The Science behind the Boston Heart Fatty Acid Balance™ Test

Current Western diets tend to be deficient in essential omega-3 fatty acids and excessive in saturated and trans fats. The resulting imbalance promotes the development of cardiovascular disease.1

Dietary guidelines call for restricting animal fats and trans fats, and increasing the intake of fish, fruits, whole grains, and vegetables (including vegetable oils).2,3 Dietary studies have clearly shown that this type of dietary modification can lead to significant heart disease risk reduction.1,4-9 The fatty acids in the bloodstream reflect the kinds of fats consumed in the diet provided the blood was collected after fasting for at least eight hours.1,10

Fatty Acid Impact to the Cell Membrane

An optimal balance of fatty acids enhances the fluidity and permeability of cell membranes. The double bonds found in the good fatty acids improve the fluidity of the membrane; saturated and trans fats have the reverse effect, causing lack of membrane fluidity.1

The Boston Heart Fatty Acid Balance™ Test Guides Treatment

In addition to test results, Boston Heart provides valuable indices and treatment considerations to help determine the most effective treatment strategy for reducing patients’ risk of heart disease.

    • Saturated Fatty Acid Index: Saturated fatty acids are chains of carbons with hydrogens attached, that have no double bonds, raise the level of low density lipoprotein (LDL) cholesterol in the bloodstream, and increase heart disease risk.1 These fats are solid and whitish at room temperature, and are found in beef, pork, and lamb meat, dairy products (butter, cheese, and whole milk), poultry, lard, tallow, coconut oil, and palm oil. Having a high saturated fatty acid index of > 32% increases heart disease risk, and indicates the need to choose more vegetables and fruits, poultry without skin, fish, low fat dairy products, and lean cuts of meat, and replace butter with vegetable oil or trans fat free soft margarine.1
    • Trans Fatty Acid Index: Trans fatty acids are produced when vegetable oils rich in fat with double bonds (monounsaturated fats or polyunsaturated fats) are subjected to repeated heating and cooling, such as when pastries, cookies, or French fries are made, or in the production of hard or stick margarines. When this happens the double bonds are either hydrogenated to saturated fat or converted from a normal cis position to the trans position, where they markedly increase the risk of heart disease by raising LDL cholesterol and lowering high density lipoprotein (HDL) cholesterol.11 Having a high trans fatty acid index of > 1.10% increases heart disease risk, and indicates a patient should restrict dietary intake of fried foods, foods containing hydrogenated fats, shortening, stick margarine, and replace these foods with trans fat free tub margarine and vegetable oils.11
    • Monounsaturated Fatty Acid Index: Monounsaturated fatty acids have one double bond, and are liquid at room temperature. Major dietary sources of the fats include vegetable oils, especially olive oil and canola oil. These fats in the diet are beneficial and lower heart disease risk.5 Having a monounsaturated fatty acid index of < 19.0% increases heart disease risk, and indicates the need to increase intake of olive oil and or canola oil in salads or use more of these oils in cooking.5
    • Unsaturated/Saturated Ratio Index: Unsaturated fatty acids have one or more double bonds. These fats are liquid at room temperature, and increasing their intake has been shown to lower LDL cholesterol and decrease heart disease risk. Omega-6 fatty acids are essential, and must be obtained in the diet, since they cannot be made in the body, in contrast to other fats.1 Having a low ratio of < 2.0 increases heart disease risk, and indicates the need to increase the intake of vegetables, vegetable fats (nuts, seeds, canola, soybean or other oils) and fish or fish oil and decrease your intake of animal fats (fatty meats, cheese, butter, dairy products, and ice cream).1
    • Omega-3 Fatty Acid Index: Omega-3 fatty acids are very beneficial fats that have three or more double bonds with the first being at the third carbon position. The two major omega-3 fatty acids are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), found in oily fish or in fish oil capsules. When consumed at doses of about 6 grams per day as fish oil or as 4 grams of concentrated fish oil or pure EPA they can significantly lower triglyceride levels in people with elevated plasma levels of triglycerides.12 Consuming either 1-2 grams of concentrated fish oil or 1800 mg per day of EPA in studies has been shown to decrease heart disease morbidity and mortality.6-9 Having an omega-3 fatty acid index of <1.85% increases heart disease risk, and indicates the need to increase the intake of oily fish such as herring, mackerel, salmon, sardines, sea bass, swordfish, or tuna, or take at least two fish oil or pure EPA capsules daily.

Fatty Acid Balance Testing Methodology & Specimen Type

The Boston Heart Fatty Acid Balance™ test is based in part on research published in the American Journal of Clinical Nutrition by Boston Heart’s Chief Medical Officer, Ernst J. Schaefer, M.D. The test measures all 14 major plasma fatty acids as determined by gas liquid column chromatography/mass (GC-MS) spectrometry after lipid extraction. These fatty acids comprise more than 90% of all plasma fatty acids. Plasma fatty acids are a better reflection of dietary fat as they are based on fatty acids stored in the fat and liver. Other specimen types, such as red blood cells, preferentially take up omega-3 fats: therefore, their fatty acid content does not reflect dietary intake of all fats as well as plasma does.1,10,11

Optimize Treatment Strategies & Patient Management

The results of the Boston Heart Fatty Acid Balance™ test allows healthcare providers to determine the most effective dietary treatment strategies for reducing a patient’s risk of heart disease. Every lab report includes treatment considerations that can be used to help identify some key dietary recommendations to improve the fatty acid results. Patients also have the option to enroll in the Boston Heart Lifestyle Program. This program integrates the patient’s Boston Heart Fatty Acid Balance results into key, actionable recommendations.

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1. Schaefer EJ. Lipoproteins, nutrition, and heart disease. Am J Clin Nutr. 2002;75(2):191-212.
2. Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2960-2984.
3. US Department of Agriculture, US Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th ed. Washington, DC:US Government Printing Office, 2010.
4. Turpeinen O. Effect of a cholesterol lowering diet on mortality from coronary heart diseases and other causes. Circulation. 1979;59(1):1-7.
5. Estruch R, Ros E, Salas-Salvadó J, et al; PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368(14):1279-1290.
6. Marchioli R, Barzi F, Bomba E, et al. GISSI-Prevenzione Investigators. Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI)- Prevenzione. Circulation. 2002;105(16):1897-1903.
7. Yokoyama M, Origasa H, Matsuzaki M, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Japan EPA lipid intervention study (JELIS) Investigators. Lancet. 2007;369(9567):1090-1098.
8. Saito Y, Yokoyama M, Origasa H, et al. JELIS Investigators. Effects of EPA on coronary artery disease in hypercholesterolemic patients with multiple risk factors: sub-analysis of primary prevention cases from the Japan EPA Lipid Intervention Study (JELIS). Atherosclerosis. 2008;200(1):135-140.
9. Itakura H, Yokoyama M, Matsuzaki M, et al. JELIS Investigators. Relationships between plasma fatty acid composition and coronary artery disease. J Atheroscler Thromb. 2011;18(2):99-107.
10. Ooi E., Lichtenstein A., Millar J, Diffenderfer MR, Lamon-Fava S, Rasmussen H, Welty FK, Barrett PH, Schaefer EJ. Effects of Therapeutic Lifestyle Change diets high and low in dietary fish-derived FAs on lipoprotein metabolism in middle-aged and elderly subjects. J Lipid Research.2012;53(9):1958-1967.
11. Lichtenstein AH, Ausman LM, Jalbert SM, Schaefer EJ. Effects of different forms of dietary hydrogenated fats on serum lipoprotein cholesterol levels. N Engl J Med. 1999;340(25):1933-1940.
12. Maki KC, Bays HE, Dicklin MR. Treatment options for the management of hypertriglyceridemia: strategies based on the best-available evidence. J Clin Lipidol. 2012;6(5):413-426.