A Scoping Review of Current Guidelines on Dietary Fat and Fat Quality

Introduction: We conducted a scoping review of dietary guidelines with the intent of developing a position paper by the “IUNS Task force on Dietary Fat Quality” tasked to summarize the available evidence and provide the basis for dietary recommendations. Methods: We systematically searched several databases and Web sites for relevant documents published between 2015 and 2019. Results: Twenty documents were included. Quantitative range intake recommendations for daily total fat intake included boundaries from 20 to 35% of total energy intake (TEI), for monounsaturated fat (MUFA) 10–25%, for polyunsaturated fat (PUFA) 6–11%, for saturated-fat (SFA) ≤11–≤7%, for industrial trans-fat (TFA) ≤2–0%, and <300–<200 mg/d for dietary cholesterol. The methodological approaches to grade the strength of recommendations were heterogeneous, and varied highly between the included guidelines. Only the World Health Organization applied the GRADE approach and graded the following recommendation as “strong”: to reduce SFA to below 10%, and TFA to below 1% and replace both with PUFA if SFA intake is greater than 10% of TEI. Conclusion: Although the methodological approaches of the dietary guidelines were heterogeneous, most of them recommend total fat intakes of 30–≤35% of TEI, replacement of SFA with PUFA and MUFA, and avoidance of industrial TFA.

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Effects of Diet on Blood Lipids In Man

Clinical Chemistry ◽

10.1093/clinchem/1.1.34 ◽

1955 ◽

Vol 1 (1) ◽

pp. 34-52 ◽

Cited By ~ 50

Author(s):

Ancel Keys ◽

Joseph T Anderson ◽

Flaminio Fidanza ◽

Margaret Haney Keys ◽

Bengt Swahn

Keyword(s):

Serum Cholesterol ◽

Dietary Fat ◽

Blood Lipids ◽

Dietary Cholesterol ◽

Average Concentration ◽

Cholesterol Concentration ◽

Calorie Intake ◽

Serum Cholesterol Concentration ◽

Per Se ◽

Total Fat

Abstract 1. Lipids exist in the blood serum as emulsions ("chylomicrons") and as solutions of lipoprotein containing proteins, cholesterol, and other lipids. Interest in relation to atherosclerosis is centered on the cholesterol and the beta lipoproteins which contain most of the cholesterol. 2. The diet influences the blood lipids in man and animals but great quantitative differences between species makes it essential to study man himself to discover the effects of the diet on the blood lipids in man. 3. The amount of lipid in the chylomicron form in the serum is practically independent of the concentration of cholesterol and lipoproteins in the serum. The correlation between the concentrations of alpha and beta lipoproteins is very low. 4. Experiments on man show that dietary cholesterol per Se, even in large amount, has no important influence on the serum cholesterol concentration but that the latter is markedly affected by the total fat content of the diet. 5. Calorie intake per se has little influence on the blood lipids. Such effect as it has may be secondary to fat metabolism differences commonly associated with differences in calorie intakes. 6. Studies on population samples of healthy men show a marked direct relationship between the content or proportion of fat in the diet on the one hand and the concentration of total cholesterol and of beta lipoproteins in the serum on the other. The effect of the diet tends to be greater in middle-aged men than in younger men. 7. The average concentration of cholesterol in the serum of men in areas where the diets are very high in fats (of the order of 40 per cent of calories), is 25 to 50 per cent greater than the average in areas where the diets are low in fats (of the order of 20 per cent, or less, of calories). 8. A significant effect of dietary fat level on the serum cholesterol concentration is evident in man in a few weeks on a changed diet. The effect tends to increase very slowly with time thereafter and it is most pronounced when comparison is made between populations habitually subsisting on different diets. 9. It is not known how the dietary fat intake exerts its controlling influence on the blood lipids of man but the mechanisms must be complex.

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Consumers’ Understanding of the Dietary Guidelines for Americans: Insights into the Future

Health Education & Behavior ◽

10.1177/109019810202900111 ◽

2002 ◽

Vol 29 (1) ◽

pp. 124-135 ◽

Cited By ~ 19

Author(s):

Debra Palmer Keenan ◽

Rayane AbuSabha ◽

Natalie G. Robinson

Keyword(s):

Health Information ◽

Dietary Fat ◽

Dietary Guidelines ◽

Twin Cities ◽

Health Educators ◽

Dietary Guidelines For Americans ◽

The Media ◽

Total Fat ◽

Nutrition Messages ◽

Behavior Health

The purpose of this study was to examine consumers’ knowledge and understanding of the 1995 Dietary Guidelines for Americans and the sources from where consumers obtain their health information. A telephone survey was administered to 400 adults in the Twin Cities area in Minnesota. The number of guideline recommendations recalled per person was, on average, less than 2.5 of a total of 13 recommendations. Participants had difficulties interpreting the guidelines. Knowledge of the dietary fat guideline was especially poor. Only 17% of survey participants correctly stated the amount of total fat they should have in their diet. The total number of media sources used to obtain health information was the variable that best explained the variance in knowledge of the Dietary Guidelines recommendations. To effectively change dietary behavior, health educators must work effectively with the media to develop behavior-focused nutrition messages that are meaningful and clear to consumers.

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Abstract P358: Dietary Fat Quality and Risk of CHD in the 28 Year Follow-up of a Large Prospective Study of US Women

Circulation ◽

10.1161/circ.125.suppl_10.ap358 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Stephanie E Chiuve ◽

Frank B Hu ◽

Christine M Albert ◽

Kathryn M Rexrode ◽

JoAnn E Manson ◽

...

Keyword(s):

Dietary Fat ◽

Disease Risk ◽

Saturated Fat ◽

Health Study ◽

Fat Intake ◽

Polyunsaturated Fat ◽

Fat Quality ◽

Nutrient Density ◽

Chd Risk ◽

Total Fat

Background: The importance of fat quality is reflected in the recent 2010 Dietary Guidelines for Americans, which recommend reducing saturated fat intake, and replacing this with polyunsaturated fat. Health effects of dietary fat are often estimated as an isocaloric substitution with carbohydrates (nutrient density models). Expressing fat intake as a % of total fat instead better quantifies fat quality, in overall diet and individual foods, and may provide an alternative approach to evaluate associated disease risk. We evaluated this novel measure of dietary fat quality, the % of fat type relative to total fat intake, on CHD risk among women in the Nurses' Health Study. Methods: We followed 84,531 women, free of chronic disease at baseline, from 1980-2008. Data on diet and other factors were ascertained every 2-4 years via questionnaires. For saturated and polyunsaturated fats, fat quality was calculated as grams of fat type / grams of total fat, and included in Cox proportional hazards models with total fat (fat density model), to estimate the association between fat intake and risk of CHD. We also estimated these associations using traditional nutrient density models, with isocaloric replacement of fat with carbohydrates. Results: Over 28 years, there were 3373 cases of CHD. A greater proportion of fat intake as saturated fat was associated with higher risk of CHD (p, trend<0.001) ( Table ). Conversely, a greater proportion of fat intake as polyunsaturated fat was associated with lower risk (p, trend<0.001), which was seen for both N-6 and N-3 fats. Compared with nutrient density models, RR obtained from fat density models were greater in magnitude for saturated and N-3 fats, but similar in magnitude for total and N-6 polyunsaturated fat. Conclusions: Saturated and polyunsaturated fat, quantified as a % of total fat, were significantly associated with CHD risk. This novel measure of dietary fat may aid in the translation of dietary recommendations of fat quality and may provide guidance in distinguishing foods based on fat quality.

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A high energy intake from dietary fat among middle-aged and older adults is associated with increased risk of malnutrition 10 years later

British Journal Of Nutrition ◽

10.1017/s0007114515002317 ◽

2015 ◽

Vol 114 (6) ◽

pp. 915-923 ◽

Cited By ~ 5

Author(s):

Lisa Söderström ◽

Andreas Rosenblad ◽

Eva T. Adolfsson ◽

Alicja Wolk ◽

Niclas Håkansson ◽

...

Keyword(s):

Older Adults ◽

Energy Intake ◽

Dietary Fat ◽

High Energy ◽

Fat Intake ◽

Monounsaturated Fat ◽

Middle Aged ◽

High Energy Intake ◽

Total Fat

AbstractA higher fat content in the diet could be an advantage for preventing malnutrition among older adults. However, there is sparse scientific evidence to determine the optimal fat intake among older adults. This prospective cohort study examined whether a high energy intake of dietary fat among middle-aged and older adults is associated with the risk of malnutrition 10 years later. The study population comprised 725 Swedish men and women aged 53–80 years who had completed a questionnaire about dietary intake and lifestyle factors in 1997 (baseline) and whose nutritional status was assessed when admitted to the hospital in 2008–2009 (follow-up). At the follow-up, 383 (52·8 %) participants were identified as being at risk of malnutrition and fifty-two (7·2 %) were identified as malnourished. Multinomial logistic regression models were used to analyse the association between previous dietary fat intake and nutritional status later in life. Contrary to what was expected, a high energy intake from total fat, saturated fat and monounsaturated fat among middle-aged and older adults increased the risk of exhibiting malnutrition 10 years later. However, this applied only to individuals with a BMI<25 kg/m2 at the baseline. In conclusion, these findings suggest that preventive actions to counteract malnutrition in older adults should focus on limiting the intake of total fat in the diet by reducing consumption of food with a high content of saturated and monounsaturated fat.

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Time trends in dietary fat intake in a sample of German children and adolescents between 2000 and 2010: not quantity, but quality is the issue

British Journal Of Nutrition ◽

10.1017/s0007114513002031 ◽

2013 ◽

Vol 111 (1) ◽

pp. 141-150 ◽

Cited By ~ 14

Author(s):

Lars Libuda ◽

Ute Alexy ◽

Mathilde Kersting

Keyword(s):

Children And Adolescents ◽

Dietary Fat ◽

Repeated Measures ◽

Time Trends ◽

Age Groups ◽

Fat Intake ◽

Fat Quality ◽

Dietary Fat Intake ◽

Total Fat ◽

German Children

Dietary fat intake in childhood may influence the risk for developing chronic diseases. The objective of the present study was to examine secular trends in the parameters of fat intake between 2000 and 2010 in a sample of German children and adolescents (n 808) participating in the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study. Dietary data from 4380 3 d weighed dietary records were analysed using repeated-measures regression to determine time trends in fat quantity, i.e. the intake of total fat, and in fat quality, i.e. the ratios of SFA, MUFA and PUFA. In young children (2–3 years) and in adolescents (13–18 years), total fat intake remained stable over time, but decreased by 0·08 % of total energy (%E) per year in 4–12-year-old children. In 2010, median fat intake was at the upper end of the recommendations. SFA intake decreased slightly in 2–3- and 4–12-year-old children by 0·09 and 0·05 %E per year, respectively. MUFA and PUFA intakes remained stable in all the age groups except in adolescents. Here, PUFA intake decreased initially, but increased between 2005 and 2010. In 2010, only between 3 and 18 % of the respective age groups had an intake of SFA or PUFA within the recommendations. In conclusion, fat quantity and quality did not change substantially between 2000 and 2010. Fat quality, in particular, needs to be improved, since a large percentage of our sample did not meet the recommended intakes for SFA and PUFA.

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Total Dietary Fat Intake, Fat Quality, and Health Outcomes: A Scoping Review of Systematic Reviews of Prospective Studies

Annals of Nutrition and Metabolism ◽

10.1159/000515058 ◽

2021 ◽

pp. 1-12

Author(s):

Lukas Schwingshackl ◽

Jasmin Zähringer ◽

Jessica Beyerbach ◽

Sarah W. Werner ◽

Helmut Heseker ◽

...

Keyword(s):

Fatty Acid ◽

Health Outcomes ◽

Cohort Studies ◽

Systematic Reviews ◽

Scoping Review ◽

Dietary Fat ◽

Prospective Cohort ◽

Fat Intake ◽

Prospective Cohort Studies ◽

Fat Quality

Introduction: We conducted a scoping review of systematic reviews (SRs) on dietary fat intake and health outcomes in human adults within the context of a position paper by the “International Union of Nutritional Sciences Task force on Dietary Fat Quality” tasked to summarize the available evidence and provide dietary recommendations. Methods: We systematically searched several databases for relevant SRs of randomized controlled trials (RCTs) and/or prospective cohort studies published between 2015 and 2019 assessing the association between dietary fat and health outcomes. Results: Fifty-nine SRs were included. The findings from SRs of prospective cohort studies, which frequently compare the highest versus lowest intake categories, found mainly no association of total fat, monounsaturated fatty acid (MUFA), polyunsaturated fatty acid (PUFA), and saturated fatty acid (SFA) with risk of chronic diseases. SRs of RCTs applying substitution analyses indicate that SFA replacement with PUFA and/or MUFA improves blood lipids and glycemic control, with the effect of PUFA being more pronounced. A higher intake of total trans-fatty acid (TFA), but not ruminant TFA, was probably associated with an increased risk of mortality and cardiovascular disease based on existing SRs. Conclusion: Overall, the available published evidence deems it reasonable to recommend replacement of SFA with MUFA and PUFA and avoidance of consumption of industrial TFA.

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Abstract MP12: Dietary Fatty Acids and Risk of Incident Atrial Fibrillation in the Women’s Health Study

Circulation ◽

10.1161/circ.129.suppl_1.mp12 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Stephanie E Chiuve ◽

Roopinder K Sandhu ◽

M. V Moorthy ◽

Robert J Glynn ◽

Christine M Albert

Keyword(s):

Atrial Fibrillation ◽

Women’S Health ◽

Women's Health ◽

Dietary Fat ◽

Saturated Fat ◽

Dietary Guidelines ◽

Dietary Fatty Acids ◽

Dietary Fats ◽

Health Study ◽

Monounsaturated Fat

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and a major risk factor for stroke, heart failure and mortality. Dietary fats may have effects on biologic pathways involved in inflammation, fibrosis, and cellular electrophysiology that influence the development and maintenance of AF. Prior studies evaluating the relationship between N-3 polyunsaturated fats and total AF events have had inconsistent results. Furthermore, few studies have reported the association between other dietary fats and incident AF or whether associations might differ by AF pattern. Methods: We followed 33,041 initially healthy women from the Women's Health Study, who were >45 years and free of AF at baseline in 1993. Intake of individual fats was calculated from a food frequency questionnaire administered at baseline. Self-reported AF was confirmed by EKG and medical record review. We defined AF patterns as paroxysmal (self-terminating for <7 days and no cardioversion), persistent (sustained >7 days and/or required cardioversion) and chronic (cardioversion failed / not attempted). Patterns were classified according to the most severe pattern within 2 years of AF onset and we combined persistent and chronic AF for analysis. We used isocaloric multivariable Cox proportional hazards models, adjusting for diet, lifestyle and clinical CVD risk factors, with a competing risk framework to evaluate whether dietary fats share equal associations across various AF patterns. Results: We documented 1286 cases of AF (821 paroxysmal & 423 persistent/chronic) over a median follow-up of 17.4 years. There was no significant association between any dietary fat and risk of incident AF. Saturated fat was associated with higher risk, and monounsaturated fat with lower risk of persistent/chronic AF. The RR (95%CI) for a substitution of 5% of energy from saturated fat for an equal percentage of energy from carbohydrates was 1.47 (1.02, 2.12) for persistent/chronic AF and 0.84 (0.64, 1.10) for paroxysmal AF (p, diff = 0.01). For monounsaturated fat, the RR for a 5% increment was 0.67 (0.45, 0.98) for persistent/chronic AF and 0.86 (0.73, 1.27) for paroxysmal AF, although the difference between patterns did not reach significance (p, diff = 0.12). Intake of N-3 and n-6 polyunsaturated fat and trans fat were not differentially associated with risk of paroxysmal or persistent/chronic AF. Conclusions: We observed no association between subclasses of dietary fat intake and total AF risk. Saturated fat was positively and monounsaturated fat was inversely associated with risk of persistent/chronic AF. Thus, improving dietary fat quality may help in the prevention of sustained forms of AF, which are often less amenable to treatment and associated with higher rates of morbidity. These results support AHA dietary guidelines to decrease intake of saturated fat for overall cardiovascular health.

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The role of unprocessed beef and lamb in the diets of Irish children and teenagers (5–17 years)

Proceedings of The Nutrition Society ◽

10.1017/s0029665120004012 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Jacqueline Lyons ◽

Christopher Cocking ◽

Laura Kehoe ◽

Breige McNulty ◽

Anne Nugent ◽

...

Keyword(s):

Vitamin D ◽

Dietary Intake ◽

Vitamin B12 ◽

Saturated Fat ◽

Dietary Guidelines ◽

Monounsaturated Fat ◽

Nutrient Intakes ◽

Food Composition Tables ◽

Total Fat ◽

Daily Intakes

AbstractIntroductionMeat is a nutrient-dense food that plays a central role in the diets of many children globally, contributing significantly to intakes of energy, protein and a number of essential micronutrients. However, nutritive quality is variable across meat types and cuts, and dietary guidelines across Europe typically encourage the consumption of lean meats whilst limiting the consumption of processed meats. The current work aimed to estimate intakes of unprocessed beef and lamb and their contribution to nutrient intakes in Irish children and teenagers.MethodsAnalyses were based on data from the Irish National Children's Food Survey (NCFS) (2003–2004; 5–12 years; n 594) and National Teens’ Food Survey (NTFS) (2005–2006; 13–17 years; n 441) (www.iuna.net). Both surveys used a 7-day weighed (NCFS) or semi-weighed (NTFS) food record to collect dietary intake data from nationally representative samples of Irish children. Dietary intake data were converted to nutrient data using WISP©, based on UK and Irish food composition tables. Unprocessed beef and lamb was defined as beef or lamb that had not undergone any preserving process other than chilling, freezing or salting, and included beef or lamb dishes that were wrapped in a controlled atmosphere. Meat intakes from composite dishes (e.g. beef lasagne) were estimated following disaggregation of the non-meat components. Statistical analyses were carried out using SPSS© v23.0.ResultsUnprocessed beef was consumed by 79% of children and 83% of teenagers, while unprocessed lamb was consumed by 19% of children and 20% of teenagers. Mean daily intakes of unprocessed beef were 21 g and 34 g in children and teenagers (consumers only), while mean daily intakes of unprocessed lamb were 14 g and 23 g. Unprocessed beef and lamb contributed 5–6% to mean daily energy intakes and contributed the following proportions to daily nutrient intakes in children and teenagers, respectively: protein (11%, 15%), total fat (7%, 9%), saturated fat (7%, 10%), monounsaturated fat (9%, 11%), iron (7%, 10%), zinc (18%, 23%), vitamin A (7%, 7%), vitamin D (12%, 16%), total niacin (9%, 13%), vitamin B6 (6%, 9%), vitamin B12 (15%, 22%), sodium (6%, 7%).DiscussionUnprocessed beef and lamb are valuable sources of nutrients for Irish children and teenagers. Relative to their energy contribution, they contribute higher proportions of a number of important nutrients, such as protein, zinc, vitamin D, vitamin B12 and total niacin, while contributing relatively small proportions of total fat, saturated fat and sodium. This research was funded by Meat Technology Ireland.

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Breakfast Skipping Is an Independent Predictor of Obesity but not Overweight Among Children in a Southeastern European Population

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000272 ◽

2016 ◽

Vol 86 (5-6) ◽

pp. 242-248 ◽

Cited By ~ 2

Author(s):

Genc Burazeri ◽

Jolanda Hyska ◽

Iris Mone ◽

Enver Roshi

Keyword(s):

Task Force ◽

Demographic Data ◽

Cross Sectional Study ◽

European Population ◽

Overweight And Obesity ◽

World Health ◽

Communist Country ◽

Western Balkans ◽

Cross Sectional ◽

Breakfast Skipping

Abstract.Aim: To assess the association of breakfast skipping with overweight and obesity among children in Albania, a post-communist country in the Western Balkans, which is undergoing a long and difficult political and socioeconomic transition towards a market-oriented economy. Methods: A nationwide cross-sectional study was carried out in Albania in 2013 including a representative sample of 5810 children aged 7.0 – 9.9 years (49.5% girls aged 8.4 ± 0.6 years and 51.5% boys aged 8.5 ± 0.6 years; overall response rate: 97%). Children were measured for height and weight, and body mass index (BMI) calculated. Cut-off BMI values of the World Health Organization (WHO) and the International Obesity Task Force (IOTF) were used to define overweight and obesity in children. Demographic data were also collected. Results: Upon adjustment for age, sex, and place of residence, breakfast skipping was positively related to obesity (WHO criteria: OR = 1.5, 95% CI = 1.3–1.9; IOTF criteria: OR = 1.9, 95% CI = 1.4–2.5), but not overweight (OR = 1.1, 95% CI = 0.9–1.3 and OR = 1.1, 95% CI = 0.9–1.4, respectively). Furthermore, breakfast skipping was associated with a higher BMI (multivariable-adjusted OR = 1.05, 95% CI = 1.02–1.07). Conclusions: Our findings point to a strong and consistent positive relationship between breakfast skipping and obesity, but not overweight, among children in this transitional southeastern European population. Future studies in Albania and other transitional settings should prospectively examine the causal role of breakfast skipping in the development of overweight and obesity.

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