<p>In the present thesis dietary markers for intake of milk fat, associations between intake of milk fat and risk factors for coronary heart disease (CHD), and the effects of supplementation with conjugated linoleic acid (CLA) to healthy humans are investigated.</p><p>The dietary fat quality is one of the main lifestyle factors affecting risk for CHD. When studying the associations between diet and health it is important to have accurate dietary information. Objective dietary markers increase the possibilities to interpret dietary surveys.</p><p>In a study of 62 men we demonstrated that the milk fatty acid pentadecanoic acid (15:0) measured in serum lipids can be used as marker for intake of fat from milk products. In the same study we observed inverse correlations between intake of milk fat and certain risk factors for CHD, especially anthropometric variables.</p><p>To further investigate these findings we supplemented humans with CLA, naturally present in milk. CLA has in animals and <i>in vitro</i> been ascribed positive effects on adiposity and glucose and lipid metabolism. When supplementing humans with CLA we observed a slight decrease in body fat, but no effects on other anthropometric variables or serum lipids. However, markers of lipid peroxidation and inflammation increased. From a second supplementation study we concluded that CLA <i>trans </i>10, <i>cis </i>12 induced lipid peroxidation more than did a mixture of isomers.</p><p>We conclude that the inverse associations between milk fat intake and CHD risk factors, and the effects of CLA, are interesting and need further investigation. However, according to current knowledge, the general population is still advised to have a limited intake of total and saturated fat and to instead choose unsaturated fats. In addition, there is to date no medical reasons for humans to take CLA as supplements.</p>

In the present thesis dietary markers for intake of milk fat, associations between intake of milk fat and risk factors for coronary heart disease (CHD), and the effects of supplementation with conjugated linoleic acid (CLA) to healthy humans are investigated. The dietary fat quality is one of the main lifestyle factors affecting risk for CHD. When studying the associations between diet and health it is important to have accurate dietary information. Objective dietary markers increase the possibilities to interpret dietary surveys. In a study of 62 men we demonstrated that the milk fatty acid pentadecanoic acid (15:0) measured in serum lipids can be used as marker for intake of fat from milk products. In the same study we observed inverse correlations between intake of milk fat and certain risk factors for CHD, especially anthropometric variables. To further investigate these findings we supplemented humans with CLA, naturally present in milk. CLA has in animals and in vitro been ascribed positive effects on adiposity and glucose and lipid metabolism. When supplementing humans with CLA we observed a slight decrease in body fat, but no effects on other anthropometric variables or serum lipids. However, markers of lipid peroxidation and inflammation increased. From a second supplementation study we concluded that CLA trans 10, cis 12 induced lipid peroxidation more than did a mixture of isomers. We conclude that the inverse associations between milk fat intake and CHD risk factors, and the effects of CLA, are interesting and need further investigation. However, according to current knowledge, the general population is still advised to have a limited intake of total and saturated fat and to instead choose unsaturated fats. In addition, there is to date no medical reasons for humans to take CLA as supplements.

Recent findings have shown an inverse association between the circulating levels of pentadecanoic acid (C15:0) and heptadecanoic acid (C17:0) with the risk of pathological development in type 2 diabetes, cardio vascular disease and neurological disorders. From previously published research, it has been said that both these odd chain fatty acids are biomarkers of their dietary intake and are significantly correlated to dietary ruminant fat intake. However, there are profound studies that show the contrary where they do not display this biomarker correlation. Additionally, several astute studies have suggested or shown odd chain fatty acid endogenous biosynthesis, most often suggested via alpha oxidation; the cleavage of a single carbon unit from a fatty acid chain within the peroxisomes. To better understand the correlations and interactions between these two fatty acids with pathological development, the origin of these odd chain fatty acids needed to be determined, along with confirming their association with the disease aetiology. To minimise animal & human experimentation we made use of existing sample sets made available through institutional collaborations, which produced both animal and human interventional study samples suitable for odd chain fatty acid investigations. These sample collaborations allowed us to comprehensively investigate all plausible contributory sources of these odd chain fatty acids; including from the intestinal microbiota, from dietary contributions, and derived from novel endogenous biosynthesis. The investigations included two intestinal germ-free studies, two ruminant fat diet studies, two dietary fat studies and an ethanol intake study. Endogenous biosynthesis was assessed through: a stearic acid infusion, phytol supplementation, and an Hacl1 knockout mouse model. A human dietary intervention study was used to translate the results. Finally, a study comparing circulating baseline C15:0 and C17:0 levels with the development of glucose intolerance. We found that the circulating C15:0 and C17:0 levels were not significantly influenced by the presence or absence of intestinal microbiota. The circulating C15:0 levels were significantly and linearly increased when the C15:0 dietary composition increased; however, there was no significant correlation in the circulating C17:0 levels with intake. Circulating levels of C15:0 were affected by the dietary composition and factors affecting the dietary intake, e.g. total fat intake and ethanol, whereas circulating C17:0 levels were found to be independent of these variables. In our studies, the circulating C15:0 levels were not significantly affected by any expected variations in alpha oxidation caused by pathway substrate inhibition or gene knockout. However, C17:0 was significantly related, demonstrating it is substantially endogenously biosynthesised. Furthermore, we found that the circulating C15:0 levels, when independent of any dietary variations, did not correlate with the progression of glucose intolerance when induced, but the circulating C17:0 levels did significantly relate and linearly correlated with the development of glucose intolerance. To summarise, the circulating C15:0 and C17:0 levels were independently derived; the C15:0 levels substantially correlated with its dietary intake, whilst the C17:0 levels proved to be separately derived from its endogenous biosynthesis via alpha oxidation of stearic acid. C15:0 was found to be minimally endogenously biosynthesised via a single cycle of beta oxidation of C17:0 in the peroxisomes, however, this did not significantly contribute to the circulating levels of C15:0. Additionally, only the baseline levels of C17:0 significantly correlated with the development of glucose intolerance. These findings highlight the considerable differences between both of these odd chain fatty acids that were once thought to be homogeneous and similarly derived. On the contrary, they display profound dietary, metabolic, and pathological differences.

Cardiovascular diseases are the leading cause of death in most industrialised countries and in developing countries the trend in cardiovascular-related deaths is increasing. World-wide, type 2 diabetes mellitus (T2DM) is an emerging cause of disability and premature death. Both these conditions are closely associated with the consumption of energy-dense foods and food products that are poor in nutrients, as well as with a sedentary lifestyle. Pharmacological and surgical interventions can improve the outcome and delay the progression of the disease, but in terms of population-level prevention there is no substitute for the adoption of a healthy lifestyle. SETTING The underlying studies were conducted in Västerbotten (the VIP study), and in Norrbotten and Västerbotten combined (the MONICA Project). Norrbotten andVästerbotten are the two northernmost counties in Sweden. Since the mid-1980sthe prevalence of cardiovascular disease has decreased and diabetes rates haveremained stable in this region, despite of an unbroken trend of increasing body weight. OBJECTIVE The aim of this thesis is to describe changes in reported dietary habits, estimatetheir relative importance as risk factors for diabetes and cardiovascular disease, and finally to identify lifestyle components as potential targets for intervention. RESULTS The first paper describes changes in self-reported food consumption between 1986 and 1999. During this period, the population in question switched from products with high saturated fatty acid content (e.g. milk containing 3% fat, butter) to foods containing less saturated fat (e.g. milk containing 1.5% fat, vegetable oil, low-fat margarine); pasta and rice were consumed more often, and potatoes were consumed less. Convenience foods (e.g. hamburgers, snacks, sweets) became more popular, whilst traditional dishes (e.g. potato dumplings, black pudding, blöta) decreased in popularity. Fruit and vegetable intake remained low. In paper two we study the effects of these changes in food intake on the risk of developing T2DM using body fat distribution as an early indicator. Increased consumption of convenience foods was associated with unfavourable changes (smaller hip circumference and larger waist circumference), whereas the increased consumption of vegetable oil and pasta was associated with low-risk fat distribution. In the third paper we report studies on the association between fat consumption and T2DM. We used the pattern of fatty acids in the membranes of red blood cells as a marker of fat intake. In addition to confirming earlier findings (markers of the intake of saturated fat are associated with increased risk of T2DM and markers of unsaturated fat are associated with reduced T2DM risk), we also identified associations between two markers of milk-derived saturated fat intake and enterolactone, a biomarker of dietary fibre intake, and the risk of developing myocardial infarction. Our results indicate that moderately high levels of enterolactone intake in men are associated with lower risk of experiencing myocardial infarction. Manuscript 5 ranks education level, physical activity, smoking status, and self-reported intake of dietary fibre and fatty acids according to their effects on body fat distribution. Increased levels of physical activity, a higher education level and a reduced intake of saturated fat from meat were ranked as the most strongly associated factors in both men and women. Increased intake of dietary fibre from grains in women, and increased intake of dietary fibre from fruits and vegetables in men, was also inversely associated with average waist circumference. CONCLUSION Both questionnaire-based and biological markers of the risk of developing diabetes or cardiovascular disease have been identified. Based on available population level measurements, reduced consumption of convenience foods, increased consumption of whole-grain products, fruits and vegetables, vegetable oil and pasta as well as increased physical activity are potential goals for interventions in northern Sweden.