Reduction in saturated fat intake for cardiovascular disease

Published on Jun 10, 2015in Cochrane Database of Systematic Reviews 6.75
· DOI :10.1002/14651858.CD011737
Lee Hooper50
Estimated H-index: 50
(University of East Anglia),
Nicole Martin5
Estimated H-index: 5
(University of London)
+ 1 AuthorsGeorge Davey-Smith173
Estimated H-index: 173
(University of Bristol)
Background Reducing saturated fat reduces serum cholesterol, but effects on other intermediate outcomes may be less clear. Additionally it is unclear whether the energy from saturated fats that are lost in the diet are more helpfully replaced by polyunsaturated fats, monounsaturated fats, carbohydrate or protein. This review is part of a series split from and updating an overarching review. Objectives To assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA) or monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity, using all available randomised clinical trials. Search methods We updated our searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and EMBASE (Ovid) on 5 March 2014. We also checked references of included studies and reviews. Selection criteria Trials fulfilled the following criteria: 1) randomised with appropriate control group; 2) intention to reduce saturated fat intake OR intention to alter dietary fats and achieving a reduction in saturated fat; 3) not multifactorial; 4) adult humans with or without cardiovascular disease (but not acutely ill, pregnant or breastfeeding); 5) intervention at least 24 months; 6) mortality or cardiovascular morbidity data available. Data collection and analysis Two review authors working independently extracted participant numbers experiencing health outcomes in each arm, and we performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity analyses and funnel plots. Main results We include 15 randomised controlled trials (RCTs) (17 comparisons, ˜59,000 participants), which used a variety of interventions from providing all food to advice on how to reduce saturated fat. The included long-term trials suggested that reducing dietary saturated fat reduced the risk of cardiovascular events by 17% (risk ratio (RR) 0.83; 95% confidence interval (CI) 0.72 to 0.96, 13 comparisons, 53,300 participants of whom 8% had a cardiovascular event, I² 65%, GRADE moderate quality of evidence), but effects on all-cause mortality (RR 0.97; 95% CI 0.90 to 1.05; 12 trials, 55,858 participants) and cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 12 trials, 53,421 participants) were less clear (both GRADE moderate quality of evidence). There was some evidence that reducing saturated fats reduced the risk of myocardial infarction (fatal and non-fatal, RR 0.90; 95% CI 0.80 to 1.01; 11 trials, 53,167 participants), but evidence for non-fatal myocardial infarction (RR 0.95; 95% CI 0.80 to 1.13; 9 trials, 52,834 participants) was unclear and there were no clear effects on stroke (any stroke, RR 1.00; 95% CI 0.89 to 1.12; 8 trials, 50,952 participants). These relationships did not alter with sensitivity analysis. Subgrouping suggested that the reduction in cardiovascular events was seen in studies that primarily replaced saturated fat calories with polyunsaturated fat, and no effects were seen in studies replacing saturated fat with carbohydrate or protein, but effects in studies replacing with monounsaturated fats were unclear (as we located only one small trial). Subgrouping and meta-regression suggested that the degree of reduction in cardiovascular events was related to the degree of reduction of serum total cholesterol, and there were suggestions of greater protection with greater saturated fat reduction or greater increase in polyunsaturated and monounsaturated fats. There was no evidence of harmful effects of reducing saturated fat intakes on cancer mortality, cancer diagnoses or blood pressure, while there was some evidence of improvements in weight and BMI. Authors' conclusions The findings of this updated review are suggestive of a small but potentially important reduction in cardiovascular risk on reduction of saturated fat intake. Replacing the energy from saturated fat with polyunsaturated fat appears to be a useful strategy, and replacement with carbohydrate appears less useful, but effects of replacement with monounsaturated fat were unclear due to inclusion of only one small trial. This effect did not appear to alter by study duration, sex or baseline level of cardiovascular risk. Lifestyle advice to all those at risk of cardiovascular disease and to lower risk population groups should continue to include permanent reduction of dietary saturated fat and partial replacement by unsaturated fats. The ideal type of unsaturated fat is unclear.
  • References (680)
  • Citations (127)
Published on Sep 27, 1986in The Lancet 53.25
Murray Gi1
Estimated H-index: 1
T.S. Barnes1
Estimated H-index: 1
+ 3 AuthorsBurke1
Estimated H-index: 1
898 Citations
Published on Jan 1, 1995in Advances in Experimental Medicine and Biology 1.76
Henry N. Ginsberg78
Estimated H-index: 78
(Columbia University)
Although many clinical studies of dietary effects on plasma lipids and lipoproteins have been conducted during the past 30 years, significant issues remain to be clarified. Previous studies have often lacked adequate sample size and or dietary control, and the diets used have either been extreme in composition or comprised of liquid formulas. Additionally, most of the subjects studied to date have been young white males; very little is known about the relative efficacies of prudent diets in Afri...
9 Citations Source Cite
Published on Jan 1, 1991in Family Medicine 1.14
Estimated H-index: 1
D'Amico Fj1
Estimated H-index: 1
Merenstein Jh1
Estimated H-index: 1
41 Citations
Published on Jan 1, 1990in International Journal of Obesity 5.16
Marniemi J1
Estimated H-index: 1
Seppänen A1
Estimated H-index: 1
Hakala P1
Estimated H-index: 1
The effect of 2 dietary weight reduction programmes(1200 kcal/day) on lipid metabolism were followed for one year in moderately obese subjects. The groups consisted of lactovegetarian (n=31), mixed diet (n=37) and control (n=42) group. Changes in serum triglycerides and cholesterol levels, in lipoproteins and HDL subfractions levels , in the activity of adipose tissu lipoprotein lipase and of post-heparin plasma hepatic lipase are analyzed in term of diet and sex ,as well as skinfold. The result...
15 Citations
Published on Sep 1, 1993in European Journal of Clinical Nutrition 2.95
E.S. Sarkkinen1
Estimated H-index: 1
M. Uusitupa7
Estimated H-index: 7
+ 3 AuthorsJukka T. Salonen24
Estimated H-index: 24
Diet enriched with polyunsaturated fat may increase the susceptibility of LDL to oxidation. Therefore the effects of two low-fat diets on plasma lipid peroxides in free-living mildly hypercholesterolaemic men (n = 37) were investigated in a randomized single-blind 28-week study. Composition of the diets were (1) American Heart Association (AHA) type 32/10:8:8 (indicating percentages of energy from total fat/saturated fat:monoenes:polyenes in actual diet); (2) low-fat 30/12:8:3. The subjects kept...
17 Citations
Linda M. Delahanty37
Estimated H-index: 37
(Harvard University),
Lillian Sonnenberg14
Estimated H-index: 14
(Harvard University)
+ 1 AuthorsDavid M. Nathan103
Estimated H-index: 103
(Harvard University)
Abstract Objective To compare the results and cost-effectiveness of a cholesterol lowering protocol implemented by registered dietitians with cholesterol lowering advice by physicians. Design Six month randomized controlled trial, cost-effectiveness analysis. Subjects included 90 ambulatory care patients (60 men, 30 women), age range 21 to 65 years, with hypercholesterolemia and not taking hypolipidemic drugs. Patients were randomly assigned to receive medical nutrition therapy (MNT) from dietit...
70 Citations Source Cite
Published on Mar 1, 1966in Journal of Molecular Medicine
H. Glatzel1
Estimated H-index: 1
(Max Planck Society)
Bei gesunden Versuchspersonen wurden unter fettreich/kohlenhydratarmer und unter fettarm/kohlenhydratreicher Kost (rd. 60 bzw. rd. 5% Fettcalorien) nach peroraler Zufuhr von 1 g Olivenol/kg Korpergewicht die Triglyceride im Serum bestimmt. Unter fettreich/kohlenhydratarmer Kost stiegen die Triglyceride postcenal von tiefem Nuchternniveau aus hoch an, wahrend sie unter fettarm/kohlenhydratreicher Kost von hohem Nuchternniveau aus kaum oder gar nicht anstiegen.
8 Citations Source Cite
Published on Jan 1, 1992in Voprosy onkologii
Sopotsinskaia Eb1
Estimated H-index: 1
Balitskiĭ Kp1
Estimated H-index: 1
+ 4 AuthorsGrigorov IuG1
Estimated H-index: 1
Abstract The paper discusses results of three-year follow-up of breast cancer patients keeping to a low-calorie diet after radical mastectomy and chemotherapy. The diet was planned according to age, energy expenditures and body weight and was aimed at a 15% decrease in the total caloricity as compared to corresponding individually-tailored norms for healthy people. This was achieved by reduction in fat (by 30%) and carbohydrates (by 9%). To assure the diet on the domiciliary basis, patients were...
7 Citations
  • References (680)
  • Citations (127)
Cited By127
Published on Sep 1, 2018in Journal of Atherosclerosis and Thrombosis 3.04
Makoto Kinoshita1
Estimated H-index: 1
(Toray Industries),
Koutaro Yokote34
Estimated H-index: 34
(Chiba University)
+ 29 AuthorsTomonori Okamura48
Estimated H-index: 48
(Keio University)
36 Citations Source Cite
Published on Jan 1, 2016in International Dairy Journal 2.20
Peter W. Parodi4
Estimated H-index: 4
Dietary guidelines recommend that intake of saturated fat should be <7–10% of daily energy. Supporting evidence relates mainly to saturated fatty acids (SFA) increasing blood total and LDL-cholesterol levels, which are risk factors for coronary heart disease (CHD). Recent meta-analyses of prospective cohort studies and of randomised controlled trials that substituted polyunsaturated fatty acids for SFA did not find any meaningful association between SFA intake and risk of CHD. The most likely al...
12 Citations Source Cite
Published on Aug 7, 2015in Cochrane Database of Systematic Reviews 6.75
Lee Hooper50
Estimated H-index: 50
(University of East Anglia),
Asmaa Abdelhamid14
Estimated H-index: 14
(University of East Anglia)
+ 3 AuthorsCarolyn Summerbell51
Estimated H-index: 51
(Durham University)
Background In order to prevent overweight and obesity in the general population we need to understand the relationship between the proportion of energy from fat and resulting weight and body fatness in the general population. Objectives To assess the effects of proportion of energy intake from fat on measures of weight and body fatness (including obesity, waist circumference and body mass index) in people not aiming to lose weight, using all appropriate randomised controlled trials (RCTs) and co...
21 Citations Source Cite
Published on Dec 1, 2015in Diabetes Therapy 2.22
Pamela Dyson6
Estimated H-index: 6
(University of Oxford)
Introduction Low carbohydrate diets are again in the spotlight and have been identified as particularly appropriate for people with type 2 diabetes. There is confusion amongst both health professionals and people with diabetes about the suitability of these diets. This review aims to provide an overview of the latest evidence and to explore the role of low carbohydrate diets for people with type 2 diabetes.
17 Citations Source Cite
Published on Sep 1, 2015in Practical Diabetes
Trudi Deakin , Leonie Garden (James Cook University Hospital)
Source Cite
Robert A. Hegele82
Estimated H-index: 82
Samuel S. Gidding54
Estimated H-index: 54
+ 5 AuthorsFrancine K. Welty35
Estimated H-index: 35
Pharmacological reduction of low-density lipoprotein (LDL) cholesterol using statin drugs is foundational therapy to reduce cardiovascular disease (CVD) risk. Here, we consider the place of nonstatin therapies that also reduce LDL cholesterol in prevention of CVD. Among conventional nonstatins, placebo-controlled randomized clinical trials showed that bile acid sequestrants, niacin, and fibrates given as monotherapy each reduce CVD end points. From trials in which patients’ LDL cholesterol was a...
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Published on Aug 11, 2015in BMJ 23.56
Russell J. de Souza34
Estimated H-index: 34
Andrew Mente29
Estimated H-index: 29
(McMaster University)
+ 8 AuthorsJoseph Beyene60
Estimated H-index: 60
(McMaster University)
Objective To systematically review associations between intake of saturated fat and trans unsaturated fat and all cause mortality, cardiovascular disease (CVD) and associated mortality, coronary heart disease (CHD) and associated mortality, ischemic stroke, and type 2 diabetes. Design Systematic review and meta-analysis. Data sources Medline, Embase, Cochrane Central Registry of Controlled Trials, Evidence-Based Medicine Reviews, and CINAHL from inception to 1 May 2015, supplemented by bibliogra...
318 Citations Source Cite
Published on Mar 1, 2016in Progress in Cardiovascular Diseases 6.75
James J. DiNicolantonio19
Estimated H-index: 19
Sean C. Lucan17
Estimated H-index: 17
James H. O'Keefe49
Estimated H-index: 49
Dietary guidelines continue to recommend restricting intake of saturated fats. This recommendation follows largely from the observation that saturated fats can raise levels of total serum cholesterol (TC), thereby putatively increasing the risk of atherosclerotic coronary heart disease (CHD). However, TC is only modestly associated with CHD, and more important than the total level of cholesterol in the blood may be the number and size of low-density lipoprotein (LDL) particles that contain it. A...
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Published on Dec 1, 2015in Nutrition Metabolism and Cardiovascular Diseases 3.32
Christine Dawczynski10
Estimated H-index: 10
(University of Jena),
Marcus E. Kleber45
Estimated H-index: 45
(Heidelberg University)
+ 2 AuthorsStefan Lorkowski21
Estimated H-index: 21
(University of Jena)
Abstract A recent meta-analysis by Chowdhury et al. (2014) has disclaimed the association between coronary artery diseases and either circulating blood levels or the intake of total saturated fatty acids (SFA). Scrutiny revealed that two of the eight studies included in the meta-analysis focused on the proportion of pentadecanoic acid (C15:0) and heptadecanoic acid (C17:0) and their impact on cardiovascular disease (CVD) risk. These odd-chain fatty acids are markers for milk or ruminant fat inta...
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Published on May 1, 2016in Lipids 1.94
Shatha S. Hammad2
Estimated H-index: 2
(University of Manitoba),
Shuaihua Pu8
Estimated H-index: 8
(University of Manitoba),
Peter J. H. Jones64
Estimated H-index: 64
(University of Manitoba)
Lack of consensus exists pertaining to the scientific evidence regarding effects of various dietary fatty acids on cardiovascular disease (CVD) risk. The objective of this article is to review current evidence concerning cardiovascular health effects of the main dietary fatty acid types; namely, trans (TFA), saturated (SFA), polyunsaturated (PUFA; n-3 PUFA and n-6 PUFA), and monounsaturated fatty acids (MUFA). Accumulating evidence shows negative health impacts of TFA and SFA; both may increase ...
47 Citations Source Cite