1. Ⅰ Ⅱ INTRODUCTION Ⅲ Ⅳ RISK FACTORS 1. Lifestyle 2. Nutrition 3. Fat intake, obesity 4. Fat intake and plasma lipids ① Dietary cholesterol ②Saturated fatty acids ③ Unsaturated fatty acids ④ α-Linolenic acid ⑤ Eicosapentaenoic and docosahexaenoic acid ⑥ Trans unsaturated fatty acids 5. Dietary fat and atherosclerotic vascular disease CONTENTS CONCLUSION ◊ Practical aspects of dietary recommendations ◊ Perspectives for public health Functional food for CHD

2. INTRODUCTION Mortality rate per 100,000 population (men aged 35-74 years) Mortality from CVD and CHD in Selected Countries

4. Lifestyle lower the mean cholesterol level Atherosclerosis modifiable risk factors such as lifestyle and nutritional behavior the extent of atherosclerosis plasma cholesterol CHD  In high risk populations such as Finland or Scotland the rate of myocardial infarction is more than one order of magnitude higher than in low risk areas like China or Japan RISK FACTORS

5. Nutrition fat intake, specifically saturated fat, mean total cholesterol levels , rates of CHD mortality Effect of fat consumption on cholcoronary risk . Association between intake of saturated fat, mean plasma esterol concentrations, and rates of fatal myocardial infarctions in various populations. Figure RISK FACTORS

8. Fat intake & obesity Effect of weight loss on common causes of death. Reduction of total mortality, cancer, coronary heart  disease (CHD), and diabetes-associated mortality by intentional weight loss of 0.5–9 kg in non-smoking women with preexisting obesity related health conditions like diabetes or hypertension observed over 12 years RISK FACTORS Figure HDL cholesterol Cholesterol triglyceride levels Obesity Fat & Body Mass Index

14. Fat intake & Plasma lipids Japan Greenland Eskimos The high consumption of fish a major source of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) Omega-3 fatty acids lower coronary risk Their diet is rich in fat and cholesterol however contains a larger proportion of n-3 fatty acids from seal and whale The supplementation of 1 g of EPA and DHA  reduction of fatal and non-fatal cardiac events between 10 and 30% RISK FACTORS Eicosapentaenoic and docosahexaenoic acid 5

17. Dietary fat In the Lifestyle Heart Trial rigorous lipid-lowering vegetarian diet  Total fat intake : reduced from 31.5 to 6.8% of dietary energy  The P/S-ratio >1  The amount of dietary cholesterol : reduced from 213 to 12.4 mg per day  The intake of complex carbohydrates : raised to more than 70% of dietary energy  Lost 10.9 kg  LDL cholesterol levels decreased by 40% to about 100 mg/dl (2.6 mmol/l)  significant changes in coronary angiograms were detectable RISK FACTORS

18. Dietary fat The Framingham study vegetarian diet  reduced plasma cholesterol to levels of 125–135 mg/dl (3.2–3.5 mmol/l) Relationship Between Cholesterol and CHD Risk vegetarian diet  weight lost  reduction of hypertension  reversal of insulin resistance RISK FACTORS Figure 0 25 50 75 100 125 150 <204 205-234 235-264 265-294 >295 CHD incidence per 1000 Serum cholesterol (mg/100 mL)

22. General dietary recommendations. Dietary advice for the prevention of atherosclerotic disease for a healthy population free from specific metabolic diseases as derived from the experience of international observational studies and intervention trials. CONCLUSION Figure Perspectives for public health