measured with a point-of-care analyser (Cholestech). Sex- and age-specific reference values were computed with the GAMLSS method with the statistical software R.Results:Reference curves and 1st, 3rd, 10th, 25th, 50th, 75th, 90th, 97th and 99th percentile values are presented. HDL-C showed a positive trend with age, from 2 years onwards, but was relatively stable above the age of 7. For LDL-C and TC, linear but small age-related trends were seen. The TC/HDL-C values showed a gradual negative trend from the age of 2 up to 6 and were relatively stable afterwards. For TG, no age trend was found (P=0.285). Boys had higher mean HDL-C values than girls (1.414 vs 1.368 mmol l−1), and lower TC, LDL-C, TC/HDL-C and TG values (3.981 vs 4.087 mmol l−1; 2.297 vs 2.435 mmol l−1; 2.84 vs 3.01mmol l−1;  and 0.509 vs 0.542 mmol l−1, respectively).Conclusions:These new and recent references could serve as a European orientation of blood lipid values in children in the context of standard medical practice and for the purpose of public health screening.

Insulin resistance modifies plasma fatty acid distribution and decreases cardiac tolerance to in vivo ischaemia/reperfusion in rats

1. The early stage of insulin resistance, also termed the ‘prediabetic state’, is characterized by the development of hyperinsulinaemia, which maintains normoglycaemia under fasting conditions. The metabolic disorders induced in myocardial cells during this stage of the disease may constitute a basis for an alteration of the tolerance of the heart to ischaemia and reperfusion.

C reactive protein and its determinants in healthy men and women from European regions at different risk of coronary disease: the IMMIDIET Project

Aim: Differences in C‐reactive protein (CRP) levels and its determinants in three European populations at different risk of coronary artery disease (CAD) were studied.Methods: Subjects were recruited randomly in Limburg (Belgium), Abruzzo (Italy) and south‐west (SW) London (England).Results: Ten‐year risk of fatal coronary events (estimated using risk equations provided by the SCORE Project) was lower both in men and women from Abruzzo, intermediate in people from Limburg and higher in subjects from SW London. Within each country, high sensitivity (hs)‐CRP levels were higher in the high‐risk class in men but not in women. Men from Abruzzo had higher hs‐CRP levels than those from Limburg and SW London. Women always had higher hs‐CRP levels than men. The strongest hs‐CRP determinant was body mass index (BMI, R2 = 0.14) in women and waist circumference (WC, R2 = 0.046) in men. The highest hs‐CRP levels were observed in subjects with both high BMI and high WC. Metabolic syndrome was associated with high levels of CRP both in men and women, even after adjustment for confounders. Discussion: Difference in CRP levels cannot explain the European gradient of CVD risk, although CRP levels are associated with the calculated SCORE risk of fatal coronary events within each country.

Alpha-linolenic acid in the prevention and treatment of coronary heart disease

Alpha-linolenic acid is one of the two essential fatty acids in humans. Epidemiological studies and dietary trials strongly suggest that this fatty acid is important in relation with the pathogenesis (and prevention) of coronary heart disease. Like other n-3 fatty acids from marine origin, it may prevent cardiac arrhythmias and sudden cardiac death. The optimal dietary intake of alpha-linolenic acid seems to be about 2 g per day or 0·6‐1% of total energy intake. Obtaining an optimal ratio of the two essential fatty acids, linoleic and alpha-linolenic acids — i.e. a ratio of about 4 to 1 in the diet — is a major issue. The main sources of alpha-linolenic acid for the European population should be canola oil (and canola-oil-based margarine if available), nuts (English walnut), ground linseeds and green leafy vegetables such as purslane.

Resveratrol and non-ethanolic components of wine in experimental cardiology.

The mechanisms through which the consumption of alcoholic beverages, in particular wine, protects against cardiac and vascular diseases remain largely unexplored. New methods are needed to investigate that crucial medical and scientific question. Several groups are now beginning to use animal models of myocardial ischemia and reperfusion to explore whether certain nutrients, including ethanol and non-ethanolic components of wine, may have a specific protective effect on the myocardium, independently from the classical risk factors involved in vascular atherosclerosis and thrombosis. Concepts used in experimental cardiology, such as preconditioning and stunning, are now entering the field of nutrition, and this will undoubtedly lead to considerable improvements in the prevention and treatment of cardiovascular diseases.

Dietary patterns and fatty acids levels of three European populations. Results from the IMMIDIET study

BACKGROUND AND AIMS Differences in blood fatty acids (FAs) profile among populations with different lifestyle have partly been attributed to differences in food intake. A holistic approach in dietary guidance through dietary patterns is essential. This study aimed at evaluating the main plasma and red blood cell (RBC) FAs in three European populations and assessing the role of dietary patterns in explaining variation in their levels. METHODS In the framework of the IMMIDIET Project, 1604 subjects (802 male-female pairs) aged 26-65 years were enrolled in Italy, Belgium and UK. Plasma and RBC FAs were measured. One year recall food frequency questionnaires were used to evaluate dietary habits of each individual. RESULTS Italian cohort showed lower plasma and RBC n-3 levels than participants of the other two populations (P<0.001). Both plasma and RBC arachidonic acid were higher in Italian cohort as compared to Belgian and English. Reduced rank regression analysis indicated two dietary patterns explaining 35% and 17% of the total variation of the sum of plasma and RBC n-3, respectively. In a holistic dietary analysis, neither fish nor mollusks intake seemed to contribute to n-3 variation as compared to vegetable oils and polyphenol-rich foods. CONCLUSION The Italian cohort presented significant lower plasma and RBC n-3 FA levels compared to Belgians and English. A holistic approach in dietary analysis seemed to explain a relatively high proportion of plasma and RBC n-3 FAs variability. Dietary pattern analysis may contribute to the study of the association of human diet with FAs levels.

Régime méditerranéen et maladies cardiovasculaires

RésuméNous avons un faisceau d’arguments scientifiques robustes permettant de penser que le modèle alimentaire méditerranéen protège de nombreuses maladies, notamment les pathologies cardiovasculaires et les cancers. Toutefois, les conditions d’existence modernes, les modes de production des aliments (agriculture, élevage et industrie) et la détérioration accélérée des environnements marins et terrestres doivent conduire à l’élaboration d’un nouveau type d’alimentation qui soit à la fois proche du modèle méditerranéen traditionnel et adapté (modernisé) à l’époque. Cette nouvelle alimentation méditerranéenne doit protéger notre santé et contribuer à celle de la planète.AbstractThere is now strong evidence that the Mediterranean diet protects against cardiovascular disease and cancers. However, the present lifestyle and environmental conditions, as well as the way the foods are produced (farming, rearing and industry), are problematic. There is an obvious need for a new (modernised) Mediterranean diet which must be adapted to the new consumers and to the new types of foods proposed to the today consumers. The new Mediterranean model should definitively protect the consumers’ health and the planet.

Dietary prevention of post-angioplasty restenosis. From illusion and disillusion to pragmatism

Prevention of restenosis and major cardiac events after percutaneous coronary intervention (PCI) is of enormous public health importance. Despite the considerable decrease in the restenosis rate in relation to the advent of the drug-eluting stents, it is likely that the complication will still occur in some patients and/or after a certain delay. Thus, dietary or systemic drug prevention will probably have a role in the drama in the future, although the way they can be used is not clear at present. This discussion focuses on the dietary approach of post-PCI restenosis because, among the many drugs that have been tested, none has been consistently shown to be helpful--with the exception of the potent antioxidant drug probucol--, whereas the results of several dietary trials have been encouraging. As discussed in the present issue of NMCD, vitamins of the B group were recently shown to decrease the risk of restenosis, supposedly through an effect on homocysteine metabolization. It seems, however, that homocysteine is a minor risk factor of post-PCI restenosis. On the other hand, 5-methyltetrahydrofolate (the active form of folic acid) was shown to improve endothelial function independently from homocysteine. Thus, folic acid could prevent restenosis not only by reducing homocysteine, but also by promoting nitric oxide formation. Because of their potential to prevent post-PCI restenosis and acute cardiac complications, n-3 fatty acids have been the most widely studied post-PCI medical intervention. Taken together, trial data suggest that if n-3 fatty acids can be useful in certain populations to prevent restenosis, their effects are probably weak. However, according to recent studies on endothelial nitric oxide synthase (eNOS) gene polymorphisms, it is likely that only certain patients could benefit from n-3 fatty acid supplementation. The same reasoning can probably apply to the folic acid and eNOS issue. In conclusion, although none has been concluding, the studies about n-3 fatty acids and folic acid after PCI suggest that certain nutrients (or more probably a combination of nutrients) may be useful for the prevention of post-PCI restenosis. Any future trial involving these nutrients should combine them and take into account some major genetic confounders. In the meantime, it is medically and ethically justified to supplement our CHD patients after PCI. They should receive n-3 fatty acids to prevent sudden cardiac death, and B group vitamins (at the dosages tested in the Swiss Heart Study) to decrease the risk of restenosis. This would be, at least, a low cost intervention, and there is no fear of adverse side effects, contrary to those one can expect from drug treatments.