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Convincing evidence supports reducing saturated fat to decrease cardiovascular disease risk

Published on Dec 1, 2018
· DOI :10.1136/bmjnph-2018-000009
Penny M. Kris-Etherton89
Estimated H-index: 89
(PSU: Pennsylvania State University),
Kristina S. Petersen10
Estimated H-index: 10
(PSU: Pennsylvania State University),
Linda Van Horn78
Estimated H-index: 78
(NU: Northwestern University)
Sources
Abstract
Treatment guidelines and population-based recommendations evolve from research vetted by the scientific community. Healthcare providers require practice guidelines resulting from rigorous review of the totality of evidence. Open discussion/debate among experts is fundamental and encouraged, but blatant disregard for scientific process can lead to confusion and public distrust. A recent example is the controversy among scientists, healthcare professionals and the public about dietary saturated fat (SFA) recommendations to lower risk of cardiovascular disease (CVD). ### Dietary recommendations for SFA from authoritative organisations More than 60 years ago (in 1957), the American Heart Association (AHA) proposed that modifying dietary fat could reduce the incidence of coronary heart disease (CHD). This was based on research, including controlled feeding studies, and endpoint measures of blood lipids and blood pressure.1 In 1980, the first Dietary Guidelines for Americans recommended ‘avoiding too much SFA’.2 For decades, research has substantiated this consistent dietary recommendation from authoritative organisations to decrease SFA to reduce CVD risk.3–6 Current dietary guidelines for SFA and evidence ratings are summarised in table 1. While the strong evidence to reduce SFA specifically targets decreasing low-density lipoprotein (LDL)-cholesterol, it is very much germane to CVD risk reduction. View this table: Table 1 Authoritative recommendations for saturated fat and evidence ratings ### Challenging practice guidelines and population-based recommendations: the SFA SAGA In 2010, a meta-analysis of 21 prospective epidemiological studies totalling 347 747 subjects reported that higher intake of SFA was not associated with an increased risk of CHD, stroke or CVD.7 Aspects of this methodology were widely …
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References25
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#2Ronald M. Krauss (Children's Hospital Oakland Research Institute)H-Index: 116
Last. Barry M. Popkin (Harvard University)H-Index: 323
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Although difficulties in nutrition research and formulating guidelines fuel ongoing debate, the complexities of dietary fats and overall diet are becoming better understood, argue Nita G Forouhi and colleagues
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#1Brian A. Ference (WSU: Wayne State University)H-Index: 19
#2Henry N. Ginsberg (Columbia University)H-Index: 82
Last. Alberico L. Catapano (University of Milan)H-Index: 64
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Aims: To appraise the clinical and genetic evidence that low-density lipoproteins (LDLs) cause atherosclerotic cardiovascular disease (ASCVD). Methods and results: We assessed whether the association between LDL and ASCVD fulfils the criteria for causality by evaluating the totality of evidence from genetic studies, prospective epidemiologic cohort studies, Mendelian randomization studies, and randomized trials of LDL-lowering therapies. In clinical studies, plasma LDL burden is usually estimate...
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#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...
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#1Geng Zong (Harvard University)H-Index: 20
#2Yanping Li (Harvard University)H-Index: 48
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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...
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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 ...
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Dietary guidelines provide evidence-based statements on food choices to meet nutritional requirements and reduce the risk of prevailing chronic disease. They involve a substantial amount of research translation, and their implementation has important health consequences. Foods, however, are complex combinations of nutrients and other compounds that act synergistically within the food and across food combinations. In addition, the evidence base underpinning dietary guidelines accesses research th...
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