Scientific Opinion on the substantiation of health claims related to olive oil  
and maintenance of normal blood LDL-cholesterol concentrations  
(ID 1316, 1332), maintenance of normal (fasting) blood concentrations of  
triglycerides (ID 1316, 1332), maintenance of normal blood  
HDL-cholesterol concentrations (ID 1316, 1332) and maintenance of  
normal blood glucose concentrations (ID 4244) pursuant to Article 13(1) of  
Regulation (EC) No 1924/2006[sup]1[/sup]  
EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA)2, 3  
European Food Safety Authority (EFSA), Parma, Italy  
Słowa kluczowe:
HDL
 
LDL
 
Olive oil
 
cholesterol
 
glucose
 
health claims
 
triglycerides
 
	
	1. Charakterystyka żywności / składnika
	
        
		The food that is the subject of the health claims is olive oil.
Olive oil is produced from the fruits of the olive tree. The composition varies by cultivar, region,  altitude, time of harvest and extraction process, particularly with regard to its polyphenol content. Its  fatty acid composition is less variable and includes about 70 % oleic acid, 15 % saturated fatty acids  (SFAs) and 11 % polyunsaturated fatty acids (PUFAs), mainly linoleic acid (LA), by weight.
The Panel considers that the food, olive oil, which is the subject of the health claims, is sufficiently  characterised in relation to the claimed effects.
		
	
	
    
	
	
		
 
	
	2. Znaczenie oświadczenia dla zdrowia człowieka
	
        
		
		
	
	
    
	
	
		
			
2.1. Utrzymanie prawidłowego stężenia cholesterolu LDL we krwi (ID 1316, 1332)
	
	
			The claimed effects are “health of the cardiovascular system, general population” and “improves  blood lipid profile”. The Panel assumes that the target population is the general population.
In the context of the proposed wording and clarifications provided by Member States, the Panel  assumes that the claimed effects refer to the maintenance of normal LDL-cholesterol concentrations.
Low-density lipoproteins (LDL) carry cholesterol from the liver to peripheral tissues, including the  arteries. Elevated LDL-cholesterol, by convention >160 mg/dL (>4.1 mmol/L), may compromise the  normal structure and function of the arteries.
The Panel considers that maintenance of normal blood LDL-cholesterol concentrations is a beneficial  physiological effect.
	
    
			
	
		
			
2.2. Utrzymanie prawidłowego stężenia trójglicerydów we krwi na czczo (ID 1316, 1332)
	
	
			The claimed effects are “health of the cardiovascular system, general population” and “improves  blood lipid profile”. The Panel assumes that the target population is the general population.
In the context of the proposed wording and clarifications provided by Member States, the Panel  assumes that the claimed effects refer to the maintenance of normal (fasting) blood concentrations of  triglycerides.
Triglycerides in plasma are either derived from dietary fats or synthesised in the body from other  energy sources like carbohydrates. In fasting conditions, serum triglycerides are mainly transported in  very-low-density lipoproteins (VLDL) synthesised in the liver. Hormones regulate the release of  triglycerides from adipose tissue in order to meet energy needs between meals. Normal values for  blood concentrations of triglycerides have been defined.
The Panel considers that maintenance of normal (fasting) blood concentrations of triglycerides may  be a beneficial physiological effect.
	
    
			
	
		
			
2.3. Utrzymanie prawidłowego stężenia cholesterolu HDL we krwi (ID 1316, 1332)
	
	
			The claimed effects are “health of the cardiovascular system, general population” and “improves  blood lipid profile”. The Panel assumes that the target population is the general population.
In the context of the proposed wording and clarifications provided by Member States, the Panel  assumes that the claimed effects refer to the maintenance of normal HDL-cholesterol concentrations.
High-density lipoproteins (HDL) act as cholesterol scavengers and are involved in the reverse  transport of cholesterol in the body (from peripheral tissues back to the liver). Conversely,  low-density lipoproteins (LDL) carry cholesterol from the liver to peripheral tissues, including the  arteries.
The Panel considers that maintenance of normal HDL-cholesterol concentrations (without increasing  LDL-cholesterol concentrations) is a beneficial physiological effect.
	
    
			
	
		
			
2.4. Utrzymanie prawidłowego stężenia glukozy we krwi (ID 4244)
	
	
			The claimed effect is “permet de réguler le glucoses dans le sang”. The Panel assumes that the target  population is the general population.
The Panel assumes that the claimed effect refers to the maintenance of normal blood glucose  concentrations.
The Panel considers that long-term maintenance of normal blood glucose concentrations is a  beneficial physiological effect.
	
    
			
	
		
 
	
	3. Naukowe uzasadnienia wpływu na zdrowie człowieka - 
	
        
		Most of the references provided in relation to the claims evaluated in this opinion were narrative  reviews that did not contain any original data which could be used for the scientific substantiation of  the claimed effects, reports on epidemiological and intervention studies on foods or diets other than  olive oil (e.g. Mediterranean diet) and/or on health outcomes other than the claimed effects (e.g.  cardiovascular events, oxidative stress, endothelium-dependent vasodilation, blood pressure). The
Panel considers that no conclusions can be drawn from these references for the scientific  substantiation of the claimed effects.
		
	
	
    
	
	
		
			
3.1. Utrzymanie prawidłowego stężenia cholesterolu LDL we krwi (ID 1316, 1332)
	
	
			Mensink et al. (2003) found in a meta-analysis of 60 controlled trials, that replacing carbohydrates  with SFAs in an amount representing 1 E% increased LDL-cholesterol concentrations by  0.032 mmol/L. Replacement with cis-MUFAs (oleic acid) reduced LDL-cholesterol concentrations  only by 0.009 mmol/L. The corresponding reduction in LDL-cholesterol concentrations by PUFAs  was significantly larger (i.e. 0.019 mmol/L).
A number of human intervention studies comparing the effects of olive oils vs. other vegetable oils  were provided.
Pedersen et al. (2000) investigated the effect of olive oil (35 % of daily energy intake as fat  (11 E% SFAs, 21 E% MUFAs, 3 E% PUFAs)), rapeseed oil (35 % of daily energy intake as fat (9 E%  SFAs, 18 E% MUFAs, 7 E% PUFAs)), and sunflower oil (35 % of daily energy intake as fat (10 E%  SFAs, 9 E% MUFAs, 15 E% PUFAs)) based diets on blood lipids and lipoproteins in 18 healthy  subjects in a double-blind, randomised, cross-over study (3-week intervention period) with 50 g  oil/10 MJ incorporated into a constant diet. Total and LDL-cholesterol concentrations were  significantly higher after consumption of the olive oil diet compared with the rapeseed oil and  sunflower oil diets. Lichtenstein et al. (1993) compared rapeseed oil (about 6 % SFAs, 62 % oleic  acid, 20 % linoleic acid (LA) and 10 % alpha-linolenic acid (ALA)), maize oil (about 60 % LA, 28 %  oleic acid and 13 % SFAs) and olive oil (about 70 % oleic acid, 15 % SFAs, and 11 % PUFAs, mainly  LA) as part of the National Cholesterol Education Program (NCEP) Step 2 diet with the average US  diet in a randomised cross-over study in 15 persons. Both rapeseed oil and maize oil reduced serum  total cholesterol levels more (-12 and -13 %, respectively) than olive oil (-7 %). In the randomised,  cross-over intervention by Nydahl et al. (1995), 22 hyperlipidaemic subjects consumed either low  erucic acid rapeseed (canola) oil or olive oil in the context of a “lipid-lowering” diet for 3.5 weeks  each. LDL-cholesterol concentrations decreased significantly more during the canola oil diet (-17%)  than during the olive oil diet (-13%). The Panel notes that the different effects of different oils on  blood cholesterol concentrations could be explained by the fatty acid composition of these oils.
The only study presented which assessed the effects of olive oil while controlling for its fatty acid  composition was a multicentre (six centres in Finland, Denmark, Germany, Italy and Spain)  randomised, cross-over, controlled human intervention study in which olive oils with high (366 mg/kg  oil, i.e. 8.0 mg/day), moderate (164 mg/kg oil, i.e. 3.6 mg/day), and low (2.7 mg/kg oil,  i.e. 0.1 mg/day) polyphenol content were consumed by 200 male subjects for three weeks  (25 mL/day) each (Covas et al., 2006). Changes in LDL-cholesterol concentrations were not  significantly different between olive oil treatments.
In weighing the evidence, the Panel took into account that the evidence provided did not establish that  olive oil consumption had an effect on blood LDL-cholesterol concentrations beyond what could be  expected from the fatty acid composition of olive oil, and that the only study which assessed the  effects of olive oil while controlling for its fatty acid composition did not find any significant changes  in LDL-cholesterol concentrations when comparing olive oils with high, moderate and low  polyphenol content.
The Panel concludes that a cause and effect relationship has not been established between the  consumption of olive oil and maintenance of normal blood LDL-cholesterol concentrations beyond  what could be expected from the fatty acid composition of olive oil.
A claim on the replacement of mixtures of SFAs with cis-MUFAs and/or cis-PUFAs in foods or diets  and maintenance of normal blood LDL-cholesterol concentrations has already been assessed with a  favourable outcome (EFSA Panel on Dietetic Products Nutrition and Allergies (NDA), 2011a).
A claim on linoleic acid and maintenance of normal blood cholesterol concentrations has also already  been assessed with a favourable outcome (EFSA Panel on Dietetic Products Nutrition and Allergies  (NDA), 2009).
	
    
			
	
		
			
3.2. Utrzymanie prawidłowego stężenia trójglicerydów we krwi na czczo (ID 1316, 1332)
	
	
			When carbohydrates are replaced with fats, fasting triglyceride concentrations are reduced, but there  is no difference between the effects of different fatty acid classes. Mensink and Katan (1992) found in  a meta-analysis of 27 trials that an isocaloric exchange between carbohydrates and fats resulted in  similar predicted effects on triglyceride levels for SFAs, MUFAs and PUFAs. The Panel notes that  carbohydrates are not neutral with respect to their effects on blood concentrations of triglycerides.
In clinical trials, no differences have been observed between olive oil, rapeseed oil, corn oil and  sunflower oil with respect to their effects on blood concentrations of triglycerides (Lichtenstein et al.,  1993; Nydahl et al., 1995; Pedersen et al., 2000).
The Panel concludes that a cause and effect relationship has not been established between the  consumption of olive oil and maintenance of normal (fasting) blood concentrations of triglycerides.
	
    
			
	
		
			
3.3. Utrzymanie prawidłowego stężenia cholesterolu HDL we krwi (ID 1316, 1332)
	
	
			Mensink et al. (2003) concluded in a meta-analysis of 60 controlled trials that all types of fatty acids  except trans fatty acids increase HDL-cholesterol concentrations as compared with carbohydrates.  The effect of SFAs on increasing HDL-cholesterol concentrations is reduced by increasing chain  length. Replacement of 1 E% of SFAs with an equal E% of cis-MUFAs was predicted to lower  HDL-cholesterol by 0.002 mmol/L, and a similar decrease was expected when replacing the same  amount of MUFAs with PUFAs. The Panel notes that oleic acid reduces HDL-cholesterol  concentrations as compared with SFAs with 12-16 carbon atoms, but less than a similar amount of  PUFAs. The Panel also notes that carbohydrates are not neutral with respect to their effects on  HDL-cholesterol concentrations.
In clinical trials no statistically significant differences have been observed when comparing olive oil  with rapeseed oil, sunflower oil or corn oil with respect to their effects on HDL-cholesterol  concentrations (Lichtenstein et al., 1993; Nydahl et al., 1995; Pedersen et al., 2000).
The only study presented which assessed the effects of olive oil while controlling for its fatty acid  composition was the multicentre study described in section 3.1. A significant linear dose-dependent  increase in HDL-cholesterol concentrations was observed for low- (+0.025 mmol/L, 95 % CI = 0.003  to 0.05 mmol/L), medium- (+0.032 mmol/L, 95 % CI = 0.005 to 0.05 mmol/L), and high-polyphenol  olive oil (p per trend 0.018). The total-to-HDL-cholesterol ratio decreased linearly with the  polyphenol content of the olive oils (p per trend 0.013).
A claim on olive polyphenols and maintenance of normal blood HDL-cholesterol concentrations has  already been assessed with an unfavourable outcome (EFSA Panel on Dietetic Products Nutrition and  Allergies (NDA), 2011b).
In weighing the evidence, the Panel took into account that based on its fatty acid composition olive oil  is not expected to have an effect on HDL-cholesterol concentrations, that a linear dose-response effect  of olive oil polyphenols on HDL-cholesterol concentrations was observed in one study only, and that
no evidence on a plausible mechanism by which olive oil polyphenols could exert an effect on  HDL-cholesterol concentrations has been provided.
The Panel concludes that a cause and effect relationship has not been established between the  consumption of olive oil and maintenance of normal HDL-cholesterol concentrations.
	
    
			
	
		
			
3.4. Utrzymanie prawidłowego stężenia glukozy we krwi (ID 4244)
	
	
			Only one reference was provided for the scientific substantiation of the claimed effect which was a  narrative review on the relationship between impaired fatty acid and phospholipid metabolism, and  depression and bipolar disorder in the context of different chronic diseases. The Panel considers that  no conclusions can be drawn from this reference for the scientific substantiation of the claim.
The Panel concludes that a cause and effect relationship has not been established between the  consumption of olive oil and maintenance of normal blood glucose concentrations.
	
    
			
	
		
 
Wnioski
	
		On the basis of the data presented, the Panel concludes that:  
The food, olive oil, which is the subject of the health claims, is sufficiently characterised in  relation to the claimed effect.  
Maintenance of normal blood LDL-cholesterol concentrations (ID 1316, 1332)  
The claimed effects are “health of the cardiovascular system, general population” and  “improves blood lipid profile”. The target population is assumed to be the general population.  In the context of the proposed wording and clarifications provided by Member States, it is  assumed that the claimed effects refer to the maintenance of normal LDL-cholesterol  concentrations. Maintenance of normal blood LDL-cholesterol concentrations is a beneficial  physiological effect.  
A cause and effect relationship has not been established between the consumption of olive oil  and maintenance of normal blood LDL-cholesterol concentrations beyond what could be  expected from the fatty acid composition of olive oil.  
A claim on the replacement of a mixture of SFAs with cis-MUFAs and/or cis-PUFAs in foods  or diets and maintenance of normal blood cholesterol concentrations has been assessed with a  favourable outcome. A claim on linoleic acid and maintenance of normal blood cholesterol  concentrations has also already been assessed with a favourable outcome.  
Maintenance of normal (fasting) blood concentrations of triglycerides (ID 1316, 1332)  
The claimed effects are “health of the cardiovascular system, general population” and  “improves blood lipid profile”. The target population is assumed to be the general population.  In the context of the proposed wording and clarifications provided by Member States, it is  assumed that the claimed effects refer to the maintenance of normal (fasting) blood  concentrations of triglycerides. Maintenance of normal (fasting) blood concentrations of  triglycerides may be a beneficial physiological effect.  
The Panel concludes that a cause and effect relationship has not been established between the  consumption of olive oil and maintenance of normal (fasting) blood concentrations of  triglycerides. 
Maintenance of normal blood HDL-cholesterol concentrations (ID 1316, 1332)  
The claimed effects are “health of the cardiovascular system, general population” and  “improves blood lipid profile”. The target population is assumed to be the general population.  In the context of the proposed wording and clarifications provided by Member States, it is  assumed that the claimed effects refer to the maintenance of normal HDL-cholesterol  concentrations. Maintenance of normal HDL-cholesterol concentrations (without increasing  LDL-cholesterol concentrations) is a beneficial physiological effect.  
The Panel concludes that a cause and effect relationship has not been established between the  consumption of olive oil and maintenance of normal blood HDL-cholesterol concentrations.  
Maintenance of normal blood glucose concentrations (ID 4244)  
The claimed effect is “permet de réguler le glucoses dans le sang”. The target population is  assumed to be the general population. It is assumed that the claimed effect refers to the  maintenance of normal blood glucose concentrations. Long-term maintenance of normal  blood glucose concentrations is a beneficial physiological effect.  
A cause and effect relationship has not been established between the consumption of olive oil  and maintenance of normal blood glucose concentrations.