(27-02-2018) Saturated fat, carbohydrate, and cardiovascular disease

Patty W Siri-Tarino
1
From the Department of Atherosclerosis Research Children’s Hospital Oakland Research Institute Oakland CA (PWS-TRMK); the Center for Excellence in Nutritional Genomics University of California at Davis Davis CA (PWS-TRMK);the Departments of Nutrition (QS)Epidemiology (FBH) Harvard School of Public Health Boston MA
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Patty W Siri-Tarino
Qi Sun
1
From the Department of Atherosclerosis Research Children’s Hospital Oakland Research Institute Oakland CA (PWS-TRMK); the Center for Excellence in Nutritional Genomics University of California at Davis Davis CA (PWS-TRMK);the Departments of Nutrition (QS)Epidemiology (FBH) Harvard School of Public Health Boston MA
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Qi Sun
Frank B Hu
1
From the Department of Atherosclerosis Research Children’s Hospital Oakland Research Institute Oakland CA (PWS-TRMK); the Center for Excellence in Nutritional Genomics University of California at Davis Davis CA (PWS-TRMK);the Departments of Nutrition (QS)Epidemiology (FBH) Harvard School of Public Health Boston MA
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Frank B Hu
Ronald M Krauss
1
From the Department of Atherosclerosis Research Children’s Hospital Oakland Research Institute Oakland CA (PWS-TRMK); the Center for Excellence in Nutritional Genomics University of California at Davis Davis CA (PWS-TRMK);the Departments of Nutrition (QS)Epidemiology (FBH) Harvard School of Public Health Boston MA

4
Address correspondence to RM Krauss, Children’s Hospital Oakland Research Institute, 5700 Martin Luther King Junior Way, Oakland, CA 94609. E-mail: [email protected].
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Ronald M Krauss
2
The contents are solely the responsibility of the authors and do not necessarily represent the official view of the National Center for Research Resources or the National Institutes of Health. Information on the NCRR is available at http://www.ncrr.nih.gov/.
Author Notes
The American Journal of Clinical Nutrition, Volume 91, Issue 3, 1 March 2010, Pages 502–509, https://doi.org/10.3945/ajcn.2008.26285


ABSTRACT
A focus of dietary recommendations for cardiovascular disease (CVD) prevention and treatment has been a reduction in saturated fat intake, primarily as a means of lowering LDL-cholesterol concentrations. However, the evidence that supports a reduction in saturated fat intake must be evaluated in the context of replacement by other macronutrients. Clinical trials that replaced saturated fat with polyunsaturated fat have generally shown a reduction in CVD events, although several studies showed no effects. An independent association of saturated fat intake with CVD risk has not been consistently shown in prospective epidemiologic studies, although some have provided evidence of an increased risk in young individuals and in women. Replacement of saturated fat by polyunsaturated or monounsaturated fat lowers both LDL and HDL cholesterol. However, replacement with a higher carbohydrate intake, particularly refined carbohydrate, can exacerbate the atherogenic dyslipidemia associated with insulin resistance and obesity that includes increased triglycerides, small LDL particles, and reduced HDL cholesterol. In summary, although substitution of dietary polyunsaturated fat for saturated fat has been shown to lower CVD risk, there are few epidemiologic or clinical trial data to support a benefit of replacing saturated fat with carbohydrate. Furthermore, particularly given the differential effects of dietary saturated fats and carbohydrates on concentrations of larger and smaller LDL particles, respectively, dietary efforts to improve the increasing burden of CVD risk associated with atherogenic dyslipidemia should primarily emphasize the limitation of refined carbohydrate intakes and a reduction in excess adiposity.

Source: https://academic.oup.com/ajcn/article/91/3/502/4597078

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