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Serum Fatty Acid, Lipid Profile and Dietary Intake of Hong Kong

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Serum Fatty Acid, Lipid Profile and Dietary Intake of Hong Kong European Journal of Clinical Nutrition (2000) 54, 768±773 ß 2000 Macmillan Publishers Ltd All rights reserved 0954±3007/00 $15.00 www.nature.com/ejcn Serum fatty acid, lipid pro®le and dietary intake of Hong Kong Chinese omnivores and vegetarians HY Lee1, J Woo1*, ZY Chen2, SF Leung3 and XH Peng3 1Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong; 2Department of Biochemistry, The Chinese University of Hong Kong, Hong Kong; and 3Department of Paediatries, The Chinese University of Hong Kong, Hong Kong Objective: To examine the serum fatty acid and lipid pro®les and dietary intake of Hong Kong Chinese omnivores and vegetarians with respect to cardiovascular health. Design: Random population survey strati®ed by age and sex. Subjects: One-hundred and ninety-four omnivore subjects (81 men, 113 women) age 25 ± 70 y, and 60 ovo-lacto- vegetarian adults (15 men, 45 women) age 30 ± 55 y. Measurements: Nutrient quantitation was by a food frequency method. Serum fatty acids were analysed by gas chromatography, and serum lipid by standard laboratory methods. Results: Compared with omnivores, vegetarians had higher serum concentrations of polyunsaturated (PUFA) and monosaturated fatty acids (MUFA), and lower saturated fatty acids (SFA), long chain omega-3 and trans fatty acids (TFA). They also had lower serum cholesterol and higher apoA-I concentrations, but the LDL=HDL ratio was not different. The ratio of polyunsaturated to saturated fatty acids intake was higher in vegetarians. Compared with results from populations with higher incidences of coronary heart disease, while lower myristic and palmitic acid concentrations and higher eicosapentaneoic (EPA) and docosahexanoic acid (DHA) may partly account for the difference in incidence, linoleic acid concentration was higher. Although the Chinese vegetarian diet may be bene®cial for heart health in that antioxidant and ®bre intakes are higher and saturated fat lower, the low EPA and DHA due to omission from dietary source and suppressed formation by high linoleic acid level, and the presence of TFA in the diet, may exert an opposite effect. Conclusion: There are some favourable features in the serum fatty acid pro®le in the Hong Kong Chinese population with respect to cardiovascular health, but the consumption of TFA is of concern. The Chinese vegetarian diet also contains some adverse features. Sponsorship: This study is partly sponsored by the Hong Kong Health Services Research Grant. Descriptors: serum fatty acids; Hong Kong Chinese; vegetarian; lipid pro®le European Journal of Clinical Nutrition (2000) 54, 768±773 Introduction 1992). To date the serum fatty acid pro®le has not been documented for the Chinese population. As part of a The relationship between dietary factors such as the territory-wide cardiovascular risk factor study in Hong adverse effect of meat and saturated fat consumption and Kong, we investigated the serum fatty acid composition, the bene®cial effect of vegetables, fruits and nuts, towards serum lipids and dietary intake of Chinese omnivores and coronary heart disease has been well documented in Cau- vegetarians with respect to cardiovascular health. casian populations (Bonanome & Grundy, 1988; Key et al, 1996; Fraser, 1999). Studies also showed that vegetarians have lower incidence of cardiovascular diseases (Key et al, Methods 1996; Fraser, 1999). The incidence and mortality from coronary heart disease in Hong Kong Chinese is one- Subjects eighth to one-quarter of that in Caucasian populations One hundred and ninety-four (81 men and 113 women) (Woo & Donnan, 1989; Department of Health, 1994). aged 25 ± 70 y healthy community omnivore subjects were This may in part be explained by dietary differences. randomly selected, strati®ed for age and sex, from the Dietary fat and fatty acid composition have been documen- territory-wide cardiovascular risk factor study (CRFS) ted as risk factors for coronary heart disease (Ascherio 1995 (Woo et al, 1997). The number of subjects in each et al, 1994, 1999; Simon et al, 1995). Fatty acid intake age and sex group was according to the percentage dis- estimated by dietary record or duplicated meal measure- tribution in the CRFS (Table 1). For comparison between ment alone is either unreliable or too complicated (Rosha- omnivores and vegetarians, serum fatty acid analysis was nai & Sanders, 1985; Hunter et al, 1992). However, body carried out in 133 (56 men and 77 women) omnivore fatty acid composition re¯ects the quality of dietary fat and subjects, matched for age and body mass index with the the type of fat consumed over a long period (Hunter et al, vegetarian subjects. Data from all omnivore subjects were used for comparison with other countries. Sixty healthy vegetarian adults (15 men and 45 women) *Correspondence: J Woo, Department of Medicine and Therapeutics, aged 25 ± 55 y, were recruited from the local vegetarian Prince of Wales Hospital, Shatin NT, Hong Kong. societies and religious groups by advertising through letters E-mail: [email protected]. and telephone contacts to the respective representatives. Dietary intake of Hong Kong Chinese HY Lee et al 769 Table 1 Age distribution (%) of 194 omnivore subjects and in the 14 ± 22 were measured. Individual fatty acid level was territory-wide cardiovascular risk factor study (CRFS) expressed as the percentage of the total serum fatty acids. Men Women Dietary assessment Age (y) n 81 CRFS (n 1399) n 113 CRFS (n 1482) A food frequency questionnaire consisting of most fre- quently consumed food items in the following seven 20 ± 29 8.6 8.7 9.7 7.2 30 ± 39 32.1 28.7 31.9 30.6 categories was used: bread=pasta=rice (16 items); vegeta- 40 ± 49 32.1 25.8 26.6 29.7 bles (63 items); fruits (26 items); meat (39 items); ®sh (31 50 ± 59 17.3 15.9 19.5 15.7 items); eggs (5 items); beverages (37 items); dimsum= 60 ± 69 9.9 16.7 12.4 13.2 snacks (39 items); soups (10 items); and oil=salt=sauces. 70 0.0 4.1 0.0 3.7 For vegetarians, meat and meat products were removed from the food questionnaire and vegetarian food that are commonly consumed in Hong Kong were added. Wherever The criteria for inclusion as vegetarian subjects were that possible, subjects were told prior to the visit that a survey they consumed no meat or ®sh but may consume dairy on a week's diet would be carried out and were advised to products or eggs, and had maintained a vegetarian diet for record brie¯y their diet to help the interview. On the day of at least one year. the interview, each subject was asked to complete the questionnaire, including the food item, the size of each Serum lipid analysis portion, and the frequency of consumption on a daily or Twenty millilitres of venous blood were taken after an weekly basis. Data were crossed-checked by examining the overnight fast. Sera were collected for blood lipids exam- dietary pattern (for example, if meals were skipped) to see ination and the remainders were stored at 70C before if it corresponded to the number of times staple foods such fatty acid analysis. Cholesterol concentration was measured as rice or noodles were consumed over a one week period. on the Hitachi 717 analyser using the cholesterol oxidation The amount of cooking oil was estimated according to the method (CV2 2.9% at 3.3 mmol=l and 2.5% at 7.0 mmol=l), method of preparing different foods: 0.2 tablespoon for and triglyceride by the same instrument using the lipase= steaming ®sh or stir-frying half a portion of vegetables or glycerol kinase method (CV 3.3% at 0.63 mmol=l). High- one portion of meat. Quantitation of dietary lipids was density-lipoprotein cholesterol (HDL-C) was measured on carried out using food tables for Hong Kong which were the Hitachi 717 analyser after precipitation of very-low- compiled from McCane and Widdowson (Holland et al, density-lipoprotein cholesterol (VLDL-C), and low density 1992), and two food tables used in China, published by lipoprotein (LDL-C) by polyethylene glycol PEG 6000 (CV Zhongshan University (Tsang & Fung, 1991) and the 4.2% at 1.64 mmol=l). LDL-C was calculated by the Institute of Health of the Chinese Medical Science Institute Friedewald equation (Friedewald et al, 1972), provided (1992). Only crude ®bre intake instead of soluble ®bre total triglycerides did not exceed 4.0 mmol=l. The serum could be quanti®ed, since many vegetables are not found in apolipoprotein-A (apoA-I) and apolipoprotein B (apoB) English food tables and only appear in the Chinese tables, concentrations were assayed using an immunoradiometric which provide crude ®bre content. assay (IRMA, Mercadia apo(a) RIA kit, Uppsala, Sweden, previously known as Pharmacia apo(a) (RIA). The method Comparison between local omnivores and Caucasians, has an average interassay variation of 3 ± 5%. Japanese and Eskimos Serum fatty acids of the studied omnivores (n 194) were compared with other populations with different dietary fat Serum fatty acid analysis consumption patterns. Due to lack of comprehensive data Sera were thawed to room temperature for fatty acids for Caucasians, data from Austin, Minnesota in 1975, analysis. Serum lipids were extracted from blood samples including 103 healthy males and 101 healthy females with 5 ml chloroform-methanol (2 : 1, v=v). Heptadecanoic with 10 subjects per sex for each decade of age from 0 to acid (17:0) was added as an internal standard to quantify 90 y, was used for analysis (Holman et al, 1979). The serum the fatty acids in serum samples. This fatty acid was used fatty acid concentration was presented as regression model because it is not presented in human plasma and its with age, therefore, the mean age of our studied males and recovery rate is greater than 98%.
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