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Journal of the American College of Nutrition, Vol. 20, No. 1, 5-19 (2001)
Published by the American College of Nutrition


Review

Types of Dietary Fat and Risk of Coronary Heart Disease: A Critical Review

Frank B. Hu, MD, PhD, JoAnn E. Manson, MD, DrPh and Walter C. Willett, MD, DrPh

Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts

Address correspondence to: Dr. Frank Hu, Dept. of Nutrition, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115. E-mail: Frank.hu{at}channing.harvard.edu

During the past several decades, reduction in fat intake has been the main focus of national dietary recommendations to decrease risk of coronary heart disease (CHD). Several lines of evidence, however, have indicated that types of fat have a more important role in determining risk of CHD than total amount of fat in the diet. Metabolic studies have long established that the type of fat, but not total amount of fat, predicts serum cholesterol levels. In addition, results from epidemiologic studies and controlled clinical trials have indicated that replacing saturated fat with unsaturated fat is more effective in lowering risk of CHD than simply reducing total fat consumption. Moreover, prospective cohort studies and secondary prevention trials have provided strong evidence that an increasing intake of n-3 fatty acids from fish or plant sources substantially lowers risk of cardiovascular mortality. In this article, we review evidence from epidemiologic studies and dietary intervention trials addressing the relationship between dietary fat intake and risk of CHD, with a particular emphasis on different major types of fat, n-3 fatty acids and the optimal balance between n-3 and n-6 fatty acids. We also discuss the implications of the available evidence in the context of current dietary recommendations.

Key words: dietary fat, saturated fat, monounsaturated fat, polyunsaturated fat, trans fatty acids, n-3 fatty acids, cardiovascular disease, coronary heart disease, women




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