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dietary fat

Physiology: - saturated fatty acids increase LDL cholesterol & HDL cholesterol [8] Adverse effects: - a single high fat meal, 100 g fat, 50 g saturated fat, 300 g of cholesterol can decrease mean & peak coronary artery flow (20% reduction in mean flow) 5 hours after meal in young, healthy men - Foods fried in olive oil, sunflower oil, or other vegetable oils not associated with increased cardiac risk [2] - increased all-cause mortality & increased cardiovascular mortality from replacing saturated fat in diet with linoleic acid (omega-6) (RR = 1.70) [3] - evidence in support of adverse health effect of saturated fat is weak [6] - saturated fat in dairy products & coconut may have health benefits [6] - high-fat diet compared with high carbohydrate diet associated with diminished mortality (RR= 0.84) [10] - relative risk associated with specific dietary fats replacing dietary carbohydrate - 0.81 polyunsaturated fatty acid (PUFA) - 0.89 monounsaturated fatty acid (MUFA) - 1.08 saturated fat - 1.13 trans-fat [10] Management: Recommendations: 1) < 30% of calories from fat 2) < 10% of calories from saturated fat or trans fatty acids - < 1% of calories from trans fatty acids [13] (WHO) 3) American Heart Association has recommended >= 5-10% energy from omega-6 polyunsaturated fatty acids [4] - reducing saturated fat intake while increasing polyunsaturated fat intake is associated with a reduction in cardiovascular events similar to what is achieved by statins [11] - replacing saturated fats with polyunsaturated or monounsaturated fats lowers LDL cholesterol & serum triglycerides - polyunsaturated fats appear to be more effective than monounsaturated fats reducing cardiovascular events - this recommendation may increase mortality [3,9] 4) no evidence to support recommenation of limiting overall fat intake to 30% of total calories & saturated fat to 10% [7,11] 5) the switch from saturated to unsaturated fats should occur alongside adherence to a healthy eating pattern like the Mediterranean diet or DASH diet [11] 6) greater fat intake from plants is associated with lower overall & cardiovascular mortality, especially fat from grains & vegetable oils [15] - plant sources of monounsaturated fat may reduce all-cause mortality (RR=0.84), whereas animal sources may increase it (RR=1.21) [12] 7) polyunsaturated fats lower mortality in type 2 diabetes (RR=0.7) [14] - only fish-derived fatty acids confer a benefit for cardiovascular mortality - animal fats increase mortality in type 2 diabetes (RR=1.2) [14] * 1 serving of fat is 1 tablespoon (15 mL) about 110 kcal

Related

diet fatty acid, omega-3 (Epanova) fatty acid, omega-6 triglyceride

Specific

dietary cholesterol essential fatty acid fish oil medium-chain triglyceride monounsaturated fat polyunsaturated fat saturated fat vegetable oil

General

macronutrient

References

  1. Journal Watch 22(9):68-69, 2002 Hozuni T et al Change in coronary flow reserve on transthoracic Doppler echocardiography after a single high-fat meal in young healthy men. Ann Intern Med 136:523, 2002 PMID: 11926787
  2. Guallar-Castillon P et al Consumption of fried foods and risk of coronary heart disease: Spanish cohort of the European Prospective Investigation into Cancer and Nutrition study BMJ 2012;344:e363 PMID: 22275385 http://www.bmj.com/content/344/bmj.e363 - Leitzmann MF Fried foods and the risk of coronary heart disease BMJ 2012;344:d8274 PMID: 22275384 http://www.bmj.com/content/344/bmj.d8274
  3. Ramsden CE et al Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. BMJ 2013;346:e8707 PMID: 23386268 http://www.bmj.com/content/346/bmj.e8707 - Calder PC Old study sheds new light on the fatty acids and cardiovascular health debate. BMJ 2013;346:f493 PMID: 23386269 http://www.bmj.com/content/346/bmj.f493
  4. Harris WS et al Omega-6 Fatty Acids and Risk for Cardiovascular Disease: A Science Advisory From the American Heart Association Nutritional Subcommittee on the Council on Nutirion, Physical Activity, and Metabolism; Council on Cardiovascular Nursing; and Council on Epidemiology and Prevention. Circulation 2009 119:902-907 PMID: 19171857 http://circ.ahajournals.org/content/119/6/902.full.pdf
  5. Baum SJ, Kris-Etherton PM, Willett WC et al Fatty acids in cardiovascular health and disease: a comprehensive update. J Clin Lipidol. 2012 May-Jun;6(3):216-34 PMID: 22658146
  6. Lawrence GD. Dietary fats and health: dietary recommendations in the context of scientific evidence. Adv Nutr. 2013 May 1;4(3):294-302. PMID: 23674795
  7. Harcombe Z et al Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis. Open Heart 2015;2: PMID: 25685363 http://openheart.bmj.com/content/2/1/e000196 R - Bahl R The evidence base for fat guidelines: a balanced diet. Open Heart 2015;2: PMID: 25685365 http://openheart.bmj.com/content/2/1/e000229
  8. 2014 DGAC Meeting 7. December 15, 2015 Science Base Chapter. Food and Nutrient Intakes, and Health: Current Status and Trends. Suncommittee 1. http://www.health.gov/dietaryguidelines/2015-BINDER/meeting7/docs/DGAC-Meeting-7-SC-1.pdf
  9. Ramsden CE et al Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73). BMJ 2016;353:i1246 PMID: 27071971 http://www.bmj.com/content/353/bmj.i1246 - Veerman JL et al Dietary fats: a new look at old data challenges established wisdom. BMJ 2016;353:i1512 PMID: 27072816 Free PMC Article http://www.bmj.com/content/353/bmj.i1512
  10. Wang DD, Li Y, Chiuve SE et al Association of Specific Dietary Fats With Total and Cause- Specific Mortality. JAMA Intern Med. Published online July 05, 2016 PMID: 27379574 http://archinte.jamanetwork.com/article.aspx?articleid=2530902
  11. Sacks FM, Lichtenstein AH, Wu JH et al Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association. Circulation. June 15, 2017 PMID: 28620111 http://circ.ahajournals.org/content/early/2017/06/15/CIR.0000000000000510
  12. Melville NA Animal-Based Monounsaturated Fats Linked to Total, CVD Mortality Medscape - Mar 29, 2018. https://www.medscape.com/viewarticle/894598
  13. World Health Organizaton (WHO) Call for public comments on the draft WHO Guidelines: Saturated fatty acid and trans-fatty intake for adults and children. Online public consultation open: May 4 - June 1, 2018 http://www.who.int/nutrition/topics/sfa-tfa-public-consultation-4may2018/en/
  14. Jiao J, Liu G, Shin HJ et al Dietary fats and mortality among patients with type 2 diabetes: analysis in two population based cohort studies. BMJ 2019;366:l4009 PMID: 31266749 Free Article https://www.bmj.com/content/366/bmj.l4009
  15. Zhao B, Gan L, Graubard BI et al Plant and Animal Fat Intake and Overall and Cardiovascular Disease Mortality. JAMA Intern Med. 2024 Aug 12:e243799. PMID: 39133482 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle