Skip to main content Accessibility help

The confusion about dietary fatty acids recommendations for CHD prevention

  • Daan Kromhout (a1) (a2), Johanna M. Geleijnse (a1), Alessandro Menotti (a3) and David R. Jacobs (a2)

A recent meta-analysis of prospective cohort studies has not found an association between dietary saturated fat intake and CHD incidence. This funnelled the discussion about the importance of the recommendation to lower the intake of saturated fat for the prevention of CHD. At the same time a document of the European Food Safety Authority has suggested that specific quantitative recommendations are not needed for individual fatty acids but that more general statements can suffice. In this review, we discuss methodological aspects of the absence of association between SFA intake and CHD incidence in prospective cohort studies. We also summarise the results of the controlled dietary experiments on blood lipids and on CHD incidence in which saturated fat was replaced by either cis-unsaturated fat or carbohydrates. Finally, we propose a nutritionally adequate diet with an optimal fatty acid composition for the prevention of CHD in the context of dietary patterns. Such diets are characterised by a low intake of saturated fat, and as low as possible intake of trans-fat and fulfil the requirements for the intake of n-6 and n-3 fatty acids. No recommendation is needed for the intake of cis-MUFA.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      The confusion about dietary fatty acids recommendations for CHD prevention
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      The confusion about dietary fatty acids recommendations for CHD prevention
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      The confusion about dietary fatty acids recommendations for CHD prevention
      Available formats
Corresponding author
*Corresponding author: Professor D. Kromhout, fax +31 317 483342, email
Hide All
1Siri-Tarino, PW, Sun, Q, Hu, FB, et al. (2010) Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr 91, 535546.
2Siri-Tarino, PW, Sun, Q, Hu, FB, et al. (2010) Saturated fat, carbohydrate, and cardiovascular disease. Am J Clin Nutr 91, 502509.
3EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA) (2010) Scientific opinion on dietary reference values for fats, including saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, trans fatty acids, and cholesterol. EFSA J 8, 1107.
4Stamler, J (2010) Diet-heart: a problematic revisit. Am J Clin Nutr 91, 497499.
5Balogh, M, Kahn, HA & Medalie, JH (1971) Random repeat 24-hour dietary recalls. Am J Clin Nutr 24, 304310.
6Kannel, WB and Gordon, T (editors) (1970) The Framingham Study – an Epidemiological Investigation of Cardiovascular Disease. Section 24: The Framingham Diet Study: Diet and the Regulation of Serum Cholesterol. Washington, DC: US Department of Health, Education, and Welfare, PHS, NIH.
7Nichols, AB, Ravenscroft, C, Lamphiear, DE, et al. (1976) Daily nutritional intake and serum lipid levels. The Tecumseh Study. Am J Clin Nutr 29, 13841392.
8Kromhout, D (1983) Body weight, diet and serum cholesterol in 871 middle-aged men during 10 years of follow-up (The Zutphen Study). Am J Clin Nutr 38, 591598.
9Keys, A (1965) Dietary survey methods in studies on cardiovascular epidemiology. Voeding 26, 464483.
10Jacobs, DR Jr, Anderson, JT & Blackburn, H (1979) Diet and serum cholesterol – do zero correlations negate the relationship? Am J Epidemiol 110, 7787.
11Keys, A, Anderson, JT & Grande, F (1965) Serum cholesterol response to changes in diet. IV. Particular saturated fatty acids in the diet. Metabolism 14, 776787.
12Hegsted, DM, McGandy, RB, Myers, ML, et al. (1965) Quantitative effects of dietary fat on serum cholesterol in man. Am J Clin Nutr 17, 281295.
13Mensink, RP & Katan, MB (1992) Effect of dietary fatty acids on serum lipids and lipoproteins. A meta-analysis of 27 trials. Arterioscler Thromb 12, 911919.
14Jebb, SA, Lovegrove, JA, Griffin, BA, et al. (2010) Effect of changing the amount and type of fat and carbohydrate on insulin sensitivity and cardiovascular risk: the RISCK (Reading, Imperial, Surrey, Cambridge, and Kings) trial. Am J Clin Nutr 92, 748758.
15Micha, R & Mozaffarian, D (2010) Saturated fat and cardiometabolic risk factors, coronary heart disease, stroke, and diabetes: a fresh look at the evidence. Lipids 45, 893905.
16Mensink, RP, Zock, PL, Kester, ADM, et al. (2003) Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr 77, 11461155.
17Hayes, KC & Pronczuk, A (2010) Replacing trans fat: the argument for palm oil with a cautionary note on interesterification. J Am Coll Nutr 29, Suppl. 3, 253S284S.
18Sacks, FM & Katan, MB (2002) Randomized clinical trials on the effects of dietary fat and carbohydrate on plasma lipoproteins and cardiovascular disease. Am J Med 113, 13S24S.
19Mozaffarian, D, Micha, R & Wallace, S (2010) Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PLoS Med 7, e1000252.
20Ramsden, CE, Hibbeln, JR, Majchrzak, SF, et al. (2010) n-6 Fatty acid-specific and mixed polyunsaturate dietary interventions have different effects on CHD risk: a meta-analysis of randomised controlled trials. Br J Nutr 104, 1586–1560.
21McLennan, PL, Owen, AJ, Slee, EL, et al. (2007) Myocardial function, ischaemia and n-3 polyunsaturated fatty acids: a membrane basis. J Cardiovasc Med (Hagerstown) 8, Suppl. 1, 15S18S.
22Howard, BV, Van Horn, L, Hsia, J, et al. (2006) Low-fat dietary pattern and risk of cardiovascular disease: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA 295, 655666.
23Jakobsen, MU, Dethlefsen, C, Joensen, AM, et al. (2010) Intake of carbohydrates compared with intake of saturated fatty acids and risk of myocardial infarction: importance of the glycemic index. Am J Clin Nutr 91, 17641768.
24Lewis, B, Hammett, F, Katan, M, et al. (1981) Towards an improved lipid-lowering diet: additive effects of changes in nutrient intake. Lancet 2, 13101313.
25Jenkins, DJA, Kendall, CWC, Marchie, A, et al. (2005) Direct comparison of a dietary portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants. Am J Clin Nutr 81, 380387.
26Estruch, R, Martinez-Gonzalez, MA, Corella, D, et al. (2006) Effects of a Mediterranean-style diet on cardiovascular risk factors. A randomized trial. Ann Intern Med 145, 111.
27Jakobsen, MU, O'Reilly, EJ, Heitmann, BL, et al. (2009) Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. Am J Clin Nutr 89, 14251432.
28Oomen, CM, Ocke, MC, Feskens, EJM, et al. (2001) Association between trans fatty acid intake and 10-year risk of coronary heart disease in the Zutphen Elderly Study: a prospective population-based study. Lancet 357, 746751.
29Brouwer, IA, Katan, MB & Zock, PL (2004) Dietary alpha-linolenic acid is associated with reduced risk of fatal coronary heart disease, but increased prostate cancer risk: a meta-analysis. J Nutr 134, 919922.
30He, K, Song, Y, Daviglus, ML, et al. (2004) Accumulated evidence on fish consumption and coronary heart disease mortality: a meta-analysis of cohort studies. Circulation 109, 27052711.
31León, H, Shibata, MC, Sivakumaran, S, et al. (2008) Effect of fish oil on arrhythmias and mortality: systematic review. BMJ 337, a2931.
32Marik, PE & Varon, J (2009) Omega-3 dietary supplements and the risk of cardiovascular events: a systematic review. Clin Cardiol 32, 365372.
33Mozaffarian, D & Rimm, EB (2006) Fish intake, contaminants, and human health. Evaluating the risks and the benefits. JAMA 296, 18851899.
34U.S. Department of Health and Human Services and U.S. Department of Agriculture (2005) Dietary Guidelines for Americans, 6th ed.Washington, DC: U.S. Government Printing Office.
35Health Council of the Netherlands (2006) Guidelines for a healthy diet 2006. The Hague: Health Council of the Netherlands, 2006. Publication no. 2006/21E. ISBN 90-5549-656-3 (
36Elmadfa, I & Kornsteiner, M (2009) Fats and fatty acid requirements for adults. Ann Nutr Metab 55, 5675.
37Harris, WS, Mozaffarian, D, Rimm, E, et al. (2009) Omega-6 fatty acids and risk for cardiovascular disease. A scientific advisory from the American Heart Association Nutrition subcommittee of the Council on Nutrition, Physical activity, and Metabolism; Council on Cardiovascular Nursing; and Council on Epidemiology and Prevention. Circulation 119, 902907.
38Keys, A (1970) Coronary heart disease in seven countries. Circulation 41, Suppl. 1, 1S211S.
39Menotti, A, Kromhout, D, Blackburn, H, et al. (1999) Food intake patterns and 25-year mortality from coronary heart disease: cross-cultural correlations in the Seven Countries Study. Eur J Epidemiol 6, 315319.
40Kromhout, D, Keys, A, Aravanis, C, et al. (1989) Food consumption patterns in the 1960 s in seven countries. Am J Clin Nutr 49, 889894.
41Jacobs, DR Jr & Steffen, LM (2003) Nutrients, foods, and dietary patterns as exposures in research: a framework for food synergy. Am J Clin Nutr 78, Suppl. 3, 508S513S.
42Mozaffarian, D & Ludwig, DS (2010) Dietary guidelines in the 21st century – a time for food. JAMA 304, 681682.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
  • URL: /core/journals/british-journal-of-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed