ORIGINAL ARTICLEEffects of milk enriched with ω-3 fatty acid, oleic acid and folic acid in patients with metabolic syndrome
Introduction
The term metabolic syndrome (MS) describes a cluster of diseases with high prevalence, mainly type 2 diabetes mellitus, android obesity, hypertension and dyslipoproteinemia.1 The pathogenic basis are not clear. Two potential etiological categories have been postulated: insulin resistance with increased plasma insulin levels and central obesity, both favouring a chronic inflammatory status.2, 3 Recently, new definitions of this syndrome has been propossed,4 producing a substantial confusion and a considerable doubt regarding its value as a cardiovascular risk marker.5 Nevertheless, all these factors are atherogenic, in such a way that patients with MS are at high risk of suffering an acute cardiovascular event. At present, the more useful definition is still considered to be the ATP III one, that requires three factors among the increased waist circumference, high blood pressure, hypertriglyceridemia, low cholesterol, and increased fasting glucose.6
Modification of dietary fat composition, mainly free fatty acid, can improve the lipid and carbohydrate metabolism, thus decreasing cardiovascular risk. In fact, a high consumption of fish and ω-3 polyunsaturated fatty acids (PUFAs), have been associated with a lower coronary heart disease incidence and total mortality.7, 8, 9 Several mechanisms explaining this cardioprotective effect have been suggested including antiarhythmic, hypolipemic, antithrombotic and antiinflammatory properties. With this evidence, the American Heart Association recommends the intake of 1 g of ω-3 per day, preferably from oily fish, in patients with documented coronary artery disease.10 In addition, a diet rich in oleic acid, has been shown to decrease LDL cholesterol and its oxidizability, as well as insulin resistance and endothelial function.11, 12 Opposite effects are obtained with high intakes of saturated fatty acids (SFA). For this reason the Fat Consensus Statemens recomends the traditional Mediterranean diet, in which olive oil is the principal source of fats.13 Overall, we can assume that the reduction in total mortality after this diet, should be due to the cumulative effects of multiple dietary components, being the ratio between monounsaturated to saturated lipids, one of the keystones.14
Recently, a semi-skimmed milk enriched with ω-3 PUFAs, oleic acid, folic acid and vitamin E, has been commercialized. This milk has proved to decrease triglycerol, total cholesterol and LDL colesterol plasma levels in volunteers with or without hyperlipidemia.15, 16 The present study was perfomed to assess the effects of a similar milk on cadiovascular risk factors in patients with MS.
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Material and methods
Study population: Patients were included, according to the ATP III concept of MS,6 with three or more of the following risk factors: waist circumference more than 102 cm in men or 88 cm in women, tryglicerol levels above 150 mg/dl, HDL cholesterol levels lower than 40 mg/dl in men and 50 mg/dl in women, blood pressure higher than 130/85 mmHg, and fasting blood glucose levels higher than 110 mg/dl. Patients with any of the following conditions were excluded: bad control of baseline illness, alcohol
Results
All but six patients (four in the test group and two in the control group) completed the study. Reasons for withdrawal were unwillingness to continue the study (two patients in each group) or moving away (two patients in the test group). Both milks were well tolerated and accepted by the patients.
All of them, meat the criteria for MS according to the ATP III panel.6 Mean age (M±SD) in the test group was 52±11 years, BMI 35±5, waist circumference 108±12 cm, systolic blood pressure 151±19 mmHg, and
Discussion
A great number of cardiovascular risk factors are increased in patients with MS. These include diabetes or altered glucose metabolism as the main manifestation of insulin resistance, central obesity, high blood pressure, and increased triglycerol and LDL cholesterol with decreased HDL cholesterol. Non-classical cardiovascular risk factors like homocysteine, ultrasensible C reactive protein (CRP) or adhesion molecules such as VCAM-1 are also increased in patients with MS.1, 17 Therefore, a
Acknowledgements
This work was supported by a clinical research grant from the Medical College Fundation of Cordoba. We thank Susan Webb for revising the manuscript and COVAP SA for the free supply of milk.
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