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Fats and Cholesterol in Health

Fats and Cholesterol in Health

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E S U andM O O CholesterolG R N S I S N inA Health R L A C E R L O E E G L A A G S N E R O C F F T O O Y N T ± R E Y P L Nutrition OScoreboardN O R TRUE FALSE 1 It is currently recommendedP that adults consume diets providing less thanW 30% of calories from . 2 The types of fat consumedE are more important to health than is totalI fat intake. V 3 isE present in every . 4 Saturated R fat intake has a much stronger influence on blood cholesterol levels than does cholesterol intake.R

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E S U Answers to Nutrition Scoreboard [ KEY CONCEPTS AND FACTS ] M TRUE FALSE 1 Recommendations for fat intake have changed!O The ✔ • Fats are our most concen- tive effects, and some acceptable range of fat intake is now 20-35%O of trated source of food have negative effects on total calories. energy. They supply 9 calo- health. G R ries per gram. • Saturated fats and trans 2 The types of fat consumedN are moreS important to ✔ 1 • Dietary fats “carry” the fats raise blood choles- health than the total amountI of fat.S essential fatty acids, fat- terol levels more than N A soluble , and does dietary cholesterol or 3 Cholesterol is present only in animal products. ✔ healthful phytochemicals any other type of fat. R L along with them in . 4 ,A which is foundC primarily in animal ✔ products, raises blood cholesterol levels a good deal • Fats are not created equal. E more than does dietaryR cholesterol. Some types of fat have posi- L O E E G L Changing ViewsA aboutA Fat Intake and Health G S Scientific evidence andN opinionsR related to the effects of fat on health have changed substantially in recentE years—and so have recommendations about fat intake. In the past, it was recommendedC O that Americans aim for diets providing less than 30% of total calories from fat.F Evidence indicating that the type of fat consumed is more important toF health than is total fat intake has changed this advice. The watchwords for thinking about fatT have become “not all fats are created equal: some are better O for you than others.”O American adults are being urged to select food sources of “healthy”Y or “good” fats while keeping fat intake within the range of 20–35% of total caloric intake. N Concerns that high-fat diets encourage the development of obe- sityT have been± eased by studies demonstrating that excessive caloric intakes—and Rnot just diets high in fat—are related to weight gain.2 E NewY recommendations regarding fat intake do not encourage increased fat con- sumption.L Rather, they emphasize that healthy diets include certain types of fat, and P that total caloric intake and physical activity are the most important components of O weightN management. Diets providing as low as 20% of calories from fat, and those Oproviding 30–35%, can be healthy—depending on the types of fat consumed and R 3 P the quality of the rest of the diet. This unit provides facts about fats, explains the W reasons behind recent changes in recommendations for fat intake, and addresses the E practical meaning of it all. I V Facts about Fats E R Fats are a group of substances found in food. They have one major property in com- Compounds that are insoluble mon: they are not soluble (or, in other words, will not dissolve) in . If you have in water andR soluble in fat. ever tried to mix vinegar and when making salad dressing, you have observed the , saturated and principle of water and fat solubility firsthand. unsaturatedO fats, and essential Fats are actually a subcategory of the fat-soluble substances known as lipids. fatty acidsF are examples of Lipids include fats, , and cholesterol. Dietary fats such as , , and lipids, or “fats.” are often distinguished from oils by their property of being solid at room Brown_U18_1-20.qxd 5/21/04 12:11 PM Page 3

E TABLE 18.1 S temperature. This physical difference between fats and oils is due to their chemical U structures. ROLES OF DIETARY FAT. • ProvidesM a concen- Contributions of Dietary Fats trated source of energy • CarriesO the essential Ofatty acids, the fat- Fats in Foods Supply Energy and Fat-Soluble ] Fats include the soluble vitamins, and essential fatty acids ( and alpha-linolenic acid) and provide the fat-G Rcertain phytochemicals soluble vitamins D, E, K, and A (the “deka” vitamins). So, part of the reason we S N • Increases the need fats in our diet is to get a supply of the essential nutrients they contain I(Table S and palatability of 18.1). Diets containing little fat (less than 20% of total calories) often fallN short onA foods delivering adequate amounts of essential fatty acids and fat-soluble vitamins.4 R L • Provides sustained relief from hunger Fats Increase the Flavor and Palatability of Foods] Although A“pure” fats C by themselves tend to be tasteless, they absorb and retain the flavor ofE substances that • Serves as a component R of cell membranes surround them. Thus, fats in and other foods pick up flavLors from their envi- ronment and give those to the food. This characteristic of fat is Owhy butter, if placed next to the garlic in the refrigerator, tastes like garlic.E E G Fats Contribute to the Sensation of Feeling Full] As they Lshould, at 9 calo- essential fatty acids ries per gram! Fats tend to stay in the stomach longerA than carAbohydrates or pro- Components of fats (linoleic teins and are absorbed over a longer period of time. That’sG whyS foods with fat “stick acid—pronounced lynn-oh-lay- to your ribs.”5 ick and alpha-linolenic acid— N R lynn-oh-len-ick) required in A Crucial Role of Fat Is to Serve as a ComponentE of Cell Membranes] the diet. Some types of fats give cell membranes flexibilityC andO help regulate the transfer of nutrients into and out of cells.6 F F T Excess Dietary Fat, , O and Are Stored as Fat O Y N Fats in the body include those consumedT in the diet and those produced from car- bohydrates and . Humans eat only ± a few times a day, but we need energy throughout the day. To ensureR a constant supply of energy, the body converts car- bohydrates and proteins, whichE haveY been supplied from foods and are not used to meet immediate needs, toP storage formsL of energy. Some of the excess and protein is converted to glycogen,N the storage form of glucose under normal cir- cumstances, but mostO of the excess is changed to fat and stored in fat cells (Illustra- tion 18.1). R O Body fat is notP just skin deep. Fat is also located around organs such as the kid- neys and heart. It’s thereW to cushion and protect the organs and keep them insulated. Cold-water swimmersE can attest to the effectiveness of fat as an insulation material. They purposefully buildI up body fat stores because they need the extra layer of insu- lation (IllustrationV 18.2). E Fats RCome in Many Varieties R There are many types of fat in food and our bodies (Table 18.2). Of primary impor- tance Oare triglycerides (or “triacylglycerols”), saturated and unsaturated fats, and cholesterolF (for definitions, see Table 18.3). The different types of fats have differ- ent effects on health. Brown_U18_1-20.qxd 5/21/04 12:11 PM Page 4

E S Triglycerides, which consist U of one AP Photo unit (a glucose-like substance) and three fatty acids (Illustration 18.3), make up 98% of our dietary fat intakeM and the vast majority of our body’sO fat stores. Biophoto/Photo Researchers Triglycerides are transportedO in blood attached to protein carriers and are used by cells for energyG formationR and tissue main- tenance. NA minorityS of fats take the form of diglyceridesI ( plus two fatty acids) and monoglyceridesN A (glycerol and one ). are present in some oils Illustration 18.1 R L A close look at fat cells and small amounts are used in food prod- Aucts as Cemulsifiers—or to increase the (color-enhanced blending of fat- and water-soluble sub- microphotograph). E R L stances. are present in smallO amounts in some oils; we don’t con- E sume very much of them in foods. E G As far as health is concerned, the glyc- L erol component of fat is relatively unim- Illustration 18.2 A A portant. It’s the fatty acids that influence Although their body fat storesG don’t fit what the body does with the fat we eat; and the image of the superathlete, cold- S they are responsible, in part, for how fat water swimmers need Nthe fat toR help affects health. Many different types of fatty stay warm. PicturedE here is the English acids are found in triglycerides. You’ve swimmer Mike Read,C who hadO swum the heard of the major ones: those that make English Channel 20 times byF age 39. fat “saturated” or “unsaturated.” F T SaturatedO and Unsaturated Fats] Fatty acids found in fats consist primarily of atoms Oattached to carbon atoms (Illustration 18.4). When the carbons are attachedY to asN many as possible, the fatty acid is “saturated”—that is, saturatedT with hydrogen. Saturated fats tend to be solid at room temperature. Except for ±palm and oil, only animal products are rich in saturated fats R(Illustration 18.5 on p. 18–6).7 Fatty acids that contain fewer hydrogens than the EmaximumY are “unsaturated.” They tend to be liquid at room temperature. By and TABLE 18.2 P large,L plant foods are the best sources of unsaturated fats. Unsaturated fats are classified by their degree of unsaturation. If only one BASIC FACTS ABOUT THE N O carbon-carbon bond in the fatty acid is unsaturated, the fat is called “monounsatu- TYPES OF FAT. R Orated.” If two or more carbon-carbon bonds are unsaturated with hydrogen, the fat Fats can be: P qualifies as “polyunsaturated.” • Monoglycerides W • Diglycerides E The Omega-3 and Omega-6 Fatty Acids I • Triglycerides V The essential fatty acids linoleic acid and alpha-linolenic acid are members of the Fats can be: fatty acid families of omega-6 (also called n-6 fatty acids) and omega-3 fatty acids E (also known as n-3 fatty acids), respectively. Both are polyunsaturated, can be used • SaturatedR as a source of energy, and are stored in fat tissue. Because they are essential, both • Monounsaturated linoleic and alpha-linolenic acid are required in the diet. • PolyunsaturatedR Linoleic acid is required for growth, maintenance of healthy skin, and normal Unsaturated fats come in: functioning of the reproductive system. It is a component of all cell membranes and O is found in particularly high amounts in nerves and the brain. A number of biolog- F• “Cis” forms ically active compounds, produced in the body, that participate in regulation of • “Trans” forms blood pressure and blood clotting are derived from linoleic acid. The major food sources of linoleic acid are sunflower, , corn, and oils. Brown_U18_1-20.qxd 5/21/04 12:11 PM Page 5

E TABLE 18.3 S Illustration 18.3 U A GLOSSARY OF FATS. A . Triglycerides: Fats in which the glycerol molecule has three fatty acids attached to it; also Glycerol + 3 fattyM acids = Triglyceride called triacylglycerol. Triglycerides are the most common type of fat in foods and in body + fat stores. + O Saturated fats: Molecules of fat in which adjacent carbons within fatty acids are linked + O only by single bonds. The carbons are “saturated” with hydrogens; that is, they are attached to the maximum possible number of hydrogens. Saturated fats tend to be solid at room G R temperature. Animal products and palm and are sources of saturated fats. N S I Unsaturated fats: Molecules of fat in which adjacent carbons are linked by one or more S double bonds. The carbons are not saturated with hydrogens; that is, they are attachedN to A fewer than the maximum possible number of hydrogens. Unsaturated fats tend toR be liquid L at room temperature and are found in plants, vegetable oils, meats, and dairy products.A C Glycerol: A syrupy, colorless liquid component of fats that is soluble in water. It is similar to glucose in chemical structure. E R Cholesterol: A fat-soluble, colorless liquid found in animals but not in plaLnts. Cholesterol is O used by the body to form hormones such as testosterone and estrogenE and is a component of animal cell membranes. E : A fat in which the glycerol molecule has two fatty acidsG attachLed to it; also called diacylglycerol. A : A fat in which the glycerol molecule has one fatty acidA attached to it; also called monoacylglycerol. G S Monounsaturated fats: Fats that contain a fatty acid inN which oneR carbon-carbon bond is not saturated with hydrogen. E Polyunsaturated fats: Fats that contain a fatty acidC in whichO two or more carbon-carbon bonds are not saturated with hydrogen. F F T O O Y N T Illustration 18.4 Hydrogen ± A look at the difference Oxygen R Y between a saturated and an E unsaturated fatty acid. L CH3 Carbon P Oxygen SaturatedO fatty acidN R O P CH CH MonounsaturatedW fatty acid E I V CH CH CH CH E Polyunsaturated fatty acid R Two hydrogens are missing from each of these R carbon-carbon links, making the fatty acid O polyunsaturated. With fewer hydrogens to attach to, these carbons are doubly bonded to F each other. Monounsaturated fatty acids have only one carbon-carbon bond that is "unsaturated" with hydrogen atoms. Brown_U18_1-20.qxd 5/21/04 12:11 PM Page 6

E Saturated Monounsaturated PolyunsaturatedS Illustration 18.5 U Fat profiles of selected foods. PERCENTAGE FATTY ACID COMPOSITION DAIRY PRODUCTS M Brick 67 O 30 3 Cheddar cheese 67 30 3 Cottage cheese 67 O 30 3 American cheese 67 G R 30 3 Whole 65 N S 31 4 Butter 65 I S 31 4 HUMAN MILK 48 N A 40 12 EGG (medium) 37R L 48 15 A C OILS AND E 6 58R 36 Coconut oil L 92 62 O 13 E 25 62 Corn oil margarine 17 E 61 22 Flaxseed oil G9 18L 73 A 14 77 9 A 52 38 10 oil G 18 S 48 34 N 15 25 60 Soybean oil margarine R 28 E 22 50 21 C O11 68 F MEATS F T HamburgerO (21% fat) 53 43 4 Chicken, roastedO (no skin) 26 46 28 YPork chop N 39 49 12 Turkey, roasted 40 25 35 T ± R E NUTSY AND SEEDS LCashews 21 62 17 P Nuts 16 46 2 O N , dry-roasted 15 52 33 O 18 51 32 R 11 20 69 P Sunflower seeds (dried) W E I V

E Photo Disc R R Alpha-linolenic acid, EPA (—pronounced e-co-sah-pent- O tah-no-ick) and DHA (: dough-cos-ah-hex-ah-no-ick) are pri- F mary members of the omega-3 fatty acid family. Alpha-linolenic acid is an essential , but EPA and DHA are not. These two members of the omega-3 fatty acid family can be produced in the body from alpha-linolenic acid. However, the con- Brown_U18_1-20.qxd 5/21/04 12:11 PM Page 7

E S version of this to EPA and DHA is slow and results in the avail- U ability of relatively little EPA and DHA.9 Alpha-linolenic acid is a structural com- ponent of all cell membranes and is found in high amounts in cells of the brain and eyes. Alpha-linolenic acid is also involved in the formation of biologically M active compounds used in regulating blood pressure and blood clotting; O but these compounds have the opposite effect on the blood pressure O and blood clotting, as do linoleic acid derivatives.10 Omega 3-fatty FishyG eggs? AnR odd source of oil ON THE SIDE acids are found in a few foods such as , flaxseed, canola oil, and has become part of North Americans’ in the form of alpha-linolenic acid. The most beneficial sources N S I diets. Hens given feed with added cod of omega-3 fatty acids, however, are marine oils—due to their content liver oil Sproduce eggs with con- 11 of DHA and EPA. These two omega-3 fatty acids play important N tainingA 100 to 350 milligrams of highly roles in disease prevention and health promotion. R unsaturatedL omega-3 fatty acids.8 Omega-3 fatty acids are not just good fats,A C they affect heart health in positive ways. E 12 —Penny Kris-Etherton, Distinguished Professor of Nutrition R L

O Eric Risberg/AP Photo The Omega-3 Fatty Acids and Fish Oils] Many unsaturatedE fats contain fatty acids with one or two unsaturated carbon-to-carboEn bonds. DHA and EPA found in fish oils, however, stand outG in thatL they contain from 4 to 6 double bonds. This high level of unsaturatiA on gives these omega-3 fatty acids the unique property of being highly fluidA even at cold temperatures. This property allows the fattyG acids Sto keep cell membranes and fat-containing tissues in fish flexibleN in Rcold water. Fatty fish and fish that live in cold water contain the highestE amounts of DHA and EPA (Table 18.4). C O In humans, DHA and EPA form biologically Factive compounds that reduce blood pressure and the tendency of bloodF to clot, and these properties confer health advantages. Regular consumption of these omega-3T fatty acids (two or more fish- O containing meals per week) decreases the risk Oof heart attack, protects against irreg- ular heartbeat and sudden death, decreasesY plaque formation in arteries, lowers high blood pressure, and decreases the risk of stroke. N capsules are being increas- ingly viewed as potential sourcesT of EPA± and DHA. They are sometimes recom- mended for people at risk ofR heart disease and should be taken under medical supervision. High levels of fish oils (overY 3 grams per day) can prevent blood from 14 E clotting. P L Mercury in Fish and FishO Intake}N Some fish contain high levels of mercury that can end up in fish oil supplements.R O15 Mercury was found to be a potent fungicide over 100 years ago and was used extensively to prevent mold growth on crop seeds. Some of it endedP up in streams, lakes, and oceans, and it lingers there for many decades. Several catastrophicW outbreaks of mercury poisoning due to consumption of contaminated fish Eoccurred during the mid-1900s and brought a halt to the use of mercury fungicides.I Mercury is still found in some ocean and lake fish, but recent studies indicate thatV the benefits of fish intake among people over the age of 40 far outweigh risksE related to mercury.16 PregnantR and breastfeeding women, and infants, are particularly susceptible to the harmful effects of mercury and are advised to omit from their diets the top four mercury-richR fish: shark, swordfish, king mackerel, and tilefish (also called golden snapper and golden bass). Intake of all other fish should be limited to 12 ounces or less perO week among pregnant and breastfeeding women, and to 2 ounces or less for childrenF under the age of 6 years.17 Local advisories related to mercury levels of fish in lakes and streams are avail- able online (www.epa.gov/ost/fish), and advice on intake levels of fish caught in Brown_U18_1-20.qxd 5/21/04 12:11 PM Page 8

E TABLE 18.4 S U OMEGA-3 FATTY ACID (EPA & DHA) CONTENT OF SELECTED SEAFOODS.13 OMEGA-3 OMEGA-3 SEAFOOD SEAFOOD M 1 FATTY ACIDS 1 FATTY ACIDS (3 ⁄2-OUNCE SERVING) (3 ⁄2-OUNCE SERVING (GRAMS) O(GRAMS) Sardines in sardine oil 3.3 Oysters 0.6 Mackerel 2.6 Catfish O 0.5 , Atlantic, farmed 2.2 FlounderG R 0.2 Lake trout 2.0 ShrimpS 0.5 Herring 1.8 HalibutN 0.5 Salmon, Atlantic, wild 1.8 PollockI S 0.5 Tuna, white, canned 1.7 ScallopsN A 0.5 Salmon, sockeye 1.5 RWhitingL 0.5 Whitefish, lake 1.5 Carp 0.3 Anchovies 1.4 A Crab C 0.3 Salmon, chinook 1.4 E Pike, walleye 0.3 Bluefish 1.2 Tuna,R fresh 0.3 L Halibut 1.2 OCatfish, wild 0.2 Trout, rainbow, farmed 1.2E Clams 0.2 Oysters 1.1 E Fish sticks 0.2 Salmon, pinkG 1.0 L Haddock 0.2 Trout, rainbow, wildA 1.0 Lobster 0.2 Bass, striped 0.8 A Salmon, red 0.2 SwordfishG 0.8S Snapper, red 0.2 N E R them should be heeded. LargeO fish (longer than 20 inches) in general contain higher concentrations Cof mercuryF than do smaller fish, so you may want to let the big ones get away . .F . Fish such as flounder,T cod, trout, sole, salmon, , haddock, pollack, and “light” tuna—asO well as shrimp and —generally contain low levels of mer- 18 O cury.YOther sources of DHA and EPA include eggs enriched with omega-3 fatty acids. The American N Heart Association recommends that adults consume two or moreT servings of fish per week, or a total of 0.65 gram of DHA and EPA daily.19 ± RBalancing Intake of Omega-6 and Omega-3 Fatty Acids] The ratio of Eomega-6Y to omega-3 fatty acid intake is important because the functions of one are P adverselyL modified by the presence of disproportionately high amounts of the other. AlthoughN an exact ratio has not been agreed upon, it is thought that people should O consume omega-6 fatty acids and omega-3 fatty acids in a proportion of roughly 4 R O(or less) to 1. Many Americans regularly consume vegetable oils but eat fish infre- P quently. Consequently, the ratio between the intake of omega-6 and omega-3 fatty W acids is over 9 to 1, indicating a need to increase intake of omega-3 fatty acids.20 E I Modifying Fats V Unsaturated fats aren’t as stable as saturated fats. They are more likely to turn ran- E cid with time and exposure to air and heat than are saturated fats. Additionally, R solid fats are preferable to oils for some applications. These problems with unsaturated fats have a solution. It’s called hydrogenation. R hydrogenation What’s Hydrogenation?] Hydrogenation is a process that adds hydrogen to liq- The additionO of hydrogen to uid unsaturated fats, thereby making them more saturated and solid. The shelf life, unsaturatedF fatty acids. cooking properties, and taste of vegetable oils are improved in the process. Hydro- genation has two drawbacks, however. Hydrogenated vegetable oils contain more Brown_U18_1-20.qxd 5/21/04 12:11 PM Page 9

E S saturated fat than the original oil. Corn oil, for example, contains only 6% satu- U rated fats; but corn oil margarine has 17%. The other negative is that hydrogena- tion causes a change in the structure of the unsaturated fatty acids. Specifically, M hydrogenation converts some unsaturated fats into trans fats. trans fats UnsaturatedO fatty acids in fats Trans Fatty Acids] Up to 30% of the fatty acids in unsaturated fat molecules may that containO atoms of hydro- be converted from their naturally occurring “cis” to the “trans” form as a result of gen attached to opposite sides hydrogenation.21 Fatty acids in this structural form raise blood cholesterol levelsG of carbonsR joined by a double more than dietary cholesterol, saturated fats or any other type of fat do.22 The Nbulk bond:S I of trans fat in our diet comes from hydrogenated vegetable oils. Trans fats are more SH stable and have a longer shelf life than other fats and are preferred for useN in mar-A –CC garine, snack foods, bakery products, and fried foods (Table 18.5). RuminantR ani-L HH H mals like cows form some trans fat in the stomach; so milk, other dairy products, –CC– , and lamb contain small amounts of this type of fat. People in theA United StatesC Trans fatty Cis fatty 23 consume an average of 2.6% of total calories from trans fat, or 5.8E grams per day. acid acid R24 It is recommended that Americans consume as little trans fatsL as possible, and new nutrition information labeling requirements are making that easierO to accom- Fats containing fatty acids in plish. Nutrition Facts panels must include the trans fat contenEt of food products by the trans form are generally January 1, 2006 (Illustration 18.6). The %DV column (for percent Eof Daily Value) referred to as trans fats. Cis G fatty acids are the most com- will not be used for trans fats because there is no recommended levelL of intake. Prod- ucts labeled “trans fat–free” must contain less than 0.5A gram ofA both trans and sat- mon, naturally occurring form urated fats. It is expected that the requirement to labelG the trans fat content of food of unsaturated fatty acids. products will increase the number of foods labeled “trans fat–f S ree” and “no trans They contain hydrogens fat” (Illustration 18.7) and decrease its use in foods.N Food Rcompanies are busy devel- located on the same side of oping other ways to produce foods without them.E 25 doubly bonded carbons. O C F Checking Out CholesterolF T Cholesterol is a found only in animalO products. TABLE 18.5 O It is tasteless and odorless and contained in both the TRANS FATTY ACID CONTENT OF FOOD PRODUCTS. lean and fat parts of animal products.Y Table 18.6 lists N Values may change as companies lower the some sources of cholesterol. PlantsT don’t± contain trans fat content of foods. cholesterol because they can’tR produce it and don’t need it to function and growE normally.Y FOOD TRANS FATTY ACIDS (GRAMS) Kentucky Fried Chicken pot pie 8 Sources of CholesterolP L O N , large serving 4–7 The cholesterol used by theO body comes from two Cake doughnut 6 sources. Most (aboutR two-thirds) of the cholesterol Breaded fish sticks, 3 5 available to the body is produced by the liver. The P Margarine, 1 tbs 4 rest comes from the dietW (Illustration 18.8). Because the liver produces Echolesterol from other sub- Dutch apple pie 3–4 stances in our diet,I it does not qualify as an essen- crackers 3 tial nutrient. V chip cookie 2 The ContributionsE of Cholesterol Snack crackers,1 2 oz 2 R Shortening, 1 tbs 1 Would you be surprised to learn that cholesterol: Tub margarine, 1 tbs 1 • isR found in every cell in your body? Butter, 1 tbs 0 •Oserves as the building block for estrogen, “No trans fat” margarine 0 F testosterone, and the D that is pro- Olive oil 0 duced in your skin upon exposure to sunlight? Brown_U18_1-20.qxd 5/21/04 12:11 PM Page 10

E S Illustration 18.6 • is a major component of nerves and the brain? U Trans fat: the newest addi- • cannot be used for energy (so it provides no calories)? tion to Nutrition Facts panels. The body has many uses for cholesterol (Table 18.7). It doesn’t just accumulateM in arteries! O Nutrition Facts O Serving Size 1 Entree Serving Per Container 1 Fat Substitutes G R N S Amount Per Serving The fat content of processed foods can be partiallyI or fullyS replaced by fat substi- Calories 380 Calories from Fat 170 tutes. Fat substitutes attempt to imitate the taste, texture, and cooking properties of %Daily Value our favorite fats, but with fewer calories. TableN 18.8 listsA some of the more than 60 Total Fat 19g 29% Saturated Fat 10g 50% products that are already on the market; othersR are Lunder development. The degree Trans Fat 2g to which these products succeed in imitatingA the Cqualities of fat varies. Making the Cholesterol 85g 28% Sodium 810mg 34% E R Total Carbohydrate 33g 11% L 3g 12% TABLE 18.6 O 5g E Protein 20g FOOD SOURCES OF CHOLESTEROL. E 10% Vitamin C 0% Note that all the sources are animalG products. Cholesterol in foods is a clear, oily liquid 10% Iron 15% found in the fat and lean portions of manyL animal products. Percent Daily Values are based on a 2000 A calorie diet. Your daily values may be higher A CHOLESTEROL or lower depending on your calorie needs: ANIMAL PRODUCT G AMOUNT S (MILLIGRAMS) Calories 2000 2500 N Total Fat Less Than 65g 80g BrainR 3 oz 1746 Sat Fat Less Than 20g 25g E Cholesterol Less Than 300mg 300mg LiverO 3 oz 470 Sodium Less Than 2400mg 2400mg C Total Carbohydrate 300g 375g Egg F 1 212 Dietary Fiber 25g 30g VealF 3 oz 128 T Shrimp O 3 oz 107 Prime ribO 3 oz 80 Y N TChicken (no skin) 3 oz 75 Turkey (no ± skin) 3 oz 65 R Hamburger, regular 3 oz 64 E Y P PorkL chop, lean 3 oz 60 NFish, baked (haddock, flounder) 3 oz 58 O Ice 1 cup 56 R O 3 oz 55 P W Hamburger, lean 3 oz 50 Illustration 18.7 E Milk, whole 1 cup 34 Products that feature “noI Crab, boiled 3 oz 33 trans fats” and “trans Lobster 3 oz 29 fat–free” labels. V E Cheese (cheddar) 1 oz 26 R Milk, 2% 1 cup 22 , low-fat 1 cup 17

Richard Anderson R Milk, 1% 1 cup 14 O Butter 1 tsp 10 F Milk, skim 1 cup 7 Brown_U18_1-20.qxd 5/21/04 12:11 PM Page 11

E TABLE 18.7 S perfect fat substitute is not an easy task. Not all of the fat substitutes that have U entered the marketplace have met the test of consumer acceptability.28 HOW THE BODY USES CHOLESTEROL. Are Fat Substitutes Safe? M • CholesterolO is a compo- Consumers sometimes wonder about the safety of fat substitutes. Because most fat nent of all cell mem- substitutes are derived from ingredients of food such as carbohydrates, protein, and Obranes, the brain, and nerves. vegetable oils, they are often assumed to be safe. Fat replacers that are made fromG R substances that do not occur naturally in foods must be tested for safety. Olean,N a S • It is needed to produce non-naturally occurring fat replacer that cannot be digested, was tested extensivelyI S estrogen, testosterone, before being approved for use. It can cause diarrhea and oily stools if consumed in and vitamin D. large amounts.29 N A R L Can Fat Substitutes Benefit Health? A C Illustration 18.8 When substituted for foods containing saturated fats, fat substitutesE may benefit Food sources of cholesterol in R 26 health by lowering blood cholesterol levels. Studies suggest that theL use of foods con- the U.S. diet. taining fat substitutes reduces total fat consumption, but whether they lead O to weight Percentages indicate the pro- loss is controversial. So, although they may not be the answerE to weight control, fat portion of cholesterol each E substitutes may provide part of the solution to high fat intakeG s and the health prob- type of food contributes to lems related to them.30 L the diet. A A G S Finding Out about the Fat Content Other Photo Disc N foods Eggs of Food R 15% (egg ) E Fats 5% 29% O Not all of the fat in food is visible. To avoid beingC fooled, it helps to use Milk and milk products 15% a reference on the fat composition of foods. Table 18.9 F lists the fat con- tent of common food sources of fat, includingF candy. Vegetables and T Meats 36% fruits (except and coconut) andO are not listed because they contain relatively little fat. Other referencesO can also be used, such as the food composition tables in AppendixY A, the Diet Analysis Plus N Program software, and the nutritionT labels± on food products. R TABLE 18.8 E Y P L SOME FAT SUBSTITUTES.27 O N CARBOHYDRATE-BASED PROTEIN-BASED FAT-BASED O COMBINATIONS (0–4 CAL/G)R (1–2 CAL/G) (0–5 CAL/G) Amalean I andP II K-Blazer Benefat Fitesse CrystaLeanW Proplus Caprenin Nutrifat Instant StellarE Simplesse Olean Prolestra Juguar I Litesse V Maltrin N-Lite E fiberR Oatrim OptaR Grade Pure-gel OSta-Slim F Sta-Lite Brown_U18_1-20.qxd 5/21/04 12:11 PM Page 12

E S Knowledge of the caloric and fat content of a food can be used to calculateU the percentage of calories provided by fat. For example, suppose that a slice of cherry pie provides 350 calories and 15 grams of fat. To calculate the percentage of fat calories, multiply 15 grams by 9 (the number of calories in each gram Mof fat), divide the result by 350 calories, and then multiply by 100: O 15 grams fat 9 calories/gram 135 calories O 135 calories/350 0.39 G R 0.39 100 39% of totalN caloriesS from fat I S Fat Labeling N A Nutrition labeling regulations for fat requireR food manufactureL rs to adhere to stan- dard definitions of “low fat,” “fat-free,” and related terms used on food labels. Sim- ilarly, claims made about the cholesterolA content ofC food products must comply with standard definitions (Table 18.10, onE page 18-14).R If a claim is made about the fat content of a food, the Nutrition Facts L panel must specify the food’s fat, saturated fat, trans fat, and cholesterol content. If a O claim is made about cholesterol content (and claims can be made only Efor products that normally contain cholesterol), the E nutrition panel must also revealG the product’s fat and saturated fat content. To pre- vent the use of unrealistically small servingL sizes as a way to appear to cut down on a product’s fat content, standardA servingA sizes must be used on food labels. G S TABLE 18.9 N R THE FAT CONTENTE OF SOME FOODS. O C PERCENTAGE OF FOOD F AMOUNT GRAMS F TOTAL CALORIES FROM FAT T Fats andO oils Butter O 1 tsp 4.0 100% YMargarine 1 tsp 4.0 100 Oil N 1 tsp 4.7 100 TMayonnaise± 1 tbs 11.0 99 Heavy cream 1 tbs 5.5 93 R Salad dressing 1 tbs 6.0 83 E MeatsY and fast foods P LHot dog 1 (2 oz) 17.0 83 N Bologna 1 oz 8.0 80 O Sausage 4 links 18.0 77 R O 3 pieces 9.0 74 2 oz 11.0 68 P steak 3 oz 18.0 62 W Hamburger, regular (20% fat) 3 oz 16.5 62 E Chicken, fried with skin 3 oz 14.0 53 I Big Mac 6.6 oz 31.4 52 V Quarter Pounder with cheese 6.8 oz 28.6 50 Whopper 8.9 oz 32.0 48 E Steak (rib eye) 3 oz 9.9 47 R Hamburger, lean (10% fat) 3 oz 9.5 45 Steak (T-bone), lean 3 oz 8.9 44 R Rabbit 3 oz 7.0 38 O Veggie pita 1 17.0 38 F Ranch chicken pita 1 18.0 34 Brown_U18_1-20.qxd 5/21/04 12:11 PM Page 13

E TABLE 18.9 S U THE FAT CONTENT OF SOME FOODS. (CONTINUED)

PERCENTAGE OF FOOD AMOUNT GRAMS M TOTAL CALORIES FROM FAT O Meats and fast foods—continued Steak (round), lean only 3 oz 5.2 29 O Chicken, baked without skin 3 oz 4.0 25 G R Turkey wrap 1 9.0 24 N S Hamburger, extra lean I (4% fat) 3 oz 2.3 23 S Venison 3 oz 2.7 18 N A Subway, club 6" 5.0 14 R L Flounder, baked 3 oz 1.0 13 Subway, veggie 6" 3.0 11A C Shrimp, boiled 3 oz 1.0E 10 Milk and milk products R L Cheddar cheese 1 oz 9.5 74 O American cheese 1 oz 6.0E 66 Milk, whole 1 cup 8.5 49E 1 Cottage cheese, regular ⁄2 cup 5.1G L 39 Milk, 2% 1 cup 5.0A 32 Milk, 1% 1 cup 2.7A 24 1 Cottage cheese, 1% fat ⁄2 cup 1.2G S 13 Milk, skim 1 cup 0.4 4 3 N Yogurt, frozen ⁄4 cup 0.0–6.6R 0–3 Other E Olives 4 medium 1.5O 90 1 C Avocado ⁄2 15.0F 84 1 ozF 15.0 80 1 Sunflower seeds ⁄4 cup 17.0T 77 Peanut butter 1 tbsO 8.0 76 1 Peanuts ⁄4 cupO 17.5 75 1 ozY N 13.2 73 Egg 1T 6.0 61 chips 1 oz (13 chips) ± 11.0 61 Chocolate chip cookiesR 4 11.0 54 French friesE 20 friesY 20.0 49 Taco chipsP 1 ozL (10 chips) 6.2 41 Candy Mr. GoodbarO 1.7N oz 15.0 56 Peanut butter cups, 2 regularO 1.6 oz 15.0 54 Milk chocolateR 1.6 oz 14.0 53 JoyP 1.8 oz 14.0 50 Kit KatW 1.5 oz 12.0 47 M and M’s, peanutE 1.7 oz 13.0 47 Nestlé’s CrunchI 1.6 oz 11.0 45 TwixV 2.0 oz 14.0 45 Baby Ruth 2.1 oz 14.0 43 Pay DayE 1.9 oz 12.0 43 SnickersR 2.1 oz 13.0 42 Butterfinger 2.1 oz 12.0 39 M andR M’s, plain 1.7 oz 10.0 39 Milky Way 2.2 oz 11.0 35 3O Musketeers 2.1 oz 9.0 31 FTootsie Roll 2.3 oz 6.0 21 Brown_U18_1-20.qxd 5/21/04 12:11 PM Page 14

E TABLE 18.10 S U WHAT CLAIMS ABOUT THE CHOLESTEROL CONTENT OF FOODS THAT NORMALLY CONTAIN CHOLESTEROL MUST MEAN. M • No cholesterol or cholesterol-free: Contains less than 3 milligrams of cholesterol per serving. O • Low cholesterol: Contains 20 milligrams or less of cholesterol per serving.O • Reduced cholesterol: Contains at least 75% less cholesterolG than normal.R • Less cholesterol: Contains at least 25% less cholesterolN than normal.S The percentage less must be stated on the label. I S N A R L A C Reasons for the Revised E R Recommendations for FatL Intake O Several lines of evidence led to theE recent changes in recommendations for fat intake. One line of evidence has taught us that Ealthough people tend to lose weight on low- fat diets, people also lose weightG on high-fat,L low- or high-carbohydrate, and low- or high-protein diets. WhetherA peopleA lose weight and keep it off depends strongly on the acceptability of the Gdietary changes made, and not on the relative proportions of fat, carbohydrate, and protein content S in the diet that lead to .31 Fat consumptionN amongR Americans decreased from 43% of total calories in 1970 to around 33%E of calories in recent years. Yet, the incidence of overweight and in Cthe UnitedO States has increased since 1970. Consequently, it is diffi- cult to argue that highF fat diets are at the root of the obesity epidemic.32 As fat intake has decreased,F carbohydrate intake has increased. Scientists are asking the question about whetherT high intakes of carbohydrate are related to rising rates of O obesity. Some evidenceO suggests that consumption of high-carbohydrate diets by peopleY with low levels of physical activity and obesity may hasten the development of type 2 N and other disorders related to .33 TThe experience± of groups of people who have traditionally consumed high-fat Rdiets yet have average or below-average rates of heart and other chronic diseases has Etaught usY to view fat intake in the context of overall diet and lifestyle.34 A classic exampleL of the paradox between high-fat diets and low disease rates comes from P Greece and the traditional . This diet is based on whole O products,N vegetables, fruits, nuts, olive oil, dried beans, wine, fish, and poultry (Illus- R Otration 18.9). Over 40% of the calories in the diet come from fat, most of which is P provided in the form of monounsaturated fats. People consuming the traditional W Mediterranean diet tend to be physically active and of normal weight or lean. Despite this diet’s high fat content, populations consuming the diet and living the typical E 35 I lifestyle have low rates of heart disease and cancer, and long life expectancy. A different example making the point that fat intake and health relationships V should be evaluated in the context of the overall diet and lifestyles come from Nige- E ria. The Fulani pastoralists of Northern Nigeria subsist on a diet primarily com- R posed of animal blood, , and dairy products. It is very high in fat and rich in saturated fat—yet the Fulani have normal levels of and are not at R increased risk for heart disease. The Fulani are highly physically active, lean, and tend not to smoke.36 O Rates of heart disease, cancer, , and obesity tend to increase in pop- F ulations as they move from traditional diets and high levels of physical activity to Western-type diets and sedentary lifestyles.37 In the new context, the relationship Brown_U18_1-20.qxd 5/21/04 12:11 PM Page 15

E S between fat intake and health changes—it becomes U similar to the situation in the United States and Photo Disc Canada. High-fat diets in these two countries are often high in calories and saturated fat and low in M vegetables, fruits, and whole grain products. Gen- O eral levels of physical activity in these countries tend O to be low, and rates of obesity high. A high-fat, high-saturated fat diet under these circumstances is G R related to increased blood cholesterol levels and the N S risk of heart disease.38 New recommendations for I S fat intake take into consideration the effects on N A health of different sources and amounts of dietary fat, and the potentially problematic influence of R L low-fat diets on increasing carbohydrate intake in A C populations that tend to be inactive and obese. Rec- E R ommendations for fat intake are changing in part L because of evidence pointing to the fact that some O types of fat are better for health than others. E E G L Good Fats, Bad Fats A Illustration 18.9 A A look at the cuisine of the Fats come in many types in foods, and with few exceptions,G they serve as a source of energy and provide a number of essential functions in the S body. With regard to Mediterranean diet. raising or lowering the risk of heart disease and Nstroke, howevR er, fats differ. Those that elevate total cholesterol and LDL-cholesterolE levels are regarded as “bad” or “unhealthy” fats. Those that lower total cholesterolC andO LDL-cholesterol and raise blood levels of HDL-cholesterol (the one that helpsF the body get rid of cholesterol in the blood) are considered “good” or healthy.”F 39 The list of unhealthy fats includes trans fats, Tsaturated fats, and cholesterol. Fats O labeled bad are generally solid at room temperatureO and are included in foods such as high-fat meats and dairy products,Y hard margarines, shortening, and crispy snack foods.40 Monounsaturated fats, polyunsaturated N fats, alpha-linolenic acid, DHA, and EPA are considered healthy fats andT are present± in food in the form of oils (Table 18.11). R E Y P L REALITY CHECK O N Good fats, bad fats R O Good fats, bad fats Photo Disc P What foods provide W “healthy” fats E I Who gets thumbs up V E RPaprika: ? Butch: How can I be wrong? I’m thinking foods like Low-fatR food products are fish, peanut butter, and best for healthy fat trans fat-free margarine Obecause they contain contain healthy fats. F almost no fat!

Answers on next page Brown_U18_1-20.qxd 5/21/04 12:11 PM Page 16

E S ANSWERS TO REALITY CHECK U Good fats, bad fats

Photo Disc Good fats, bad fats M Low-fat foods contain less fat than the regu- lar version of the foods. But that doesn’t O mean the products contain no fat, or only O good fats. Food sources of fish oils, unsatu- G R rated fat, and trans fat-free products provide N S the healthy fats. As always, healthy diets I S aren’t based on individual foods, they are Paprika Butch based on overall diets. You can emphasizeN A foods providing healthy fats without feelingR L bad about occasionally eating foods brandedA C with the bad fat label. E R L O E E RecommendationsG for Fat and CholesterolL Intake A A Current recommendationsG for adults S call for consumption of 20–35% of total calo- ries from fat. The AIsN (AdequateR Intakes) for the essential fatty acid linoleic acid is set at 17 grams a Eday for men and 12 grams for women. AIs for the other essential fatty acid, alpha-linolenicO acid, are 1.6 grams per day for men and 1.1 grams for women. It is recommended C F that intake of trans fats and saturated fats be as low as possible whileF consuming a nutritionally adequate diet. Only a small proportion of Americans consumeT too little linoleic acid, but intakes of alpha-linolenic acid tend to be low. O Americans are being encouraged to increase consumption of EPA and DHA by eating fishO more often. In addition, saturated fat intake averages 11–12% Y 41 of calories, an N amount that increases the risk of heart disease. TThere is± no recommended level of cholesterol intake, because there is no evi- Rdence to indicate that cholesterol is required in the diet. The body is able to produce EenoughY cholesterol, and people do not develop a cholesterol deficiency disease if it P L O NTABLE 18.11 R O HEALTHY AND UNHEALTHY FATS AND EXAMPLES OF FOOD SOURCES. P W HEALTHY FATS UNHEALTHY FATS E I DHA, EPA (omega-3 fatty acids) Trans fats fish and seafood Snack and fried foods, bakery goods V Monounsaturated fats Saturated fats E Olive and , nuts, Animal fats R Polyunsaturated fats Cholesterol Vegetable oils eggs, seafood, and meat R Alpha-linolenic acid O Soybeans, walnuts, flaxseed F Brown_U18_1-20.qxd 5/21/04 12:11 PM Page 17

E S is not consumed. Because blood cholesterol levels tend to increase somewhat as con- U sumption of cholesterol increases, it is recommended that intake should be minimal. Although cholesterol intake averages around 250 mg per day in the United States, a more health-promoting level of intake would be less than 200 mg a day.42 M Recent recommendations for fat intake represent an unusually large but neces- O sary change in dietary intake guidance. The rationale for the changes has been devel- O oping for years as research results emerged, showing consistent results that supported the new recommendations. Much remains to be understood about theG R effects of dietary fats on health, and how other components of the diet and lifestyleN S and genetic traits modify relationships between fat intake and health. A beneficialI S by-product of the new recommendations for fat intake is that nutrient andN healthA relationships are much more likely to be studied in the context of overall diets and lifestyles in the future. R L A C E R L O E E G L A A G S N E R O C F F T O O Y N T ± R E Y P L O N R O P W E I V E R R O F Brown_U18_1-20.qxd 5/21/04 12:11 PM Page 18

E S U Nutrition UP CLOSE The Healthy Fats in Your Diet M O FOCAL POINT: Identify your healthy fat food choices. O G R N S Are the fats in your diet the I S healthy type? Check it out by N A answering these questions: R L A C How Often Do You Eat: E R Seldom 1L–2 Times 3–5 Times Almost O or NeverE per Week per Week Daily E 1. Sausage, hot dogs, ribs, and G luncheon meats? L A A 2. Heavily marbled steaks or roasts and G S chicken with the skin? N R 3. Soybean products such as E or soynuts? C O F 4. Nuts or seeds? F T O 5. Whole milk, cheese, or ? O Y 6. Soft margarine or olive oil? N T ± 7. French fries, snack crackers,R commercial bakery products? E Y L 8. Rich sauces and gravies?P O N 9. Fish or seafood?R O P 10. Peanut butter? W FEEDBACK (including scoring)E can be found at the end of Unit 18. I V E Key Terms R essential fattyR acids, page 18-3 lipids, page 18-2 trans fats, page 18-9 hydrogenation,O page 18-8 F Brown_U18_1-20.qxd 5/21/04 12:11 PM Page 19

E S www links U www.nlm.nih.gov/medlineplus/ www.healthfinder.gov www.epa.gov/ost/fish dietaryfat.html Good source of information on fats, trans The Environmental ProtectionM Agency’s site Provides a menu that connects you to sites fat, and cholesterol through search terms for looking up national and local advisories such as good and bad fats, interpreting such as dietary fat and healthy fats. on fish contaminationO and consumption. blood lipid profiles, benefits of flaxseed, www.mayoclinic.org O and fat substitutes. Healthy fats, bad fats, know your fats, fats G R www.nal.usda.gov/fnic and heart disease, and other topics are Find out more about fats and fat substi- intelligently covered in sites available N S tutes from the extensive list of topics cov- through the Mayo Clinic’s home page. I S ered under the search term “fats.” N A R L Notes A C 1. Dietary Reference Intakes, Energy, car- 14. Kris-Etherton, New guidelines.E 30. Mattes, Position of the ADA: fat replac- bohydrate, fiber, fat, fatty acids, choles- 15. Stone NJ. Fish consumption, fish oil, R ers; and Bray et al., A 9-month random- terol, protein, and amino acids. Institute lipids, and coronary heart Ldisease. Am J ized controlled trial. of Medicine, National Academy of Sci- Clin Nutr 1997;65:1083–6. O 31. Olson RE. Dietary fats: friend or foe? ences, Washington, DC: National Acad- E 16. Kris Etherton, New guidelines; and Nutr Notes, American Society of Nutri- emies Press; 2002; and Mensink RP et E tional Sciences, 2000;Mar.:3. al., Effects of dietary fatty acids and car- Clarkson TW, StrainG JJ, NutritionL fac- bohydrates on the ratio of serum total tors may modifyA the toxic action of 32. Olson, Dietary fats: friend or foe? to HDL cholesterol and serum lipids, methyl mercury in fish-eatingA popula- 33. Dietary Reference Intakes; and Schwartz Am J Clin Nutr 2003;77:1146–55. tions, J NutrG 2003;133:1539S-43S.S J-M et al., Hepatic de novo lipogenesis 2. Dietary Reference Intakes. 17. Kris-Etherton, New guidelines. in normoinsulinemic and hyperinsuline- N mic subjects consuming high-fat, low- 3. Fat in your diet. How low should you 18. Kris-Etherton, NewR guidelines. E carbohydrate and low-fat, high go? www.mayoclinic.com/invoke 19. Krauss et al., RevisionO 2000. carbohydrate isoenergetic diets, Am J .cfm?id=HQ00670, accessed 6/03. C Clin Nutr 2003;77:43–50. 20. Kris-Etherton F PM et al. Polyunsaturated 4. Dietary Reference Intakes. fatty acids in the food chain in the 34. Dietary Reference Intakes. 5. Fats: the good and the bad. www FUnited States. Am J Clin Nutr 2000;71 (suppl):179S–88S.T 35. Trichopoulou A et al. Adherence to a .mayoclinic.com/invoke.cfm?id=NU00262, O Mediterranean diet and survival in a accessed 9/03. 21. WalshO J. Low fat, no fat, some fat . . . Greek population. N Engl J Med 6. Connor WE. Importance of n-3 fatty Y highN fat? Envir Nutr 1998;21(April):1, 6. 2003;348:2599–608. acids in health and disease. Am J Clin 22. Krauss et al., Revision 2000. 36. Glew RH et al. Nutr 2000;71(suppl):171S–5S. T ± 23. Stuppy P, Transitioning away from trans risk factors and diet of the Fulani pas- 7. Hepburn FN et al. Provisional tablesR on fatty acids, Today’s Dietitian 2003;Jan.: toralists of Northern Nigeria. Am J Clin the content of omega-3-fattyE acids and Y 12–14; and Dietary Reference Intakes. Nutr 2001;74:730–6. other fat components of selected foods. P L 24. Dietary Reference Intakes. 37. Hu FB. The Mediterranean diet and J Am Diet Assoc 1986;86:788–93. mortality—olive oil and beyond. N Engl 8. Everything you alwaysO wanted to knowN 25. Vranico S. PepsiCo sets health-snack J Med 2003;348:2595–6. about those newfangled eggs. Nutr effort. Wall Street Journal 2003, Sept. R O 23, p. B6. 38. Dietary Reference Intakes; and Krauss et Today 2003;38:75. al., Revision 2000. 9. Dietary ReferenceP Intakes. 26. Sabar AF et al. Dietary sources of nutri- W ents among U.S. adults. J Am Diet Assoc 39. Fats: the good and the bad (www 10. Vanschoonbeek K et al. Fish oil, con- 1998;98:537–47. .mayoclinic.com/invoke.cfm?id= sumption and reductionE of arterial dis- NU00262); and Kris-Etherton et al., ease. J Nutr 2003;133:657–60.I 27. Gershoff SN, Nutrition evaluation of New guidelines. dietary fat substitutes, Nutr Rev 11. Krauss RM et al.,V Revision 2000: a 1995;53:305–13; and Mattes RD, Posi- 40. Fats: the good and the bad (www statement for Ehealthcare providers from tion of the American Dietetic Associa- .mayoclinic.com/invoke.cfm?id= the Nutrition Committee of the Ameri- tion: fat replacers, J Am Diet Assoc NU00262). can Heart RAssociation, J Nutr 2001; 1998;98:463–8. 41. Dietary Reference Intakes. 131:132-46; and Kris-Etherton PM et al. NewR guidelines focus on fish, fish 28. Mattes, Position of the ADA: fat replacers. 42. Krauss et al., Revision 2000. oil, omega-3 fatty acids. AHA State- 29. Bray GA et al. A 9-month randomized ment.O Circulation, 2002;Oct. 18. controlled trial comparing fat-substituted 12. Kris-Etherton, New guidelines. and fat-reduced diets in healthy obese F men: the Ole Study. Am J Clin Nutr 13. Connor, Importance of n-3 fatty acids; 2002;76:928–34. and Hepburn et al., Provisional tables. Brown_U18_1-20.qxd 5/21/04 12:11 PM Page 20

E S U Nutrition UP CLOSE M The Healthy Fats in Your Diet O O Feedback for Unit 18 Give yourself a point for each time you checked the “3-5 Times per Week”G or “AlmostR Daily” columns for numbers 3, 4, 6, 9, and 10. These foods are sources ofN healthy unsaturatedS fats or DHA and EPA. Take a point away for each time your answer endedI up in theS same columns for foods listed in numbers 1, 2, 5, 7, and 8. These foods provide saturatedN Aor trans fats. If you have any points left, your selection of food sources of fat regularlRy includeL healthy fats. A C E R L O E E G L A A G S N E R O C F F T O O Y N T ± R E Y P L O N R O P W E I V E R R O F

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