The most important recent publications around fats and cardiovascular health
Dietary fat quality and health
This narrative review provides a comprehensive overview of the rationale for the dietary recommendations for fat intake, limiting the discussion to ASCVD as the outcome. The link between low-density lipoprotein (LDL) particles and ASCVD is discussed, drawing upon evidence from genetic studies, randomized controlled trials (RCTs), epidemiology, and mechanistic studies. Secondly, the link between dietary fat quality and LDL particles is explained, drawing upon metabolic ward studies, controlled trials (randomized and non-randomized), and mechanistic studies. Thirdly, the link between dietary fat quality, LDL particles, and ASCVD is explained; drawing especially on RCTs in animals and humans, epidemiology, population-based changes, and experiments of nature. The authors conclude that based on the evidence, fat quality affects the risk of ASCVD risk mainly by modifying plasma LDL-C; our current dietary guidelines for fat build on the totality and strength of evidence; and and there is a low probability that these recommendations will fundamentally change in the future.
Culinary oils and their health effects
A briefing paper from the British Nutrition Foundation
Taking into consideration the totality of the scientific evidence, satisfying rigorous criteria for causality, the AHA conclude strongly that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD.
Dietary fat and cardiometabolic health: evidence, controversies, and consensus for guidance (BMJ)
This article takes a critical look at the evolution of scientific understanding about dietary fats and health, the difficulties of establishing public health dietary guidelines, and what the current advice should be for dietary fat consumption.
Saturated fatty acids, trans fatty acids and health
Scientific Advisory Committee on Nutrition Report on Saturated Fats and Health (2019)
Having examined the evidence, SACN concluded that reducing saturated fats reduces the risk of Cardiovascular Disease and Coronary Heart Disease events, lowers total, LDL and HDL cholesterol and improves indicators of glycaemic control. The evidence also indicates that reducing saturated fats is unlikely to increase health risks for the general UK population. SACN concluded that reducing population average saturated fat intakes from current levels of intake to no more than about 10% of [total] dietary energy would result in health benefits to the population.
Results of this systematic review show that replacing saturated fatty acids with other macronutrients, particularly polyunsaturated fatty acids, has a favourable effect on the blood lipid profile, including lowering of LDL cholesterol levels.
Draft WHO Guidelines: Saturated fatty acid and trans-fatty intake for adults and children (2018)
The objective of these guidelines is to provide recommendations on the intake of saturated fatty acids and trans-fatty acids to reduce the risk of CVDs in adults and children.
This systematic review and meta-analysis of randomised controlled trials (RCTs) and prospective cohort studies found that reducing children's saturated fatty acids intake resulted in a significant reduction in total and LDL-cholesterol levels as well as diastolic blood pressure without evidence of adverse effects on growth and development. Dietary guidelines for children and adolescents should continue to recommend diets low in saturated fat.
Poly- and mono-unsaturated fatty acids
Dietary Fatty Acids and Inflammation: Focus on the n-6 Series. Andrea Poli, Carlo Agostoni and Francesco Visioli. Int. J. Mol. Sci. 2023, 24, 4567. https://doi.org/10.3390/ijms24054567
This narrative review addressed the issue of whether n-6 PUFAs are pro-inflammatory and discussed the most recent evidence of their role(s) in human health and prognosis. The authors concluded that adequate intakes of n-6 fatty acids are associated with better cardiovascular health.
Despite concern being expressed that a high intake of dietary n-6 polyunsaturated fatty acid contributes to excess chronic inflammation, this systematic review concluded that virtually no evidence is available to show that the addition of linoleic acid to the diet increases the concentration of inflammatory markers in healthy, non-infant human beings.
In this pooled global analyses, higher in vivo circulating and tissue levels of linoleic acid and possibly arachidonic acid were associated with lower risk of major cardiovascular events. These results support a favourable role for LA in CVD prevention.
In prospective cohort studies, higher linoleic acid intake, assessed by dietary surveys or biomarkers, was associated with a modestly lower risk of mortality from all causes, CVD, and cancer. These data support the potential long-term benefits of PUFA intake in lowering the risk of CVD and premature death.
Coconut fat
This systematic review examined the effects of coconut oil consumption on blood lipids and other cardiovascular risk factors using data from clinical trials. Results from the meta-analysis, which included 16 articles, found that consuming coconut oil results in significantly higher LDL-cholesterol than nontropical vegetable oils. Coconut oil did not significantly affect markers of glycaemia, inflammation, and adiposity compared to nontropical vegetable oils.