A systematic review of the effect of dietary saturated and polyunsaturated fat on heart disease

Published on Dec 1, 2017in Nutrition Metabolism and Cardiovascular Diseases 3.32
· DOI :10.1016/j.numecd.2017.10.010
Peter M. Clifton64
Estimated H-index: 64
(University of South Australia),
Jennifer B. Keogh38
Estimated H-index: 38
(University of South Australia)
Abstract Aims Over the last 7 years there has been intense debate about the advice to reduce saturated fat and increase polyunsaturated fat to reduce CVD risk. The aim of this review was to examine systematic reviews and meta-analyses since 2010 on this topic plus additional cohort studies and interventions not included in these reviews. Data Synthesis High saturated and trans fat intake (which elevates LDL like saturated fat) in the Nurses and Health Professional Follow-Up Studies combined is associated with an 8–13% higher mortality and replacement of saturated fat with any carbohydrate, PUFA and MUFA is associated with lower mortality with PUFA being more effective than MUFA (19% reduction versus 11%). With CVD mortality only PUFA and fish oil replacement of saturated fat lowers risk with a 28% reduction in CVD mortality per 5% of energy. Replacing saturated fat with PUFA or MUFA is equally effective at reducing CHD events and replacement with whole grains will lower events while replacement with sugar and starch increases events. Replacement of saturated fat with carbohydrate has no effect on CHD events or death. Only PUFA replacement of saturated fat lowers CHD events and CVD and total mortality. Replacing saturated fat with linoleic acid appears to be beneficial based on the Hooper Cochrane meta-analysis of interventions although other analyses with fewer studies have shown no effect. Conclusions Reducing saturated fat and replacing it with carbohydrate will not lower CHD events or CVD mortality although it will reduce total mortality. Replacing saturated fat with PUFA, MUFA or high-quality carbohydrate will lower CHD events.
  • References (49)
  • Citations (9)
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 Jun 10, 2015in Cochrane Database of Systematic Reviews 6.75
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),...
127 Citations Source Cite
Published on Oct 1, 2015in Journal of the American College of Cardiology 16.83
Yanping Li42
Estimated H-index: 42
(Harvard University),
Adela Hruby18
Estimated H-index: 18
(Harvard University)
+ 8 AuthorsBarry M. Popkin317
Estimated H-index: 317
(Harvard University)
Abstract Background The associations between dietary saturated fats and the risk of coronary heart disease (CHD) remain controversial, but few studies have compared saturated with unsaturated fats and sources of carbohydrates in relation to CHD risk. Objectives This study sought to investigate associations of saturated fats compared with unsaturated fats and different sources of carbohydrates in relation to CHD risk. Methods We followed 84,628 women (Nurses’ Health Study, 1980 to 2010), and 42,9...
132 Citations Source Cite
Published on Nov 16, 2015in Cochrane Database of Systematic Reviews 6.75
Lena Al-Khudairy8
Estimated H-index: 8
(University of Warwick),
Louise Hartley31
Estimated H-index: 31
(University of Warwick)
+ 3 AuthorsKaren Rees30
Estimated H-index: 30
(University of Warwick)
Background Omega 6 plays a vital role in many physiological functions but there is controversy concerning its effect on cardiovascular disease (CVD) risk. There is conflicting evidence whether increasing or decreasing omega 6 intake results in beneficial effects. Objectives The two primary objectives of this Cochrane review were to determine the effectiveness of: 1. Increasing omega 6 (Linoleic acid (LA), Gamma-linolenic acid (GLA), Dihomo-gamma-linolenic acid (DGLA), Arachidonic acid (AA), or a...
22 Citations Source Cite
Published on Nov 1, 1968in The Lancet 53.25
Seymour Dayton5
Estimated H-index: 5
(United States Department of Veterans Affairs),
MortonLee Pearce3
Estimated H-index: 3
(United States Department of Veterans Affairs)
+ 6 AuthorsWilfrid J. Dixon4
Estimated H-index: 4
(United States Department of Veterans Affairs)
Abstract In a clinical trial of a diet low in saturated fat and cholesterol, and high in unsaturated fat of vegetable origin, carried out on 846 middle-aged and elderly men living in an institution, the subjects were allocated randomly to the experimental diet or to a control diet, and were followed double-blind. The combined incidence of myocardial infarction, sudden death, and cerebral infarction was significantly lower in the experimental group than in the control group. The incidence of fata...
125 Citations Source Cite
Published on Sep 1, 1989in The Lancet 53.25
Michael Leslie Burr24
Estimated H-index: 24
(Cardiff University),
James Gilbert2
Estimated H-index: 2
(Cardiff University)
+ 5 AuthorsN.M. Deadman1
Estimated H-index: 1
(Cardiff University)
A randomised controlled trial with a factorial design was done to examine the effects of dietary intervention in the secondary prevention of myocardial infarction (MI). 2033 men who had recovered from MI were allocated to receive or not to receive advice on each of three dietary factors: a reduction in fat intake and an increase in the ratio of polyunsaturated to saturated fat, an increase in fatty fish intake, and an increase in cereal fibre intake. The advice on fat was not associated with any...
2,248 Citations Source Cite
Published on Jul 1, 2004in British Journal of Clinical Pharmacology 3.84
Sean Hennessy43
Estimated H-index: 43
(University of Pennsylvania),
Warren B. Bilker82
Estimated H-index: 82
(University of Pennsylvania)
+ 6 AuthorsBrian L. Strom90
Estimated H-index: 90
(University of Pennsylvania)
Aim To compare the rate of ventricular arrhythmia, sudden death and unexplained or unattended death among users of thioridazine and haloperidol. Methods Observational cohort study of thioridazine and haloperidol users in the UK General Practice Research Database (GPRD) using data from 1987 through 29 June 2000. Patients were followed for 30 days following each study prescription. The event of interest was a diagnosis of ventricular arrhythmia, sudden death, or unexplained or unattended death. Co...
10 Citations Source Cite
Published on Oct 28, 2013in JAMA Internal Medicine 19.99
Shanshan Li14
Estimated H-index: 14
(Harvard University),
Stephanie E. Chiuve43
Estimated H-index: 43
(Harvard University)
+ 6 AuthorsEric B. Rimm165
Estimated H-index: 165
(Harvard University)
DESIGN, SETTING, AND PARTICIPANTS We included 2258 women from the Nurses’ Health Study and 1840 men from the Health Professionals Follow-up Study. Participants had survived an initial MI during the study follow-up period and completed the pre- and post-MI food frequency questionnaire. Diet quality was measured using Alternative Healthy Eating Index 2010 (AHEI2010), which consists of food and nutrients associated with the risk of chronic disease reported in the literature. We adjusted for medicat...
32 Citations Source Cite
Published on Jan 1, 2004in Journal of Internal Medicine 6.75
E. M. Hjerkinn1
Estimated H-index: 1
L. Sandvik1
Estimated H-index: 1
+ 1 AuthorsH. Arnesen1
Estimated H-index: 1
. Objectives. The aim was to study the effect of a 5-year diet intervention on 24-year mortality in middle aged men with combined hyperlipidaemia. Setting. We studied 104 initially healthy men (in 1972) aged 40–49 years with baseline values of total serum cholesterol >6.45 mmol L−1 and fasting triglycerides >2.55 mmol L−1, within the randomized diet and smoking cessation trial of the Oslo study (n = 1232). Methods. The participants were randomized to a 5-year diet intervention or a control group...
12 Citations Source Cite
Published on Jul 1, 2011in European Journal of Clinical Nutrition 2.95
N T Bendsen1
Estimated H-index: 1
Robin Christensen43
Estimated H-index: 43
+ 1 AuthorsA.V. Astrup91
Estimated H-index: 91
Consumption of industrial and ruminant trans fatty acids and risk of coronary heart disease: a systematic review and meta-analysis of cohort studies
123 Citations Source Cite
  • References (49)
  • Citations (9)
Cited By9
Published on Dec 30, 2017in International Journal of Molecular Sciences 3.69
Andreina Alfieri6
Estimated H-index: 6
Esther Imperlini10
Estimated H-index: 10
+ 5 AuthorsAnnamaria Mancini6
Estimated H-index: 6
The position of the fatty acids (sn-1, sn-2 and sn-3) (stereospecific numbering (sn)) in triacylglycerol (TAG) molecules produces a characteristic stereospecificity that defines the physical properties of the fats and influences their absorption, metabolism and uptake into tissues. Fat interesterification is a process that implies a positional distribution of fatty acids (FAs) within the TAG molecules, generating new TAG species, without affecting the FA cis-trans natural balance. The interester...
2 Citations Source Cite
Published on Sep 1, 2018in Current Nutrition Reports
Senthilkumar Sankararaman1
Estimated H-index: 1
(Case Western Reserve University),
Thomas J. Sferra22
Estimated H-index: 22
(Case Western Reserve University)
Purpose of Review Sales and consumption of coconut oil have been on the raise due to effective marketing strategies. Coconut oil is stated to offer various benefits including weight loss, improvement in immunity, heart health support, and memory enhancement. Also, it is often portrayed as an excellent source of medium chain triglycerides (MCTs). Here, we review the evidence behind the clinical utility of coconut oil consumption.
1 Citations Source Cite
Published on Jul 6, 2018in Journal of Culinary Science & Technology
Joelle E. Romanchik-Cerpovicz4
Estimated H-index: 4
(Georgia Southern University),
Megan J.A. Jeffords1
Estimated H-index: 1
Ann C. Onyenwoke1
Estimated H-index: 1
(University of North Carolina at Chapel Hill)
1 Citations Source Cite
Published on Oct 17, 2018in Nutrients 4.20
Bruce A. Griffin38
Estimated H-index: 38
(University of Surrey),
Celia G. Walker11
Estimated H-index: 11
(Medical Research Council)
+ 8 AuthorsRachel Gitau15
Estimated H-index: 15
(University of Reading)
We examined the impact of APOE genotype on plasma lipids and glucose in a secondary analysis of data from a five-arm, randomised controlled, parallel dietary intervention trial ('RISCK' study), to investigate the impact of replacing saturated fatty acids (SFA) with either monounsaturated fat (MUFA) or carbohydrate of high or low glycaemic index (GI) on CVD risk factors and insulin sensitivity. We tested the impact of APOE genotype (carriage of E2 and E4 alleles versus E3/E3), determined retrospe...
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Published on Feb 1, 2019in Nutrition Metabolism and Cardiovascular Diseases 3.32
Daniel Medenwald5
Estimated H-index: 5
(Martin Luther University of Halle-Wittenberg),
Alexander Kluttig19
Estimated H-index: 19
(Martin Luther University of Halle-Wittenberg)
+ 1 AuthorsJ. Schumann
Abstract Background and Aims Diet is known to play a decisive role in the development of coronary heart disease (CHD). One factor believed to decrease lifetime risk of CHD is the consumption of omega-3 fatty acids. Yet, conclusive evidence regarding the potential cardioprotective effects of fatty acids is far from being reached. The present study aimed to provide further evidence on the association of serum fatty acid profiles with CHD risk. Methods and Results The CARdio-vascular Disease, Livin...
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Dominika Głąbska6
Estimated H-index: 6
Dominika Guzek7
Estimated H-index: 7
+ 2 AuthorsAgnieszka Sulich3
Estimated H-index: 3
Despite a general relation between fat intake and cardiovascular risk factors, the association is often not observed in studies conducted in heterogenic populations, as for population groups, it may differ. The aim of the study was to analyze the associations between dietary fat intake and lipoprotein cholesterol fractions, as well as atherogenic blood properties, in young and middle-aged overweight Caucasian women. In a group of 138 overweight women, the three-day dietary records were assessed,...
3 Citations Source Cite
Published on Jan 1, 2019in Diabetologe 0.17
Stefan Lorkowski21
Estimated H-index: 21
(University of Jena),
Christine Dawczynski10
Estimated H-index: 10
(University of Jena)
Die Verbesserung der Nahrungsfettqualitat ist bei Diabetes-Patienten mit einer Hypercholesterolamie ein wesentlicher Baustein der Ernahrungsumstellung zum Erhalt der kardiovaskularen Gesundheit und zur Reduktion des kardiovaskularen Risikos. Ebenso wie bei einer isolierten Hypercholesterolamie sollten bei der diabetischen Dyslipoproteinamie die Zufuhr industriell erzeugter Transfettsauren minimiert sowie der Verzehr gesattigter Fettsauren zugunsten einer erhohten Aufnahme von einfach und mehrfac...
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Published on Feb 27, 2019in Scientific Reports 4.12
Ashley E. Walker1
Estimated H-index: 1
(University of Oregon),
Sarah R. Breevoort1
Estimated H-index: 1
(University of Utah)
+ 8 AuthorsAnthony J. Donato37
Estimated H-index: 37
(University of Utah)
Atherogenic remodeling often occurs at arterial locations with disturbed blood flow (i.e., low or oscillatory) and both aging and western diet (WD) increase the likelihood for pro-atherogenic remodeling. However, it is unknown if old age and/or a WD modify the pro-atherogenic response to disturbed blood flow. We induced disturbed blood flow by partial carotid ligation (PCL) of the left carotid artery in young and old, normal chow (NC) or WD fed male B6D2F1 mice. Three weeks post-PCL, ligated car...
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Published on Mar 1, 2019in Journal of Physiology and Biochemistry 2.74
Luc Demaison17
Estimated H-index: 17
(Institut national de la recherche agronomique),
Thibault Leger1
Estimated H-index: 1
(Institut national de la recherche agronomique)
+ 2 AuthorsKasra Azarnoush5
Estimated H-index: 5
Several meta-analyses describing the effect of n-3 polyunsaturated fatty acids on the survival rate of the victims of an acute coronary event do not clearly support a beneficial impact of these fatty acids. Yet, animal studies consistently show n-3 PUFA–induced protection against ischemia-reperfusion-induced myocardial injuries. The impact on reperfusion arrhythmias of these PUFAs is more controversial. The literature shows the anti-arrhythmic properties of circulating n-3 PUFAs. However, when t...
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