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Saturated fat and cardiovascular disease

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This is an old revision of this page, as edited by Lambanog (talk | contribs) at 06:33, 12 March 2011 (Replaced AHA ref with one that seems more thorough and more about fats than cholesterol. Not sure where to put government guidelines: secondary or tertiary? Most of it looks out-of-date and COI might be raised as an issue.). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

Whether saturated fat is a risk factor for cardiovascular disease (CVD) is a question with numerous controversial views.[1] 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 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.[2] 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.[3] 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.[4]

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 fats and foods with a high glycemic index.[5] 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.[1][5]

Some meta-analyses have found a significant relationship between saturated fat and serum cholesterol levels,[6][7] and serum cholesterol levels and cardiovascular disease,[8] 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.[9] Furthermore, a positive relationship between saturated fat and fatal coronary heart disease was found despite an over-adjustment for serum lipids.[9]

In 2010, a meta-analysis of prospective cohort studies supported by the National Dairy Council including 348,000 subjects found no statistically significant relationship between cardiovascular disease and dietary saturated fat.[1][10]

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.[11]

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.[12]

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.[13][14][15]

Mayo Clinic highlighted oils that are high in saturated fats include 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.[16]

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.[17]

Heart-health organizations

Consumption of saturated fat is a risk factor for cardiovascular disease in the view of the Canadian Heart and Stroke Foundation,[18] the American Heart Association,[19] the British Heart Foundation,[20] the National Heart Foundation of Australia,[21] the National Heart Foundation of New Zealand [22] and the World Heart Federation.[23] The Irish Heart Foundation states that saturated fats can raise your LDL cholesterol and increase your chances of getting heart disease.[24]

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.[25]

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.[26]

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."[27]

Pacific island populations who obtain 30-60% of their total caloric intake from fully saturated coconut fat have low rates of cardiovascular disease.[28]

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.[29]

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.[30]

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.[31] 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.[32]

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.[33] 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.[34] 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.[35]

Lay scientific books

Gary Taubes, a science writer specializing in controversy and three-time winner of the 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."[36]

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." [37]

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.[38]

See also

References

  1. ^ a b c Siri-Tarino PW, Sun Q, Hu FB, Krauss RM (2010). "Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease". The American Journal of Clinical Nutrition. 91 (3): 535–46. doi:10.3945/ajcn.2009.27725. PMC 2824152. PMID 20071648. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  2. ^ Mozaffarian D, Micha R, Wallace S (2010). "Effects on Coronary Heart Disease of Increasing Polyunsaturated Fat in Place of Saturated Fat: A Systematic Review and Meta-Analysis of Randomized Controlled Trials". PLoS Medicine. 7 (3): 1–10. doi:10.1371/journal.pmed.1000252. ISSN 1549-1277. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  3. ^ Van Horn L; et al. (2008). "The evidence for dietary prevention and treatment of cardiovascular disease". Journal of the American Dietetic Association. 108 (2): 287–331. doi:10.1016/j.jada.2007.10.050. ISSN 0002-8223. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)
  4. ^ Hu FB, Stampfer MJ (1999). "Nut consumption and risk of coronary heart disease: a review of epidemiologic evidence". Current Atherosclerosis Reports. 1 (3): 204–209. doi:10.1007/s11883-999-0033-7. PMID 11122711. {{cite journal}}: Unknown parameter |month= ignored (help)
  5. ^ a b Mente A, de Koning L, Shannon HS, Anand SS (2009). "A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease". Arch. Intern. Med. 169 (7): 659–69. doi:10.1001/archinternmed.2009.38. PMID 19364995. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) Free full-text
  6. ^ Clarke, R; Frost, C; Collins, R; Appleby, P; Peto, R (1997). "Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies". BMJ (Clinical research ed.). 314 (7074): 112–7. PMC 2125600. PMID 9006469.
  7. ^ Mensink RP, Zock PL, Kester ADM, Katan MB (2003). "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". American Journal of Clinical Nutrition. 77 (5): 1146–1155. ISSN 0002-9165. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  8. ^ Lewington S, Whitlock G, Clarke R, Sherliker P, Emberson J, Halsey J, Qizilbash N, Peto R, Collins R (2007). "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". Lancet. 370 (9602): 1829–39. doi:10.1016/S0140-6736(07)61778-4. PMID 18061058. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  9. ^ a b Stamler J (2010). "Diet-heart: a problematic revisit" (PDF). The American Journal of Clinical Nutrition. 91 (3): 497–99. doi:10.3945/ajcn.2010.29216. PMID 20130097. {{cite journal}}: Unknown parameter |month= ignored (help)
  10. ^ Siri-Tarino PW, Sun Q, Hu FB, Krauss RM (2010). "Saturated fat, carbohydrate, and cardiovascular disease". The American Journal of Clinical Nutrition. 91 (3): 502–9. doi:10.3945/ajcn.2008.26285. PMC 2824150. PMID 20089734. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  11. ^ Chanu B (2003). "Primary dietetic prevention of ischaemic heart disease". Archives des Maladies du Coeur et des Vaisseux. 96 (Sp. Iss. 6): 21–25. ISSN 0003-9683. {{cite journal}}: Unknown parameter |month= ignored (help)
  12. ^ Jakobsen, MU; O'Reilly, EJ; Heitmann, BL; Pereira, MA; Bälter, K; Fraser, GE; Goldbourt, U; Hallmans, G; Knekt, P (2009). "Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies". The American journal of clinical nutrition. 89 (5): 1425–32. doi:10.3945/ajcn.2008.27124. PMC 2676998. PMID 19211817.
  13. ^ World Health Organization Risk factor: lipids
  14. ^ World Health Organization Prevention: personal choices and actions
  15. ^ Report of a Joint WHO/FAO Expert Consultation (2003). "Diet, Nutrition and the Prevention of Chronic Diseases" (PDF). World Health Organization. Retrieved 2011-03-11.
  16. ^ Dietary fats: Know which types to choose Mayo Clinic website
  17. ^ Mead, A; et al. (2006). "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 of Human Nutrition and Dietetics. 19 (6): 401–419. doi:10.1111/j.1365-277X.2006.00726.x. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)
  18. ^ "Dietary fats, oils and cholesterol". Retrieved 2010-12-22.
  19. ^ "Fat". Retrieved 2011-03-12.
  20. ^ "Saturated Fat". Retrieved 2010-12-22.
  21. ^ "'Reduce saturated fat' urges Heart Foundation after major review" (PDF). Retrieved 2010-12-22.
  22. ^ Seddon MB. ChB. MPH., M (March 1999). "Dietary Fats: An Evidence-Based Nutrition Statement from the National Heart Foundation of New Zealand's Nutrition Advisory Committee" (PDF). Retrieved 2010-12-22.
  23. ^ "Cardiovascular Disease Risk Factors". Retrieved 2010-12-23.
  24. ^ "Cholesterol". Irish Heart Foundation. Retrieved 2011-02-28.
  25. ^ 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.
  26. ^ Glew RH, Williams M, Conn CA; et al. (2001). "Cardiovascular disease risk factors and diet of Fulani pastoralists of northern Nigeria". The American Journal of Clinical Nutrition. 74 (6): 730–6. PMID 11722953. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  27. ^ Halton TL, Willett WC, Liu S; et al. (2006). "Low-carbohydrate-diet score and the risk of coronary heart disease in women". The New England Journal of Medicine. 355 (19): 1991–2002. doi:10.1056/NEJMoa055317. PMID 17093250. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  28. ^ Prior IA, Davidson F, Salmond CE, Czochanska Z (1981). "Cholesterol, coconuts, and diet on Polynesian atolls: a natural experiment: the Pukapuka and Tokelau island studies". The American Journal of Clinical Nutrition. 34 (8): 1552–61. PMID 7270479. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  29. ^ 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.)
  30. ^ Astrup; et al. (2011). "The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010?". American Journal of Clinical Nutrition. doi:10.3945/ajcn.110.004622. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)
  31. ^ Lottenberg AMP (2009). "Importance of the dietary fat on the prevention and control of metabolic disturbances and cardiovascular disease". Arquivos Brasileiros de Endocrinologia e Metabologia. doi:10.1590/S0004-27302009000500012. ISSN 0004-2730. {{cite journal}}: Unknown parameter |Issue= ignored (|issue= suggested) (help); Unknown parameter |Pages= ignored (|pages= suggested) (help); Unknown parameter |Volume= ignored (|volume= suggested) (help)
  32. ^ Hall WL (2009). "Dietary saturated and unsaturated fats as determinants of blood pressure and vascular function". Nutrition Research Reviews. 22 (1): 18–38. doi:10.1017/S095442240925846X. {{cite journal}}: Unknown parameter |month= ignored (help)
  33. ^ German JB, Dillard CJ (2004). "Saturated fats: what dietary intake?". The American Journal of Clinical Nutrition. 80 (3): 550–9. PMID 15321792. {{cite journal}}: Unknown parameter |month= ignored (help)
  34. ^ Knopp RH, Retzlaff BM (2004). "Saturated fat prevents coronary artery disease? An American paradox". The American Journal of Clinical Nutrition. 80 (5): 1102–3. PMID 15531654. {{cite journal}}: Unknown parameter |month= ignored (help)
  35. ^ German JB, Gibson RA, Krauss RM; et al. (2009). "A reappraisal of the impact of dairy foods and milk fat on cardiovascular disease risk". European Journal of Nutrition. 48 (4): 191–203. doi:10.1007/s00394-009-0002-5. PMC 2695872. PMID 19259609. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  36. ^ Taubes, Gary (2007). Good Calories, Bad Calories: Google Book Preview, Page 454. Knopf. p. 609. Retrieved 2011-01-02.
  37. ^ Teicholz, Nina. (October 10, 2007). What if Bad Fat Is Actually Good for You?". Men's Health Magazine.
  38. ^ 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.

Further reading

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