Match!

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

Published on Dec 1, 2017in Nutrition Metabolism and Cardiovascular Diseases3.34
· DOI :10.1016/j.numecd.2017.10.010
Peter M. Clifton72
Estimated H-index: 72
(UniSA: University of South Australia),
Jennifer B. Keogh40
Estimated H-index: 40
(UniSA: 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 (20)
📖 Papers frequently viewed together
201527.60BMJ
384 Citations
367 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
References49
Newest
#1Mahshid Dehghan (Population Health Research Institute)H-Index: 24
#2Andrew Mente (McMaster University)H-Index: 32
Last. R MapangaH-Index: 4
view all 355 authors...
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...
224 CitationsSource
#1Frank M. SacksH-Index: 110
Last. Linda Van HornH-Index: 78
view all 12 authors...
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 re...
219 CitationsSource
#1Steven Hamley (Deakin University)H-Index: 6
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...
28 CitationsSource
#1Geng Zong (Harvard University)H-Index: 20
#2Yanping Li (Harvard University)H-Index: 48
Last. Qi Sun (Harvard University)H-Index: 62
view all 8 authors...
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...
63 CitationsSource
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 CitationsSource
#1Dong D. Wang (Harvard University)H-Index: 21
#2Yanping Li (Harvard University)H-Index: 48
Last. Frank B. Hu (Harvard University)H-Index: 205
view all 8 authors...
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...
133 CitationsSource
#1Zoë Harcombe (University of the West of Scotland)H-Index: 7
#2Julien S. Baker (University of the West of Scotland)H-Index: 31
Last. Bruce Davies (UNSW: University of New South Wales)H-Index: 32
view all 5 authors...
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 ...
21 CitationsSource
#1Christopher E. Ramsden (UNC: University of North Carolina at Chapel Hill)H-Index: 13
#2Daisy Zamora (UNC: University of North Carolina at Chapel Hill)H-Index: 12
Last. Joseph R. Hibbeln (NIH: National Institutes of Health)H-Index: 51
view all 10 authors...
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 ...
130 CitationsSource
#1Jaike Praagman (UU: Utrecht University)H-Index: 4
#2Joline W.J. Beulens (UU: Utrecht University)H-Index: 50
Last. Y. T. van der Schouw (UU: Utrecht University)H-Index: 88
view all 7 authors...
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...
65 CitationsSource
#1Sabina A. Murphy (Brigham and Women's Hospital)H-Index: 4
#2Christopher P. Cannon (Brigham and Women's Hospital)H-Index: 134
Last. Eugene Braunwald (Brigham and Women's Hospital)H-Index: 212
view all 15 authors...
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...
86 CitationsSource
Cited By20
Newest
#1Penny M. Kris-Etherton (PSU: Pennsylvania State University)H-Index: 89
#2Ronald M. Krauss (University of California, Berkeley)H-Index: 116
Based on decades of research, there is strong evidence that supports ongoing dietary recommendations to decrease intakes of SFAs and, more recently, to replace SFAs with unsaturated fat, including PUFAs and MUFAs. Epidemiologic research has shown that replacement of SFAs with unsaturated fat, but not refined carbohydrate and added sugars, is associated with a reduction in coronary heart disease events and death. There is much evidence from controlled clinical studies demonstrating that SFAs incr...
Source
#1Ujué FresánH-Index: 2
#1Ujué Fresán (LLU: Loma Linda University)H-Index: 3
Last. Maira Bes-Rastrollo (University of Navarra)H-Index: 41
view all 5 authors...
Abstract Several healthy diet indices have been associated with mortality risk. However, the ideal diet should not only be healthy but also environmentally friendly and affordable. The study aimed to determine if a new Sustainable Diet Index (SDI), which takes into account the nutritional quality, environmental impacts and market price of diets, was associated with all-cause and cause-specific mortality. Using data from the “Seguimiento Universidad de Navarra” Project, a prospective cohort study...
Source
#1Janet A. Tooze (Wake Forest University)H-Index: 35
#3Jamie L. Crandell (UNC: University of North Carolina at Chapel Hill)H-Index: 16
Last. Angela D. Liese (USC: University of South Carolina)H-Index: 45
view all 6 authors...
Traditionally, nutritional epidemiologists have utilized single nutrient or dietary pattern approaches to examine diet-health relationships. However, the former ignores that nutrients are consumed from foods within dietary patterns, and, conversely, dietary patterns may provide little information on mechanisms of action. Substitution provides a framework for estimating diet-health relationships while holding some nutrient intakes constant. We examined substitution effects of polyunsaturated fatt...
Source
Source
#1Leandro Santos e Silva (UFRPE: Universidade Federal Rural de Pernambuco)
Last. Omer Cavalcanti de Almeida (UFRPE: Universidade Federal Rural de Pernambuco)H-Index: 2
view all 8 authors...
Abstract The objective of this study was to evaluate the productive performance, macro compounds and fatty acid (FA) profile of goats’ milk receiving diets supplemented with three amounts of soybean oil. Additionally, we tested to which extent lactating goats can positively respond to the influence of the soybean oil supplementation. Our hypothesis is that the FA profile in the milk will change with the increasing doses of soybean oil, i.e., the healthy FAs concentrations will increase and the c...
1 CitationsSource
#1Paula Kiyomi Okuro (State University of Campinas)H-Index: 4
#2Artur J. MartinsH-Index: 6
Last. Rosiane Lopes da Cunha (State University of Campinas)H-Index: 30
view all 4 authors...
The concepts of either multi-component supramolecular gels or structures derived from oleogels have not yet been fully investigated to their respective potentials. The study of hybrid structures might cover technological points such as (i) how to vehiculate hydro- and/or liposoluble bioactive components simultaneously? (ii) how could the framework of an oleogel contribute to a specific structure design strategy? (iii) how does oleogels’ structure influence bioactivity during digestion? A deeper ...
Source
#1François MachH-Index: 58
#2Colin BaigentH-Index: 66
Last. Riyaz S. PatelH-Index: 31
view all 121 authors...
305 CitationsSource
#1Deep DuttaH-Index: 12
#2Soumitra GhoshH-Index: 1
Last. Meha SharmaH-Index: 1
view all 5 authors...
Source
#1S Flowers (UF: University of Florida)
#2Brandon R. McFadden (UD: University of Delaware)H-Index: 8
Last. Raluca G. Mateescu (UF: University of Florida)H-Index: 16
view all 4 authors...
Although beef is a nutrient-rich foodstuff excelling in protein, vitamins, and minerals, there is controversy regarding the fat content of beef and its healthfulness in the diet. Although much of the fatty acid (FA) content in beef is considered "healthy fats," many consumers are confused about the different classifications of FA. The objectives of this study were to determine consumers' knowledge about the nutritional value of beef and its importance in purchasing decisions, and to gain a bette...
Source
#2Shelly-Ann Bowen (ICF International)H-Index: 1
view all 2 authors...
Plant-based diets are associated with reduced risks of various chronic diseases in the general population. However, it is unclear how these benefits translate to Blacks living in the United States, who are disproportionately burdened with heart disease, cancer, diabetes, obesity, and chronic kidney disease. The objectives of this study were to: (1) review the general evidence of plant-based diets and health outcomes; (2) discuss how this evidence translates to Blacks following a plant-based diet...
Source