**Dietary Antioxidant Properties of Vegetable Oils and Nuts – The Race Against Cardiovascular Disease Progression**

Wongama Given Pantsi, Dirk Jacobus Bester, Adriaan Johannes Esterhuyse and Guillaume Aboua

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/57184

**1. Introduction**

Cardiovascular disease (CVD) is a substantial and growing problem in most of the developing regions of the world. Evidence from experimental, clinical and epidemiological studies has unequivocally pointed to oxidative stress as the key culprit in the pathogenesis of CVD [1, 2]. CVD continues to remain a concern in developed countries and is a growing health concern worldwide. Although death rates from CVD have decreased in many countries due to advances in the field of medicine, the prevalence of CVD risk factors continues to increase. Diet is a centrally important, modifiable risk factor in the prevention of CVD [221-224].

The protection offered by foods is probably mediated through multiple beneficial nutrients contained in these foods, including mono- and polyunsaturated fatty acids, antioxidant vitamins, minerals, phytochemicals, fibre and plant protein. In dietary practice, healthy plantbased diets do not necessarily have to be low in fat. Instead, these diets may include unsatu‐ rated fats as the predominant form of dietary fat (e.g., fats from natural vegetable oils and nuts).

Consistent evidence suggests that diets rich in fruit and vegetables and other plant foods are associated with moderately lower overall mortality rates and lower death rates from chronic diseases including CVD [3- 6]. The 'antioxidant hypothesis' proposes that vitamin C, vitamin E, carotenoids and other antioxidant nutrients offer protection against CVD by decreasing oxidative damage [7-9]. As evidence began to mount from animal studies and human epide‐

© 2014 Pantsi et al.; licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

miological studies on the potential protective effects of antioxidants, excitement in both the lay and medical communities also began to increase.

infectious diseases, while NCDs account for 25% of the lives lost [27]. The burden of diseases related to NCDs is predicted to rise substantially in SA over the next decade if necessary measures are not in place to combat the trend [28]. WHO estimates the burden from NCDs in

Dietary Antioxidant Properties of Vegetable Oils and Nuts – The Race Against Cardiovascular Disease Progression

http://dx.doi.org/10.5772/57184

211

Approximately 35-65% of all deaths worldwide occur due to CVDs and death rates exceed these estimated figures owing to malnutrition and infections [29, 30]. CVDs and their risk factors are increasing in SSA [17, 31] with a high prevalence of ischaemic heart disease among men in their sixties followed by women of the same age group [17]. The common potential risk factors for NCDs are tobacco use, physical inactivity and an unhealthy diet, which all lead to CVD, diabetes and cancer [32, 33]. This burgeoning epidemic of NCDs has many root causes. Additional perpetuators of these epidemics are globalization and urbanization [34-37] with abdominal obesity contributing significantly to CVD in the SSA region [38]. Compelling evidence demonstrates a rise in mortality and morbidity from the NCDs in all strata of South African society. Leeder and colleagues [39] estimated that even without changes in the risk factor profile or the mortality rates from CVD, the demographic changes will result in a doubling of the number of cardiovascular deaths in SA by 2040. Chronic diseases such as CVD, obesity and diabetes have therefore become at least as important as infectious disease.

In summary, CVD is a substantial and growing problem in most of the developing regions of the world. The burden of NCD on the African continent and in SA in particular continues to demonstrate the potential for a sustained rise. A significant investment in the health care system and in particular the primary health care system is therefore justified. Further innova‐ tive strategies and plans are needed to address the determinants of this disease burden. However, indications still point to the paucity of community-based studies aimed at investi‐ gating NCD prevalence, incidence and risk factors. Consistent evidence suggests that diets rich in fruit and vegetables and other plant foods are associated with moderately lower overall mortality rates and lower death rates from chronic diseases including CVD [3-6]. The 'antiox‐ idant hypothesis' proposes that carotenoids, polyphenols, vitamin C, vitamin E and other antioxidant nutrients afford protection against CVD by decreasing oxidative damage [7-9]. As the evidence began to mount from animal studies and human epidemiologic studies on potential protective effects of antioxidants, excitement in both the lay and medical communi‐ ties also began to increase. The idea that natural compounds, if taken in supplement form, may offer a broad and inexpensive means of decreasing the risk for CVD and other age-related diseases is a very attractive hypothesis. Enthusiasm has grown to the point where people around the globe have become aware of the need to consume a diet with a high content of fruit

Indeed, evidence from experimental, clinical and epidemiologic studies has unequivocally pointed to oxidative stress as the key culprit in the pathogenesis of CVD [1, 2, 40, 41]. CVD continues to remain a significant problem in developed countries and is a growing health concern worldwide. Although death rates from CVD have decreased in many countries, due to advances in the field of medicine, the prevalence of CVD risk factors continues to increase. Diet is a centrally important, modifiable risk factor in the prevention of CVD [221-224].

SA to be two to three times higher than that in developed countries [13].

and vegetables.

There has been a global increase in the use of medicinal plants that contain significant amounts of antioxidant-rich oils, offering multiple health benefits with fewer side effects compared to their synthetic counterparts. The idea is that natural compounds, if taken in supplement form, may offer a broad and inexpensive means of decreasing the risk for CVD. Natural products, such as vegetable oils and nuts, may be viewed as a cocktail of active ingredients that often have a synergistic effect on health. The (n-3) PUFAs have been shown in epidemiological and clinical trials to reduce the incidence of CVD. Large-scale epidemiological studies suggest that individuals at risk of coronary heart disease (CHD) benefit from the consumption of plant and marine derived (n-3) PUFAs, although the ideal intake is presently unclear. Overall, in view of the prevalence of CHD, consumption of (n-3) PUFA oils should be considered as a useful complementary option for the amelioration of CVD. Several researchers have shown encour‐ aging findings on the protective effects of some vegetable oils and nuts. However, more research needs to be done with regards to the nutrients in these vegetable oils and nuts to elucidate the protective effects against CVD progression. This chapter focuses on the beneficial roles of antioxidant-rich vegetable oils and nuts in the management of CVD, their mechanisms of action and future prospects.

The term "cardiovascular disease (CVD)" encompasses the major clinical end-points related to the heart and vascular system, including ischaemic myocardium (heart failure and angina), myocardial infarction (heart attack), cerebrovascular disease (stroke), high blood pressure (hypertension), peripheral arterial disease (ischaemia of the limbs), arrhythmias, congenital heart disease and rheumatic heart disease. The facts are unequivocal and disturbing; CVD is the leading cause of death worldwide [10-12].

Chronic diseases are disorders with a long duration and generally slow progression. They comprise four major non-communicable diseases (NCDs) as listed by the World Health Organization(WHO),namelyCVD, cancer, chronic respiratorydiseaseanddiabetes [13],which are now reaching epidemic proportions in low- and middle-income countries (LIMIC) of the world[14-18].NCDs constitutethemajorglobalhealthburdenofthe21st century[19-20]without discriminating among age groups [21]. Chronic diseases are implicated in 35 million deaths annually worldwide and a large portion of these deaths occurs due to CVD in LIMIC [22].

There is a rising epidemic of NCDs in sub-Saharan Africa (SSA). However, as in other LIMICs, individuals in SSA suffer from the dual burdens of infectious disease and NCDs [22, 23]. Walker and colleagues [24] reported that SSA continues to suffer under the weight of infectious diseases such as HIV and malaria, as well as high rates of undernutrition. Facing these issues in conjunction with the chronic diseases that accompany high rates of overnutrition is a daunting task [25] for the health burden in Africa. SSA has a disproportionate burden of both infectious and chronic diseases compared with other parts of the world [26]. South Africa (SA) is a country of great diversity extending from highly industrialized cities with an urban advanced-economy lifestyle to remote rural areas with more traditional lifestyles. SA, like many SSA countries, is not immune to the NCD epidemic accompanied by the continued burden of undernutrition. In SA, approximately 28% of deaths annually are attributed to infectious diseases, while NCDs account for 25% of the lives lost [27]. The burden of diseases related to NCDs is predicted to rise substantially in SA over the next decade if necessary measures are not in place to combat the trend [28]. WHO estimates the burden from NCDs in SA to be two to three times higher than that in developed countries [13].

miological studies on the potential protective effects of antioxidants, excitement in both the

There has been a global increase in the use of medicinal plants that contain significant amounts of antioxidant-rich oils, offering multiple health benefits with fewer side effects compared to their synthetic counterparts. The idea is that natural compounds, if taken in supplement form, may offer a broad and inexpensive means of decreasing the risk for CVD. Natural products, such as vegetable oils and nuts, may be viewed as a cocktail of active ingredients that often have a synergistic effect on health. The (n-3) PUFAs have been shown in epidemiological and clinical trials to reduce the incidence of CVD. Large-scale epidemiological studies suggest that individuals at risk of coronary heart disease (CHD) benefit from the consumption of plant and marine derived (n-3) PUFAs, although the ideal intake is presently unclear. Overall, in view of the prevalence of CHD, consumption of (n-3) PUFA oils should be considered as a useful complementary option for the amelioration of CVD. Several researchers have shown encour‐ aging findings on the protective effects of some vegetable oils and nuts. However, more research needs to be done with regards to the nutrients in these vegetable oils and nuts to elucidate the protective effects against CVD progression. This chapter focuses on the beneficial roles of antioxidant-rich vegetable oils and nuts in the management of CVD, their mechanisms

The term "cardiovascular disease (CVD)" encompasses the major clinical end-points related to the heart and vascular system, including ischaemic myocardium (heart failure and angina), myocardial infarction (heart attack), cerebrovascular disease (stroke), high blood pressure (hypertension), peripheral arterial disease (ischaemia of the limbs), arrhythmias, congenital heart disease and rheumatic heart disease. The facts are unequivocal and disturbing; CVD is

Chronic diseases are disorders with a long duration and generally slow progression. They comprise four major non-communicable diseases (NCDs) as listed by the World Health Organization(WHO),namelyCVD, cancer, chronic respiratorydiseaseanddiabetes [13],which are now reaching epidemic proportions in low- and middle-income countries (LIMIC) of the world[14-18].NCDs constitutethemajorglobalhealthburdenofthe21st century[19-20]without discriminating among age groups [21]. Chronic diseases are implicated in 35 million deaths annually worldwide and a large portion of these deaths occurs due to CVD in LIMIC [22].

There is a rising epidemic of NCDs in sub-Saharan Africa (SSA). However, as in other LIMICs, individuals in SSA suffer from the dual burdens of infectious disease and NCDs [22, 23]. Walker and colleagues [24] reported that SSA continues to suffer under the weight of infectious diseases such as HIV and malaria, as well as high rates of undernutrition. Facing these issues in conjunction with the chronic diseases that accompany high rates of overnutrition is a daunting task [25] for the health burden in Africa. SSA has a disproportionate burden of both infectious and chronic diseases compared with other parts of the world [26]. South Africa (SA) is a country of great diversity extending from highly industrialized cities with an urban advanced-economy lifestyle to remote rural areas with more traditional lifestyles. SA, like many SSA countries, is not immune to the NCD epidemic accompanied by the continued burden of undernutrition. In SA, approximately 28% of deaths annually are attributed to

lay and medical communities also began to increase.

210 Antioxidant-Antidiabetic Agents and Human Health

of action and future prospects.

the leading cause of death worldwide [10-12].

Approximately 35-65% of all deaths worldwide occur due to CVDs and death rates exceed these estimated figures owing to malnutrition and infections [29, 30]. CVDs and their risk factors are increasing in SSA [17, 31] with a high prevalence of ischaemic heart disease among men in their sixties followed by women of the same age group [17]. The common potential risk factors for NCDs are tobacco use, physical inactivity and an unhealthy diet, which all lead to CVD, diabetes and cancer [32, 33]. This burgeoning epidemic of NCDs has many root causes. Additional perpetuators of these epidemics are globalization and urbanization [34-37] with abdominal obesity contributing significantly to CVD in the SSA region [38]. Compelling evidence demonstrates a rise in mortality and morbidity from the NCDs in all strata of South African society. Leeder and colleagues [39] estimated that even without changes in the risk factor profile or the mortality rates from CVD, the demographic changes will result in a doubling of the number of cardiovascular deaths in SA by 2040. Chronic diseases such as CVD, obesity and diabetes have therefore become at least as important as infectious disease.

In summary, CVD is a substantial and growing problem in most of the developing regions of the world. The burden of NCD on the African continent and in SA in particular continues to demonstrate the potential for a sustained rise. A significant investment in the health care system and in particular the primary health care system is therefore justified. Further innova‐ tive strategies and plans are needed to address the determinants of this disease burden. However, indications still point to the paucity of community-based studies aimed at investi‐ gating NCD prevalence, incidence and risk factors. Consistent evidence suggests that diets rich in fruit and vegetables and other plant foods are associated with moderately lower overall mortality rates and lower death rates from chronic diseases including CVD [3-6]. The 'antiox‐ idant hypothesis' proposes that carotenoids, polyphenols, vitamin C, vitamin E and other antioxidant nutrients afford protection against CVD by decreasing oxidative damage [7-9]. As the evidence began to mount from animal studies and human epidemiologic studies on potential protective effects of antioxidants, excitement in both the lay and medical communi‐ ties also began to increase. The idea that natural compounds, if taken in supplement form, may offer a broad and inexpensive means of decreasing the risk for CVD and other age-related diseases is a very attractive hypothesis. Enthusiasm has grown to the point where people around the globe have become aware of the need to consume a diet with a high content of fruit and vegetables.

Indeed, evidence from experimental, clinical and epidemiologic studies has unequivocally pointed to oxidative stress as the key culprit in the pathogenesis of CVD [1, 2, 40, 41]. CVD continues to remain a significant problem in developed countries and is a growing health concern worldwide. Although death rates from CVD have decreased in many countries, due to advances in the field of medicine, the prevalence of CVD risk factors continues to increase. Diet is a centrally important, modifiable risk factor in the prevention of CVD [221-224].
