- •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.
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.
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.
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.
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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Published online: October 17, 2017
Accepted: October 9, 2017
Received in revised form: September 26, 2017
Received: June 28, 2017Handling Editor: Dr. A. Siani
☆This work is based on an Evidence Check review brokered by the Sax Institute and funded by the National Heart Foundation of Australia. The opinions are those of the authors alone and not that of the funding bodies.
© 2017 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.