Saturated fats and health: A reassessment and proposal for food-based recommendations: JACC state-of-the-art review

Authors: ASTRUP, ARNE - University Of Copenhagen; MAGKOS, FAIDON - University Of Copenhagen; Bier, Dennis; BRENNA, J. THOMAS - University Of Texas At Austin; DE OLIVEIRA OTTO, MARCIA - University Of Texas Health Science Center; HILL, JAMES - University Of Alabama At Birmingham; KING, JANET - University Of California; MENTE, ANDREW - McMaster University; ORDOVAS, JOSE - Boston University; VOLEK, JEFF - The Ohio State University; DPHIL, SALIM YUSUF - McMaster University; KRAUSS, RONALD - University Of California

Submitted to: Journal of the American College of Cardiology
Publication Type: Review Article
Publication Acceptance Date: 5/12/2020
Publication Date: 6/17/2020
Citation: Astrup, A., Magkos, F., Bier, D.M., Brenna, J., De Oliveira Otto, M.C., Hill, J.O., King, J.C., Mente, A., Ordovas, J.M., Volek, J.S., Dphil, S., Krauss, R.M. 2020. Saturated fats and health: A reassessment and proposal for food-based recommendations: JACC state-of-the-art review. Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2020.05.077.
DOI: https://doi.org/10.1016/j.jacc.2020.05.077

Interpretive Summary:

Technical Abstract: The recommendation to limit dietary saturated fatty acid (SFA) intake has persisted despite mounting evidence to the contrary. Most recent meta-analyses of randomized trials and observational studies found no beneficial effects of reducing SFA intake on cardiovascular disease (CVD) and total mortality, and instead found protective effects against stroke. Although SFAs increase low-density lipoprotein (LDL)-cholesterol, in most individuals, this is not due to increasing levels of small, dense LDL particles, but rather larger LDL which are much less strongly related to CVD risk. It is also apparent that the health effects of foods cannot be predicted by their content in any nutrient group, without considering the overall macronutrient distribution. Whole-fat dairy, unprocessed meat, eggs and dark chocolate are SFA-rich foods with a complex matrix that are not associated with increased risk of CVD. The totality of available evidence does not support further limiting the intake of such foods. Overall, the results of randomized clinical trials and observational cohort studies do not support a rationale for population-wide restriction of dietary saturated fat to a target below current intake levels. Furthermore, lower cardiovascular disease risk cannot be confidently inferred from reduction in plasma low-density lipoprotein cholesterol concentrations induced by such a dietary restriction. Conversely, a reciprocal increase in carbohydrate intake can lead to unfavorable changes in cardiometabolic risk factors. A food-based approach to guiding saturated fat intake is warranted particularly since foods have a complex matrix, and their health effects cannot be predicted by the content of any individual nutrient.