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lundi 17 mars 2014

Saturated fats and atheroma

It's a complex and dynamic issue. 1/ With time the amount of cheap calories from processed foods ingested has increased significantly all over the world. This increase depends on GDP/hab, food production, availability, subsidies and prices. At the present time refined cereals and starches are the most important contributors to this increase in calorie intake. Nevertheless in the same time sat fats consumption slightly decreased or remained unchanged. 2/ During the last century people sat and all physical exertions were drastically reduced by motors leading to a very positive calorie balance. 3/ During the same period of time we increased W6/W3 ratio mainly because of advises which favored veg oils. This have an impact on our chronic inflammatory potential. 4/ Progressively we identified trans fats as the most potent atherogenic fat. And BTW we revised our precedent data about sat fats and atheroma. 5/ One must not forget that we are not equal in front of atheroma. The prevalence of CHD which is a very reliable index of atheroma is widely distributed all over the world and even in EU! Finland Scotland have a very high prevalence and France a very low one despite a high consumption of sat fats. So sat fats are not the culprit. They could add a risk but largely below - central obesity (W/H ratio) - smoking - Hypertension. Why? because sat fats (an heterogeneous set of fatty acids) increase both HDL and LDL levels and some of them only LDL. This atherogenous effect is negligible when CHD and atheroma has a low prevalence but is of significant importance when the prevalence is high. On a personal basis it is the same, it's negligible if the risk equation shows a low risk situation it's significant if the patient is at high risk. And eventually one must keep in mind that lives can be easily saved by tackling the main risk factors of atheroma I mentioned previously instead of focusing on sat fats and push the patient in the sugar or W6 excesses..

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