Mechanisms to Explain Variation in Serum Low Density Lipoprotein Cholesterol Response to Dietary Saturated Fat

Lead Research Organisation: University of Surrey
Department Name: Nutrition & Metabolism

Abstract

A raised level of blood cholesterol (also referred to as LDL or 'bad' cholesterol) is an important risk factor for developing heart disease. Lowering cholesterol levels by changing our diet and taking certain medication (e.g. statins) represents a major public health strategy to decrease the risk of developing and suffering from heart disease in the UK population. A type of fat eaten in our diet known as saturated fat (found predominately in animal products such as meat and dairy) is well recognised as the main dietary component responsible for raising blood cholesterol, and reducing its intake has been the mainstay of dietary guidelines for the prevention of heart disease for over 30 years. However, findings from large, powerful studies called meta-analyses show no evidence for a direct link between the intake of saturated fat and deaths from heart attack and stroke. One explanation for this outcome is that the link between saturated fat and heart disease is not a direct one, but relies on the ability of saturated fat to raise blood cholesterol (LDL-C) levels. This effect is complex, and highly variable between individuals because of important differences in metabolism and the way in which our body's absorb and digest cholesterol after eating meals high in dietary saturated fat. These individual differences make it difficult to study how dietary factors like saturated fat influence blood cholesterol in large numbers of people. However, these variations in metabolism can be measured relatively easily and used as biological markers to determine which people will respond well and those who will respond less well to diets which are lower in saturated fat.

The main aims of this proposal are to measure variation in blood LDL cholesterol in response to lowering the amount of saturated fat in the diet to the level recommended by the government for heart disease prevention (LDL Screening Study). From this initial study, we will select a group of high responders and a group of low responders in blood LDL cholesterol for a more detailed study to determine the metabolic processes responsible for the variation between these two groups (Metabolic Study). We predict that people who show a high blood LDL-cholesterol response to a diet lower in saturated fat will show a greater reduction in the absorption of dietary fat in their gut than low responders. We believe that this effect may be explained by changes in their gut bacteria, which can alter the composition of compounds called bile acids that promote the absorption of dietary fat. It may also be explained by a phenomenon known as gut permeability which may be increased by eating saturated fat. Gut permeability also differs between individuals and affects fat absorption and gut bacteria. In addition, we will measure the activity of specific receptors on the surface of cells (LDL receptors) that remove LDL from the blood and have been shown to be reduced by eating diets high in saturated fat (causing LDL cholesterol to rise). Finally, in the Metabolic Study we will also undertake a holistic measure of the metabolic state in high and low LDL-C responders using a technique known as metabonomics. This approach can measure thousands of metabolites simultaneously in samples of blood and urine, and detect subtle differences (metabolic signatures) between high and low responders that can be used as simple biomarkers for the sensitivity to dietary saturated fat. The results from this study will be used to overcome the problems of setting dietary guidelines for whole populations, which are frequently inappropriate for some subgroups of people in the population. This will be achieved by the tailoring of dietary advice to those at higher risk of developing heart disease and who therefore stand to gain the greatest benefit to their health.

Technical Summary

The relationship between a high intake of dietary saturated fat and CVD is not direct, but largely mediated through the effects of certain saturated fatty acids (SFA) in raising serum LDL-cholesterol (LDL-C). A key outstanding question of fundamental importance to understanding the complexity of the relationship between dietary SFA, serum LDL-C and CVD risk is; what determines the biologically intrinsic, inter-individual differences in LDL-C response to dietary SFA? The overall aims of this proposal are to determine the metabolic and gut-related mechanisms that give rise to inter-individual variation in LDL-C to dietary SFA, and to identify biomarkers of these mechanisms that can be used to detect sensitivity to SFA.
The main objectives are; 1) to demonstrate variations in serum LDL-C in response to changing from a high to a low SFA diet; 2) to undertake a metabolic study in two groups of individuals, those in the top and bottom 10% of change in serum LDL-C, to demonstrate a relatively greater reduction in fat absorption in response to a reduction of dietary SFA, using stable isotope trace-labelling, in high versus low responders. This effect will be accompanied by relatively greater increases in the expression of LDL-receptors (in PBMCs by PCR), endogenous cholesterol synthesis (serum phytosterols), and serum deconjugated bile acids (targeted UPLC-MS) and/or short chain fatty acids (NMR & LCMS); 3) these effects will be related to changes in the gut microbiota (FISH, NGS & CLS genomics), and/or gut permeability (absorption & recovery of 51Cr-EDTA probe); 4) to identify serum and urinary biomarkers of these metabolic differences (1H-NMR & UPLC-MS metabonomics). Outputs from this study will provide new evidence to progress beyond dietary guidelines that are inappropriate for whole populations, towards the tailoring of advice to subgroups of individuals who are more or less responsive to dietary SFA, and who stand to gain more or less benefit to their CVD risk.

Planned Impact

The current UK dietary guideline to reduce total energy intake from dietary saturated fatty acids (SFA) in men from 12.7% to 10% of total energy or less, can be estimated to achieve a decrease in serum LDL-C of 0.13mmol/l. In terms of impact, this equates to a 6% reduction in coronary heart disease (CHD) risk or delaying or averting 3,000 deaths from CHD. In comparison, the inter-individual variation in serum LDL-C response to dietary SFA between the highest and lowest responders in two randomised controlled trials (DIVAS & RISCK) was in the order of 1.5 mmol/l. This represents a greater than 20-fold difference in CHD risk relative to the UK target, and provides a true perspective of the substantial impact of inter-individual variation in serum LDL-C response relative to our National dietary guideline for reducing CHD risk. This helps to explain why a dietary guideline for a population, with a diverse range of serum LDL-C responses, lacks impact in achieving its aim, and the urgent need to identify and intervene in responsive and unresponsive groups.

New knowledge and insight into the mechanisms that underlie variation in the serum LDL-C response to dietary SFA will exert multiple impacts by transforming the way in which dietary guidelines are formulated and applied, and in changing dietary practices to affect those most in need of dietary advice. These impacts will be achieved through academics, dieticians, health care professionals and medics at the interface of public health and medicine, who can inform and educate the end users of our research outputs. These end users include:

Policy makers - This includes academic and non-academic members of boards and panels who advise government and formulate policy on food and nutrition in relation to public health e.g. SACN, Public Health England and the Department of Health. Applicants on this proposal have a direct impact on these influential bodies as members, scientific advisers and consultants (see Pathways to Impact)

Charities, learned societies - bodies that exert significant impacts as active stakeholders of the role of nutrition in human health e.g. Nutrition Society, HEART UK, The British Nutrition Foundation, Association for Nutrition, British Heart Foundation. Applicants on this proposal also have a direct impact on these influential bodies as members, scientific advisers and consultants (see Pathways to Impact).

Industry and commerce - Our outputs will create opportunities in the food industry to reformulate foods and expand the portfolio diet for blood cholesterol reduction, by providing information on the mechanisms of action of functional foods. This also applies especially to the development of pre and pro-biotic products, with modes of action linked to the metabolic variables under study in this proposal. This translates into economic and societal impacts through the marketing and commercial sales of new products.

Research funders (e.g. BBSRC): our mechanistic outputs would inform future research by featuring in the frameworks and strategic priorities of research funding bodies in the UK and Europe, creating employment and new knowledge. This process will produce highly trained young researchers capable of tackling contemporary challenges in either the public or private sectors. All of which could make a substantial contribution to the economic competitiveness of the UK.

General public - subgroups of variable LDL-C responders may represent up to 20% of the UK population, who are either more or less in need of dietary advice to reduce CVD risk. The identification of both subgroups translates into economic and societal impact by reducing CVD risk in one group and the need for health care in the other. CVD has been described as a disease that begins in adolescence. Crucially, the impact of our research could exert impact in childhood, and thus be preventative through-out the life course, reducing the need for drugs, like statins, in later life.
 
Description A high intake of saturated fat tends to raise blood cholesterol level, so dietary guidelines recommend reducing our intake of saturated fat to help lower our blood cholesterol. By lowering intake of saturated fat this will reduce the risk of developing cardiovascular disease, for which a raised blood cholesterol level is a major risk factor. However, when different people reduce their intake of saturated fat, their blood cholesterol level changes in different ways, with some people showing large reductions, while others show no change or even an increase. A principal aim of the RISSCI study was to investigate the way in which saturated fat is metabolised by the body, as it is possible that differences in fat metabolism between different people could help to explain why their blood cholesterol changes in different ways. The RISSCI study was designed in two phases, the first of which was to demonstrate the variable response in blood cholesterol, known as LDL-cholesterol, to a reduced intake of saturated fat, that had been reported previously in large dietary intervention trials. An aim was then to identify and select people whose blood LDL cholesterol was raised (LDL-cholesterol 'Responders'), and people whose blood cholesterol showed little or no change ('Non-responders'). In the second phase of the RISSCI study, the 'Responders' and 'Non-responders' were studied in greater depth, to establish differences in their metabolism could explain why they showed different blood cholesterol responses to saturated fat.
Results from the first phase of the RISSCI study were highly successful in reproducing the variability in blood LDL-cholesterol in response to a reduction in the intake of saturated fat. This enabled the identification and selection of 'Responders' and 'Non-responders' for further study in phase 2. The dietary interventions and sample collection for Phase-2 of the RISSCI study were completed at the Universities of Surrey and Reading at the end of February 2020, and the analyses is now underway.
Exploitation Route The identification of inter-individual differences in metabolism that contribute to variation in serum LDL cholesterol response to reduction in saturated fat, will inform future dietary guidelines by allowing the targeting of dietary advice to those who stand to achieve the greatest response in LDL-C, and thus benefit to their cardiovascular health.

Elucidation of metabolic phenotypes ('metabotypes') also has wider implications for health maintenance and disease risk management, the need to reformulate foods and alter the food chain, and in gaining an increased understanding of the relationship between dietary macronutrients and human lipid metabolism in relation to health and disease.
Sectors Agriculture, Food and Drink,Education,Healthcare,Government, Democracy and Justice

 
Title Measurement of dietary sugars (lactulose, mannitol) in human urine by liquid chromatography mass spectrometry (LCMS) 
Description The dietary sugars lactulose and mannitol are given orally, and recovered in urine as a measure of gut permeability. The sugars are detected by a LCMS. 1. Andre F et al (1988) Assessment of the lactulose-mannitol test in Crohn's disease. Gut 29: 511-515. PMID: 3131194 2. Johnston SD et al (2001) Lactulose-mannitol intestinal permeability test: a useful screening test for adult coeliac disease. Annals of Clinical Biochemistry 38: 416-416. 3. Kuitunen M, et al (2002) Intestinal permeability to mannitol and lactulose in children with type 1 diabetes with the HLA-DQB1* 02 allele. Autoimmunity 35: 365- 368. PMID: 12515291 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2019 
Provided To Others? Yes  
Impact None as yet. This method will be used as an alternative measure of gut permeability, on urine samples that have been collected after interventions high and low in dietary saturated fatty acids. The method has been developed in place of measuring the recovery of a radioactive label 51Cr in urine, which became unavailable during the course of the study. 
 
Description Analytical service for measurement of plasma non-cholesterol sterols as biomarkers of cholesterol synthesis and intestinal absorption (RISSCI-2) 
Organisation Newcastle upon Tyne Hospitals NHS Foundation Trust
Country United Kingdom 
Sector Academic/University 
PI Contribution We provided the NHS laboratory in Newcastle with human plasma samples from the RISSC-2 intervention study, for the analysis of non-cholesterol sterols by GCMS. This analysis was originally to undertaken in-house at Surrey, but this became impossible because of the closure of our lab during the COVID-19 lockdown, restricted access to our lab following the lockdown, and extended sick leave of the PDRA at Surrey.
Collaborator Contribution Analysis of plasma non-cholesterol sterols as markers of cholesterol synthesis and intestinal absorption (RISSCI-2).
Impact There have been no output or outcomes from this collaborative service as yet, and it is not multi-disciplnary
Start Year 2020
 
Description Multi-lateral collaboration between University of Surrey (Prof Bruce Griffin), University of Reading (Prof Julie Lovegrove) & Imperial College London (Dr Jonathan Swann) 
Organisation Imperial College London
Department Department of Surgery and Cancer
Country United Kingdom 
Sector Academic/University 
PI Contribution University of Surrey: Professor Bruce Griffin (PI at Surrey and overall project PI) is responsible for the recruitment of study participants and dietary intervention studies for part 1 ('RISSCI 1') and part 2 ('RISSCI 2') of the project. Primary outcome measures at Surrey include: intestinal absorption of dietary fat by stable isotope trace-labelling (Dr Barbara Fielding, Co-investigator), and gut permeability using radiolabelled chromium (51Cr) (Dr Denise Robertson - Co-investigator).
Collaborator Contribution University of Reading (BB/P009891/1): Julie Lovegrove (PI at Reading) is responsible for the recruitment of study participants and dietary intervention studies for part 1 ('RISSCI 1') and part 2 ('RISSCI 2') of the project. Primary outcome measures at Reading include: blood biochemistry (screening & interventions), LDL-receptor gene expression (Dr Kim Jackson - Co-investigator), gut microbiota (Prof Glenn Gibson, Co-investigator). Imperial College London: Dr Jonathan Swann (PI at ICP) is responsible for measuring bile acid composition and metabonomics analysis on blood serum, urine and faeces in part 2 of the project ('RISSCI 2').
Impact None so far.
Start Year 2017
 
Description Multi-lateral collaboration between University of Surrey (Prof Bruce Griffin), University of Reading (Prof Julie Lovegrove) & Imperial College London (Dr Jonathan Swann) 
Organisation University of Reading
Department Department of Food and Nutritional Sciences
Country United Kingdom 
Sector Academic/University 
PI Contribution University of Surrey: Professor Bruce Griffin (PI at Surrey and overall project PI) is responsible for the recruitment of study participants and dietary intervention studies for part 1 ('RISSCI 1') and part 2 ('RISSCI 2') of the project. Primary outcome measures at Surrey include: intestinal absorption of dietary fat by stable isotope trace-labelling (Dr Barbara Fielding, Co-investigator), and gut permeability using radiolabelled chromium (51Cr) (Dr Denise Robertson - Co-investigator).
Collaborator Contribution University of Reading (BB/P009891/1): Julie Lovegrove (PI at Reading) is responsible for the recruitment of study participants and dietary intervention studies for part 1 ('RISSCI 1') and part 2 ('RISSCI 2') of the project. Primary outcome measures at Reading include: blood biochemistry (screening & interventions), LDL-receptor gene expression (Dr Kim Jackson - Co-investigator), gut microbiota (Prof Glenn Gibson, Co-investigator). Imperial College London: Dr Jonathan Swann (PI at ICP) is responsible for measuring bile acid composition and metabonomics analysis on blood serum, urine and faeces in part 2 of the project ('RISSCI 2').
Impact None so far.
Start Year 2017
 
Title Reading Imperial Surrey Saturated fat Cholesterol Intervention ('RISSCI') study - Part 1 ('RISSCI 1') ClinicalTrials.gov ID: NCT03270527 
Description The aim of this study is to measure the amount of variation in blood LDL-cholesterol in 150 healthy volunteers (75 at the University of Surrey and 75 at the University of Reading) in response to lowering the amount of saturated fat in their diet to the level recommended by the government for the prevention of heart disease. This collaborative project between the Universities of Reading and Surrey ('RISSCI-1 Blood Cholesterol Response Study'), will allow us to investigate possible underlying causes for this variation in the blood cholesterol response in the whole group, and to identify two subgroups of men who show either a high or low LDL-cholesterol response to a reduction in dietary saturated intake. Metabolic characteristics of these two subgroups that are of relevance to the handling of saturated fat and cholesterol homeostasis will be examined in depth in part 2 of the project ('RISSCI-2), in collaboration with the University of Reading and Imperial College London. The project is funded by the BBSRC. 
Type Support Tool - For Fundamental Research
Current Stage Of Development Early clinical assessment
Year Development Stage Completed 2018
Development Status Under active development/distribution
Impact N/A 
URL https://clinicaltrials.gov/ct2/show/NCT03270527
 
Title Registration of phase 2 of RISSCI study (RISSCI-2) as a clinical trial with ISRCTN Registry: 'Study to explain the reason for the variation in blood cholesterol responses to saturated fat'. Reference: ISRCTN16727984. 
Description The second phase of the RISSCI study (RISSCI-2) was registered as a clinical trial with ISRCTN Registry (SRCTN16727984). The application was approved on 13 August 2020. The re-call of volunteers for RISSC-2 from the first phase of the RISSCI study (RISSCI-1) was initiated at the end of August 2020. 
Type Support Tool - For Fundamental Research
Current Stage Of Development Initial development
Year Development Stage Completed 2020
Development Status Under active development/distribution
Impact All aspects of the human dietary interventions for RISSCI-2 were completed at Surrey and Reading Universities in February 2020. Sample analysis is still ongoing until August 2021. As such, there is as yet no notable impacts from this phase of the study. 
URL https://doi.org/10.1186/ISRCTN16727984
 
Description Original Communication at the Nutrition Society's Winter Meeting (3-4 December 2018): 'A dietary exchange model to study inter-individual variation in serum low density lipoprotein cholesterol response to dietary staurated fat' 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact Dr Rona Antoni (Postdoctoral research assistant at Surrey on: "Mechanisms to Explain Variation in Serum Low Density Lipoprotein Cholesterol Response to Dietary Saturated Fat") presented an Original Communication abstract at the Nutrition Society's Winter Meeting entitled: 'Optimal diet and lifestyle strategies for the management of cardio-metabolic risk' - (Principal Organiser of the scientific programme, Griffin BA).
Year(s) Of Engagement Activity 2018
URL https://www.nutritionsociety.org/events/winter-conference-2018-optimal-diet-and-lifestyle-strategies...
 
Description European Atherosclerosis Society (EAS) Advanced Course in Nutrition 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Two day course (teaching workshop) organised by the European Atherosclerosis Society entitled 'Advanced Course in Nutrition' (Athens, Greece 19-20 April 2018). The primary purpose was to educate and inform healthcare professionals, postgraduate students, junior academics across Europe. The delegation included between 20-25 Russian, Irish, Spanish, Italian, Danish, Greek and UK delegates. Professor Griffin was a co-organiser of the event and delivered two presentations on dietary cholesterol and personalised nutrition (including address of NAFLD and dietary response to sugars).
Year(s) Of Engagement Activity 2018
URL https://www.eas-society.org/page/course_NUTRAthens
 
Description Invited presentation and debate on 'Dietary dilemmas & deflating Trust in nutritional science' at Green Templeton College, University of Oxford, UK (12th February 2020) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact I delivered an invited presentation (1-2 hours) to a scientific debating society at the University of Oxford. My presentation stimulated a heated debate about a number of controversial issues in nutrition, including the current dietary recommendation for the replacement of dietary saturated fat and cardiovascular disease risk, which outputs and outcomes from the current RISSCI study will address and help to resolve.
Year(s) Of Engagement Activity 2020
 
Description Lecture to the Faculty of Health & Medical Sciences, University of Surrey 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Other audiences
Results and Impact School of Biosciences & Medicine
Seminar series
Wednesday, 17th January 2018
Time: 1-2pm
Venue: 01DK03
Which is worse, sugar or saturated fat? An examination of the evidence behind the futility of this dietary dilemma.
Professor Bruce Griffin
Professor of Nutritional Metabolism, School of Bioscience & Medicine
Failure of recent meta-analyses to produce evidence for a direct relationship between saturated fat intake and death from coronary heart disease (CHD), has fuelled a backlash of propaganda from the social media against our National dietary guidelines to reduce intake of saturated fat to reduce the risk of CHD, primarily by lowering blood cholesterol. The resulting mixed messages have caused confusion and mistrust amongst the general public, many of whom now believe that saturated fat is harmless and can be consumed with impunity, while blaming sugar as the culprit for obesity, diabetes and CHD. In reality, both sugar and saturated fat can produce detrimental effects on our cardiovascular health. To spend time vilifying one nutrient over the other is pointless. It perpetuates misinformation about diet and health and sells newspapers, but may also contribute to an increased risk of premature death from CHD. This presentation will review the incontrovertible evidence to support the link between raised blood cholesterol and CHD, and the more contentious effects of saturated fat on blood cholesterol. It will critically appraise the shortcomings of meta-analyses in assessing the indirect relationship between saturated fat and CHD, and place the impact of sugars on cardio-metabolic health in perspective of the risks for the UK population, and more vulnerable subgroups consuming very high intakes of free sugars.
Year(s) Of Engagement Activity 2018
 
Description Nutrition Society's Member-led Meeting entitled: 'How stable isotope techniques can enhance human nutrition research' at the University of Surrey, 9th January 2020. 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The one-day meeting was organised by a co-applicant of the Award, Dr Barbara Fielding (65 delegates). Dr Barbara Fielding and I (Prof Bruce Griffin) delivered a joint presentation on the application of the stable isotope technology within the awarded 'RISSCI' study, entitled: 'Inter-individual variation in serum LDL-cholesterol response to saturated fat in men'. The outputs from the workshop are to be published in an Editorial in the Proceedings of the Nutrition Society.
Year(s) Of Engagement Activity 2020
 
Description Poster presentation by Dr Rona Antoni at Nutrition Society Live 2020 (on-line) entitled: 'A dietary exchange model to achieve target nutrient intakes in diets high and lower insaturated fatty acids' 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Presentation of a poster by Dr Rona Antoni (PDRA at Surrey on the RISSCI study) as an free oral communication at Nutrition Society Live 2020. This on-line meeting was held in place of the Nutrition Society's Annual Summer Conference. The presentation, which concerned the development and performance of the dietary intervention used in the RISSCI study, was well received and prompted many questions from the audience.
Year(s) Of Engagement Activity 2020
URL https://www.nutritionsociety.org/events/nutrition-society-live-2020
 
Description Presentation by Dr Barbara Fielding at the Diabetes & Nutritional Sciences Division, Kings College London entitled 'Tracing metabolism: a focus on fats and sugars' (28/06/2018) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Postgraduate students
Results and Impact Dr Fielding was a co-worker on the project: "How does dietary carbohydrate influence the formation of an atherogenic lipoprotein phenotype?" and a co-applicant on "Mechanisms to Explain Variation in Serum Low Density Lipoprotein Cholesterol Response to Dietary Saturated Fat". In this presentation she addressed the role of isotope trace-labelling to study the effects of free sugars and saturated fat on lipid and carbohydrate metabolism.
Year(s) Of Engagement Activity 2018
 
Description Presentation by Professor Griffin at the Nutrition Society's Winter Meeting at the Royal Society of Medicine, London 2-4 December 2019. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The presentation was entitled: 'Determination of variability in serum LDL-cholesterol response to the replacement of dietary saturated fat with unsaturated fat in the Reading, Imperial, Surrey, Saturated fat and Cholesterol Intervention ('RISSCI') study' (03/12/19). The purpose of the presentation was to introduce the RISSCI study, highlight its aims, objectives and methods, to showcase the results from the first phase of the study, and to describe the on-going second phase, which was completed in February 2020. An abstract of the presentation has been published in the Proceedings of the Nutrition Society (DOI: 10.1017/S0029665119001277).
Year(s) Of Engagement Activity 2019
 
Description Presentation to the Institute of Grocery Distribution (IGD) Strategy Group at Clarence House (Royal Society of Medicine), London 25 September 2018 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact Professor Griffin delivered a 45 minute presentation, the purpose of which was to update key members of the IGD from the food industry and commercial sectors about key issues in nutritional science and human health; covering the impact of dietary fats and sugars on obesity and cardio-metabolic disease.
Year(s) Of Engagement Activity 2018
 
Description Social media blog 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact A social media blog designed to inform the public on the science and controversies surrounding saturated fat. It also includes volunteer recruitment messages.
Year(s) Of Engagement Activity 2018
URL https://www.facebook.com/theRISSCIStudy/?notif_id=1519054440712259¬if_t=page_fan&ref=notif