AHA 2017 Presidential Advisory on Dietary Fats and CV Disease

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Eddy Edson

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Relationship to Diabetes
Type 2
https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000510

Just because it's a nuanced, detailed review of the evidence. Main conclusions (p17):

• Randomized clinical trials showed that polyunsaturated fat from vegetable oils replacing saturated fats from dairy and meat lowers CVD.
• A dietary strategy of reducing intake of total dietary fat, including saturated fat, and replacing the fats mainly with unspecified carbohydrates does not prevent CHD.
• Prospective observational studies in many populations showed that lower intake of saturated fat coupled with higher intake of polyunsaturated and monounsaturated fat is associated with lower rates of CVD and all-cause mortality.
• Saturated fat increases LDL cholesterol, a major cause of atherosclerosis and CVD, and replacing it with polyunsaturated or monounsaturated fat decreases LDL cholesterol
• Replacing saturated with polyunsaturated or monounsaturated fat lowers blood triglyceride levels, an independent biomarker of risk for CVD.
• Replacing saturated with polyunsaturated fat prevents and regresses atherosclerosis in nonhuman primates.
• Overall, evidence supports the conclusion that polyunsaturated fat from vegetable oils (mainly n-6, linoleic acid) reduces CVD somewhat more than monounsaturated fat (mainly oleic acid) when replacing saturated fat.

Evidence has accumulated during the past several years that strengthens long-standing AHA recommendations to replace saturated fat with polyunsaturated and monounsaturated fat to lower the incidence of CVD. Reduction in total dietary fat or a goal for total fat intake is not recommended. This shift from saturated to unsaturated fats should occur simultaneously in an overall healthful dietary pattern such as the DASH or Mediterranean diet as emphasized by the 2013 AHA/American College of Cardiology lifestyle guidelines and the 2015 to 2020 Dietary Guidelines for Americans.
 
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