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

  • P.M. Clifton
    Correspondence
    Corresponding author.
    Affiliations
    School of Pharmacy and Medical Sciences, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Sansom Institute for Health Science, University of South Australia, GPO Box 2471 Adelaide, SA, 5000, Australia
    Search for articles by this author
  • J.B. Keogh
    Affiliations
    School of Pharmacy and Medical Sciences, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Sansom Institute for Health Science, University of South Australia, GPO Box 2471 Adelaide, SA, 5000, Australia
    Search for articles by this author
Published:October 17, 2017DOI:https://doi.org/10.1016/j.numecd.2017.10.010

      Highlights

      • Replacement of saturated fat with unsaturated fat lowers CHD events and replacement with linoleic acid lowers CHD deaths as well.
      • Replacement of saturated fat with linoleic acid lowers CHD deaths as well.
      • Trial evidence is limited but the most recent Cochrane meta-analysis suggests replacement of saturated fat with unsaturated fat reduces events.
      • Replacement of saturated fat with high quality carbohydrate lowers CHD events.

      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.

      Keywords

      Abbreviations:

      MUFA (monounsaturated fat), PUFA (polyunsaturated fat), AA (arachidonic acid), LA (linoleic acid), EPA (eicosipentaenoic acid), DPA (docosapentaenoic acid), DHA (docosahexaenoic acid), RR (relative risk), HR (hazard ratio), CI (confidence interval)
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