Background. The effects of coconut fat and soya fat on serum lipids are controversial. This study was designed to investigate the lipid effects of coconut milk and soya milk supplementation on the lipid profile of free living healthy subjects. Methods. Sixty (60) healthy volunteers aged 18–57 years were given coconut milk porridge (CMP) for 5 days of the week for 8 weeks, followed by a 2-week washout period, subsequent to which they received isoenergetic soya milk porridge (SMP) for 8 weeks. Results. The LDL (low density lipoprotein) levels decreased with CMP and reached statistical significance in the total study population and in the >130 baseline LDL group. The HDL (high density lipoprotein) levels rose significantly with CMP supplementation ( ). Conclusions. We conclude that coconut fat in the form of CM does not cause a detrimental effect on the lipid profile in the general population and in fact is beneficial due to the decrease in LDL and rise in HDL. SMP will be of benefit only in those whose baseline LDL levels are elevated. 1. Introduction Abnormal blood lipids are generally accepted as a major risk factor for ischaemic heart disease amongst all ethnic populations [1]. However, dietary modifications which would help prevent ischaemic heart disease remain controversial as data from different studies are at times inconsistent [2–8]. It must be emphasized that test diet results cannot always be confirmed in community studies when usual day-to-day diets are consumed which are often quite different from test diets. The above statement is true for coconut and coconut based foods, which, being a relatively cheaper fat, is consumed extensively in Asia mainly due to age-old sociocultural culinary practices. The fact that coconut is cultivated locally also contributes in no small measure to its integration into the daily diet of Asians. However, being primarily a source of a saturated fat, coconut has been incriminated as a risk factor for the high incidence of atherosclerotic disease seen in Asians. Early studies regarding the role of coconut in atherogenesis were performed on animals such as rabbits, mice, rats, gerbils, dogs, and monkeys where hydrogenated coconut fat was used in the test diet. This has prompted a significant debate regarding the relevance of these animal studies in humans [9, 10]. Some have gone to the extent of even recommending coconut as a dietary item which would help reduce or prevent coronary arterial disease on the basis of the “Polynesian paradox,” where it is claimed that the high fat intake in the form of coconut has
References
[1]
S. Yusuf, S. Hawken, and S. Ounpuu, “Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study,” The Lancet, vol. 364, no. 9438, pp. 937–952, 2004.
[2]
S. M. Artaud-Wild, S. L. Connor, G. Sexton, and W. E. Connor, “Differences in coronary mortality can be explained by differences in cholesterol and saturated fat intakes in 40 countries but not in France and Finland: a paradox,” Circulation, vol. 88, no. 6, pp. 2771–2779, 1993.
[3]
H. Müller, A. S. Lindman, A. L. Brants？tert, and J. I. Pedersen, “The serum LDL/HDL cholesterol ratio is influenced more favorably by exchanging saturated with unsaturated fat than by reducing saturated fat in the diet of women,” Journal of Nutrition, vol. 133, no. 1, pp. 78–83, 2003.
[4]
P. W. Siri-Tarino, Q. Sun, F. B. Hu, and R. M. Krauss, “Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease,” American Journal of Clinical Nutrition, vol. 91, no. 3, pp. 535–546, 2010.
[5]
N. I. Lipoeto, Z. Agus, F. Oenzil, M. L. Wahlqvist, and N. Wattanapenpaiboon, “Dietary intake and the risk of coronary heart disease among the coconut-consuming Minangkabau in West Sumatra, Indonesia,” Asia Pacific Journal of Clinical Nutrition, vol. 13, no. 4, pp. 377–384, 2004.
[6]
I. A. Prior, F. Davidson, C. E. Salmond, and Z. Czochanska, “Cholesterol, coconuts, and diet on Polynesian atolls: a natural experiment: the Pukapuka and Tokelau Island studies,” American Journal of Clinical Nutrition, vol. 34, no. 8, pp. 1552–1561, 1981.
[7]
P. Dileep Kumar, “The role of coconut and coconut oil in coronary heart disease in Kerala, South India,” Tropical Doctor, vol. 27, no. 4, pp. 215–217, 1997.
[8]
J. Stamler, “Diet-heart: a problematic revisit,” American Journal of Clinical Nutrition, vol. 91, no. 3, pp. 497–499, 2010.
[9]
D. S. Conrado, “Coconut oil: atherogenic or not?” Philippine Journal of Cardiology, vol. 31, no. 3, pp. 97–104, 2003.
[10]
Q. L. Kintanar, “Is coconut oil hypercholesterolemic and atherogenic? A focused review of the literature,” Transactions of the National Academy of Sciences, vol. 10, pp. 371–414, 1988.
[11]
D. Mozaffarian, E. B. Rimm, and D. M. Herrington, “Dietary fats, carbohydrate, and progression of coronary atherosclerosis in postmenopausal women,” American Journal of Clinical Nutrition, vol. 80, no. 5, pp. 1175–1184, 2004.
[12]
A. Mente, L. de Koning, H. S. Shannon, and S. S. Anand, “A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease,” Archives of Internal Medicine, vol. 169, no. 7, pp. 659–669, 2009.
[13]
P. W. Siri-Tarino, Q. Sun, F. B. Hu, and R. M. Krauss, “Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease,” American Journal of Clinical Nutrition, vol. 91, no. 3, pp. 535–546, 2010.
[14]
World Health Organization, Food and Agriculture, “Organization of the United Nations: diet, nutrition and the prevention of the chronic disease,” Report of a Joint WHO/FAO Expert Consultation 916, World Health Organization, Geneva, Switzerland, 2003.
[15]
R. O. Bonow, D. L. Mann, and D. P. Zipes, Eds., Braunwald's Heart Disease, A Textbook of CardiovaScular Medicine, 9th edition, 2011.
[16]
D. E. Laaksonen, K. Nyyss？nen, L. Niskanen, T. H. Rissanen, and J. T. Salonen, “Prediction of cardiovascular mortality in middle-aged men by dietary and serum linoleic and polyunsaturated fatty acids,” Archives of Internal Medicine, vol. 165, no. 2, pp. 193–199, 2005.
[17]
F. B. Hu, M. J. Stampfer, J. E. Manson et al., “Dietary fat intake and the risk of coronary heart disease in women,” The New England Journal of Medicine, vol. 337, no. 21, pp. 1491–1499, 1997.
[18]
F. B. Hu, M. J. Stampfer, J. E. Manson et al., “Dietary saturated fats and their food sources in relation to the risk of coronary heart disease in women,” American Journal of Clinical Nutrition, vol. 70, no. 6, pp. 1001–1008, 1999.
[19]
S. Dayton, M. Pearee, S. Hashimoto, et al., “A controlled clinical trial of a diet high in unsaturated fat in preventing complications of atherosclerosis,” Circulation, vol. 40, no. 2, pp. 1–63, 1969.
[20]
O. Turpeinen, M. J. Karvonen, and M. Pekkarinen, “Dietary prevention of coronary heart disease: the Finnish Mental Hospital study,” International Journal of Epidemiology, vol. 8, no. 2, pp. 99–118, 1979.
[21]
R. K. Murray, D. K. Granner, P. A. Mayes, and V. W. Rodwell, Harper's Biochemistry, Lange Series, McGraw-Hill, 25th edition, 1999.
[22]
N. Spritz and M. A. Mishkel, “Effects of dietary fats on plasma lipids and lipoproteins: an hypothesis for the lipid-lowering effect of unsaturated fatty acids,” Journal of Clinical Investigation, vol. 48, no. 1, pp. 78–86, 1969.
[23]
D. J. McNamara, R. Kolb, and T. S. Parker, “Heterogeneity of cholesterol homeostasis in man. Response to changes in dietary fat quality and cholesterol quantity,” Journal of Clinical Investigation, vol. 79, no. 6, pp. 1729–1739, 1987.
[24]
National Heart Lung and Blood Institute, NIH Publication No. 02-5215, 2002, http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf.
[25]
A. Keys, J. T. Anderson, and F. Grande, “Serum cholesterol response to changes in the diet. IV. Particular saturated fatty acids in the diet,” Metabolism, vol. 14, no. 7, pp. 776–787, 1965.
[26]
“Multiple risk factor intervention trial. Risk factor changes & mortality results. Multiple Risk Factor Intervention Trial Research Group,” The Journal of the American Medical Association, vol. 248, no. 12, pp. 1465–1477, 1982.
[27]
“The lipid research clinic, coronary primary prevention trial results. I. Reduction in incidence of coronary heart disease,” The Journal of the American Medical Association, vol. 251, no. 3, pp. 351–364, 1984.
[28]
A. J. Lawrance, T. J. Moore, E. Obarzanek, et al., “A clinical trial of the effects of Dietary patterns on Blood pressure,” The New England Journal of Medicine, vol. 336, pp. 1117–1124, 1997.
[29]
A. Keys, F. Grande, and J. T. Anderson, “Bias and misrepresentation revisited: “perspective” on saturated fat,” American Journal of Clinical Nutrition, vol. 27, no. 2, pp. 188–212, 1974.
[30]
D. M. Hegsted, R. B. McGandy, M. L. Myers, and F. J. Stare, “Quantitative effects of dietary fat on serum cholesterol in man,” American Journal of Clinical Nutrition, vol. 17, no. 5, pp. 281–295, 1965.
[31]
W. G. Lindsheer and A. J. Vergroesen, “Lipids,” in Modern Nutrition in Health and Disease, M. E. Shils, Ed., pp. 42–88, Lea and Febiger, Philadelphia, Pa, USA, 1994.
[32]
T. B. Seaton, S. L. Welle, M. K. Warenko, and R. G. Campbell, “Thermic effect of medium-chain and long-chain triglycerides in man,” American Journal of Clinical Nutrition, vol. 44, no. 5, pp. 630–634, 1986.
[33]
N. B. Cater, H. J. Heller, and M. A. Denke, “Comparison of the effects of medium-chain triacylglycerols, palm oil, and high oleic acid sunflower oil on plasma triacylglycerol fatty acids and lipid and lipoprotein concentrations in humans,” American Journal of Clinical Nutrition, vol. 65, no. 1, pp. 41–45, 1997.
[34]
A. A. Papamandjaris, M. F. di Buono, P. J. H. Jones, N. B. Cater, and M. A. Denke, “Fatty acid chain-length designations are important to study conclusions,” American Journal of Clinical Nutrition, vol. 66, no. 3, pp. 710–712, 1997.
[35]
R. Reiser, “Saturated fat in the diet and serum cholesterol concentration: a critical examination of the literature,” American Journal of Clinical Nutrition, vol. 26, no. 5, pp. 524–555, 1973.
[36]
D. S. Fredrickson, R. I. Levy, and R. S. Lees, “Fat transport in lipoproteins—an integrated approach to mechanisms and disorders,” The New England Journal of Medicine, vol. 276, no. 1, pp. 34–42, 1967.
[37]
M. S. Brown and J. L. Goldstein, “Lipoprotein receptors in the liver. Control signals for plasma cholesterol traffic,” Journal of Clinical Investigation, vol. 72, no. 3, pp. 743–747, 1983.
[38]
J. L. Goldstein and M. S. Brown, “Regulation of low-density lipoprotein receptors: implications for pathogenesis and therapy of hypercholesterolemia and atherosclerosis,” Circulation, vol. 76, no. 3, pp. 504–507, 1987.
[39]
M. Sorci-Thomas, M. D. Wilson, F. L. Johnson, D. L. Williams, and L. L. Rudel, “Studies on the expression of genes encoding apolipoproteins B100 and B48 and the low density lipoprotein receptor in nonhuman primates. Comparison of dietary fat and cholesterol,” Journal of Biological Chemistry, vol. 264, no. 15, pp. 9039–9045, 1989.
[40]
J. C. Fox, H. C. McGill Jr., K. D. Carey, and G. S. Getz, “In vivo regulation of hepatic LDL receptor mRNA in the baboon. Differential effects of saturated and unsaturated fat,” Journal of Biological Chemistry, vol. 262, no. 15, pp. 7014–7020, 1987.
[41]
T. P. Trinidad, A. S. Loyola, A. C. Mallillin et al., “The cholesterol-lowering effect of coconut flakes in humans with moderately raised serum cholesterol,” Journal of Medicinal Food, vol. 7, no. 2, pp. 136–140, 2004.
[42]
P. K. D. N. Anuradha, Dietary risk factors for coronary heart disease in Sri Lanka [Ph.D. thesis], The University of Wayamba, Dandagamuwa, Sri Lanka, 2003.
[43]
K. G. Padmakumaran Nair, T. Rajamohan, and P. A. Kurup, “Coconut kernel protein modifies the effect of coconut oil on serum lipids,” Plant Foods for Human Nutrition, vol. 53, no. 2, pp. 133–144, 1998.
[44]
E. J. Schaefer, R. I. Levy, and N. D. Ernst, “The effects of low cholesterol, high polyunsaturated fat, and low fat diets on plasma lipid and lipoprotein cholesterol levels in normal and hypercholesterolemic subjects,” American Journal of Clinical Nutrition, vol. 34, no. 9, pp. 1758–1763, 1981.
[45]
C. B. Blum, R. I. Levy, and S. Eisenberg, “High density lipoprotein metabolism in man,” Journal of Clinical Investigation, vol. 60, no. 4, pp. 795–807, 1977.
[46]
J. Shepherd, C. J. Packard, and J. R. Patsch, “Effects of dietary polyunsaturated and saturated fat on the properties of high density lipoproteins and the metabolism of apolipoprotein A-I,” Journal of Clinical Investigation, vol. 61, no. 6, pp. 1582–1592, 1978.
[47]
R. P. Mensink and M. B. Katan, “Effect of dietary fatty acids on serum lipids and lipoproteins: a meta-analysis of 27 trials,” Arteriosclerosis and Thrombosis, vol. 12, no. 8, pp. 911–919, 1992.
[48]
R. P. Mensink and M. B. Katan, “Effect of a diet enriched with monounsaturated or polyunsaturated fatty acids on levels of low-density and high-density lipoprotein cholesterol in healthy women and men,” The New England Journal of Medicine, vol. 321, no. 7, pp. 436–441, 1989.
[49]
W. E. Connor, D. T. Witiak, D. B. Stone, and M. L. Armstrong, “Cholesterol balance and fecal neutral steroid and bile acid excretion in normal men fed dietary fats of different fatty acid composition,” Journal of Clinical Investigation, vol. 48, no. 8, pp. 1363–1375, 1969.
[50]
N. Spritz and M. A. Mishkel, “Effects of dietary fats on plasma lipids and lipoproteins: an hypothesis for the lipid-lowering effect of unsaturated fatty acids,” Journal of Clinical Investigation, vol. 48, no. 1, pp. 78–86, 1969.
[51]
F. H. Mattson and S. M. Grundy, “Comparison of effects of dietary saturated, monounsaturated, and polyunsaturated fatty acids on plasma lipids and lipoproteins in man,” Journal of Lipid Research, vol. 26, no. 2, pp. 194–202, 1985.
[52]
J. W. Anderson, B. M. Johnstone, and M. E. Cook-Newell, “Meta-analysis of the effects of soy protein intake on serum lipids,” The New England Journal of Medicine, vol. 333, no. 5, pp. 276–282, 1995.
[53]
R. M. Weggemans and E. A. Trautwein, “Relation between soy-associated isoflavones and LDL and HDL cholesterol concentrations in humans: a meta-analysis,” European Journal of Clinical Nutrition, vol. 57, no. 8, pp. 940–946, 2003.
[54]
F. M. Sacks, A. Lichtenstein, L. van Horn, W. Harris, P. Kris-Etherton, and M. Winston, “Soy protein, isoflavones, and cardiovascular health: an American Heart Association Science Advisory for professionals from the Nutrition Committee,” Circulation, vol. 113, no. 7, pp. 1034–1044, 2006.
[55]
M. Z. Nichaman, C. C. Sweeley, and R. E. Olson, “Plasma fatty acids in normolipemic and hyperlipemic subjects during fasting and after linoleate feeding,” American Journal of Clinical Nutrition, vol. 20, no. 10, pp. 1057–1069, 1967.
[56]
S. Mendis and R. Kumarasunderam, “The effect of daily consumption of coconut fat and soya-bean fat on plasma lipids and lipoproteins of young normolipidaemic men,” British Journal of Nutrition, vol. 63, no. 3, pp. 547–552, 1990.
[57]
E. J. Schaefer, R. I. Levy, and N. D. Ernst, “The effects of low cholesterol, high polyunsaturated fat, and low fat diets on plasma lipid and lipoprotein cholesterol levels in normal and hypercholesterolemic subjects,” American Journal of Clinical Nutrition, vol. 34, no. 9, pp. 1758–1763, 1981.
[58]
G. L. Vega, E. Groszek, R. Wolf, and S. M. Grundy, “Influence of polyunsaturated fats on composition of plasma lipoproteins and apolipoproteins,” Journal of Lipid Research, vol. 23, no. 6, pp. 811–822, 1982.
[59]
F. H. Mattson and S. M. Grundy, “Comparison of effects of dietary saturated, monounsaturated, and polyunsaturated fatty acids on plasma lipids and lipoproteins in man,” Journal of Lipid Research, vol. 26, no. 2, pp. 194–202, 1985.
[60]
R. P. Mensink, P. L. Zock, A. D. M. Kester, and M. B. Katan, “Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials,” American Journal of Clinical Nutrition, vol. 77, no. 5, pp. 1146–1155, 2003.
[61]
P. J. Nestel and A. Poyser, “Changes in cholesterol synthesis and excretion when cholesterol intake is increased,” Metabolism, vol. 25, no. 12, pp. 1591–1599, 1976.
[62]
E. C. R. Quintao, S. Brumer, and K. Stechhahn, “Tissue storage and control of cholesterol metabolism in man on high cholesterol diets,” Atherosclerosis, vol. 26, no. 3, pp. 297–310, 1977.
[63]
F. A. Kummerow, Y. Kim, and J. Hull, “The influence of egg consumption on the serum cholesterol level in human subjects,” American Journal of Clinical Nutrition, vol. 30, no. 5, pp. 664–673, 1977.
