Gorduras e sa de

1. Gorduras e sa�de Alfredo Halpern Grupo de Obesidade e Doen�as Metab�licas do HCFMUSP

2. Import�ncia da gordura da alimenta��o Fun��o energ�tica (1g = 9 Kcal) Fornecimento de �cidos graxos essenciais Transporte de vitaminas lipossol�veis( A,D,E,K) PAPEL BIOL�GICO: Forma��o das membranas celulares Produ��o de horm�nios Isolante t�rmico Prote��o mec�nica

3. Recomenda��o de consumo de gorduras: Indiv�duo ativo: <35% VET em gordura <10% VET em gordura saturada <1% VET em gordura trans <300 mg de colesterol Indiv�duo sedent�rio ou de risco: <30% VET em gordura <7% VET em gordura saturada <1% VET em gordura trans <200 mg de colesterol

4. Exemplo de consumo energ�tico na forma de gordura em uma dieta de 2000 calorias <35 % de gordura = 700 cal = 78g <10% de gordura saturada = 200 cal = 22g <1% de gordura trans = 20 cal = 2,2 g < 30% de gordura = 600 cal = 67g <7% de gordura saturada = 140 cal = 15,5g <1% de gordura trans = 20 cal = 2,2 g

5. Conhecendo os tipos de gorduras Saturadas Monoinsaturadas Poliinsaturadas Transsaturadas

6. Saturadas (SFA) Estrutura qu�mica: Cadeia de hidrocarbonetos com todas as val�ncias de hidrog�nio ligadas a atomos de carbono Fontes alimentares: Carnes, aves, leite integral, queijos, manteiga, coco, �leo de palma

7. Tipos de gorduras saturadas Palm�tico (carne, leite) Este�rico (cacau) Mir�stico (leite, manteiga) L�urico, capr�ico, capr�lico, c�prico (coco, baba�u e leite) Propionato, acetato, butirato (fermenta��o bacteriana)

8. Poliinsaturadas (PUFA) Estrutura qu�mica: Cadeia de hidrocarbonetos com 2 ou mais dupla liga��es Fontes alimentares: W6 - �mega 6 - ac. linoleico (�leos vegetais) W3 - �mega 3 - ac. gama linol�nico (peixes, linha�a, canola, soja) EPA e DHA

9. Monoinsaturadas (MUFA) Estrutura qu�mica: Cadeia de hidrocarbonetos com apenas 1 dupla liga��o Fontes alimentares: azeite de oliva, abacate, azeitona, castanhas

12. Como a gordura � transportada no nosso organismo?

13. Lipoproteinas

14. Estrutura do triglicer�deo:

15. Entendendo o que � o colesterol HDL= �colesterol bom� Remove o colesterol das art�rias Quanto mais alto melhor LDL = �colesterol ruim� Deposita o colesterol nas art�rias Quanto mais baixo melhor

17. Entendendo o que � aterosclerose

18. Hist�rico sobre gorduras e sa�de

19. The �Diet-heart hypothesis,� Dieta e aterosclerose 1800 A aterosclerose foi reconhecida, mas seu significado patol�gico n�o foi bem estabelecido. A.I. Ignatowski relatou com sucesso a produ��o de aterosclerose em coelhos alimentados com carne, leite e ovos

20. The �Diet-heart hypothesis,� Dieta e aterosclerose Anitschkow e Chalatow demonstraram que as les�es nos coelhos era resultado da gordura e colesterol da dieta. 1950 Malmros correlacionou a queda da mortalidade cardiovascular no per�odo de guerras com a queda do consumo de leite, manteiga e ovos.

21. John Gofman identificou as LDL e HDL e correlacionou aumento de LDL com IAM e rela��o inversa entre HDL e risco de doen�a coronariana. Laurence Kinsel encontrou que o consumo de verduras e a redu��o do consumo de carne vermelha reduzia os n�veis de colesterol no sangue. American Heart Association iniciou o encorajamento das pessoas para seguirem uma dieta �prudente� 1970 Keys publicou os importantes resultados do Seven Countries Study, definindo valores de consumo de gordura The �Diet-heart hypothesis,� Dieta e aterosclerose

22. Seven Countries Study: CHD Events are Correlated with % of Calories from Fat

23. Seven Countries Study: CHD Events are Better Correlated with Saturated Fat

24. Efeitos metab�licos das gorduras das dietas

25. Efeito dos tipos de gorduras no LDL-colesterol e HDL-colesterol

26. Classifica��o dos principais �cidos graxos e suas fontes alimentares

27. Efeitos do tipo de gordura saturada no LDL-colesterol e HDL-colesterol

28. Por que gordura saturada aumenta o LDL-colesterol?

29. SFA diminui o clearance de LDL

30. Receptor de LDL Hep�tico sofre �Down Regulatation� pelo SFA

31. Gorduras poliinsaturadas

34. Consumo adequado de ?-3 / ?-6 � necess�rio para o balan�o de produ��o de prostaglandinas

37. Gordura trans

38. Efeitos delet�rios da gordura trans Aumento de LDL-colesterol Redu��o de HDL-colesterol Aumento de triglic�rides Redu��o da fun��o endotelial Aumento de gordura abdominal Resist�ncia insul�nica Aumenta o risco de diabetes

39. Efeitos delet�rios da gordura trans Aumento de LDL-colesterol Redu��o de HDL-colesterol Aumento de triglic�rides Redu��o da fun��o endotelial Aumento de gordura abdominal Resit�ncia insul�nica Aumenta o risco de diabetes

40. Efeito dos tipos de gorduras no LDL-colesterol e HDL-colesterol

41. Efeitos delet�rios da gordura trans Aumento de LDL-colesterol Redu��o de HDL-colesterol Aumento de triglic�rides Redu��o da fun��o endotelial Aumento de gordura abdominal Resit�ncia insul�nica Aumenta o risco de diabetes

43. Efeitos delet�rios da gordura trans Aumento de LDL-colesterol Redu��o de HDL-colesterol Aumento de triglic�rides Redu��o da fun��o endotelial Aumento de gordura abdominal Resit�ncia insul�nica Aumenta o risco de diabetes

44. Avalia��o da fun��o endotelial Fluxo da art�ria braquial mediada por vasodilata��o Two endpoints may be relevant in this regard. The first is brachial artery flow-mediated dilation, an endothelium dependent vasodilation. Coronary endothelial dysfunction is one of the earliest events in the development of cardiovascular disease. Impaired brachial artery flow-mediated dilation predicts coronary endothelial dysfunction. Endothelium-dependent vasodilation is influenced by LDL-C, HDL-C, postprandial lipemia, Type 2 diabetes and blood pressure, all established risk factors for cardiovascular disease.Two endpoints may be relevant in this regard. The first is brachial artery flow-mediated dilation, an endothelium dependent vasodilation. Coronary endothelial dysfunction is one of the earliest events in the development of cardiovascular disease. Impaired brachial artery flow-mediated dilation predicts coronary endothelial dysfunction. Endothelium-dependent vasodilation is influenced by LDL-C, HDL-C, postprandial lipemia, Type 2 diabetes and blood pressure, all established risk factors for cardiovascular disease.

45. Gordura trans e fun��o endotelial

46. Efeitos delet�rios da gordura trans Aumento de LDL-colesterol Redu��o de HDL-colesterol Aumento de triglic�rides Redu��o da fun��o endotelial Aumento de gordura abdominal Resist�ncia insul�nica Aumenta o risco de diabetes

49. Efeitos delet�rios da gordura trans Aumento de LDL-colesterol Redu��o de HDL-colesterol Aumento de triglic�rides Redu��o da fun��o endotelial Aumento de gordura abdominal Resit�ncia insul�nica Aumenta o risco de diabetes

50. Gordura da dieta e risco de DM

51. Gordura trans e risco de DM O consumo de gordura trans nos EUA = 3% VCT Se consumida na forma n�o hidrogenada, >40% dos casos de diabetes poderia ser evitado

52. Consumo de gordura trans e risco de coronariopatiaNurse�s health study

53. Risco relativo de doen�a coronariana e aumento de consumo de gordura trans

54. Figure 5. Estimated Effects of Reducing the Consumption of Industrially Produced Trans Fatty Acids on the Incidence of CHD (Nonfatal Myocardial Infarction or Death from CHD) in the United States. Population attributable risks were calculated for a reduction by approximately half in the percent of energy intake (from 2.1 percent to 1.1 percent) or the near-elimination (from 2.1 percent to 0.1 percent) of trans fatty acid intake. Three effects were estimated: based on the effects of isocaloric replacement of trans fats with cis mono- or polyunsaturated fats (averaged effect) on the ratio of total to HDL cholesterol in controlled trials (as shown in Fig. 2) and the relation of this ratio to the incidence of CHD21; based on the reported relation of trans fatty acid intake, substituted for carbohydrate intake, with the incidence of CHD in a pooled analysis of prospective studies (as shown in Fig. 4); and based on the additional potential benefits if trans fats were replaced with cis mono- or polyunsaturated fats (averaged effect), as calculated from the pooled analysis of the prospective studies and the difference in relative risk resulting from trans fats being replaced by carbohydrates as compared with cis unsaturated fats in updated 2005 analyses from two cohorts.55,56Figure 5. Estimated Effects of Reducing the Consumption of Industrially Produced Trans Fatty Acids on the Incidence of CHD (Nonfatal Myocardial Infarction or Death from CHD) in the United States. Population attributable risks were calculated for a reduction by approximately half in the percent of energy intake (from 2.1 percent to 1.1 percent) or the near-elimination (from 2.1 percent to 0.1 percent) of trans fatty acid intake. Three effects were estimated: based on the effects of isocaloric replacement of trans fats with cis mono- or polyunsaturated fats (averaged effect) on the ratio of total to HDL cholesterol in controlled trials (as shown in Fig. 2) and the relation of this ratio to the incidence of CHD21; based on the reported relation of trans fatty acid intake, substituted for carbohydrate intake, with the incidence of CHD in a pooled analysis of prospective studies (as shown in Fig. 4); and based on the additional potential benefits if trans fats were replaced with cis mono- or polyunsaturated fats (averaged effect), as calculated from the pooled analysis of the prospective studies and the difference in relative risk resulting from trans fats being replaced by carbohydrates as compared with cis unsaturated fats in updated 2005 analyses from two cohorts.55,56

55. N�o h� d�vida que quanto menor o consumo de gordura trans menores s�o os riscos � sa�de

56. Posicionamento quanto a gordura trans National Academy of Sciences (NAS) 2005 "recommended that trans fatty acid consumption be as low as possible while consuming a nutritionally adequate diet" World Health Organization (WHO) 2003 Consumo inferior a 1% VET US National Dairy Council 2004 � the trans fats present in animal foods are of a different type than those in partially hydrogenated oils, and do not appear to exhibit the same negative effects.�

58. Conclus�es: Gorduras s�o essenciais para a sa�de O limite de consumo de gorduras de 30-35 % do VET deve ser respeitado Deve-se privilegiar gorduras insaturadas (mono e poli) Gorduras trans produzidas industrialmente devem ser eliminadas