OBJECTIVE -Few multiple lifestyle behavior change programs have been designed to reduce the risk of coronary heart disease in postmenopausal women with type 2 diabetes. This study tested the effectiveness of the Mediterranean Lifestyle Program (MLP), a comprehensive lifestyle self-management program (Mediterranean low-saturated fat diet, stress management training, exercise, group support, and smoking cessation), in reducing cardiovascular risk factors in postmenopausal women with type 2 diabetes.RESEARCH DESIGN AND METHODS -Postmenopausal women with type 2 diabetes (n ϭ 279) were randomized to either usual care (control) or treatment (MLP) conditions. MLP participants took part in an initial 3-day retreat, followed by 6 months of weekly meetings, to learn and practice program components. Biological end points were changes in HbA 1c , lipid profiles, BMI, blood pressure, plasma fatty acids, and flexibility. Impact on quality of life was assessed.RESULTS -Multivariate ANCOVAs revealed significantly greater improvements in the MLP condition compared with the usual care group on HbA 1c , BMI, plasma fatty acids, and quality of life at the 6-month follow-up. Patterns favoring intervention were seen in lipids, blood pressure, and flexibility but did not reach statistical significance.CONCLUSIONS -These results demonstrate that postmenopausal women with type 2 diabetes can make comprehensive lifestyle changes that may lead to clinically significant improvements in glycemic control, some coronary heart disease risk factors, and quality of life.

Although it is known that the fatty acid profile of human milk is altered by diet, the rapidity with which this occurs has not been addressed. We hypothesized that after absorption the fatty acids of a given meal would be transferred rapidly from the chylomicrons of the blood into human milk. Fourteen lactating women drank six test formulas, each containing a different fat: menhaden oil, herring oil, safflower oil, canola oil, coconut oil, or cocoa butter. The subjects collected a midfeeding milk sample before consuming the breakfast test formula and additional samples at 6, 10, 14, and 24 h and then once daily for 4-7 d. Fatty acids of special interest included eicosapentaenoic and docosahexaenoic acids from menhaden oil, cetoleic acid from herring oil, linoleic acid from safflower oil, linolenic acid from canola oil, lauric acid from coconut oil, and palmitic and stearic acids from cocoa butter. Each of these fatty acids increased significantly in human milk within 6 h of consumption of the test formulas (P < 0.001). Maximum increases occurred 10 h after safflower oil; 14 h after cocoa utter, coconut oil, canola oil, and menhaden oil (eicosapentaenoic acid); and 24 h after herring oil and menhaden oil (docosahexaenoic acid). All of these fatty acids remained significantly elevated in milk (P < 0.05) for 10-24 h, except for docosahexaenoic acid, which remained significantly elevated for 2 d, and eicosapentaenoic acid, which remained elevated for 3 d. These data support the hypothesis that there is a rapid transfer of dietary fatty acids from chylomicrons into human milk.

We studied the effects of feeding experimental diets containing (n-6) to (n-3) fatty acid ratios of 31:1, 5.4:1, and 1.4:1 to 20 healthy female geriatric Beagles (9.5-11.5 y) for 8-12 wk on various indices of the immune response. Compared with the 31:1 diet, consumption of the 5.4:1 and 1.4:1 diets significantly increased (n-3) fatty acids in plasma (2.17 +/- 0.64, 9.05 +/- 0.64, 17.46 +/- 0.64 g/100 g fatty acids, respectively, P < 0.0001). Although supplementation with (n-3) fatty acids did not significantly alter the humoral immune response to keyhole limpet hemocyanin (KLH), it significantly suppressed the cell-mediated immune response based on results of a delayed-type hypersensitivity (DTH) skin test. The DTH response after intradermal injection of KLH at 24 h was significantly lower in the group consuming the 1.4:1 diet compared with the group consuming the 5.4:1 (P = 0.02) or the 31:1 diets (P = 0.04), and remained significantly suppressed at 48 h in the group fed 1.4:1 relative to the group fed 31:1. After consumption of the 1.4:1 diet, stimulated mononuclear cells produced 52% less prostaglandin E2 (PGE2) than those from dogs fed the 31:1 diet (224 +/- 74 and 451 +/- 71 pmol/L, respectively, P = 0.04). Plasma concentration of alpha-tocopherol was 20% lower in dogs fed the 1.4:1 diet compared with those fed the 31:1 diet (P = 0.04), and lipid peroxidation was greater in both plasma (P = 0.03) and urine (P = 0.002). These data suggest that although a ratio of dietary (n-6) to (n-3) fatty acids of 1.4:1 depresses the cell-mediated immune response and PGE2 production, it increases lipid peroxidation and lowers vitamin E concentration.

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Background: Although the replacement of dietary saturated fat with unsaturated fat has been advocated to reduce the risk of cardiovascular disease, diets high in polyunsaturated fatty acids (PUFAs) could increase lipid peroxidation, potentially contributing to the pathology of atherosclerosis. Objective: The objective of this study was to examine indexes of in vivo lipid peroxidation, including free F 2 -isoprostanes, malondialdehyde (MDA), and thiobarbituric acid reacting substances (TBARS), in the plasma of postmenopausal women taking dietary oil supplements rich in oleate, linoleate, and both eicosapentaenoic acid and docosahexaenoic acid. Results: Plasma free F 2 -isoprostane concentrations were lower after fish-oil supplementation than after sunflower-oil supplementation (P = 0.003). When plasma free F 2 -isoprostane concentrations were normalized to plasma arachidonic acid concentrations, significant differences among the supplements were eliminated. Plasma MDA concentrations were lower after fishoil supplementation than after sunflower-oil supplementation (P = 0.04), whereas plasma TBARS were higher after fish-oil supplementation than after sunflower oil (P = 0.003) and safflower oil (P = 0.001) supplementation. When plasma MDA concentrations were normalized to plasma PUFA concentrations, significant differences were eliminated, but TBARS remained higher after fish-oil supplementation than after sunflower oil (P = 0.01) and safflower-oil (P = 0.0003) supplementation. Conclusions: With fish-oil supplementation, there was no evidence of increased lipid peroxidation when assessed by plasma F 2 -isoprostanes and MDA, although plasma TBARS was higher than with sunflower-oil and safflower-oil supplementation. Am J Clin Nutr 2000;72:714-22.

Although these data show a small but statistically significant increase in oxidative stress on the basis of plasma TBARS concentrations after the consumption of EPA and DHA, the clinical relevance of this change is questionable. In addition, as supplements of alpha-tocopheryl acetate were added to the diet, neither the plasma TBARS concentration nor the protein oxidation changed. Consequently, the results of this study indicate that there is no basis for vitamin E supplementation after consumption of EPA and DHA.

We evaluated the effects of RRR-alpha-tocpheryl acetate (alpha-tocopheryl acetate) and hormone-replacement therapy (HRT) on the oxidative susceptibility of low-density lipoprotein (LDL) in postmenopausal women consuming a fish oil supplement. The independent effect of fish oil was also assessed. Forty-eight women, equally divided between women using and not using HRT, participated in a double-blind crossover trial. Each of the four periods lasted 5 wk and was followed by a 4-wk washout interval. During each period all subjects were given a 15-g supplement of fish oil and either 0 (placebo), 100, 200, or 400 mg alpha-tocopheryl acetate daily. LDL resistance to oxidative modification was assessed by calculating lag time, propagation rate, and maximum production of conjugated dienes. Supplementation with fish oil and placebo shortened lag time and slowed propagation rate in women both using and not using HRT. After subjects consumed fish oil, supplementation with alpha-tocopheryl acetate increased plasma and LDL alpha-tocopherol contents significantly and lengthened lag time (at even the lowest concentration) but had no significant effect on propagation rate or maximum production compared with values measured after consumption of fish oil alone. Women not using HRT had faster propagation rates and higher maximum production than women using HRT; after supplementation with fish oil and alpha-tocopheryl acetate these differences prevailed. Supplements as low as 100 mg alpha-tocopheryl acetate/d increase the resistance of LDL to oxidation when fish oil supplements are used. HRT and fish oil supplements may independently affect LDL oxidative susceptibility.

The purpose of this study was to determine whether the dose of (n-3) fatty acids (FA) administered, independent of the relative ratio of (n-6) to (n-3) FA in the food, influences plasma FA composition in dogs. Healthy female, geriatric beagles (7-10 y old) were fed foods containing (n-6) to (n-3) FA ratios of either 40.0:1 or 1.4:1 for 12 wk (study 1) or 36 wk (study 2). In study 3, beagles were fed food with the same 1:1 ratio of (n-6) to (n-3) FA, but with increasing concentrations of (n-6) and (n-3) FA. Plasma FA concentrations were measured after completing the feeding studies. In studies 1 and 2, dogs fed fish oil-enriched food with a high (n-3) FA concentration had higher plasma total (n-3) FA, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) concentrations and lower plasma total (n-6) FA, linoleic acid, and arachidonic acid concentrations than dogs fed corn oil-enriched food with a low (n-3) FA concentration (P < 0.001). Both inclusion of fish oil (P < 0.001) and increased food intake independent of treatment effects increased the plasma DHA (P = 0.05) concentration. Furthermore, constancy of the dose of (n-3) FA administered over long periods of time was necessary to maintain plasma levels of total (n-3) FA, EPA, and DHA. In study 3, up to certain dietary concentrations (6.3 g total (n-3) FA/kg food for DHA and 9.8 g total (n-3) FA/kg food for EPA), the dose of (n-3) FA administered, independent of the (n-6) to (n-3) FA ratio, determined the plasma (n-3) FA composition. Results from our studies indicate that approximately 175 mg DHA/(kg body weight . d) is required to attain maximum plasma levels of DHA.