Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta- analysis. Abstract. Objective To evaluate the effectiveness of replacing dietary saturated fat with omega 6 linoleic acid, for the secondary prevention of coronary heart disease and death. Design Evaluation of recovered data from the Sydney Diet Heart Study, a single blinded, parallel group, randomized controlled trial conducted in 1. Setting Ambulatory, coronary care clinic in Sydney, Australia. Participants 4. 58 men aged 3. Interventions Replacement of dietary saturated fats (from animal fats, common margarines, and shortenings) with omega 6 linoleic acid (from safflower oil and safflower oil polyunsaturated margarine). Controls received no specific dietary instruction or study foods. All non- dietary aspects were designed to be equivalent in both groups. Outcome measures All cause mortality (primary outcome), cardiovascular mortality, and mortality from coronary heart disease (secondary outcomes). We used an intention to treat, survival analysis approach to compare mortality outcomes by group. Results The intervention group (n=2. P=0. 0. 5; cardiovascular disease 1. P=0. 0. 4; coronary heart disease 1. P=0. 0. 4). Inclusion of these recovered data in an updated meta- analysis of linoleic acid intervention trials showed non- significant trends toward increased risks of death from coronary heart disease (hazard ratio 1. P=0. 0. 6) and cardiovascular disease (1. Sunflower Production Guide. Warrick, Extension Agronomist (Retired) Description/Agronomic Characteristics: Sunflowers are grown in.Omega-3 benefits your heart health. An Italian study (GISSI) 5 of 11,324 heart attack survivors found that patients supplementing with fish oils markedly reduced. Simple Homemade 3-Ingredient Facial Oil Moisturizer – Customize It For Your Own Gorgeous Skin. Last Updated on January 17, 2017 by Crunchy Betty. Gout and the Antihypertensives Linda Brookes, MSc, Hyon K. Choi, MD, DrPH (summary below/full interview http://www.medscape.com/viewarticle/761761 Recent statements by Dr. Sanjay Gupta have been quoted and requoted all over the media, and for a good reason. It is an important issue, and his is an important voice. Earheart treatments are prescribed by a physician individually for each patient; after evaluation. P=0. 0. 7). Conclusions Advice to substitute polyunsaturated fats for saturated fats is a key component of worldwide dietary guidelines for coronary heart disease risk reduction. However, clinical benefits of the most abundant polyunsaturated fatty acid, omega 6 linoleic acid, have not been established. In this cohort, substituting dietary linoleic acid in place of saturated fats increased the rates of death from all causes, coronary heart disease, and cardiovascular disease. An updated meta- analysis of linoleic acid intervention trials showed no evidence of cardiovascular benefit. These findings could have important implications for worldwide dietary advice to substitute omega 6 linoleic acid, or polyunsaturated fats in general, for saturated fats. Trial registration Clinical trials NCT0. Introduction. Advice to substitute vegetable oils rich in polyunsaturated fatty acids (PUFAs) for animal fats rich in saturated fatty acids (SFAs) has been a cornerstone of worldwide dietary guidelines for the past half century. When this advice originated in the 1. PUFAs were regarded as a uniform molecular category with one relevant biological mechanism—the reduction in blood cholesterol. Omega 6 (n- 6) linoleic acid (LA) was the best known dietary PUFA at the time. Therefore, the terms “PUFA” and “LA” were often used interchangeably when interpreting clinical trial results and delivering dietary advice. Since that time, there has been increased recognition that the general category of PUFAs comprises multiple species of omega 3 (n- 3) and n- 6 PUFAs, each with unique biochemical properties and perhaps divergent clinical cardiovascular effects. Favorable biological actions of n- 3 eicosapentaenoic acid and docosahexaenoic acid (and to a lesser extent, n- 3 . Thus, benefits attributed to PUFAs as a general category might be due to n- 3 PUFAs specifically, particularly eicosapentaenoic acid and docosahexaenoic acid. Such benefits are not necessarily generalizable to n- 6 LA or other PUFA species. Since n- 6 LA is the most abundant dietary PUFA, and edible oil sources with markedly different contents of fatty acids are commercially available (table 1. Safflower oil is a concentrated source of LA (about 7. LA per 1. 00 g serving of oil. PUFAs. Increased all cause mortality in the safflower oil group was reported in 1. Clinical outcomes for cardiovascular disease and coronary heart disease have been considered to be more relevant than all cause mortality when evaluating the evidence base. Therefore, previous meta- analyses of PUFA intervention trials and risk of cardiovascular disease. SDHS. We recovered the original SDHS dataset and used modern statistical methods to compare rates of all cause, cardiovascular, and coronary heart disease mortality by group; and to examine whether longitudinal dietary changes in PUFAs (that is, n- 6 LA from safflower oil) or SFAs were associated with mortality outcomes. SDHS data recovery also allowed us to update our previously incomplete meta- analysis published in 2. LA including datasets from all known randomized controlled trials evaluating dietary PUFAs for cardiovascular risk reduction. Methods. SDHS data recovery and validation. We obtained permission from an original study investigator (B Leelarthaepin, coauthor) and approval from the Office of Human Research Protection to recover, analyze, and interpret de- identified SDHS data stored on a 9 track magnetic tape. Part 1 of the web appendix describes the methods used to recover the original SDHS dataset; convert these data into a useable format; and identify, confirm, and verify the recovered data. Only variables that exactly matched published data were included. All matching variables were further verified by an original study investigator (B Leelarthaepin) to ensure accuracy. Study design and participants. The SDHS was a randomized controlled dietary trial, evaluating the effects of increasing n- 6 LA from safflower oil in place of SFA for secondary prevention of coronary heart disease. Eligible patients were men aged 3. Prince Henry, Prince of Wales, Sutherland, St George)1. University of New South Wales near Sydney, Australia, for an episode of acute myocardial infarction (8. Patients were subsequently referred to the Prince Henry Hospital Coronary Clinic for inclusion in the trial. Participants entered the study at least eight weeks (mean 1. Randomization and masking. After provision of informed consent, participants were allocated by a table of random numbers to either the dietary intervention group (n=2. The number sequence was generated by a research assistant and was concealed until after the medical evaluations and testing at baseline were completed. After the baseline phase, the study dietitians were unmasked to assign patients to their groups and administer the interventions. Medical investigators were initially masked to group assignment, although the success of blinding was not evaluated. Deaths were assigned codes from ICD- 7 (international classification of diseases, 7th revision)2. Procedures. During the baseline phase, a testing battery of clinical, laboratory, and dietary assessments was administered. Levels of serum total cholesterol and triglycerides after fasting (> 1. Abell and Van Handel,3. Coconut oil may be able to reverse the course of Alzheimer's disease 9/18/2016 - Reliable conclusions about the causes of Alzheimer's disease remain. Patented fatty acid supplement. Safflower oil blend works with the body to promote lean muscle development. Tonalin CLA provides 78% conjugated linoleic acid per serving. Sanderson CLA Safflower Oil 1000mg is a high quality source of Conjugated Linoleic Acid (CLA). CLA provides dynamic nutritional support for planned weight management. Participants recorded their dietary intake in a seven day food log between these two baseline visits. Experienced dietitians assessed daily intake via a combination of this food log and accompanying interview at the second baseline visit. Data were converted to mean daily nutrient intake using food composition tables supplemented by laboratory analyzed values on a previously established computer program. Diet intervention. The intervention group received instructions to increase their PUFA intake to about 1. SFA and dietary cholesterol to less than 1. To achieve these targets, intervention participants were provided with liquid safflower oil and safflower oil polyunsaturated margarine (“Miracle” brand, Marrickville Margarine). Liquid safflower oil was substituted for animal fats, common margarines and shortenings in cooking oils, salad dressings, baked goods, and other products, and was also taken as a supplement. Safflower oil polyunsaturated margarine was used in place of butter and common margarines. Safflower oil is a concentrated source of n- 6 LA (table 1)9 and contains no other reported PUFAs. Therefore, the intervention oil selectively increased n- 6 LA without a concurrent increase in n- 3 PUFAs; this LA selective PUFA intervention will be referred to as the LA intervention. Control. The control group received no specific dietary instruction. However, some participants began substituting polyunsaturated margarine for butter after their coronary event. Because the research team made no effort to alter the PUFA or SFA content of control diets, such dietary changes were allowed to continue. All non- dietary aspects of the study were designed to be equivalent in both groups, with all participants receiving standard medical care available at the time for secondary prevention of coronary heart disease and other medical conditions. This treatment included equivalent advice for all active smokers to quit and all overweight patients to lose weight. For follow- up, participants returned for testing three times in the first year after entry, and every six months thereafter (web appendix, part 4). At each visit, a clinical assessment was performed and fasting levels of cholesterol and triglycerides were assessed. Between each study visit, participants recorded their dietary intake in a seven day food log. At each follow- up visit, mean daily nutrient intakes were assessed by a combination of the food log and dietitian interview, similar to the baseline phase. The full food log was repeated if doubts arose about accuracy,3. Duration of diet exposure and ICD- 7 codes were recorded for all study deaths. Statistical analysis for the SDHSThe published objective of the SDHS was to evaluate whether increasing PUFAs in place of SFAs in men with “premature coronary heart disease might so improve survival.”1. However, the primary survival outcome (for example, mortality from all causes, cardiovascular disease, or coronary heart disease) was not explicitly defined. The original sample size calculations were not recovered. For our analyses, all cause mortality was selected as the primary outcome, with deaths from cardiovascular disease and coronary heart disease as secondary outcomes.
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