Genetic background Diabetes Overweight visceral adiposity Impaired insulin

Genetic background Diabetes Overweight (visceral adiposity) Impaired insulin sensitivity Cardiovascular diseases Cancer Lifestyle

Proposed mechanisms linking insulin-resistance and/or hyperinsulinemia with atherosclerosis Lifestyle - Genetics Insulin-resistance Platelet aggregation NO HDL-Col Small LDL Glycemia FFA Triglyceride arterial wall Muscle cell proliferation O+ SNS Hyperinsulinemia PAI-1 LDB

The Fluid Mosaic Model of Cell Membranes Surface protein PL bilayer Cholesterol molecules Integral proteins Alkylic FA chains

The Effect of Unsaturation on Membrane Fluidity

Dietary Fat and Insulin Sensitivity D Si (%) -3 -3 -3 L. Storlien, Diabetes, 1991

DISEGNO DELLO STUDIO (1) Modelli più comuni: • Studio osservazionale (o di coorte) – trasversale – longitudinale (prospettico o retrospettivo) – caso-controllo • Studio di intervento

Run-in : h OGTT + placebo 2 -3 weeks Randomization in 4 groups The KANWU study design SFA diet with w-3 SFA diet without w-3 MUFA diet without w-3 0000 0 03. 1 0 2 3

The Kanwu Study Clinical characteristics of the participants (M SD)

Effects of 3 months dietary intervention on insulin sensitivity in 162 healthy subjects The KANWU study Δ Si (%) 12. 4 % p = 0. 053 SAFA MUFA B. Vessby, Diabetologia, 2001

Effect of a change of dietary fat quality on insulin sensitivity (Si) when related to total dietary fat intake during treatment The KANWU Study Δ Si (%) Fat < 37% Fat > 37% 21. 3 %; p < 0. 03 4. 5 %; ns B. Vessby, Diabetologia, 2001

Effects of long chain n-3 fatty acids supplementation on insulin sensitivity ( The KANWU STUDY ) Insulin Sensitivity index (Si) SAFA Diet MUFA Diet P value Diet = 0. 054 n-3 = n. s. Interaction = n. s.

Effects of 3 months dietary intervention on blood pressure in 162 healthy subjects (The KANWU study) SBP mm. Hg p=0. 009 SFA diet MUFA diet p=0. 048 DBP mm. Hg p=0. 0001 Hermansen K, submitted AJCN SFA diet MUFA diet

FABBISOGNO DI GRASSI Ø I grassi devono ammontare almeno al 15 -20% dell’apporto energetico totale Ø Acidi grassi essenziali (1 -2% dell’energia totale) Ø Negli adulti il deficit di acidi grassi essenziali si manifesta per un apporto di acido linoleico < 2, 5 g/die Ø Rapporto ottimale tra ω-6/ω-3 da 5: 1 a 10: 1