Abstract
This
roundtable discussion on dietary fats was inspired by a recent
Presidential Advisory from the American Heart Association giving
recommendations about dietary fats for prevention of atherosclerotic
cardiovascular disease. The Advisory clarifies a long-held position that
saturated fat should be reduced in the American diet. New studies and
meta-analyses have questioned the adverse role of saturated fat. The
Advisory adds a crucial clarification based primarily on 4 randomized
controlled diet trials, each conducted over 4 to 8 years during the
1960s extending to the 1970s. In each trial, saturated fat was reduced
and replaced by vegetable oil rich in polyunsaturated fat (PUFA).
Meta-analysis showed 29% reduction in major coronary events in the
groups receiving PUFAs. Randomized clinical trials provide the best kind
of evidence. Replacing saturated fat with PUFA reduces cardiovascular
events. Replacing saturated fats with carbohydrates or trans
fats does not reduce cardiovascular events. Cardiovascular risk
reduction has also been seen in randomized trials with monounsaturated
fat in the context of whole food diets, mostly plant based
(Mediterranean diets). In this discussion, we additionally cover some of
the roller-coaster history of recommendations concerning dietary fat
and provide advice for practical counseling.
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