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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
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 (10)
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References49
Newest
Published on Dec 1, 2017in Nutrition Journal 3.57
Steven Hamley5
Estimated H-index: 5
(Deakin University)
A cornerstone of conventional dietary advice is the recommendation to replace saturated fatty acids (SFA) with mostly n-6 polyunsaturated fatty acids (PUFA) to reduce the risk of coronary heart disease (CHD). Many clinical trials aimed to test this advice and have had their results pooled in several meta-analyses. However, earlier meta-analyses did not sufficiently account for major confounding variables that were present in some of those trials. Therefore, the aim of the study was to account fo...
21 Citations Source Cite
Published on Nov 1, 2017in The Lancet 53.25
Mahshid Dehghan22
Estimated H-index: 22
(Population Health Research Institute),
Andrew Mente30
Estimated H-index: 30
(McMaster University)
+ 352 AuthorsAnders H. Rosengren84
Estimated H-index: 84
(University of Gothenburg)
Summary Background The relationship between macronutrients and cardiovascular disease and mortality is controversial. Most available data are from European and North American populations where nutrition excess is more likely, so their applicability to other populations is unclear. Methods The Prospective Urban Rural Epidemiology (PURE) study is a large, epidemiological cohort study of individuals aged 35–70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median fo...
168 Citations Source Cite
Published on Jul 18, 2017in Circulation 18.88
FrankM. Sacks3
Estimated H-index: 3
,
Alice H. Lichtenstein79
Estimated H-index: 79
+ 9 AuthorsJennifer G. Robinson57
Estimated H-index: 57
Cardiovascular disease (CVD) is the leading global cause of death, accounting for 17.3 million deaths per year. Preventive treatment that reduces CVD by even a small percentage can substantially reduce, nationally and globally, the number of people who develop CVD and the costs of caring for them. This American Heart Association presidential advisory on dietary fats and CVD reviews and discusses the scientific evidence, including the most recent studies, on the effects of dietary saturated fat i...
158 Citations Source Cite
Published on Nov 23, 2016in BMJ 23.56
Geng Zong16
Estimated H-index: 16
(Harvard University),
Yanping Li43
Estimated H-index: 43
(Harvard University)
+ 5 AuthorsQi Sun62
Estimated H-index: 62
(Harvard University)
Objectives To investigate the association between long term intake of individual saturated fatty acids (SFAs) and the risk of coronary heart disease, in two large cohort studies. Design Prospective, longitudinal cohort study. Setting Health professionals in the United States. Participants 73 147 women in the Nurses’ Health Study (1984-2012) and 42 635 men in the Health Professionals Follow-up Study (1986-2010), who were free of major chronic diseases at baseline. Main outcome measure Incidence o...
49 Citations Source Cite
Jaike Praagman3
Estimated H-index: 3
,
Ester Al de Jonge7
Estimated H-index: 7
+ 6 AuthorsOscar H. Franco74
Estimated H-index: 74
Objective— We assessed whether the association between dietary saturated fatty acids (SFA) and incident coronary heart disease (CHD) depends on the food source, the carbon chain length of SFA, and the substituting macronutrient. Approach and Results— From the Rotterdam Study, 4722 men and women (≥55 years) were included. Baseline (1990–1993) SFA intake was assessed using a validated food frequency questionnaire. CHD (nonfatal myocardial infarction and fatal CHD) was ascertained by medical record...
16 Citations Source Cite
Published on Aug 1, 2016in JAMA Internal Medicine 19.99
Dong D. Wang19
Estimated H-index: 19
(Harvard University),
Yanping Li43
Estimated H-index: 43
(Harvard University)
+ 5 AuthorsFrank B. Hu202
Estimated H-index: 202
(Harvard University)
Importance Previous studies have shown distinct associations between specific dietary fat and cardiovascular disease. However, evidence on specific dietary fat and mortality remains limited and inconsistent. Objective To examine the associations of specific dietary fats with total and cause-specific mortality in 2 large ongoing cohort studies. Design, Setting, and Participants This cohort study investigated 83 349 women from the Nurses’ Health Study (July 1, 1980, to June 30, 2012) and 42 884 me...
117 Citations Source Cite
Published on Aug 1, 2016
Zoë Harcombe7
Estimated H-index: 7
(University of the West of Scotland),
Julien S. Baker21
Estimated H-index: 21
(University of the West of Scotland)
+ 2 AuthorsBruce Davies30
Estimated H-index: 30
(University of New South Wales)
Objectives National dietary guidelines were introduced in 1977 and 1983, by the USA and UK governments, respectively, with the ambition of reducing coronary heart disease (CHD) mortality by reducing dietary fat intake. A recent systematic review and meta-analysis by the present authors, examining the randomised controlled trial (RCT) evidence available to the dietary committees during those time periods, found no support for the recommendations to restrict dietary fat. The present investigation ...
17 Citations Source Cite
Published on Apr 12, 2016in BMJ 23.56
Christopher E. Ramsden16
Estimated H-index: 16
(University of North Carolina at Chapel Hill),
Daisy Zamora11
Estimated H-index: 11
(University of North Carolina at Chapel Hill)
+ 7 AuthorsJoseph R. Hibbeln46
Estimated H-index: 46
(National Institutes of Health)
Objective To examine the traditional diet-heart hypothesis through recovery and analysis of previously unpublished data from the Minnesota Coronary Experiment (MCE) and to put findings in the context of existing diet-heart randomized controlled trials through a systematic review and meta-analysis. Design The MCE (1968-73) is a double blind randomized controlled trial designed to test whether replacement of saturated fat with vegetable oil rich in linoleic acid reduces coronary heart disease and ...
114 Citations Source Cite
Published on Feb 1, 2016in Journal of the American College of Cardiology 16.83
Sabina A. Murphy4
Estimated H-index: 4
(Brigham and Women's Hospital),
Christopher P. Cannon131
Estimated H-index: 131
(Brigham and Women's Hospital)
+ 12 AuthorsDaniel Isaza6
Estimated H-index: 6
Abstract Background Intensive low-density lipoprotein cholesterol therapy with ezetimibe/simvastatin in IMPROVE-IT (IMProved Reduction of Outcomes: Vytorin Efficacy International Trial) significantly reduced the first primary endpoint (PEP) in patients post-acute coronary syndrome (ACS) compared to placebo/simvastatin. Objectives This analysis tested the hypothesis that total events, including those beyond the first event, would also be reduced with ezetimibe/simvastatin therapy. Methods All PEP...
79 Citations Source Cite
Published on Feb 1, 2016in The American Journal of Clinical Nutrition 6.55
Jaike Praagman3
Estimated H-index: 3
(Utrecht University),
Joline W.J. Beulens48
Estimated H-index: 48
(Utrecht University)
+ 4 AuthorsY. T. van der Schouw88
Estimated H-index: 88
(Utrecht University)
Background: The association between saturated fatty acid (SFA) intake and ischemic heart disease (IHD) risk is debated. Objective: We sought to investigate whether dietary SFAs were associated with IHD risk and whether associations depended on 1) the substituting macronutrient, 2) the carbon chain length of SFAs, and 3) the SFA food source. Design: Baseline (1993-1997) SFA intake was measured with a foodfrequency questionnaire among 35,597 participants from the European Prospective Investigation...
63 Citations Source Cite
Cited By10
Newest
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. Donato38
Estimated H-index: 38
(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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Jaclyn Coffey (University of Sydney), David Raubenheimer64
Estimated H-index: 64
(University of Sydney)
+ 3 AuthorsFiona O'Leary5
Estimated H-index: 5
(University of Sydney)
Abstract Objective To examine the nutrient content and macronutrient percentages of meals representing two ends of the popular food spectrum, namely ‘fine dining’ recipes from MasterChef Australia (a television program), and Australian fast food meals, to determine commonalities and how they compare to nutrient recommendations. Design Analysis of the nutritional composition of main meals and recipes from six seasons of MasterChef Australia and seven most popular Australian fast food outlets. Res...
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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 Azarnoush7
Estimated H-index: 7
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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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 Kluttig20
Estimated H-index: 20
(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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Published on Jan 1, 2019in Diabetologe 0.17
Stefan Lorkowski34
Estimated H-index: 34
(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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Jadwiga Hamu5
Estimated H-index: 5
,
Dominika Głąbska7
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 Oct 17, 2018in Nutrients 4.20
Bruce A. Griffin39
Estimated H-index: 39
(University of Surrey),
Celia G. Walker11
Estimated H-index: 11
(Medical Research Council)
+ 8 AuthorsRachel Gitau16
Estimated H-index: 16
(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 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.
5 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 Dec 30, 2017in International Journal of Molecular Sciences 3.69
Andreina Alfieri6
Estimated H-index: 6
,
Esther Imperlini11
Estimated H-index: 11
+ 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