J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Review

Volume 7, Number 3, March 2015, pages 145-149

Effects of Dietary Fat Intake on HDL Metabolism

**Table 1.** Meta-Analyses for Effects of Various FA Intake on HDL Metabolism
Authors	Study design	Subjects	Results/conclusions
ALA: alpha linolenic acid; CI: confidence interval; CLA: conjugated linoleic acid; FA: fatty acids; HDL-C: high-density lipoprotein- cholesterol; SFA: saturated fatty acids; USFA: unsaturated fatty acids; TC: total cholesterol; TFA: trans-fatty acids.
Mensink et al [4]	Effects of changes in carbohydrate and FA intake on serum lipids	Twenty-seven controlled trials	All FA elevated HDL-C when substituted for carbohydrates
Huth et al [5]	The relationship between milk fat containing dairy foods and cardiovascular health	The published research including observational studies and short-term intervention studies, and reviews	A diet higher in SFA from whole milk and butter increases HDL-C when substituted for carbohydrates or USFA
Mensink et al [6]	Effects of the amount and type of fat on TC/HDL-C and on other lipids	Sixty controlled trials	Replacement of carbohydrates with SFA did not change TC/HDL-C, but replacement with cis-USFA decreased. Replacement of TFA with SFA decreased TC/HDL-C by 0.019; with cis-MUFA, by 0.048; and with cis-PUFA, by 0.054
Salas-Salvado et al [7]	Effects of CLA on metabolic parameters	Healthy humans or patients with overweight, obesity, metabolic syndrome, or diabetes	CLA isomers decreases HDL-C
Wendland et al [8]	Effects of dietary supplementation with ALA on cardiovascular risk markers	Fourteen studies with minimum treatment duration of 4 weeks	There was a small but clinically unimportant decrease in HDL (0.39 mg/dL, 95% CI: -0.77 - 0.00, P < 0.01)

Table 1. Meta-Analyses for Effects of Various FA Intake on HDL Metabolism

Authors

Study design

Subjects

Results/conclusions

ALA: alpha linolenic acid; CI: confidence interval; CLA: conjugated linoleic acid; FA: fatty acids; HDL-C: high-density lipoprotein- cholesterol; SFA: saturated fatty acids; USFA: unsaturated fatty acids; TC: total cholesterol; TFA: trans-fatty acids.

Mensink et al [4]

Effects of changes in carbohydrate and FA intake on serum lipids

Twenty-seven controlled trials

All FA elevated HDL-C when substituted for carbohydrates

Huth et al [5]

The relationship between milk fat containing dairy foods and cardiovascular health

The published research including observational studies and short-term intervention studies, and reviews

A diet higher in SFA from whole milk and butter increases HDL-C when substituted for carbohydrates or USFA

Mensink et al [6]

Effects of the amount and type of fat on TC/HDL-C and on other lipids

Sixty controlled trials

Replacement of carbohydrates with SFA did not change TC/HDL-C, but replacement with cis-USFA decreased. Replacement of TFA with SFA decreased TC/HDL-C by 0.019; with cis-MUFA, by 0.048; and with cis-PUFA, by 0.054

Salas-Salvado et al [7]

Effects of CLA on metabolic parameters

Healthy humans or patients with overweight, obesity, metabolic syndrome, or diabetes

CLA isomers decreases HDL-C

Wendland et al [8]

Effects of dietary supplementation with ALA on cardiovascular risk markers

Fourteen studies with minimum treatment duration of 4 weeks

There was a small but clinically unimportant decrease in HDL (0.39 mg/dL, 95% CI: -0.77 - 0.00, P < 0.01)

**Table 2.** Meta-Analyses for the Effects of MUFA and TFA on HDL Metabolism
Authors	Study design	Subjects	Results/conclusions
CHD: coronary heart diseases; MUFA: monounsaturated fatty acids; HDL-C: high-density lipoprotein-cholesterol; PHVO: partially hydrogenated vegetable oils; PUFA: polyunsaturated fatty acids, SFA: saturated fatty acids; TC: total cholesterol.
Schwingshackl et al [9]	Effects of MUFA on cardiovascular risk factors. Dietary regimens with a high amount of MUFA (> 12%) were compared to those with ≤ 12%.	Twelve studies	No effect on HDL-C
Mozaffarian et al [10]	Effects of TFA consumption on CHD	Medline publications examining TFA consumption and CHD risk factors or outcomes in humans	The effects of TFA consumption on risk factors most consistently seen in both controlled trials and observational studies included reduction of HDL-C
Mozaffarian et al [11]	Quantitative estimates of CHD effects if a person's PHVO consumption were to be replaced with alternative fats and oils based on randomized dietary trials and prospective observational studies	Meta-analyses of the effects of TFAs on blood lipids and lipoproteins in controlled dietary trials and associations of habitual TFA consumption with CHD outcomes in prospective cohort studies	In controlled trials, each 1% energy replacement of TFA with SFA, MUFA and PUFA, respectively, decreased the TC/HDL-C by 0.31, 0.54 and 0.67, respectively

Table 2. Meta-Analyses for the Effects of MUFA and TFA on HDL Metabolism

Authors

Study design

Subjects

Results/conclusions

CHD: coronary heart diseases; MUFA: monounsaturated fatty acids; HDL-C: high-density lipoprotein-cholesterol; PHVO: partially hydrogenated vegetable oils; PUFA: polyunsaturated fatty acids, SFA: saturated fatty acids; TC: total cholesterol.

Schwingshackl et al [9]

Effects of MUFA on cardiovascular risk factors. Dietary regimens with a high amount of MUFA (> 12%) were compared to those with ≤ 12%.

Twelve studies

No effect on HDL-C

Mozaffarian et al [10]

Effects of TFA consumption on CHD

Medline publications examining TFA consumption and CHD risk factors or outcomes in humans

The effects of TFA consumption on risk factors most consistently seen in both controlled trials and observational studies included reduction of HDL-C

Mozaffarian et al [11]

Quantitative estimates of CHD effects if a person's PHVO consumption were to be replaced with alternative fats and oils based on randomized dietary trials and prospective observational studies

Meta-analyses of the effects of TFAs on blood lipids and lipoproteins in controlled dietary trials and associations of habitual TFA consumption with CHD outcomes in prospective cohort studies

In controlled trials, each 1% energy replacement of TFA with SFA, MUFA and PUFA, respectively, decreased the TC/HDL-C by 0.31, 0.54 and 0.67, respectively

**Table 3.** Meta-Analyses for Effects of Fish Oils Intake on HDL Metabolism
Authors	Study design	Subjects	Results/conclusions
CI: confidence interval; DHA: docosahexaenoic acid; EPA: eicosapentaenoic acid; FA: fatty acids; HDL-C: high-density lipoprotein-cholesterol; PUFA: polyunsaturated fatty acids.
Lewis et al [12]	Efficacy of long-chain omega-3 FA as secondary agents for prevention of hypertriglyceridemia	Ten studies	Average increase in HDL was 10%
Eslick et al [13]	Effects of fish oils on serum lipids in hyperlipidemic subjects	Forty-seven studies, subjects taking fish oils (daily intake of 3.25 g of EPA and/or DHA)	Taking fish oils produced very slight increases in HDL (0.39 mg/dL, 95% CI: 0.00 - 0.77)
Pei et al [14]	Effect of n-3 PUFA consumption on plasma lipids	Five hundred fifty-seven patients with end-stage renal disease	Consumption of n-3 PUFA elevated HDL-C by 9.67 mg/dL, but these changes were not statistically significant
Bernstein et al [15]	Certain algae contain the DHA. The relation between algal oil supplementation and cardiovascular disease risk factors	Eleven randomized controlled trials with 485 healthy participants	The pooled estimate for the change in HDL-C was 2.71 mg/dL (95% CI: 1.93 - 3.87)
Wei et al [16]	Effects of EPA and DHA on serum lipids	Monotherapy with EPA (n = 10), DHA (n = 17), or EPA vs. DHA (n = 6)	DHA raised HDL (4.49 mg/dL; 95% CI: 3.50 - 5.48) compared with placebo, whereas EPA did not

Table 3. Meta-Analyses for Effects of Fish Oils Intake on HDL Metabolism

Authors

Study design

Subjects

Results/conclusions

CI: confidence interval; DHA: docosahexaenoic acid; EPA: eicosapentaenoic acid; FA: fatty acids; HDL-C: high-density lipoprotein-cholesterol; PUFA: polyunsaturated fatty acids.

Lewis et al [12]

Efficacy of long-chain omega-3 FA as secondary agents for prevention of hypertriglyceridemia

Ten studies

Average increase in HDL was 10%

Eslick et al [13]

Effects of fish oils on serum lipids in hyperlipidemic subjects

Forty-seven studies, subjects taking fish oils (daily intake of 3.25 g of EPA and/or DHA)

Taking fish oils produced very slight increases in HDL (0.39 mg/dL, 95% CI: 0.00 - 0.77)

Pei et al [14]

Effect of n-3 PUFA consumption on plasma lipids

Five hundred fifty-seven patients with end-stage renal disease

Consumption of n-3 PUFA elevated HDL-C by 9.67 mg/dL, but these changes were not statistically significant

Bernstein et al [15]

Certain algae contain the DHA. The relation between algal oil supplementation and cardiovascular disease risk factors

Eleven randomized controlled trials with 485 healthy participants

The pooled estimate for the change in HDL-C was 2.71 mg/dL (95% CI: 1.93 - 3.87)

Wei et al [16]

Effects of EPA and DHA on serum lipids

Monotherapy with EPA (n = 10), DHA (n = 17), or EPA vs. DHA (n = 6)

DHA raised HDL (4.49 mg/dL; 95% CI: 3.50 - 5.48) compared with placebo, whereas EPA did not

**Table 4.** Meta-Analyses for Effects of Plant Sterols and Stanols on HDL Metabolism
Authors	Study design	Subjects	Results/conclusions
FH: familial hypercholesterolemia; HDL-C: high-density lipoprotein-cholesterol; LDL-C: low-density lipoprotein-cholesterol; TC: total cholesterol.
Talati et al [17]	Comparison between the effect of plant sterols vs. plant stanols on serum lipids	Healthy subjects or patients with hypercholesterolemia, 14 studies (n = 531)	No statistically or clinically significant difference between plant sterols and plant stanols in their abilities to modify HDL-C
Seppo et al [18]	Effects of ingestion of low-fat milk products enriched with plant stanol esters (2 g/day) for 5 weeks on serum lipids	A total of 199 hypercholesterolemic subjects	There were no significant differences between the groups in pooled HDL-C
Moruisi et al [19]	Efficacy of plant sterols/stanols for 4 weeks to 3 months in lowering TC and LDL-C in FH subjects	Heterozygous FH patients, aged 2 - 69 years old	HDL-C were not affected
Chen et al [20]	Comparison of the efficacy and safety of plant sterols and stanols with policosanol in serum lipids	A total of 4,596 patients from 52 eligible studies	Policosanol affected HDL-C more favorably than plant sterols and stanols

Table 4. Meta-Analyses for Effects of Plant Sterols and Stanols on HDL Metabolism

Authors

Study design

Subjects

Results/conclusions

FH: familial hypercholesterolemia; HDL-C: high-density lipoprotein-cholesterol; LDL-C: low-density lipoprotein-cholesterol; TC: total cholesterol.

Talati et al [17]

Comparison between the effect of plant sterols vs. plant stanols on serum lipids

Healthy subjects or patients with hypercholesterolemia, 14 studies (n = 531)

No statistically or clinically significant difference between plant sterols and plant stanols in their abilities to modify HDL-C

Seppo et al [18]

Effects of ingestion of low-fat milk products enriched with plant stanol esters (2 g/day) for 5 weeks on serum lipids

A total of 199 hypercholesterolemic subjects

There were no significant differences between the groups in pooled HDL-C

Moruisi et al [19]

Efficacy of plant sterols/stanols for 4 weeks to 3 months in lowering TC and LDL-C in FH subjects

Heterozygous FH patients, aged 2 - 69 years old

HDL-C were not affected

Chen et al [20]

Comparison of the efficacy and safety of plant sterols and stanols with policosanol in serum lipids

A total of 4,596 patients from 52 eligible studies

Policosanol affected HDL-C more favorably than plant sterols and stanols