Different dietary fatty acids are associated with blood lipids in healthy South African men and women: The PURE study Marilize Richter ⁎ ,1 , Jeannine Baumgartner 1 , Edelweiss Wentzel-Viljoen 1 , Cornelius M. Smuts 1 Centre of Excellence for Nutrition, North-West University, Potchefstroom Campus, South Africa abstract article info Article history: Received 9 October 2013 Received in revised form 21 December 2013 Accepted 12 January 2014 Available online 22 January 2014 Keywords: Nutrition transition Blood lipids Dietary fatty acids Alpha-linolenic acid Eicosapentaenoic acid Docosahexaenoic acid Background: Preliminary data from the baseline Prospective Urban Rural Epidemiology (PURE) study in South Africa indicated a higher prevalence of dyslipidemia than previous South African studies. The intake of specific individual dietary fatty acids may affect blood lipids differently than sub-groups of fat (i.e. polyunsaturated fatty acids). We investigated the dietary intake of different individual fatty acids and their associations with blood lipids, in relation to urbanization and gender. Methods: Cross-sectional data analysis within the PURE baseline study of healthy subjects (n = 1950, 35–70 years) from rural and urban areas. Dietary data were collected and blood lipid analysis performed. Results: Intake of individual fatty acids was significantly higher in urban than rural dwellers. However, the intake of n-3 PUFAs was below recommendations in all groups. Total cholesterol and LDL were higher in females than in males, with no rural urban differences. Intake of alpha-linolenic acid (ALA) was positively associated with total cholesterol (β = 0.143) and triglycerides (β = 0.256) in males. The risk for having elevated LDL also increased with increased intake of ALA (OR 1.49, 95% CI 1.04, 2.14) in males. In females, arachidonic acid and eicosapentaenoic acid (EPA) were positively associated with total cholesterol and arachidonic acid was also positively associated with LDL, whereas docosahexaenoic acid was negatively associated with total cholesterol and LDL. Conclusions: These results suggest that specific individual dietary fatty acids may affect blood lipids in males differ- ently than in females irrespective of rural or urban dwelling. The positive association between ALA and total choles- terol and triglycerides in males is a concern, because current advice aims to improve the dietary linoleic acid to ALA ratio by increasing ALA intake. © 2014 Elsevier Ireland Ltd. All rights reserved. 1. Introduction The nutrition transition describes a range of socio-economic and de- mographic shifts caused by the migration from rural to urban environ- ments, and is accompanied by rapid changes in diet, lifestyle and patterns of undernourishment and obesity [1]. In developing countries, improved socio-economic conditions and the availability of a variety of food associated with the nutrition transition, has resulted in increased incidence of obesity and non-communicable diseases of lifestyle, such as coronary heart disease [1]. South Africa is experiencing continuous urbanization of Africans [2]. In line with global predictions [3], the urban population in South Africa accounts for more than half of the pop- ulation, the proportion of which is rising, from 55% (re-classified data to match demographic classification used in 2001 census) in 1996 to 58% in 2001 [2]. Scientific interest and public awareness of the role of fatty acids in human health has increased in the past years and dietary fatty acids have been shown to have an effect on coronary heart disease [4]. Total fat intake cannot be linked definitively to cardiovascular disease risk, in part due to opposing effects of specific types of fat [5]. The fatty acid metabolites of linoleic acid and alpha-linolenic acid (ALA), arachidonic acid and docosahexaenoic acid (DHA), are important constituents of all cell membranes, determining and influencing the behavior of membrane-bound enzymes and receptors [6]. Recently it has become clear that even within subtypes of fat such as omega-3 fatty acids, spe- cific individual fatty acids can cause different effects with regard to blood lipids. Several studies have shown that these fatty acids can affect blood lipid profiles, but the directions of the effects were inconsistent [7–9]. Convincing evidence exists for a protective effect of the polyun- saturated fatty acids, linoleic acid, eicosapentaenoic acid (EPA), and DHA on cardiovascular disease [10,11]. Increased risk of cardiovascular disease is also associated with intake of the saturated fatty acids (SFAs), myristic and palmitic acid [10]. Surprisingly, until recently, the African population did not show hy- percholesterolemia at a high level of risk [12,13]. This is in spite of ur- banization, which is accompanied with higher fat intake [1], and the fact that African women have a very high prevalence of obesity [14], International Journal of Cardiology 172 (2014) 368–374 ⁎ Corresponding author at: Private Bag X6001, Potchefstroom 2520, South Africa. Tel.: +27 182992466. E-mail address: richter.marilize@gmail.com (M. Richter). 1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. 0167-5273/$ – see front matter © 2014 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijcard.2014.01.023 Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard