Saturated fat and cardiovascular disease: Difference between revisions

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+#REDIRECT [[Saturated fat#Cardiovascular disease]]
-Whether [[saturated fat]] is a risk factor for [[cardiovascular disease]] (CVD) is a question with numerous controversial views.<ref name=Siri-Tarino2010>{{cite journal |author=Siri-Tarino PW, Sun Q, Hu FB, Krauss RM |title=Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease |journal=The American Journal of Clinical Nutrition |volume=91 |issue=3 |pages=535–46 |year=2010 |month=March |pmid=20071648 |doi=10.3945/ajcn.2009.27725 |pmc=2824152}}</ref>  Although there is a scientific consensus in the heart-health and medical communities that saturated fat is a risk factor for CVD, individual studies produce conflicting results and notable authors have given opposing viewpoints.  The following sections are presented in descending order of [[WP:MEDRS|reliability]] for medical sources.
-==Secondary sources==
-===Systematic reviews in reputable medical journals===
-A 2010 systematic review and meta-analysis of randomized controlled trials commissioned by the National Heart, Lung, and Blood Institute found that substitution of poly-unsaturated fat for saturated fat led to a 19% reduction in [[Coronary Heart Disease]].<ref>{{cite journal | author = Mozaffarian D, Micha R, Wallace S| title = Effects on Coronary Heart Disease of Increasing Polyunsaturated Fat in Place of Saturated Fat: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. | journal = PLoS Medicine | month = March | year = 2010 | volume = 7 | issue = 3 | pages = 1-10 | issn = 15491277 | doi = 10.1371/journal.pmed.1000252}}</ref>    The American Dietetic Association's 2008 systematic review found that a diet with 25%-35% total fat but less than 7% saturated fat and [[trans fat]] lowers the risk of coronary heart disease.<ref>{{cite journal | journal =Journal of the American Dietetic Association | title = The evidence for dietary prevention and treatment of cardiovascular disease | author = Van Horn L et al | volume=108 | issue=2 | pages=287-331 | month=February | year = 2008 | doi=10.1016/j.jada.2007.10.050 | issn = 0002-8223}}</ref>  A 1999 review found that substitution of the fat from one ounce of nuts for equivalent energy from saturated fat was associated with a 45% reduction in risk of coronary heart disease.<ref>{{cite journal |author=Hu FB, Stampfer MJ |title= Nut consumption and risk of coronary heart disease: a review of epidemiologic evidence. |journal=Current Atherosclerosis Reports |volume=1 |issue=3 |pages=204–209 |year=1999 |month=November |pmid=11122711 |doi=10.1007/s11883-999-0033-7}}</ref>
-In 2009, a [[systematic review]] of prospective cohort studies or randomized trials concluded that there was "insufficient evidence of association" between intake of saturated fatty acids and coronary heart disease, and pointed to strong evidence for protective factors such as vegetables and a [[Mediterranean diet]] and harmful factors such as [[trans fat]]s and foods with a high [[glycemic index]].<ref name=Mente2009>{{cite journal |author=Mente A, de Koning L, Shannon HS, Anand SS |title=A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease |journal=Arch. Intern. Med. |volume=169 |issue=7 |pages=659–69 |year=2009 |month=April |pmid=19364995 |doi=10.1001/archinternmed.2009.38 |url=}} [http://archinte.ama-assn.org/cgi/content/full/169/7/659 Free full-text]</ref> However, this [[systematic review]] included studies that adjusted for serum lipids or other dietary lipids which were also included in the previously described meta-analysis.<ref name=Siri-Tarino2010 /><ref name=Mente2009 />
-Some meta-analyses have found a significant relationship between saturated fat and serum cholesterol levels,<ref>{{Cite journal|pmid=9006469 |year=1997 |last1=Clarke |first1=R |last2=Frost |last3=Collins |last4=Appleby |last5=Peto |title=Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies |volume=314 |issue=7074 |pages=112–7 |journal=BMJ (Clinical research ed.) |first2=C |first3=R |first4=P |first5=R |pmc=2125600}}</ref><ref>{{cite journal | title = Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials | journal =American Journal of Clinical Nutrition | author = Mensink RP, Zock PL, Kester ADM, Katan MB | volume=77 | issue=5  | pages = 1146-1155 | month = May | year = 2003 | issn = 0002-9165}}</ref>  and serum cholesterol levels and cardiovascular disease,<ref>{{cite journal | author = Lewington S, Whitlock G, Clarke R, Sherliker P, Emberson J, Halsey J, Qizilbash N, Peto R, Collins R | title = Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths | journal = Lancet | volume = 370 | issue = 9602 | pages = 1829–39 | year = 2007 | month = December | pmid = 18061058 | doi = 10.1016/S0140-6736(07)61778-4 | url = | issn = }}</ref> yet 11 of the 15 studies that measured the relationship between saturated fat and coronary heart disease in this meta-analysis were adjusted for serum lipids or other dietary lipids. The remaining 4 studies found a significant relationship between saturated fat and coronary heart disease.<ref name=Stamler2010>{{cite journal |author=Stamler J |title=Diet-heart: a problematic revisit.  |journal=The American Journal of Clinical Nutrition |volume=91 |issue=3 |pages=497–99 |year=2010 |month=February |pmid=20130097 |doi=10.3945/ajcn.2010.29216 |url=http://www.canibaisereis.com/download/stamler-diet-heart-problematic-revisit.pdf}}</ref> Furthermore, a positive relationship between saturated fat and fatal coronary heart disease was found despite an over-adjustment for serum lipids.<ref name=Stamler2010 />
-In 2010, a [[meta-analysis]] of prospective [[cohort study|cohort studies]] supported by the National Dairy Council including 348,000 subjects found no [[statistically significant]] relationship between [[cardiovascular disease]] and dietary saturated fat.<ref name=Siri-Tarino2010>{{cite journal |author=Siri-Tarino PW, Sun Q, Hu FB, Krauss RM |title=Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease |journal=The American Journal of Clinical Nutrition |volume=91 |issue=3 |pages=535–46 |year=2010 |month=March |pmid=20071648 |doi=10.3945/ajcn.2009.27725 |pmc=2824152}}</ref><ref>{{cite journal |author=Siri-Tarino PW, Sun Q, Hu FB, Krauss RM |title=Saturated fat, carbohydrate, and cardiovascular disease |journal=The American Journal of Clinical Nutrition |volume=91 |issue=3 |pages=502–9 |year=2010 |month=March |pmid=20089734 |doi=10.3945/ajcn.2008.26285 |pmc=2824150}}</ref>
-A 2006 meta-analysis of prevention dietetic studies found the benefit of a modified fat diet in primary prevention is potentially significant if it is maintained for a sufficient length of time.<ref>{{cite journal | title = Primary dietetic prevention of ischaemic heart disease | author = Chanu B | journal = Archives des Maladies du Coeur et des Vaisseux | volume = 96 | issue = Sp. Iss. 6 | pages = 21-25 | month = September | year = 2003 | issn = 0003-9683}}</ref>
-A 2008 pooled analysis of 11 cohort studies supported by the National Heart, Lung, and Blood Institute, National Institutes of Health, the Danish Heart Foundation and the Danish Medical Research Council found that substituting polyunsaturated fatty acids in place of saturated fatty acids at a rate of 5%  of energy intake led to 13% decrease in coronary events and a 26% decrease in coronary deaths.<ref>{{cite journal |last1=Jakobsen |first1=MU |last2=O'Reilly |first2=EJ |last3=Heitmann |first3=BL |last4=Pereira |first4=MA |last5=Bälter |first5=K |last6=Fraser |first6=GE |last7=Goldbourt |first7=U |last8=Hallmans |first8=G |last9=Knekt |first9=P |title=Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies |journal=The American journal of clinical nutrition |volume=89 |issue=5 |pages=1425–32 |year=2009 |pmid=19211817 |pmc=2676998 |doi=10.3945/ajcn.2008.27124}}</ref>
-===Specialist/professional textbooks===
-===Position statements and guidelines of major health organizations===
-====Medical establishments====
-The [[World Health Organization]] (WHO) has concluded that saturated fats negatively affect cholesterol profiles, predisposing individuals to heart disease, and recommends avoiding saturated fats in order to reduce the risk of a cardiovascular disease.<ref>World Health Organization [http://www.who.int/cardiovascular_diseases/en/cvd_atlas_06_lipids.pdf Risk factor: lipids]</ref><ref>World Health Organization [http://www.who.int/cardiovascular_diseases/en/cvd_atlas_20_personal_choices.pdf Prevention: personal choices and actions]</ref><ref>{{cite web | url = http://www.who.int/hpr/NPH/docs/who_fao_expert_report.pdf | title = Diet, Nutrition and the Prevention of Chronic Diseases | publisher = World Health Organization | author = Report of a Joint WHO/FAO Expert Consultation | year = 2003 | accessdate = 2011-03-11}}</ref>
-[[Mayo Clinic]] highlighted oils that are high in saturated fats include [[coconut oil|coconut]], [[palm oil]] and [[palm kernel oil]]. Those of lower amounts of saturated fats, and higher levels of unsaturated (preferably monounsaturated) fats like olive oil, peanut oil, canola oil, avocados, safflower, corn, sunflower, soy and cottonseed oils are generally healthier.<ref>[http://www.mayoclinic.com/health/fat/NU00262 Dietary fats: Know which types to choose] Mayo Clinic website</ref>
-The [[British Dietetic Association]] guidelines found good evidence in systematic reviews of randomized controlled trials that reducing saturated fat reduces morbidity in patients with CVD.<ref>{{cite journal | title = Dietetic guidelines on food and nutrition in the secondary prevention of cardiovascular disease – evidence from systematic reviews of randomized controlled trials (second update, January 2006) | journal = Journal of Human Nutrition and Dietetics | volume = 19 | issue = 6 | pages = 401-419 | doi = 10.1111/j.1365-277X.2006.00726.x | author = Mead, A et al. | month = December | year = 2006}}</ref>
-====Heart-health organizations====
-Consumption of saturated fat is a risk factor for cardiovascular disease in the view of the Canadian Heart and Stroke Foundation,<ref>{{cite web | url = http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3484237/k.4695/Dietary_fats_oils_and__cholesterol.htm | title = Dietary fats, oils and cholesterol | accessdate = 2010-12-22}}</ref> the American Heart Association,<ref>{{cite web | url = http://www.americanheart.org/presenter.jhtml?identifier=4582 | title = Fat | accessdate = 2011-03-12}}</ref> the British Heart Foundation,<ref>{{cite web | url = http://www.bhf.org.uk/heart-health/prevention/healthy-eating/saturated-fat.aspx | title = Saturated Fat | accessdate = 2010-12-22}}</ref> the National Heart Foundation of Australia,<ref>{{cite web | url = http://www.heartfoundation.org.au/SiteCollectionDocuments/Dietary%20Fats.pdf | title = 'Reduce saturated fat' urges Heart Foundation after major review | accessdate = 2010-12-22}}</ref> the National Heart Foundation of New Zealand <ref>{{cite web | url = http://www.heartfoundation.org.nz/files/National%20Dietitian/Dietary%20Fats_March1999.pdf | title = Dietary Fats:  An Evidence-Based Nutrition Statement from the National Heart Foundation of New Zealand's Nutrition Advisory Committee | last = Seddon MB. ChB. MPH. | first = M | date = March 1999 | accessdate = 2010-12-22}}</ref> and the World Heart Federation.<ref>{{cite web | url = http://www.worldheart.org/cardiovascular-health/cardiovascular-disease-risk-factors/ | title = Cardiovascular Disease Risk Factors | accessdate = 2010-12-23}}</ref>  The Irish Heart Foundation states that saturated fats can raise your LDL cholesterol and increase your chances of getting heart disease.<ref>{{cite web | title = Cholesterol | url = http://www.irishheart.ie/iopen24/cholesterol-t-7_20_87.html | accessdate = 2011-02-28 | publisher  = Irish Heart Foundation}}</ref>
-====Governmental guidelines====
-''The Dietary Guidelines for Americans, 2010'' produced by the [[U.S. Department of Agriculture]] and U.S. Department of Health and Human Services says the human body makes more than enough saturated fats to meet its needs and does not require more from dietary sources.  It says higher levels of saturated fats are associated with higher levels of total cholesterol and low-density lipoprotein "bad" cholesterol and recommends reduced saturated fat intake.<ref>U.S. Department of Agriculture and U.S. Department of Health and Human Services. (December 2010). ''Dietary Guidelines for Americans, 2010'' (7th Edition). Washington, DC: U.S. Government Printing Office.</ref>
-==Primary sources==
-===Studies in reputable medical journals===
-Studies of dietary customs of certain ethnic groups may be confounded by other cultural customs. For example, [[Fulani]] of northern [[Nigeria]] get around 25% of energy from saturated fat, yet their lipid profile is indicative of a low risk of cardiovascular disease. However, this finding may be due to their high activity level and their low total energy intake.<ref name="pmid11722953">{{cite journal |author=Glew RH, Williams M, Conn CA, ''et al.'' |title=Cardiovascular disease risk factors and diet of Fulani pastoralists of northern Nigeria |journal=The American Journal of Clinical Nutrition |volume=74 |issue=6 |pages=730–6 |year=2001 |month=December |pmid=11722953 |url=http://www.ajcn.org/cgi/pmidlookup?view=long&pmid=11722953}}</ref>
-An evaluation of data from Harvard Nurses' Health Study found that "diets lower in carbohydrate and higher in protein and fat are not associated with increased risk of coronary heart disease in women. When vegetable sources of fat and protein are chosen, these diets may moderately reduce the risk of coronary heart disease."<ref>{{cite journal |author=Halton TL, Willett WC, Liu S, ''et al.'' |title=Low-carbohydrate-diet score and the risk of coronary heart disease in women |journal=The New England Journal of Medicine |volume=355 |issue=19 |pages=1991–2002 |year=2006 |month=November |pmid=17093250 |doi=10.1056/NEJMoa055317}}</ref>
-Pacific island populations who obtain 30-60% of their total caloric intake from fully saturated coconut fat have low rates of cardiovascular disease.<ref>{{cite journal |author=Prior IA, Davidson F, Salmond CE, Czochanska Z |title=Cholesterol, coconuts, and diet on Polynesian atolls: a natural experiment: the Pukapuka and Tokelau island studies |journal=The American Journal of Clinical Nutrition |volume=34 |issue=8 |pages=1552–61 |year=1981 |month=August |pmid=7270479 |url=http://www.ajcn.org/cgi/pmidlookup?view=long&pmid=7270479}}</ref>
-A study published in the Lancet in 1994 found that how long-term dietary intake of essential fatty acids affects the fatty-acid content of aortic plaques is not clear.<ref>Felton C. V. ; Crook D. ; Davies M. J. ; Oliver M. F. ; Lancet ISSN 0140-6736 CODEN LANCAO Source / Source 1994, vol. 344, no8931, pp. 1195-1196 (9 ref.)</ref>
-==Tertiary sources==
-===Editorial, commentary and conference findings in reputable medical journals===
-A 2010 perspective in the American Journal of Clinical Nutrition found that the risk of [[Coronary Heart Disease]] is reduced when saturated fatty acids are replaced with polyunsaturated fatty acids but no clear benefit in replacing saturated fatty acids with carbohydrates or monounsaturated fatty acids.<ref name=Astrup2011>{{cite journal |author=Astrup et al. |title=The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010?  |journal=American Journal of Clinical Nutrition |volume= |issue= |pages= |year=2011 |month=January |pmid= |doi=10.3945/ajcn.110.004622  |url=http://www.ajcn.org/content/early/2011/01/26/ajcn.110.004622.abstract}}</ref>
-A 2009 review from the University of Sao Paolo found that the best evidence showed reduced intake of saturated fat decreased risk for coronary heart disease.<ref>{{cite journal | title =
-Importance of the dietary fat on the prevention and control of metabolic disturbances and cardiovascular disease | journal = Arquivos Brasileiros de Endocrinologia e Metabologia | author = Lottenberg AMP | Volume=53 |  Issue=5 |  Pages=595-607 | month = July | year = 2009 | issn = 0004-2730 | doi =10.1590/S0004-27302009000500012 }}</ref>  A 2009 review from King's College London found that epidemiological evidence suggested a negative influence on vascular function from saturated fat, but that the experimental evidence did not support this convincingly.<ref>{{cite journal | title = Dietary saturated and unsaturated fats as determinants of blood pressure and vascular function  | journal = Nutrition Research Reviews | doi=10.1017/S095442240925846X | month = June | year = 2009 | volume = 22 | issue = 1 | pages=18-38 | author = Hall WL }}</ref>
-A 2004 commentary from the Nestle Research Center stated that no randomized clinical trials of low-fat diets or low-saturated fat diets of sufficient duration had been carried out. The influence of varying saturated fatty acid intakes against a background of different individual lifestyles and genetic backgrounds were recommended as the focus in future studies.<ref>{{cite journal |author=German JB, Dillard CJ |title=Saturated fats: what dietary intake? |journal=The American Journal of Clinical Nutrition |volume=80 |issue=3 |pages=550–9 |year=2004 |month=September |pmid=15321792 |url=http://www.ajcn.org/cgi/pmidlookup?view=long&pmid=15321792}}</ref>
-Saturated fat intakes may be monitored more closely than were total fat intakes, therefore ignoring the possibility that simply a larger fat intake may lead to a higher risk of coronary diseases. It also suggests that other parameters may be overlooked, such as carbohydrates intakes.<ref>{{cite journal |author=Knopp RH, Retzlaff BM |title=Saturated fat prevents coronary artery disease? An American paradox |journal=The American Journal of Clinical Nutrition |volume=80 |issue=5 |pages=1102–3 |year=2004 |month=November |pmid=15531654 |url=http://www.ajcn.org/cgi/pmidlookup?view=long&pmid=15531654}}</ref>
-A scientific conference hosted by the University of Reading (UK) and organized and facilitated by the International Dairy Federation’s Standing Committee on Nutrition and Health found that despite the contribution of dairy products to the saturated fatty acid intake of the diet, there was not clear evidence that dairy food consumption is consistently associated with a higher risk of CVD.<ref>{{cite journal |author=German JB, Gibson RA, Krauss RM, ''et al.'' |title=A reappraisal of the impact of dairy foods and milk fat on cardiovascular disease risk |journal=European Journal of Nutrition |volume=48 |issue=4 |pages=191–203 |year=2009 |month=June |pmid=19259609 |pmc=2695872 |doi=10.1007/s00394-009-0002-5}}</ref>
-===Lay scientific books===
-[[Gary Taubes]], a science writer specializing in controversy and three-time winner of the ''[[Science in Society Journalism Awards|Science in Society Award]]'' of the [[National Association of Science Writers]] concludes "Dietary fat, whether saturated or not, is not a cause of obesity, heart disease, or any other chronic disease of civilization."<ref name="Good Calorie, Bad Calories" >{{cite book|last=Taubes|first=Gary|title=Good Calories, Bad Calories: Google Book Preview, Page 454|year=2007|publisher=Knopf|pages=609|url=http://books.google.com/books?id=olfyVJLaa_YC&lpg=PA454&dq=%22%22&pg=PA454#v=onepage&q=%22%22&f=true|accessdate=2011-01-02}}</ref>
-===Popular press===
-Writing in ''Men's Health Magazine'', Nina Teicholz proposed that intake of saturated fat is only correlated with heart disease, "not a clear, causal link." <ref>Teicholz, Nina. (October 10, 2007). [http://www.menshealth.com/health/saturated-fat What if Bad Fat Is Actually Good for You?"]. ''Men's Health Magazine''.</ref>
-===Self-published works===
-[[Mary G. Enig]] a biochemist and nutritionist who is a member of [[the International Network of Cholesterol Skeptics]] states there is strong evidence for the cardiovascular benefits of saturated fats.<ref>Fallon, Sally and Mary Enig. (1999). The Truth About Saturated Fats. ''Nourishing Traditions – The Cookbook that Challenges Politically Correct Nutrition and the Diet Dictocrats''. NewTrends. ISBN 0967089735.</ref>
-==See also==
-*[[Lipid hypothesis]]
-*[[Diet and heart disease]]
-*[[Junk food]]
-*[[Fast food]]
-*[[Healthy diet]]
-==References==
-{{Reflist}}
-==Further reading==
-*{{vcite journal | title=Estimating the cardiovascular mortality burden attributable to the European Common Agricultural Policy on dietary saturated fats | journal = Bulletin of the World Health Organization | volume = 86 | year = 2008 | number = 7 | month = July | authors = Ffion Lloyd-Williams, Martin O’Flaherty, Modi Mwatsama, et al | pages = 497-576 | url = http://www.who.int/bulletin/volumes/86/7/08-053728/en/ | accessdate=2011-01-25}}
-{{DEFAULTSORT:Saturated Fat And Cardiovascular Disease Controversy}}
-[[Category:Nutrition]]
-[[Category:Prevention]]
-[[Category:Medical controversies]]
-[[Category:Diets]]