Effect of Dietary Fatty Acids on Cardiovascular Disease Risk Indicators and Inflammation

Vegetable oils high in the specific fatty acids of interest - stearic (found in cocoa butter,
meats), palmitic (found in meats, dairy and some plant oils) and stearic acid's metabolic
product, oleic (found in olive and corn oil) - will be used to displace each other in a
standardized diet and fed to mildly hypercholesterolemic postmenopausal women using a
randomized-controlled crossover design. A critical issue remains unresolved - the relative
comparability among . The findings from this research study will enable us to understand the
mechanism and potential health effect of different types of fats. Each of the diet phases
will be 5 weeks in length with a 2-4 week break between phases. All food and drink will be
provided to study volunteers. Blood pressure and body weight will be monitored once per week
and adjustments made, if necessary, to maintain a stable weight. During the 5th week of each
diet phase, volunteers will come to the center on 3 consecutive days to provide fasting blood
samples and a non-fasting blood sample.

Inclusion Criteria:

The inclusion and exclusion criteria for both studies A and B are identical.

- Postmenopausal women (menopause defined by complete natural cessation of menses for
>12 months or a bilateral oophorectomy).

- Age >50 to < 85 years

- BMI >20 to <35 kg/m2

- LDL-cholesterol >100 mg/dL

- CRP <10 ug/dL

- Normal fasting plasma glucose levels (<120 mg/dL)

- Not taking medication known to affect lipid metabolism:

HMG-CoA reductase inhibitors (statins)

- Bile Acid Sequestrants (Cholestyramine, Colestipol, Colesevelam, etc.)

- Cholesterol Absorption Inhibitors (Ezetimibe [Zetia])

- Nicotinic Acid Agents (Niacin, Niacor, Slo-Niacin, etc)

- Fibrates (Gemfibrozil, Clofibrate, Ciprofibrate, Fenofibrate [Tricor], etc)

- Probucol

- Anticoagulants (Coumadin, Heparin, Plavix, etc)

- Hormone therapy medications containing estrogen

- Acetylsalicylic acid containing medications, aspirin

- Diphenylhydantoin

- Supplements containing fatty acids (Fish Oil, Flaxseed, etc.) and any other compounds
that affect lipid metabolism (red yeast rice, etc.) for at least 3 months prior to
participation in the study

- Anabolic steroids

- Hydrocortisone

- Normal kidney function as assessed by serum creatinine and blood urea nitrogen

- Normal liver function as assessed by serum glutamic pyruvic transaminase, serum
glutamic oxaloacetic transaminase and alkaline phosphatase

- Normal thyroid function as assessed by serum TSH

- Normal gastrointestinal function

- Normotensive on or off medication

- Non-smoker for at least 2 years

- Alcohol intake < 7 drinks per week, and willingness to abstain from consuming
alcohol while participating in the study.

- Consistent physical activity

- Willingness to follow protocol as detailed in the Institutional Review Board
(IRB) approved consent form.

Exclusion criteria:

- Men

- Women who have had a double mastectomy

- Age < 50 and > 85 years

- BMI < 20 and > 35 kg/m2

- LDL-cholesterol <100 mg/dL

- CRP > 10 ug/dL

- Abnormal fasting plasma glucose levels >120 mg/dL

- Use of medications known to affect lipid metabolism:

- HMG-CoA reductase inhibitors (statins)

- Bile Acid Sequestrants (Cholestyramine, Colestipol, Colesevelam, etc.)

- Cholesterol Absorption Inhibitors (Ezetimibe [Zetia])

- Nicotinic Acid Agents (Niacin, Niacor, Slo-Niacin, etc)

- Fibrates (Gemfibrozil, Clofibrate, Ciprofibrate, Fenofibrate [Tricor], etc)

- Anticoagulants (Coumadin, Heparin, Plavix, etc)

- Hormone therapy medications containing estrogen

- Probucol

- Acetylsalicylic acid containing medications, aspirin

- Diphenylhydantoin

- Supplements containing fatty acids (Fish Oil, Flaxseed, etc.) and any other
compounds that affect lipid metabolism (red yeast rice, etc.) in the last 3
months prior to participation in the study

- Anabolic steroids and hydrocortisone

- Renal or kidney disease, as defined by a history of chronic kidney disease or by
glomerular filtration rate of < 60 ml.min/1.73 m2 calculated from screening blood
tests.

- Hypothyroidism or hyperthyroidism, as defined as screening TSH outside of normal
ranges (<0.4 or >4.5), unless controlled with medication for at least 6 months

- Gastrointestinal disease

- Uncontrolled hypertension or high BP reading at the discretion of the study physician
or nurse

- Established cardiovascular disease as defined by history of myocardial infarction,
stroke, heart failure, coronary artery bypass graft, stenosis >50%, angina and
peripheral arterial disease)

- Anemia, as defined by screening haemoglobin <11.7g/dL.

- Liver disease, as defined by a history of chronic hepatitis B or C, cholestatic or
cirrhotic liver disease, nonalcoholic fatty liver disease, elevations of SGPT or SGOT
greater than 1.5 times the upper limit of normal at screening, bilirubin greater than
2 mg/dL (in the absence of benign causes of elevated bilirubin such as Gilbert's
syndrome) at screening, or albumin below the lower limit of normal.

- Type I and II diabetes

- Any non-steroidal anti-inflammatory drugs (NSAID) or antihistamine use by subject for
72 hours prior to blood draws

- Smoking or use of nicotine-containing products within the past 2 years

- Alcohol intake > 7 drinks per week or unwillingness to abstain from consuming alcohol
while participating in the study

- Unwillingness to maintain body weight during participation in the study

- Unwillingness to adhere to diet and study protocol

- Weight gain or loss of more than 15 lb within 6 months prior to enrollment

- Vegetarians and those with food allergies or aversions

- Non-English speaking subjects

- No Social Security number

- Women who have a history of difficulty with blood draws

- Blood donation within the past 8 weeks