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Cited by 543Fatty Acid Research and HealthNutritional Studies and DietDiet, Metabolism, and Disease

Saturated Fat and Cardiometabolic Risk Factors, Coronary Heart Disease, Stroke, and Diabetes: a Fresh Look at the Evidence

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Micha, Renata, Mozaffarian, Dariush·2010·Lipids
DOI 10.1007/s11745-010-3393-4PMC PMC2950931
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Abstract

Dietary and policy recommendations frequently focus on reducing saturated fatty acid consumption for improving cardiometabolic health, based largely on ecologic and animal studies. Recent advances in nutritional science now allow assessment of critical questions about health effects of saturated fatty acids (SFA). We reviewed the evidence from randomized controlled trials (RCTs) of lipid and non‐lipid risk factors, prospective cohort studies of disease endpoints, and RCTs of disease endpoints for cardiometabolic effects of SFA consumption in humans, including whether effects vary depending on specific SFA chain‐length; on the replacement nutrient; or on disease outcomes evaluated. Compared with carbohydrate, the TC:HDL‐C ratio is nonsignificantly affected by consumption of myristic or palmitic acid, is nonsignificantly decreased by stearic acid, and is significantly decreased by lauric acid. However, insufficient evidence exists for different chain‐length‐specific effects on other risk pathways or, more importantly, disease endpoints. Based on consistent evidence from human studies, replacing SFA with polyunsaturated fat modestly lowers coronary heart disease risk, with ~10% risk reduction for a 5% energy substitution; whereas replacing SFA with carbohydrate has no benefit and replacing SFA with monounsaturated fat has uncertain effects. Evidence for the effects of SFA consumption on vascular function, insulin resistance, diabetes, and stroke is mixed, with many studies showing no clear effects, highlighting a need for further investigation of these endpoints. Public health emphasis on reducing SFA consumption without considering the replacement nutrient or, more importantly, the many other food‐based risk factors for cardiometabolic disease is unlikely to produce substantial intended benefits.

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  • Saturated fat and carbohydrates affect the ratio of total to HDL cholesterol in similar ways.

    “Similar effects of SFA and carbohydrates on the ratio of total to HDL cholesterol have been documented, and may contribute to this finding.139,143,144”

    From Components of a Cardioprotective Diet: New Insights (2011) · cites this paper as [144]

  • Most diets contain high proportions of refined carbohydrates.

    “On the basis of these findings and high proportions of refined carbohydrates in most diets, a focus on reducing SFA consumption, traditionally a major public health goal, needs to be paired with decreasing consumption of refined carbohydrates, starches, and sugars.141,144”

    From Components of a Cardioprotective Diet: New Insights (2011) · cites this paper as [144]

  • Observational cohorts and randomized trials confirm that diets focused on isolated nutrient targets, such as low-fat, low-saturated fat diets, produce no significant benefits on cardiovascular disease, diabetes, or insulin resistance.

    “In comparison, both observational cohorts and randomized trials confirm little clinical benefit of diets focused on isolated nutrient targets, such as low-fat, low-saturated fat diets, which produce no significant benefits on cardiovascular disease, diabetes, or insulin resistance.36-39”

    From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [38]

  • The large WHI randomized trial substantially lowered total dietary fat among nearly 50,000 US women followed for nearly a decade, and did not show benefits for any major endpoint including heart disease, stroke, cancers, diabetes, or insulin resistance.

    “The large WHI randomized trial substantially lowered total dietary fat among nearly 50,000 US women followed for nearly a decade, and did not show benefits for any major endpoint including heart disease (Figure 2, top panel), stroke, cancers, diabetes, or insulin resistance.36-39”

    From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [38]

  • Total monounsaturated fat intake is not associated with lower incidence of diabetes; associates with trends toward greater CVD in some cohort studies; and increases atherosclerosis in primate experiments.

    “Yet, total monounsaturated fat intake is not associated with lower incidence of diabetes;355 associates with trends toward greater CVD in some cohort studies;155 and increases atherosclerosis in primate experiments, potentially due to enrichment of LDL cholesteryl oleate and increased LDL proteoglycan binding.356”

    From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [355]

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Authors
Micha, R., & Mozaffarian, D.
Affiliations
  • Harvard University (US)
  • Brigham and Women's Hospital (US)
Corresponding author
Mozaffarian, Dariush
ORCID
Venue
Lipids
Publisher
Wiley
Published
2010-03-31
Volume
45
Issue
10
Pages
893-905
ISSN
  • 0024-4201 (ISSN-L)
  • 1558-9307
DOI
10.1007/s11745-010-3393-4
PMC
PMC2950931
OpenAlex
W2125288278
Cited by
543
References
95
Citations by year
2026: 8 · 2025: 21 · 2024: 36 · 2023: 28 · 2022: 31 · 2021: 34 · 2020: 31 · 2019: 42 · 2018: 44 · 2017: 25 · 2016: 52 · 2015: 51 · 2014: 56 · 2013: 34 · 2012: 28
FWCI
2.97
Type
journal article
Language
en
Open access
Licence
Locations
  • Lipids (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
Funders
Bill and Melinda Gates Foundation
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
Keywords
saturated fatty acids, cardiometabolic risk, coronary artery disease, stroke, diabetes mellitus, fat replacement, polyunsaturated fat, monounsaturated fatty acids, myristic acid, palmitic acid, lauric acid, stearic acid, TC/HDL-C ratio, insulin resistance, vascular function, dietary recommendations
MeSH terms
Cardiovascular Diseases, Diabetes Mellitus, Dietary Fats, Fatty Acids, Humans, Public Health, Risk Factors, Stroke

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