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Effects of dietary fats versus carbohydrates on coronary heart disease: A review of the evidence

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Abstract

Recommendations arising from the traditional diet-coronary heart disease (CHD) paradigm, which focuses on effects of total and saturated fat on serum total and low-density lipoprotein cholesterol, may have failed to reduce CHD risk and inadvertently exacerbated dyslipidemia, insulin resistance, and weight gain, particularly among individuals who are older, female, sedentary, or obese. A suitable dietary paradigm must consider types and qualities of fats and carbohydrates consumed, their effects on a range of intermediary risk factors, and characteristics that may modify individual susceptibility. Based on current evidence, replacement of total, unsaturated, and even possibly saturated fats with refined, high-glycemic index carbohydrates is unlikely to reduce CHD risk and may increase risk in persons predisposed to insulin resistance. In contrast, a diet that is 1) rich in whole grains and other minimally processed carbohydrates; 2) includes moderate amounts of fats (approximately 30%–40% of total energy), particularly unsaturated fats and omega-3 polyunsaturated fats from seafood and plant sources; 3) is lower in refined grains and carbohydrates; and 4) eliminates packaged foods, baked goods, and fast foods containing trans fatty acids, will likely reduce the risk of CHD.

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References

  1. Keys A: Coronary heart disease in seven countries. Circulation 1970, 41:1S-211S.

    Google Scholar 

  2. Connor WE, Connor SL: Should a low-fat, high-carbohydrate diet be recommended for everyone? The case for a low-fat, high-carbohydrate diet. N Engl J Med 1997, 337:562–563; discussion 566–567.

    Article  PubMed  CAS  Google Scholar 

  3. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002, 106:3143–3421.

  4. Katan MB, Grundy SM, Willett WC: Should a low-fat, high-carbohydrate diet be recommended for everyone? Beyond low-fat diets. N Engl J Med 1997, 337:563–566; discussion 566–567.

    PubMed  CAS  Google Scholar 

  5. Centers for Disease Control and Prevention: Trends in intake of energy and macronutrients—United States, 1971–2000. MMWR Morb Mortal Wkly Rep 2004, 53:80–82.

    Google Scholar 

  6. Sacks FM, Katan M: Randomized clinical trials on the effects of dietary fat and carbohydrate on plasma lipoproteins and cardiovascular disease. Am J Med 2002, 113:13S-24S.

    Article  PubMed  CAS  Google Scholar 

  7. Mensink RP, Zock PL, Kester AD, Katan MB: 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 2003, 77:1146–1155.

    PubMed  CAS  Google Scholar 

  8. Hollenbeck CB, Coulston AM: Effects of dietary carbohydrate and fat intake on glucose and lipoprotein metabolism in individuals with diabetes mellitus. Diabetes Care 1991, 14:774–785.

    Article  PubMed  CAS  Google Scholar 

  9. Lichtenstein AH, Schwab US: Relationship of dietary fat to glucose metabolism. Atherosclerosis 2000, 150:227–243.

    Article  PubMed  CAS  Google Scholar 

  10. Pischon T, Hankinson SE, Hotamisligil GS, et al.: Habitual dietary intake of n-3 and n-6 fatty acids in relation to inflammatory markers among US men and women. Circulation 2003, 108:155–160.

    Article  PubMed  CAS  Google Scholar 

  11. McLennan PL: Myocardial membrane fatty acids and the antiarrhythmic actions of dietary fish oil in animal models. Lipids 2001, 36:111S-114S.

    Article  Google Scholar 

  12. Mozaffarian D, Geelen A, Brouwer IA, et al.: The effect of fish oil on heart rate in humans: A meta-analysis of randomized controlled trials. Circulation 2005, In press.

  13. McLennan PL, Barnden LR, Bridle TM, et al.: Dietary fat modulation of left ventricular ejection fraction in the marmoset due to enhanced filling. Cardiovasc Res 1992, 26:871–877.

    Article  PubMed  CAS  Google Scholar 

  14. Mori TA, Beilin LJ: Omega-3 fatty acids and inflammation. Curr Atheroscler Rep 2004, 6:461–467.

    PubMed  Google Scholar 

  15. Christensen JH: n-3 fatty acids and the risk of sudden cardiac death. Emphasis on heart rate variability. Dan Med Bull 2003, 50:347–367.

    PubMed  CAS  Google Scholar 

  16. Mozaffarian D, Pischon T, Hankinson SE, et al.: Dietary intake of trans-fatty acids and systemic inflammation in women. Am J Clin Nutr 2004, 79:606–612.

    PubMed  CAS  Google Scholar 

  17. Baer DJ, Judd JT, Clevidence BA, Tracy RP: Dietary fatty acids affect plasma markers of inflammation in healthy men fed controlled diets: a randomized crossover study. Am J Clin Nutr 2004, 79:969–973.

    PubMed  CAS  Google Scholar 

  18. Lupton JR, Turner ND: Dietary fiber and coronary disease: does the evidence support an association? Curr Atheroscler Rep 2003, 5:500–505.

    PubMed  Google Scholar 

  19. Jacobs DR Jr, Gallaher DD: Whole grain intake and cardiovascular disease: a review. Curr Atheroscler Rep 2004, 6:415–423.

    PubMed  Google Scholar 

  20. Willett W, Manson J, Liu S: Glycemic index, glycemic load, and risk of type 2 diabetes. Am J Clin Nutr 2002, 76:274S-280S.

    PubMed  CAS  Google Scholar 

  21. Ludwig DS: The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA 2002, 287:2414–2423.

    Article  PubMed  CAS  Google Scholar 

  22. Mozaffarian D, Lemaitre RN, Kuller LH, et al.: Cardiac benefits of fish consumption may depend on the type of fish meal consumed: the Cardiovascular Health Study. Circulation 2003, 107:1372–1377.

    Article  PubMed  Google Scholar 

  23. Crouse JR 3rd: Gender, lipoproteins, diet, and cardiovascular risk. Sauce for the goose may not be sauce for the gander. Lancet 1989, 1:318–320.

    Article  PubMed  Google Scholar 

  24. Cobb M, Greenspan J, Timmons M, Teitelbaum H: Gender differences in lipoprotein responses to diet. Ann Nutr Metab 1993, 37:225–236.

    PubMed  CAS  Google Scholar 

  25. Walden CE, Retzlaff BM, Buck BL, et al.: Differential effect of National Cholesterol Education Program (NCEP) Step II diet on HDL cholesterol, its subfractions, and apoprotein A-I levels in hypercholesterolemic women and men after 1 year: the beFIT Study. Arterioscler Thromb Vasc Biol 2000, 20:1580–1587.

    PubMed  CAS  Google Scholar 

  26. Knopp RH, Zhu X, Bonet B: Effects of estrogens on lipoprotein metabolism and cardiovascular disease in women. Atherosclerosis 1994, 110:S83-S91.

    Article  PubMed  CAS  Google Scholar 

  27. Soinio M, Laakso M, Lehto S, et al.: Dietary fat predicts coronary heart disease events in subjects with type 2 diabetes. Diabetes Care 2003, 26:619–624.

    Article  PubMed  Google Scholar 

  28. Barrett-Connor E, Giardina EG, Gitt AK, et al.: Women and heart disease: the role of diabetes and hyperglycemia. Arch Intern Med 2004, 164:934–942.

    Article  PubMed  Google Scholar 

  29. Ordovas JM, Corella D, Demissie S, et al.: Dietary fat intake determines the effect of a common polymorphism in the hepatic lipase gene promoter on high-density lipoprotein metabolism: evidence of a strong dose effect in this genenutrient interaction in the Framingham Study. Circulation 2002, 106:2315–2321.

    Article  PubMed  CAS  Google Scholar 

  30. Mozaffarian D, Ascherio A, Hu FB, et al.: Interplay between intermediate-chain n-3, long-chain n-3, and n-6 polyunsaturated fatty acids and risk of coronary heart disease in men. Circulation 2005, 111:166–173.

    Article  CAS  Google Scholar 

  31. Mozaffarian D, Rimm EB, Herrington DM: Dietary fats, carbohydrate, and progression of coronary atherosclerosis among postmenopausal women. Am J Clin Nutr 2004, 80:1175–1184.

    PubMed  CAS  Google Scholar 

  32. Taubes G: Nutrition. The soft science of dietary fat. Science 2001, 291:2536–2545.

    Article  PubMed  CAS  Google Scholar 

  33. Yancy WS Jr, Westman EC, French PA, Califf RM: Diets and clinical coronary events: the truth is out there. Circulation 2003, 107:10–16.

    Article  PubMed  Google Scholar 

  34. Oh K, Hu FB, Manson JE, et al.: Dietary fat intake and risk of coronary heart disease in women: 20 years of follow-up of the Nurses’s Health study. Am J Epidemiol 2005, 161:672–679.

    Article  PubMed  Google Scholar 

  35. Research Committee: Low-fat diet in myocardial infarction: a controlled trial. Lancet 1965, 2:501–504.

    Article  Google Scholar 

  36. Burr ML, Fehily AM, Gilbert JF, et al.: Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: Diet And Reinfarction Trial (DART). Lancet 1989, 2:757–761.

    Article  PubMed  CAS  Google Scholar 

  37. Hjermann I, Velve Byre K, Holme I, Leren P: Effect of diet and smoking intervention on the incidence of coronary heart disease. Report from the Oslo Study Group of a randomised trial in healthy men. Lancet 1981, 2:1303–1310.

    Article  PubMed  CAS  Google Scholar 

  38. World Health Organisation European Collaborative Group: European collaborative trial of multifactorial prevention of coronary heart disease: final report on the 6-year results. Lancet 1986, 1:869–872.

    Google Scholar 

  39. Multiple Risk Factor Intervention Trial Research Group: Mortality rates after 10.5 years for participants in the Multiple Risk Factor Intervention Trial. JAMA 1990, 263:1795–1801.

    Article  Google Scholar 

  40. Dayton S, Pearce ML, Goldman H, et al.: Controlled trial of a diet high in unsaturated fat for prevention of atherosclerotic complications. Lancet 1968, 2:1060–1062.

    Article  PubMed  CAS  Google Scholar 

  41. Leren P: The Oslo diet-heart study. Eleven-year report. Circulation 1970, 42:935–942.

    PubMed  CAS  Google Scholar 

  42. Woodhill JM, Palmer AJ, Leelarthaepin B, et al.: Low fat, low cholesterol diet in secondary prevention of coronary heart disease. Adv Exp Med Biol 1978, 109:317–330.

    PubMed  CAS  Google Scholar 

  43. Frantz ID Jr, Dawson EA, Ashman PL, et al.: Test of effect of lipid lowering by diet on cardiovascular risk. The Minnesota Coronary Survey. Arteriosclerosis 1989, 9:129–135.

    PubMed  Google Scholar 

  44. Report of a Research Committee to the Medical Research Council: Controlled trial of soya-bean oil in myocardial infarction. Lancet 1968, 2:693–699.

    Google Scholar 

  45. Turpeinen O, Karvonen MJ, Pekkarinen M, et al.: Dietary prevention of coronary heart disease: the Finnish Mental Hospital Study. Int J Epidemiol 1979, 8:99–118.

    Article  PubMed  CAS  Google Scholar 

  46. Miettinen M, Turpeinen O, Karvonen MJ, et al.: Dietary prevention of coronary heart disease in women: the Finnish Mental Hospital Study. Int J Epidemiol 1983, 12:17–25.

    Article  PubMed  CAS  Google Scholar 

  47. Natvig H, Borchgrevink CF, Dedichen J, et al.: A controlled trial of the effect of linolenic acid on incidence of coronary heart disease. The Norwegian vegetable oil experiment of 1965–66. Scand J Clin Lab Invest Suppl 1968, 105:1–20.

    Article  PubMed  CAS  Google Scholar 

  48. Singh RB, Niaz MA, Sharma JP, et al.: Randomized, double-blind, placebo-controlled trial of fish oil and mustard oil in patients with suspected acute myocardial infarction: the Indian Experiment of Infarct Survival-4. Cardiovasc Drugs Ther 1997, 11:485–491.

    Article  PubMed  CAS  Google Scholar 

  49. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico: Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: GISSI-Prevenzione trial. Lancet 1999, 354:447–455.

    Article  Google Scholar 

  50. Burr ML, Ashfield-Watt PA, Dunstan FD, et al.: Lack of benefit of dietary advice to men with angina: results of a controlled trial. Eur J Clin Nutr 2003, 57:193–200.

    Article  PubMed  CAS  Google Scholar 

  51. Singh RB, Rastogi SS, Verma R, et al.: Randomised controlled trial of cardioprotective diet in patients with recent acute myocardial infarction: results of one year follow up. BMJ 1992, 304:1015–1019.

    PubMed  CAS  Google Scholar 

  52. de Lorgeril M, Renaud S, Mamelle N, et al.: Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet 1994, 343:1454–1459.

    Article  PubMed  Google Scholar 

  53. Singh RB, Dubnov G, Niaz MA, et al.: Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial. Lancet 2002, 360:1455–1461.

    Article  PubMed  Google Scholar 

  54. American Heart Association: An Eating Plan for Healthy Americans. http://www.americanheart.org. Accessed July 5, 2005.

  55. United States Department of Agriculture: Dietary Guidelines for Americans, 2005. http://www.mypyramid.gov. Accessed July 5, 2005.

  56. Shekelle RB, Shryock AM, Paul O, et al.: Diet, serum cholesterol, and death from coronary heart disease. The Western Electric study. N Engl J Med 1981, 304:65–70.

    Article  PubMed  CAS  Google Scholar 

  57. Kushi LH, Lew RA, Stare FJ, et al.: Diet and 20-year mortality from coronary heart disease. The Ireland-Boston Diet-Heart Study. N Engl J Med 1985, 312:811–818.

    Article  PubMed  CAS  Google Scholar 

  58. Posner BM, Cobb JL, Belanger AJ, et al.: Dietary lipid predictors of coronary heart disease in men. The Framingham Study. Arch Intern Med 1991, 151:1181–1187.

    Article  PubMed  CAS  Google Scholar 

  59. Esrey KL, Joseph L, Grover SA: Relationship between dietary intake and coronary heart disease mortality: Lipid Research Clinics prevalence follow-up study. J Clin Epidemiol 1996, 49:211–216.

    Article  PubMed  CAS  Google Scholar 

  60. Ascherio A, Rimm EB, Giovannucci EL, et al.: Dietary fat and risk of coronary heart disease in men: cohort follow up study in the United States. BMJ 1996, 313:84–90.

    PubMed  CAS  Google Scholar 

  61. Morris JN, Marr JW, Clayton DG: Diet and heart: a postscript. BMJ 1977, 2:1307–1314.

    Article  PubMed  CAS  Google Scholar 

  62. Garcia-Palmieri MR, Sorlie P, Tillotson J, et al.: Relationship of dietary intake to subsequent coronary heart disease incidence: The Puerto Rico Heart Health Program. Am J Clin Nutr 1980, 33:1818–1827.

    PubMed  CAS  Google Scholar 

  63. Gordon T, Kagan A, Garcia-Palmieri M, et al.: Diet and its relation to coronary heart disease and death in three populations. Circulation 1981, 63:500–515.

    PubMed  CAS  Google Scholar 

  64. Kromhout D, de Lezenne Coulander C: Diet, prevalence and 10-year mortality from coronary heart disease in 871 middle-aged men. The Zutphen Study. Am J Epidemiol 1984, 119:733–741.

    PubMed  CAS  Google Scholar 

  65. McGee DL, Reed DM, Yano K, et al.: Ten-year incidence of coronary heart disease in the Honolulu Heart Program. Relationship to nutrient intake. Am J Epidemiol 1984, 119:667–676.

    PubMed  CAS  Google Scholar 

  66. Pietinen P, Ascherio A, Korhonen P, et al.: Intake of fatty acids and risk of coronary heart disease in a cohort of Finnish men. The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Am J Epidemiol 1997, 145:876–887.

    PubMed  CAS  Google Scholar 

  67. Golomb BA: Dietary fats and heart disease—dogma challenged? J Clin Epidemiol 1998, 51:461–464.

    Article  PubMed  CAS  Google Scholar 

  68. Dolecek TA: Epidemiological evidence of relationships between dietary polyunsaturated PUFAs and mortality in the multiple risk factor intervention trial. Proc Soc Exp Biol Med 1992, 200:177–182.

    PubMed  CAS  Google Scholar 

  69. He K, Song Y, Daviglus ML, et al.: Accumulated evidence on fish consumption and coronary heart disease mortality: a meta-analysis of cohort studies. Circulation 2004, 109:2705–2711.

    Article  PubMed  Google Scholar 

  70. Mozaffarian D: Does alpha-linolenic acid intake reduce the risk of coronary heart disease? A review of the evidence. Altern Ther Health Med 2005, 11:24–30.

    PubMed  Google Scholar 

  71. Ascherio A, Katan MB, Zock PL, et al.: Trans fatty acids and coronary heart disease. N Engl J Med 1999, 340:1994–1998.

    Article  PubMed  CAS  Google Scholar 

  72. Schulze MB, Hu FB: Primary prevention of diabetes: what can be done and how much can be prevented? Annu Rev Pub Health 2005, 26:445–467.

    Article  Google Scholar 

  73. Liu S, Willett WC, Stampfer MJ, et al.: A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women. Am J Clin Nutr 2000, 71:1455–1461.

    PubMed  CAS  Google Scholar 

  74. van Dam RM, Visscher AW, Feskens EJ, et al.: Dietary glycemic index in relation to metabolic risk factors and incidence of coronary heart disease: the Zutphen Elderly Study. Eur J Clin Nutr 2000, 54:726–731.

    Article  PubMed  CAS  Google Scholar 

  75. Jensen MK, Koh-Banerjee P, Hu FB, et al.: Intakes of whole grains, bran, and germ and the risk of coronary heart disease in men. Am J Clin Nutr 2004, 80:1492–1499.

    PubMed  CAS  Google Scholar 

  76. Jeppesen J, Schaaf P, Jones C, et al.: Effects of low-fat, high-carbohydrate diets on risk factors for ischemic heart disease in postmenopausal women. Am J Clin Nutr 1997, 65:1027–1033.

    PubMed  CAS  Google Scholar 

  77. Ding EL, Mozaffarian D: Optimal dietary habits for the prevention of stroke. Semin Neurol 2006, In press.

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  1. Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 665 Huntington Avenue, Building 2, Room 315, 02115, Boston, MA, USA

    Dariush Mozaffarian MD, MPH

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Mozaffarian, D. Effects of dietary fats versus carbohydrates on coronary heart disease: A review of the evidence. Curr Atheroscler Rep 7, 435–445 (2005). https://doi.org/10.1007/s11883-005-0060-y

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