Lifestyle recommendations to prevent prostate cancer - prevention of heart failure

[Guest guest]

I'd say this is a rather positive statement:

"The evidence that excessive intake of saturated fat, specifically C14:0, myristic, and C16:0, palmitic acid, raises serum lipids and promotes atherogenesis is decisive."

Urologic Clinics of North AmericaVolume 31 • Number 2 • May 2004Copyright © 2004 W. B. Saunders Company

Lifestyle recommendations to prevent prostate cancer, part I: time to redirect our attention?

Lifestyle change #4: replace saturated, trans-fatty acids, and cholesterol with unsaturated fat; types of dietary fat consumed may matter more than total fat intake; the use of commercial plant sterol/stanol products may be heart- and prostate-healthy

Saturated fat (SF) or hydrogenated fat reduces LDL receptor expression and increases LDL serum levels [19] . LDL levels increase by 2% for every 1% increase in total calories from SF. The NCEP Adult Treatment Panel III recommends reducing SF to less than 7% of total calories to reduce the risk for cardiovascular disease. In the United States, the average adult intake of SF is 11% of total calories. Some nonlean meats, high-fat dairy products (whole milk, butter, cheese, ice cream, and cream), tropical oils (palm oil, coconut oil, and palm kernel oil), baked products, and mixed dishes with dairy fats, shortening, and tropical oils are the primary sources of SF. Many foods that contain high levels of SF contain high levels of trans–fatty acids.

Epidemiologic studies have demonstrated that consuming high concentrations of SF and cholesterol may increase risk for CHD [63] . A meta-analysis that included 6356 person-years of follow-up demonstrated that reducing serum cholesterol by reducing SF intake reduces the risk for CHD by 24% [64] [65] . There was also a 21% reduction in coronary mortality and a 6% reduction in total mortality. No increase in non–cardiovascular disease mortality was observed.

Most lifestyle changes and prostate cancer risk studies revolve around primary prevention, but a few studies of men post-treatment also should be emphasized [66] . A Canadian prospective study of men with prostate cancer observed 384 men for a median of 5.2 years [67] . Compared with the men consuming the lowest levels of SF, men consuming the highest amount had a significant increase in risk for death of prostate cancer (RR = 3.1). Total fat and other subtypes of fat (except saturated) showed no correlation between prostate cancer and mortality.

A collaborative analysis of five prospective studies compared death of diseases in vegetarians versus nonvegetarians with similar lifestyles [68] . Data on over 76,000 men and women showed 8330 deaths with a mean of 10.6 years of follow-up. There were no significant differences between vegetarians and nonvegetarians in death of prostate cancer, breast cancer, colorectal cancer, lung cancer, stomach cancer, or all other causes combined. Mortality from ischemic heart disease was reduced by 24% in vegetarians, however. This lower mortality from ischemic heart disease was greater at younger ages and was limited to those who had followed this diet for more than 5 years. A further analysis of vegetarian versus nonvegetarian diets found that ischemic heart disease was 20% lower in occasional meat-eaters, 34% lower in those that ate fish but not meat, 34% lower in lactoovovegetarians, and 26% lower in vegans when compared with regular meat eaters. Eliminating SF from the diet is not necessarily a practical or healthy lifestyle change. The cardiovascular goal of obtaining less than 7% of calories from SF seems ideal from past studies, because getting no calories from SF seems excessive and can decrease levels of HDL [69] . Therefore, the adage “everything is moderation” applies to this recommendation.

[19]. The Expert Panel. Executive summary of the Third Report of the National Cholesterol Education Program (NCEP). Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-98

[63]. Keys A, Menotti A, Karvonen MJ, et al. The diet and 15-year death rate in the Seven Countries Study. Am J Epidemiol 1986;124:903-15. [64]. Gordon DJ. Cholesterol and mortality: what can meta-analysis tell us? In: GalloLL, editors. Cardiovascular disease 2: cellular and molecular mechanisms, prevention, and treatment New York: Plenum Press; 1995. p. 333-40. [65]. Gordon DJ. Cholesterol lowering and total mortality. In: RifkindBM, editors. Lowering cholesterol in high-risk individuals and populations New York: Marcel Dekker, Inc.; 1995. p. 333-48. [66]. Moyad MA. The ABCs of nutrition and supplements for prostate cancer. Ann Arbor (MI): JW Publishing; 2000.

[68]. Key TJ, Fraser GE, Thorogood M, et al. Mortality in vegetarians and non-vegetarians: detailed findings from a collaborative analysis of 5 prospective studies. Am J Clin Nutr 1999;70(Suppl):516S-24S.

[69]. Yu JN, Cunningham JA, Rosenberg Thouin S, Gurvich T, Liu D. Hyperlipidemia. Prim Care 2000;27:541-87.

Medical Clinics of North AmericaVolume 88 • Number 5 • September 2004Copyright © 2004 W. B. Saunders Company Lifestyle and dietary modification for prevention of heart failure

Saturated fatty acids, those with no carbon–carbon double bonds, in particular raise total cholesterol and LDL. Foods rich in saturated fatty acids include the flesh of most domestic mammals raised for human consumption, dairy products, and several vegetable oils, notably coconut, palm, and palm kernel oils. The evidence that excessive intake of saturated fat, specifically C14:0, myristic, and C16:0, palmitic acid, raises serum lipids and promotes atherogenesis is decisive. Evidence linking diets high in saturated fats to cardiovascular events is convincing but is limited by difficulties in conducting long-term studies requiring assignment of subjects to dietary interventions. Current recommendations [28] call for reducing the intake of saturated fat to 10% or less of caloric intake (National Cholesterol Education Program) and ideally to less than 7% to 8%. The average US adult intake of these fats is approximately 13% to 14%. Prehistoric adaptations may be informative; Paleolithic intake of saturated fat was approximately 5% of calories [29] .

[28]. National Cholesterol Education Program (NCEP). Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106(25):3143-421.[29]. Eaton S, Eaton III SB, Konner M. Paleolithic nutrition revisited: A twelve-year retrospective on its nature and implications. Eur J Clin Nutr 1997;51:207-16.