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#REDIRECT [[Saturated fat#Cardiovascular disease]]
Most medical, scientific, heart-health, governmental, and professional authorities agree that '''[[saturated fat]]''' is a risk factor for [[cardiovascular disease]], including the [[World Health Organization]],<ref name="WHO">{{cite book|url=http://whqlibdoc.who.int/trs/who_trs_916.pdf|title=Diet, Nutrition and the Prevention of Chronic Diseases (WHO technical report series 916)|author=Joint WHO/FAO Expert Consultation|publisher=World Health Organization|year=2003|isbn= 978-92-4-120916-8|pages=81–94|accessdate=2011-03-11|archive-url=https://web.archive.org/web/20150724215855/http://whqlibdoc.who.int/trs/who_trs_916.pdf|archive-date=24 July 2015|url-status=}}</ref> the [[Food and Nutrition Board]] of the [[National Academy of Medicine]],<ref name="FNBmacronutrients">{{cite book|last1=Food and Nutrition Board|title=Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids|date=2005 |publisher=National Academies Press|location=Washington, DC|page=422|chapter-url=https://www.nap.edu/read/10490/chapter/10|accessdate=25 July 2017|chapter=10: Dietary Fats: Total Fat and Fatty Acids}}</ref> the [[Academy of Nutrition and Dietetics]],<ref name="ADA/DOC">{{cite journal | journal = Journal of the American Dietetic Association | pages = 1599–1611 [1603] |date=September 2007 | volume = 107 | accessdate = 2011-03-18 | url = https://pdfs.semanticscholar.org/7524/e97c6c504695d5c2f254080b69629a7dd27e.pdf | title = Position of the American Dietetic Association and Dietitians of Canada: Dietary Fatty Acids | issue = 9 | pmid = 17936958 | last1 = Kris-Etherton | first1 = PM | last2 = Innis | first2 = S | last3 = American Dietetic | first3 = Association | last4 = Dietitians Of | first4 = Canada | doi= 10.1016/j.jada.2007.07.024}}</ref> the [[Dietitians of Canada]],<ref name="ADA/DOC"/> the [[British Dietetic Association|Association of UK Dietitians]],<ref name=BDA>{{cite web|title=Food Fact Sheet - Cholesterol |url=http://www.bda.uk.com/foodfacts/cholesterol.pdf |publisher=Association of UK Dietitians |accessdate=28 July 2019|date=1 December 2018}}</ref> the [[American Heart Association]],<ref name="aha2017">{{cite journal|last1= Sacks|first1=Frank M.|last2=Lichtenstein|first2=Alice H.|last3=Wu|first3=Jason H.Y.|last4=Appel|first4=Lawrence J.|last5=Creager|first5=Mark A.|last6=Kris-Etherton|first6=Penny M.|last7=Miller|first7=Michael|last8=Rimm|first8=Eric B.|last9=Rudel|first9=Lawrence L.|last10=Robinson|first10=Jennifer G.|last11=Stone|first11=Neil J.|last12=Van Horn |first12= Linda V.|title=Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association|journal=Circulation|date=15 June 2017|pages=e1–e23|doi=10.1161/CIR.0000000000000510|pmid= 28620111 |volume=136|issue=3}}</ref> the [[British Heart Foundation]],<ref name=BHF>{{cite web | url = https://www.bhf.org.uk/heart-health/preventing-heart-disease/healthy-eating/fats-explained | title = Fats explained | accessdate = 2012-05-03}}</ref> the [[Heart and Stroke Foundation of Canada]],<ref name="HeartStrokeCanada">{{cite web|title=Dietary fats, oils and cholesterol |url=http://www.heartandstroke.ca/get-healthy/healthy-eating/fats-and-oils|website=[[Heart and Stroke Foundation of Canada]]|accessdate=25 July 2017}}</ref> the [[World Heart Federation]],<ref name=WorldHeartFederation>{{cite web | url = http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors | title = Cardiovascular Risk Factors | accessdate = |website = World Heart Federation|date = 30 May 2017}}</ref> the British [[National Health Service]],<ref name = NHS>{{cite web |title=Eat less saturated fat |url=http://www.nhs.uk/livewell/goodfood/pages/eat-less-saturated-fat.aspx|publisher=[[National Health Service]]|date=1 June 2017 |accessdate=28 July 2019 }}</ref> the United States [[Food and Drug Administration]],<ref name=FDA>{{cite web|url=https://www.fda.gov/Food/LabelingNutrition/ConsumerInformation/ucm192658.htm |title=Nutrition Facts at a Glance - Nutrients: Saturated Fat |publisher=[[Food and Drug Administration]] |date=2009-12-22 |accessdate=2012-05-03 |url-status=dead |archiveurl =https://web.archive.org/web/20110917133305/https://www.fda.gov/Food/LabelingNutrition/ConsumerInformation/ucm192658.htm |archivedate=September 17, 2011 }}</ref> and the [[European Food Safety Authority]].<ref>{{cite web|title=Scientific Opinion on Dietary Reference Values for fats, including saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, trans fatty acids, and cholesterol|url=http://www.efsa.europa.eu/en/efsajournal/pub/1461|publisher=European Food Safety Authority|accessdate=3 May 2012|date=2010-03-25}}</ref> All of these organizations recommend restricting consumption of saturated fats to reduce that risk.

Some [[meta-analysis|meta-analyses]] of [[clinical trial]]s and [[observational study|observational studies]] have provided evidence against the recommendation for reduced intake of saturated fat,<ref name="Zhu2019">{{cite journal|last=Zhu|first=Yongjian|first2=Yacong |last2=Bo|first3=Liu|last3=Yanhua|date=April 2019|title=Dietary total fat, fatty acids intake, and risk of cardiovascular disease: a dose-response meta-analysis of cohort studies|url=|journal=Lipids in Health and Disease|volume=18|issue=9|pages=91|doi=10.1186/s12944-019-1035-2|pmc=6451787|pmid=30954077}}</ref><ref name="Siri-Tarino2010">{{cite journal|last=Siri-Tarino|first=Patty W.|last2=Sun|first2=Qi|last3=Hu|first3=Frank B.|last4=Krauss|first4=Ronald M.|date=March 2010|title=Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease|url=|journal=[[The American Journal of Clinical Nutrition]]|volume=91|issue=3|pages=535–46|doi=10.3945/ajcn.2009.27725|pmc=2824152|pmid=20071648}}</ref><ref name="Hamley">{{cite journal|last=Hamley|first=Steven|title=The effect of replacing saturated fat with mostly n-6 polyunsaturated fat on coronary heart disease: a meta-analysis of randomised controlled trials|journal=[[Nutrition Journal]]|date=19 May 2017|volume=16|issue=1|page=30|doi=10.1186/s12937-017-0254-5|pmc=5437600|pmid=28526025}}</ref><ref name="Ramsden2016">{{cite journal|last1=Ramsden|first1=Christopher E|last2=Zamora|first2=Daisy|last3=Majchrzak-Hong|first3=Sharon|last4=Faurot|first4=Keturah R.|last5=Broste|first5=Steven K.|last6=Frantz|first6=Robert P.|last7=Davis|first7=John M.|last8=Ringel|first8=Amit|last9=Suchindran|first9=Chirayath M.|date=2016|title=Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73)|url=|journal=[[The BMJ]]|volume=353|pages=i1246|doi=10.1136/bmj.i1246|pmc=4836695|pmid=27071971|last10=Hibbeln|first10=Joseph R}}</ref><ref name="De Souza">{{Cite journal|last1=de Souza|first1=Russell J.|last2=Mente|first2=Andrew|last3=Maroleanu|first3=Adriana|last4=Cozma|first4=Adrian I.|last5=Ha|first5=Vanessa|last6=Kishibe|first6=Teruko|last7=Uleryk|first7=Elizabeth|last8=Budylowski|first8=Patrick|last9=Schünemann|first9=Holger|year=2015|title=Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: Systematic review and meta-analysis of observational studies|journal=[[The BMJ]]|volume=351|pages=h3978|doi=10.1136/bmj.h3978|pmc=4532752|pmid=26268692|last10=Beyene|first10=Joseph|last11=Anand|first11=Sonia S.}}</ref><ref name="Chowdhury2014">{{cite journal|last=Chowdhury|first=Rajiv|display-authors=etal|title=Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Meta-analysis|journal=[[Annals of Internal Medicine]]|date=18 March 2014|volume=160|issue=6|pages=398–406|doi=10.7326/M13-1788|pmid=24723079|url=https://semanticscholar.org/paper/c5346032b865ad17149d0e6b52299630de8de99f}}</ref> including one critique by scientists<ref name="FeinmanFaceDGAC">{{cite journal|last1=Hite|first1=Adele H.|last2=Feinman|first2=Richard David|last3=Guzman|first3=Gabriel E.|last4=Satin|first4=Morton|last5=Schoenfeld|first5=Pamela A.|last6=Wood|first6=Richard J.|year=2010|title=In the face of contradictory evidence: Report of the ''Dietary Guidelines for Americans'' Committee|journal=Nutrition|volume=26|issue=10|pages=915–24|doi=10.1016/j.nut.2010.08.012|pmid=20888548}}</ref> and one by a [[trade association]].<ref name="DairyFarmers">{{cite web|url=https://www.dairynutrition.ca/scientific-evidence/experts-summaries/new-evidence-reveals-that-saturated-fat-does-not-increase-the-risk-of-cardiovascular-disease|title=New evidence reveals that saturated fat does not increase the risk of cardiovascular disease|last=Mente|first=Andrew|website=Dairy Nutrition|publisher=Dairy Farmers of Canada|accessdate=18 March 2011}}</ref>

{{TOC limit|2}}

==History==

===Cholesterol and cardiovascular disease===
The initial connection between [[arteriosclerosis]] and dietary [[cholesterol]] is attributed to the Russian pathologist [[Nikolay Anichkov]], prior to [[World War I]].<ref name="Steinberg2004">{{Cite journal|last1=Steinberg|first1=Daniel|title=Thematic review series: The Pathogenesis of Atherosclerosis. An interpretive history of the cholesterol controversy: Part I|url=|journal=[[Journal of Lipid Research]]|date=21 April 2004|volume=45|issue=9|pages=1583–1593|doi=10.1194/jlr.R400003-JLR200|pmid=15102877|doi-access=free}}</ref>
Dutch physician [[Cornelis de Langen]] noted the correlation between nutritional cholesterol intake and incidence of [[gallstones]] in [[Javanese people|Javanese]] people in 1916.<ref name="Blackburn2012">{{Cite journal|last1=Blackburn|first1=Henry|year=2012|title=20th-Century "Medical Marco Polos" in the Origins of Preventive Cardiology and Cardiovascular Disease Epidemiology|url=https://www.ajconline.org/article/S0002-9149(11)03212-7/pdf|journal=[[The American Journal of Cardiology]]|volume=109|issue=5|pages=756–767|doi=10.1016/j.amjcard.2011.10.038|pmid=22470931|via=}}</ref><ref>{{cite journal|last1=de Langen|first1=Cornelis|title=Cholesterine-stofwisseling en rassenpathologie|journal=Geneeskundig Tijdschrift voor Nederlandsch-Indie|date=1916|volume=56|pages=1–34|language=Dutch}}</ref> de Langen showed that the traditional Javanese diet, poor in cholesterol and other lipids, was associated with a low level of blood cholesterol and low incidence of [[cardiovascular disease]] (CVD), while the prevalence of CVD in Europeans living in Java on a Western diet was higher.<ref name="Blackburn2012" /> Since de Langen published his results only in Dutch, his work remained unknown to most of the international scientific community until the 1940s and 1950s.<ref name="Blackburn2012" />

===Saturated fat and cardiovascular disease===
The hypothesis that saturated fat has a detrimental effect on human health gained prominence in the 1950s as a result of the work of [[Ancel Keys]], a US [[Nutritional science|nutritional scientist]].<ref name="Teicholz2014">{{cite web|url=https://www.wsj.com/articles/SB10001424052702303678404579533760760481486|title=The Questionable Link Between Saturated Fat and Heart Disease|last1=Teicholz|first1=Nina|date=6 May 2014|publisher=[[The Wall Street Journal]]|accessdate=9 May 2015}}</ref> At that time in the USA, the incidence of heart disease was rapidly increasing, for reasons that were not clear.<ref name="Teicholz2014"/> Keys postulated a correlation between [[Lipoproteins|circulating cholesterol]] levels and [[cardiovascular disease]], and initiated a study of Minnesota businessmen (the first [[prospective study]] of CVD).<ref name="Keys1963">{{cite journal|last=Keys|first=Ancel|last2=Taylor|first2=Henry Longstreet|last3=Blackburn|first3=Henry|last4=Brozek|first4=Josef|last5=Anderson|first5=Joseph T.|last6=Simonson|first6=Ernst|date=1 September 1963|title=Coronary Heart Disease among Minnesota Business and Professional Men Followed Fifteen Years|url=https://www.ahajournals.org/doi/pdf/10.1161/circ.28.3.381|journal=[[Circulation (journal)|Circulation]]|volume=28|issue=3|pages=381–95|doi=10.1161/01.cir.28.3.381|pmid=14059458|via=|doi-access=free}}</ref>

Keys presented his diet-lipid-heart disease hypothesis at a 1955 expert meeting of the [[World Health Organization]] in Geneva.<ref>Famous Polemics on Diet-Heart Theory. Henry Blackburn, School of Public Health, University of Minnesota. http://www.epi.umn.edu/cvdepi/essay.asp?id=33 accessed 18th March 2014</ref> In response to criticism at the conference, he set out to conduct the years-long [[Seven Countries Study]].<ref name="Keys1980">{{cite book | last = Keys | first = Ancel| title = Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease | url = https://archive.org/details/sevencountriesmu0000keys | url-access = registration | publisher = Harvard University Press | year = 1980 | isbn = 978-0-674-80237-7 }}</ref> Ancel Keys joined the nutrition committee of the American Heart Association (AHA) and successfully promulgated his idea such that in 1961, with the result that the AHA became the first group anywhere in the world to advise cutting back on saturated fat (and dietary cholesterol) to prevent heart disease.<ref>{{Cite journal|last=|first=|date=4 February 1961|title=Dietary Fat and Its Relation to Heart Attacks and Strokes|journal=[[JAMA (journal)|JAMA]]|volume=175|issue=5|pages=389–391|doi=10.1001/jama.1961.63040050001011|pmid=14447694}}</ref> This historic recommendation was reported on the cover of [[Time Magazine]] in that same year.<ref>{{Cite web|url=http://content.time.com/time/covers/0,16641,19610113,00.html|title=TIME Magazine Cover: Ancel Keys|date=13 January 1961|website=TIME.com|access-date=23 July 2017}}</ref>

==Systematic reviews ==

===Summary table of data===

{| class="wikitable"
|-
|-
! Systematic reviews and meta-analyses of both prospective cohort data and randomised controlled trials.
! Relationship between cardiovascular disease and saturated fatty acids (SFA)
|-
|-
| Zhu et al., 2019<ref name=Zhu2019/>
| A meta-analysis of cohort studies found no association between dietary saturated fat intake and risk of cardiovascular diseases. Higher intake of trans fatty acids was associated with greater risk of cardiovascular diseases.
|-
|-
| American Heart Association: Presidential Advisory on Dietary Fats and Cardiovascular Disease<ref name=aha2017/>
| "Randomized controlled trials that lowered intake of dietary saturated fat and replaced it with [[polyunsaturated fatty acids|polyunsaturated]] vegetable oil reduced cardiovascular disease by about 30%, similar to the reduction achieved by statin treatment." All-cause mortality was not reduced across the 4 trials selected.
|-
| Hamley, 2017<ref name=Hamley/>
| This review found no effect of saturated fats, when replaced by vegetable oils rich in [[polyunsaturated fatty acids]] (PUFA), on total mortality or cardiovascular mortality. "Available evidence from adequately controlled randomised controlled trials suggest replacing SFA with mostly n-6 PUFA is unlikely to reduce CHD events, CHD mortality or total mortality. The suggestion of benefits reported in earlier meta-analyses is due to the inclusion of inadequately controlled trials. These findings have implications for current dietary recommendations."
|}

===Review details===

A 2017 systematic review focusing on adequately controlled randomized controlled trials concluded that replacing saturated fats with mostly n-6 polyunsaturated fats is unlikely to reduce [[Coronary Heart Disease|coronary heart disease]] (CHD) events, CHD mortality or total mortality. The 2017 review showed that inadequately controlled trials (e.g., failing to control for other lifestyle factors) that were included in earlier meta-analyses explain the prior results.<ref name= "Hamley" />

A 2017 [[systematic review]] by the American Heart Association recommended that decreasing saturated fat intake and increasing consumption of [[monounsaturated fat]]s and [[polyunsaturated fat]]s could lower risk of cardiovascular disease by about 30%.<ref name="aha2017"/>

==See also==
* [[Diet and heart disease]]
* [[Fast food]]
* [[French paradox]]
* [[Healthy diet]]
* [[Junk food]]
* [[Lipid hypothesis]]
* [[Low-carbohydrate diet]]

==References==
{{Reflist|32em}}

{{DEFAULTSORT:Saturated Fat And Cardiovascular Disease Controversy}}
[[Category:Nutrition]]
[[Category:Prevention]]
[[Category:Medical controversies]]
[[Category:Diets]]
[[Category:Fatty acids]]
[[Category:Heart diseases]]

Latest revision as of 23:04, 28 August 2023

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