Sunday, July 19, 2020

Lipids


"Lipid" is a term used to refer to fats and oils collectively. Examples include: phospholipids, sterols, and triglycerides (the most common type found in our bodies and food). Lipids produce 9 calories per gram and thus are an excellent source of energy. Based on the "Acceptable Macronutrient Distribution Range", we should strive to get 20-35% percent of our calories daily from fat. While the human body is composed of around 60% water, the brain is 60% fat. In this article, we'll look at different types of lipids, the roles they play in our bodies, and the risks associated with not consuming enough fat.

Triglycerides
95% of the fats that we consume and that are stored in our bodies are triglycerides, which consist of three fatty acids combined with a glycerol. Excess dietary fats are stored in the body within adipocytes (fat cells) and represent about 60% of our bodies resting energy requirements. Fat also serves as a transporter; carrying (and breaking down) micronutrients such as vitamins A, D, E and K. 

Phospholipids
Phospholipids are essentially identical to triglycerides except for one main difference: phosphate. Phospholipids have one phosphate compound substituted in place of one its three fatty acids. The properties of said phosphate allows fats to work in a liquid environment without sticking together. This brings us to why phospholipids are so important; they serve as emulsifiers in the body. Emulsifiers allow us to digest fat and help carry carried in the bloodstream. 

There are two main emulsifiers in our body:
  1. Bile which is a watery substance produced by the liver (and stored in the gallbladder) 
      2. Lecithin (also known as phosphatidylcholine), a type of phospholipid that contains choline.  

Phospholipids are also found naturally in foods.  Lecithin in that regard, refers to a combination of phospholipids that come from plants. So just to be clear---in the body, lecithin refers to a specific type of phospholipid known as phosphatidylcholine. When lecithin is referred to in foods or supplements, it is actually talking about a general group of phospholipids that come from plants. 

In food service applications, lecithin allows ingredients to mix that normally would be unable to (ex: oil and water). It is added to salad dressings and coffee creamers as well as chewing gum to increase shelf life. Egg yolk, soybeans, and peanuts are sources of naturally occurring lecithin. 

Sterols
A sterol is a type of steroid; not the kind produced in a lab but instead one produced by the body. The most noteworthy of course is cholesterol. Lets take a look at the many benefits of cholesterol along with risks associated with elevated levels. Cholesterol is used as a precursor for many different substances including:
  • Vitamin D
  • Sex Hormones (estrogens and androgens)
  • Bile
  • Other sterol hormones such as: progesterone, glucocorticoids and mineralcorticoids

Fortunately for us, our body produces enough cholesterol that we really have no need to ensure that our diets contain it. 

How cholesterol is transported in the body
Lipids in general are typically not water soluble, meaning they do not dissolve or mix well in watery substances. In order to travel throughout the bloodstream and digestive tract, structures known as lipoproteins are utilized. Lipoproteins differ amongst themselves in regards to size, density, and composition and thus contribute to different health effects. 

 Lipoprotein Composition Function
 Chlyomicron Mostly triglyceride Carries dietary fat from the small intestine to cells
 Very Low Density Lipoproteins (VLDL) Apprx. 2/3 triglycerides Transports lipids made by the liver to cells
 Low Density Lipoproteins (LDL) More than 1/2 cholesterol Transports cholesterol made by the liver to cells
 Intermediate Density Lipoproteins (IDL) Apprx. 40% triglycerides Acquires cholesterol from high density lipoproteins, becomes converted to LDL in the liver.
 High Density Lipoproteins (HDL) Mostly protein Helps remove cholesterol from cells and in turn, the body.

As you can see from the table, low density lipoproteins (LDL) play an important role in providing cells with the cholesterol they need to in turn, produce hormones and other important compounds. The risk associated with having high levels of LDL in the body is the development of atherosclerosis. Atherosclerosis refers to a hardening of the arteries, where cholesterol (among other substances) builds up in artery walls and in turn, impedes blood flow. 

Research on Lipid Profile
Several studies have examined the relationship between blood lipid (and triglyceride) levels and cardiovascular disease (CVD). Among these include the Helsinki Heart Study and the Framingham Heart Study. There are scoring systems in place to allow physicians to identify those at higher risk of CVD and determine whether (and to what extent) they can benefit from lipid lowering drugs. The Framingham scoring system is the most widely used, though is has its drawbacks; namely due to the majority of risk scores being developed from data from a predominately middle aged white population. 


Predicted risk of CHD events at 7.5 years according to original Framingham functions, recalibrated Framingham functions and Health ABC functionsClick for larger image

The table above shows predictive and actual data from the original Framingham risk scoring system, a readjusted Framingham scoring system, and from the Health, Aging, and Body Composition Study.


 
Ratings of Blood Lipoprotein Levels

 Lipoprotein Rating
 Total Cholesterol 
 < 200
 Desirable
 200-239 Borderline High
 240 or Greater
 High
 LDL-Cholesterol 
 <100 Optimal
 100-129 Near Optimal
 130-159 Borderline high
 160-189 High
 190 or Greater Very High
 HDL-Cholesterol 
 <40 Low
 60 or Greater High
 Triglycerides 
 <100 Optimal
 100-149Near Optimal
 150-199 Borderline High
 200-499 High
 500 or Greater Very High
 
According to National Cholesterol Education Program (NCEP) guidelines, everyone 20 years or older should get a blood lipoprotein profile done every 5 years. The NCEP also created tables (including the one above) to help determine one's risk of developing heart disease. Heart disease is the leading cause of death in the U.S. and while genetics play a role, the type and amount of fat we consume does as well. 

References

Manore, M., 2005. Exercise and the Institute of Medicine Recommendations for Nutrition. Current Sports Medicine Reports, 4(4), pp.193-198.

Pubchem.ncbi.nlm.nih.gov. 2020. Glycerol. [online] Available at: <https://pubchem.ncbi.nlm.nih.gov/compound/Glycerol> [Accessed 16 July 2020].

Emulsifiers.org. 2020. EFEMA - What Is An Emulsifier?. [online] Available at: <http://www.emulsifiers.org/ViewDocument.asp?ItemId=11&Title=What> [Accessed 16 July 2020].

Steven H. Zeisel, A., 2020. Choline: An Essential Nutrient For Humans. [online] Citeseerx.ist.psu.edu. Available at: <http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.322.6160> [Accessed 16 July 2020].

Taves, M., Gomez-Sanchez, C., & Soma, K. (2011, July). Extra-adrenal glucocorticoids and mineralocorticoids: Evidence for local synthesis, regulation, and function. Retrieved July 16, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275156/

Feingold KR. Introduction to Lipids and Lipoproteins. Endotext [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK305896/. Published February 2, 2018. Accessed July 16, 2020.

Manninen V, Tenkanen L, Koskinen P, et al. Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study. Implications for treatment. Circulation. 1992;85(1):37-45. doi:10.1161/01.cir.85.1.37

Framingham Heart Study (FHS). National Heart Lung and Blood Institute. https://www.nhlbi.nih.gov/science/framingham-heart-study-fhs. Accessed July 16, 2020.

Rodondi N, Locatelli I, Aujesky D, et al. Framingham Risk Score and Alternatives for Prediction of Coronary Heart Disease in Older Adults. PLOS ONE. https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0034287. Accessed July 16, 2020.

Health ABC |. National Institute on Aging. https://healthabc.nia.nih.gov/. Accessed July 16, 2020.

Detection, Evaluation, Treatment. National Cholesterol Education Program. https://www.nhlbi.nih.gov/files/docs/guidelines/atp3xsum.pdf. Published May 11, 2001. Accessed July 15, 2020.

FastStats - Leading Causes of Death. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm. Published March 17, 2017. Accessed July 16, 2020.

Byrd-Bredbenner C, Moe G, Berning J, Kelly D. Wardlaw's Perspectives in Nutrition. Place of publication not identified: Mcgraw-Hill Education; 2015.

Insel, P., Ross, D., McMahon, K. and Bernstein, M., n.d. Discovering Nutrition. 6th ed. Jones and Barlett Learning.




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