Dietary fatty acids and the risk of hypertension in middle-aged and older women

Intake of polyunsaturated fat in relation to mortality among statin users and non-users in the Southern Community Cohort Study

BACKGROUND AND AIMS

Consumption of polyunsaturated fatty acids (PUFA), especially the n3-series, may protect against cardiovascular disease (CVD), but recent randomized studies have failed to demonstrate these benefits. One of the prevailing hypotheses is that PUFA intake may not confer benefits beyond those provided by statins, but studies comparing statin users to non-users with regard to effects of PUFA are lacking.

METHODS AND RESULTS

Black and white men and women (n = 69,559) in the Southern Community Cohort Study were studied. Cox regression models adjusting for age, sex, race, BMI, recruitment site, education, income, smoking, diabetes, and dietary variables were used.

RESULTS

At baseline the mean ± SD age was 52 ± 9 years, 60% of participants were women, 54% had hypertension and 16% used statins. We observed modest inverse associations between n3-PUFA and n6-PUFA intake with mortality among non-statin users but not among statin users. In adjusted analyses, the HRs (95% CIs) for all-cause mortality (6,396 deaths over a median of 6.4 years) comparing the highest to the lowest quintile were 0.90 (0.82-1.00) for n3-PUFA and 0.80 (0.70-0.92) for n6-PUFA among non-statin users, whereas they were 1.06 (0.87-1.28) and 0.96 (0.78-1.19) for n3-PUFA and n6-PUFA, respectively, among statin users.

CONCLUSIONS

Our results suggest potential benefits of PUFA consumption on mortality which are only apparent in the absence of statin therapy. It seems prudent to consider the potential benefit of PUFA consumption in the primary prevention of CVD among patients who are not candidates for statin therapy but are at increased risk for CVD and mortality.

Association between fried food consumption and hypertension in Korean adults

The present study explored the relationships between fried food consumption and metabolic risk factors and hypertension in Korean adults. The study was based on the fifth Korean National Health and Nutrition Examination Survey between 2010 and 2011. A total of 9221 Korean adults aged ≥19 years were studied. Fried food consumption was assessed using a validated FFQ. Metabolic risk factors such as waist circumference, fasting plasma glucose (FPG), TAG, HDL-cholesterol and systolic and diastolic blood pressure (SBP and DBP) were measured. Hypertension was defined as SBP≥140 mmHg, DBP≥90 mmHg or current use of antihypertensive medication. Adjusted OR for elevated blood pressure significantly increased in men (OR 1·62; 95 % CI 1·11, 2·37;Ptrend=0·0447) and women (OR 2·20; 95 % CI 1·21, 4·00;Ptrend=0·0403) with a greater than twice a week consumption of fried food compared with those who rarely consumed fried food. However, fried food consumption was not associated with other metabolic risk factors (abdominal obesity, high FPG, hypertriacylglycerolaemia, low HDL-cholesterol and the metabolic syndrome). The adjusted OR for hypertension increased by 2·4-fold in women (OR 2·37; 95 % CI 1·19, 4·72;Ptrend=0·0272) with a greater than twice a week fried food consumption compared with those who rarely consumed it. No significant association was found between fried food consumption and hypertension in men. This study suggests that frequent fried food consumption is associated with hypertension in Korean women. Further studies are needed to investigate the effect of different types of fried foods on hypertension.

Fried Food Consumption and Cardiovascular Health: A Review of Current Evidence

Fried food consumption and its effects on cardiovascular disease are still subjects of debate. The objective of this review was to summarize current evidence on the association between fried food consumption and cardiovascular disease, diabetes, hypertension and obesity and to recommend directions for future research. We used PubMed, Google Scholar and Medline searches to retrieve pertinent publications. Most available data were based on questionnaires as a tool to capture fried food intakes, and study design was limited to case-control and cohort studies. While few studies have reported a positive association between frequencies of fried food intake and risk of coronary artery disease, heart failure, diabetes or hypertension, other investigators have failed to confirm such an association. There is strong evidence suggesting a higher risk of developing chronic disease when fried foods are consumed more frequently (i.e., four or more times per week). Major gaps in the current literature include a lack of detailed information on the type of oils used for frying foods, stratification of the different types of fried food, frying procedure (deep and pan frying), temperature and duration of frying, how often oils were reused and a lack of consideration of overall dietary patterns. Besides addressing these gaps, future research should also develop tools to better define fried food consumption at home versus away from home and to assess their effects on chronic diseases. In summary, the current review provides enough evidence to suggest adverse health effects with higher frequency of fried food consumption. While awaiting confirmation from future studies, it may be advisable to the public to consume fried foods in moderation while emphasizing an overall healthy diet.

Evidence-Based Guideline of the German Nutrition Society: Fat Intake and Prevention of Selected Nutrition-Related Diseases

As nutrition-related chronic diseases have become more and more frequent, the importance of dietary prevention has also increased. Dietary fat plays a major role in human nutrition, and modification of fat and/or fatty acid intake could have a preventive potential. The aim of the guideline of the German Nutrition Society (DGE) was to systematically evaluate the evidence for the prevention of the widespread diseases obesity, type 2 diabetes mellitus, dyslipoproteinaemia, hypertension, metabolic syndrome, coronary heart disease (CHD), stroke, and cancer through the intake of fat or fatty acids. The main results can be summarized as follows: it was concluded with convincing evidence that a reduced intake of total and saturated fat as well as a larger intake of polyunsaturated fatty acids (PUFA) at the expense of saturated fatty acids (SFA) reduces the concentration of total and low-density lipoprotein cholesterol in plasma. Furthermore, there is convincing evidence that a high intake of trans fatty acids increases risk of dyslipoproteinaemia and that a high intake of long-chain polyunsaturated n-3 fatty acids reduces the triglyceride concentration in plasma. A high fat intake increases the risk of obesity with probable evidence when total energy intake is not controlled for (ad libitum diet). When energy intake is controlled for, there is probable evidence for no association between fat intake and risk of obesity. A larger intake of PUFA at the expense of SFA reduces risk of CHD with probable evidence. Furthermore, there is probable evidence that a high intake of long-chain polyunsaturated n-3 fatty acids reduces risk of hypertension and CHD. With probable evidence, a high trans fatty acid intake increases risk of CHD. The practical consequences for current dietary recommendations are described at the end of this article.

Trans-fatty acid promotes thrombus formation in mice by aggravating antithrombogenic endothelial functions via Toll-like receptors

SCOPE

Since excessive intake of trans-fatty acid (TFA) increases the risk of myocardial infarction, we investigated the effects of TFA on thrombus formation using animal and cell culture experiments.

METHODS AND RESULTS

C57BL/6 mice were fed a diet containing TFA or cis-fatty acid (5% each of total calories) or a chow diet for 4 weeks, and thrombus formation was induced in the carotid artery by He-Ne laser irradiation. The high-TFA diet significantly promoted thrombus formation in the carotid artery compared to the chow or cis-fatty acid diet. TFA activated the inflammatory signaling pathway in cultured endothelial cells and in mice; aortic gene expression levels of antithrombogenic molecules, including thrombomodulin and tissue factor pathway inhibitor, were decreased, and the expression levels of prothrombogenic molecules were increased in TFA-treated mice. TFA markedly upregulated the prothrombogenic molecules and downregulated the antithrombogenic molecules in endothelial cells. In addition, TFA induced phosphorylation of c-Jun N-terminal kinase, extracellular signal-regulated kinase, and nuclear factor-κB. The TFA-activated signal pathways and prothrombogenic phenotypic changes of endothelial cells were inhibited by genetic or pharmacological inactivation of Toll-like receptors 2 and 4.

CONCLUSION

TFA aggravates the antithrombogenic phenotypes of vascular endothelial cells via Toll-like receptors and promotes thrombus formation in mice.

Reported fried food consumption and the incidence of hypertension in a Mediterranean cohort: the SUN (Seguimiento Universidad de Navarra) project

Reported associations between the consumption of fried foods and the incidence of obesity or weight gain make it likely that fried food consumption might also be associated with the development of hypertension. However, evidence from long-term prospective studies is scarce. Therefore, the aim of the present study was to longitudinally evaluate this association in a prospective cohort. The SUN (Seguimiento Universidad de Navarra) project is a Mediterranean cohort study of university graduates conducted in Spain, which started in December 1999 and is still ongoing. In the present study, we included 13,679 participants (5059 men and 8620 women), free of hypertension at baseline with a mean age of 36·5 (SD 10·8) years. Total fried food consumption was estimated at baseline. The outcome was the incidence of a medical diagnosis of self-reported hypertension during the follow-up period. To assess the association between the consumption of fried foods and the subsequent risk of developing incident hypertension during the follow-up period, Cox regression models were used. During a median follow-up period of 6·3 years, 1232 incident cases of hypertension were identified. After adjusting for potential confounders, the adjusted hazard ratios for developing hypertension were 1·18 (95% CI 1·03, 1·36) and 1·21 (95% CI 1·04, 1·41) for those consuming fried foods 2-4 and >4 times/week, respectively, compared with those consuming fried foods < 2 times/week (P for trend = 0·009). In conclusion, frequent consumption of fried foods at baseline was found to be associated with a higher risk of hypertension during the follow-up period in a Mediterranean cohort of university graduates.

Higher erythrocyte n-3 PUFAs are associated with decreased blood pressure in middle-aged and elderly Chinese adults

Previous studies suggested that blood fatty acids (FAs) might affect blood pressure (BP), but the findings have been inconclusive. This study evaluated the cross-sectional and prospective associations of erythrocyte FAs with BP in middle-aged and elderly Chinese individuals. Between 2008 and 2010, 1834 participants (1364 women and 470 men) aged 57 ± 5 y had baseline measurements taken of their erythrocyte FAs and BP. A total of 1477 participants (1103 women and 374 men) had their BP measured again after 3.09 ± 0.32 y (range: 2.91-3.26 y). In the cross-sectional analyses (n = 1834), the erythrocyte saturated FA (SFA) content was positively associated with BP, whereas total cis polyunsaturated FAs (PUFAs), their subtypes cis n-3 (ω-3) PUFAs and cis n-6 (ω-6) PUFAs, and the PUFA-to-SFA ratio were inversely associated with BP (all P-trends < 0.05). The longitudinal results (n = 1477) showed marginally inverse associations between cis n-3 PUFAs and the n-3:n-6 PUFA ratio and BP. For individual cis n-3 PUFAs, higher contents of 20:5n-3, 22:5n-3, and 22:6n-3 were significantly associated with reduced increases in SBP over time (the mean change range between quartile 4 and quartile 1 was -0.917 to -0.749 mm Hg for SBP; all P-trends < 0.01), and 20:5n-3 was inversely associated with DBP change (the mean change between quartile 4 and quartile 1 was -0.631; P-trend < 0.001). Path analyses suggested that the associations between cis n-3 PUFAs and BP might be mediated by decreasing serum triglycerides (TGs) and body mass index (BMI). Our findings revealed that a higher content of cis n-3 PUFAs (mainly very long-chain cis n-3 PUFAs) may benefit BP progress, probably mediated by decreasing serum TGs and BMI.

Effect of the amount and type of dietary fat on cardiometabolic risk factors and risk of developing type 2 diabetes, cardiovascular diseases, and cancer: a systematic review

The effects of both the amount and quality of dietary fat have been studied intensively during the past decades. Previously, low-fat diets were recommended without much attention to the quality of fat, whereas there is general emphasis on the quality of fat in current guidelines. The objective of this systematic review (SR) was to assess the evidence of an effect of the amount and type of dietary fat on body weight (BW), risk factors, and risk of non-communicable diseases, that is, type 2 diabetes (T2DM), cardiovascular diseases (CVD), and cancer in healthy subjects or subjects at risk for these diseases. This work was performed in the process of updating the fourth edition of the Nordic Nutrition Recommendations from 2004. The literature search was performed in October 2010 covering articles published since January 2000. A complementary search was done in February 2012 covering literature until December 2011. Two authors independently selected articles for inclusion from a total of about 16,000 abstracts according to predefined criteria. Randomized controlled trials (RCT) and prospective cohort studies (PCS) were included as well as nested case-control studies. A few retrospective case-control studies were also included when limited or no data were available from other study types. Altogether 607 articles were quality graded and the observed effects in these papers were summarized. Convincing evidence was found that partial replacement of saturated fat (SFA) with polyunsaturated fat (PUFA) or monounsaturated fat (MUFA) lowers fasting serum/plasma total and LDL cholesterol concentrations. The evidence was probable for a decreasing effect of fish oil on concentration of serum/plasma total triglycerides as compared with MUFA. Beneficial effect of MUFA both on insulin sensitivity and fasting plasma/serum insulin concentration was considered as probable in comparisons of MUFA and carbohydrates versus SFA, whereas no effect was found on fasting glucose concentration in these comparisons. There was probable evidence for a moderate direct association between total fat intake and BW. Furthermore, there was convincing evidence that partial replacement of SFA with PUFA decreases the risk of CVD, especially in men. This finding was supported by an association with biomarkers of PUFA intake; the evidence of a beneficial effect of dietary total PUFA, n-6 PUFA, and linoleic acid (LA) on CVD mortality was limited suggestive. Evidence for a direct association between total fat intake and risk of T2DM was inconclusive, whereas there was limited-suggestive evidence from biomarker studies that LA is inversely associated with the risk of T2DM. However, there was limited-suggestive evidence in biomarker studies that odd-chain SFA found in milk fat and fish may be inversely related to T2DM, but these associations have not been supported by controlled studies. The evidence for an association between dietary n-3 PUFA and T2DM was inconclusive. Evidence for effects of fat on major types of cancer was inconclusive regarding both the amount and quality of dietary fat, except for prostate cancer where there was limited-suggestive evidence for an inverse association with intake of ALA and for ovarian cancer for which there was limited-suggestive evidence for a positive association with intake of SFA. This SR reviewed a large number of studies focusing on several different health outcomes. The time period covered by the search may not have allowed obtaining the full picture of the evidence in all areas covered by this SR. However, several SRs and meta-analyses that covered studies published before year 2000 were evaluated, which adds confidence to the results. Many of the investigated questions remain unresolved, mainly because of few studies on certain outcomes, conflicting results from studies, and lack of high quality-controlled studies. There is thus an evident need of highly controlled RCT and PCS with sufficient number of subjects and long enough duration, specifically regarding the effects of the amount and quality of dietary fat on insulin sensitivity, T2DM, low-grade inflammation, and blood pressure. New metabolic and other potential risk markers and utilization of new methodology in the area of lipid metabolism may provide new insight.

Impact of omega-6 fatty acids on cardiovascular outcomes: A review

Poly unsaturated fatty acids (PUFAs) have usually been associated with beneficial health effects on early life and later life disease such as cardiovascular diseases (CVD). Emerging evidence, however, suggests that PUFA species (n-3, n-6) have differential health effects. N-6 PUFAs, in particular, have sparked a scientific debate regarding their role in human physiological processes. Current dietary recommendations for n-6 fatty acids have been based on animal studies, insufficient epidemiological evidence and mixed PUFA interventions, therefore, require reconsideration. This review has analyzed human epidemiological and interventional studies, published in the last five years, focusing on n-6 fatty acids' impact on CVD outcomes (CVD events, blood lipids, blood pressure, inflammation, oxidative stress/atherosclerosis). The evidence is mixed, with differential effects within the n-6 fatty acid series. These outcomes are also dependent on ethnicity and background health status. Further, data from developing countries are sparse, thus, well designed intervention trials and population based studies in developing country settings on specific n-6 fatty acid intake and health effects are desired.

Effects of a diet high in salt, fat, and sugar on telemetric blood pressure measurements in conscious, unrestrained adult Yucatan miniature swine (Sus scrofa)

Radiotelemetry was used to evaluate diet-related elevation of blood pressure in adult Yucatan miniature swine. Systolic arterial blood pressure (SAP), diastolic atrial blood pressure (DAP), heart rate, and locomotor activity were assessed in 9- or 11-mo-old Yucatan miniature pigs fed a standard diet or a North American-type diet high in salt, fat, and sugar (HSFS). Compared with pigs fed standard diet, pigs fed HSFS diet showed markedly elevated SAP (132 ± 3 compared with 156 ± 6 mm Hg), whereas DAP was unchanged (92 ± 2 compared with 99 ± 5 mm Hg). In addition, all pigs were modestly sensitive to short-term changes in dietary salt, as indicated by a 6% to 7% response in blood pressure parameters. According to these data, the increase in SAP for pigs on the HSFS diet was too large to be explained by the NaCl content of the diet alone. We found no evidence of endothelial dysfunction, and the relaxation responses of isolated coronary arteries actually were enhanced in the HSFS group. In conclusion, in a Yucatan miniature pigs model chronically fed a HSFS diet, DAP did not increase, but SAP and pulse pressure appeared to be affected by high dietary levels of fat or sugar (or both).

Associations of plasma n-3 polyunsaturated fatty acids with blood pressure and cardiovascular risk factors among Chinese

The relationship between plasma fatty acid (FA) levels and hypertension in Chinese is not fully understood. The aim of this study was to examine relationships between plasma phospholipid (PL) FAs and hypertension in Chinese subjects. One thousand one hundred and fifty-four subjects in Hangzhou, China, were recruited in this cross-sectional study. Two hundred and fourteen (160 males, 54 females) subjects with hypertension and 940 (664 males, 276 females) healthy subjects were identified. The prevalence of hypertension in females (19.6%) was significantly higher than that in males (16.4%). Compared with healthy subjects, hypertensive subjects showed significantly lower plasma PL 22:5n-3 (p = 0.017), 22:6n-3 (p = 0.008), PL polyunsaturated fatty acids (PUFAs; p < 0.001), n-3 PUFA (p = 0.015), n-6 PUFA (p < 0.001) and 20:4n-6 (p < 0.010). PL n-3 PUFA [odds ratio (OR) = 0.43, 95% confidence interval (CI) = 0.29-1.19] and n-3:n-6 (OR = 0.48, 95% CI = 0.12-1.86) were inversely associated with hypertension. However, plasma saturated fatty acid (SFA; OR = 2.01, 95% CI = 1.05-2.98) was significantly positively associated with hypertension. PL SFA was significantly positively associated with systolic blood pressure (p = 0.048), whereas plasma PL monounsaturated FA was significantly positively associated with diastolic blood pressure (DBP; p = 0.009) in hypertensive subjects. PL PUFA (p = 0.022) and n-3 PUFA (p = 0.047) were significantly negatively associated with DBP in hypertensive subjects. Our results suggest that plasma PL n-3 PUFA was significantly inversely associated with hypertension in Chinese. It would seem appropriate for hypertensive subjects to increase their dietary n-3 PUFA which may help reduce BP.

Erythrocyte fatty acid composition is associated with the risk of hypertension in middle-aged and older women

Experimental studies have suggested different effects of various fats on blood pressure. However, epidemiologic evidence of these relations remains limited and inconsistent. We therefore assessed the association of fatty acid (FA) composition in erythrocyte membranes with the risk of hypertension. We selected 516 cases of incident hypertension and 516 matched controls during 12.9 y of follow-up in the Women's Health Study. Erythrocyte FA was measured in baseline bloods using GC. After controlling matching factors and lifestyle factors, erythrocyte SFA showed a positive association, whereas total cis PUFA, cis (n-3) PUFA, and the ratio of PUFA:SFA (PS ratio) showed an inverse association with the risk of hypertension. The multivariable RR of hypertension across the increasing quartiles of erythrocyte FA subtypes were 1.00, 1.19, 1.44, and 1.76 for total SFA; 1.00, 0.84, 0.88, and 0.56 for total cis PUFA; 1.00, 0.87, 0.66, and 0.65 for cis (n-3) PUFA; and 1.00, 0.99, 0.70, and 0.51 for the PS ratio. After further adjusting for obesity-related metabolic factors, these associations were attenuated and remained significant only for the PS ratio. cis MUFA, cis (n-6) PUFA, and trans unsaturated FA in erythrocyte membranes were not associated with the risk of hypertension. Our study showed that FA composition in erythrocyte membranes is associated with the risk of hypertension in middle-aged and older women. However, after controlling for obesity-related metabolic factors, the associations remained significant only for the PS ratio.

Dairy intake, blood pressure and incident hypertension in a general British population: the 1946 birth cohort

PURPOSE

We aimed to examine the association between intake of different subgroups of dairy products and blood pressure and incident hypertension 10 years later, adjusting for confounding factors.

METHODS

We studied 1,750 British men and women from the 1946 British birth cohort from 1989 to 1999 (age 43 and 53 years, respectively). Diet was assessed by 5-day food diaries using photographs in the estimation of portion size. Systolic (sbp) and diastolic (dbp) blood pressure and prevalent hypertension were assessed at age 43 and 53 years. Linear regression and logistic regression were used to examine 10-year blood pressure levels and incident hypertension by baseline dairy intake.

RESULTS

There was a weak non-significant trend of a protective effect of total dairy intake on blood pressure and incident hypertension, but no evidence for a dose-response relationship (OR for incident hypertension: 0.88 (95% CI 0.68;1.14) 2nd vs. 1st tertile and 0.93 (95% CI 0.72;1.18) 3rd vs. 1st tertile). Higher intake of low-fat and fermented dairy was linked to a higher sbp but in a nonlinear manner. Adjustment for other dietary factors, health behaviours and BMI attenuated these associations.

CONCLUSIONS

Total dairy intake and specific dairy subgroups were not associated with blood pressure and incident hypertension among a representative sample of British adults after adjustment for confounding factors.

Sex-specific associations of nutrition with hypertension and systolic blood pressure in Alaska Natives findings from the GOCADAN study

OBJECTIVES

To examine sex-specific associations of nutritional factors with prevalent hypertension (HTN) and systolic blood pressure (SBP) in Alaska Natives. Diet is known to affect SBP, a major risk factor for cardiovascular disease.

STUDY DESIGN

Cross-sectional analysis of participants without diabetes in the Genetics of Coronary Artery Disease in Alaska Natives study.

METHODS

Macronutrients such as fat, carbohydrate and protein and micronutrients such as sodium were investigated. HTN was defined as SBP≥140 mmHg, diastolic blood pressure≥90 mmHg and/or taking anti-HTN medication. Analyses were stratified by sex and covariates included age, body mass index (BMI), energy intake, smoking and physical activity.

RESULTS

Mean age was 42 years for men (n=456) and women (n=602). Men with HTN (n=106) compared to men without HTN consumed a higher proportion of calories from total (p=0.01), saturated (p<0.01) and trans fatty acid (p=0.03) fats. Women with HTN (n=99) compared to women without HTN consumed more total (p=0.03) and monounsaturated (p=0.04) fat, higher protein (p=0.02) and lower total (p<0.01) and simple (p<0.01) carbohydrates. After covariate adjustment, men not on anti-HTN medications (n=407) had significantly higher average SBP with increasing quartiles of trans fatty acid intake (p for linear trend=0.01) and sodium intake (p for linear trend=0.02). For women not on anti-HTN medications (n=528), after covariate adjustment, average SBP decreased with increasing quartiles of omega 3 fatty acid intake (p for linear trend <0.01).

CONCLUSIONS

Prospective evaluation of the sex-specific associations of nutritional factors with HTN and SBP on outcomes is needed along with novel interventions to lower the risk of cardiovascular disease.

Targeting energy expenditure via fuel switching and beyond

Since over-nutrition accelerates the development of obesity, progression to type 2 diabetes, and the associated co-morbidity and mortality, there has been a keen interest in therapeutic interventions targeting mechanisms that may curb appetite, increase energy expenditure or at least attenuate insulin resistance. Over the past decade, numerous peri-mitochondrial targets in the de novo lipid synthesis pathway have been linked to an increase in energy expenditure and the drug development industry has pursued the gene products involved as candidates to develop drugs against. The basis of this link, and specifically the premise that lowering tissue and cellular malonyl-CoA can increase energy expenditure, is scrutinised here. The argument presented is that fuel switching as effected by changes in cellular malonyl-CoA concentrations will not trigger the mitochondria to increase energy expenditure because: (1) an increase in beta-oxidation by lowering respiratory exchange ratio (indicative of the metabolic fuel consumed) does not equal an increase in energy expenditure (how rapidly fuel is consumed); (2) the ATP:oxygen ratios (i.e. ATP energy made:oxygen required for the reaction) are similar when metabolising lipids (2.8) vs glucose (3.0); (3) substrate availability (NEFA) does not drive energy expenditure in vivo; and (4) the availability of ADP in the mitochondrial matrix determines the rate of energy expenditure, not the availability of fuel to enter the mitochondrial matrix. To increase mitochondrial energy expenditure, work must be done (exercise) and/or the mitochondrial proton leak must be enhanced, both of which increase availability of ADP. In fact, despite the historic taboo of chemical uncoupling, this mechanism validated in humans is closest on task to increasing whole-body energy expenditure. Chemical uncoupling mimics the naturally occurring phenomenon of proton leak, accelerating the metabolism of glucose and lipids. However, it is completely non-genomic (i.e. the target is a location, not a gene product) and is not associated with addiction or mood alterations common to satiety agents. A significant hurdle for drug development is to discover a safe mitochondrial uncoupler and to formulate it potentially as a pro-drug and/or oral pump, to avoid the issue of overdosing experienced in the 1930s. The potential therapeutic impact of such a compound for an over-nutritioned patient population could be profound. If effective, the mitochondrial uncoupler mechanism could resolve many of the associated diseases such as type 2 diabetes, hypertension, obesity, depression, sleep apnoea, non-alcoholic steatohepatitis, insulin resistance and hyperlipidaemia, therefore becoming a 'disease-modifying therapy'.