In an editorial published in the British Journal of Sports Medicine, researchers report that saturated fat does not increase the risk of a heart attack by clogging up arteries and the risk of coronary heart disease can be reduced by healthy lifestyle interventions.
Dr David Nunan, Senior Researcher at the Centre for Evidence Based Medicine, University of Oxford, said:
“A number of recently published articles have concluded that associations between high cholesterol and premature death are lacking and call for current public health guidance advocating low saturated fat consumption to be revised. This latest opinion editorial published in the BJSM advocates a similar call and highlights selected evidence in support. However, the authors do not address concerns with the quality of the evidence presented and fail to highlight contradictory evidence.
“Much of the evidence the editorial authors cite for a lack of association between self-reported saturated fat intake and coronary heart disease is observational, which is considered low quality evidence according to best practice evidence-based methods due to the increased potential for bias in these types of studies. Indeed, one of the studies cited in the editorial noted the quality of evidence to be ‘very low’, indicating that the results are very uncertain.
“A high quality meta-analysis of available randomised controlled trials (which provide the highest level of evidence for cause and effect associations) found moderate quality evidence that reducing dietary saturated fat lowered the risk of cardiovascular events (for every 100 people on a lower saturated fat diet 7 of them had fewer cardiovascular events). However, there was no statistical effect on all-cause and cardiovascular mortality, risk of myocardial infarction, and stroke, compared to usual diet. The reduction in cardiovascular events was observed in the studies replacing saturated fat with polyunsaturated fat.
“The editorial also highlights evidence from randomised controlled trial suggesting diets high in mono- and poly-unsaturated fats and reduced saturated fat are better for preventing cardiovascular disease and supports the current consensus of a beneficial effect of reduced dietary saturated fat and replacement with mono- and poly-unsaturated fat in the general population.
“An encouraging element of the editorial is repetition of the current consensus for healthy lifestyle interventions including physical activity and management of stress, though the source and quality of evidence for the specific recommendation of 22 minutes of walking is not given.
“Whilst an open and honest discourse of the evidence-base underpinning our understanding of the relationship between dietary fat and human health is much needed, such discourse must consider the totality of the evidence-base and the inherent uncertainty with nutritional epidemiological studies and trials. The latest opinion editorial overlooks this complexity and uncertainty.
“There is also growing consensus for a balanced discussion of dietary patterns and behaviours away from individual macronutrients that considers collaborative efforts for improving the evidence-base and our understanding of the complex relationship between diet and health.”
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