Trending Topics pieces (Article Analyses, Evidence Clips and Other Topics) are published in timely response to recent media and journal articles, position statements, clinical guidelines, etc. Since they are based on the most recent evidence/publications, they may not be consistent with PEN evidence in other PEN content areas. As soon as possible, when this occurs, the PEN content will be reviewed and updated as needed.
Carbohydrate, Fat and Mortality
Reposted January 3, 2018 with an additional dietitian viewpoint*
The study, Associations of Fat and Carbohydrate Intake with Cardiovascular Disease and Mortality in 18 Countries from Five Continents (PURE): A Prospective Cohort Study, stemming from the PURE macronutrient studies, has been getting a lot of press across the globe (e.g. Canada, U.K.). This is a very large international cohort comprising high, middle and low income countries. It is an observational analysis with dietary intake collected by self-reported food frequency questionnaires (FFG) at baseline only. After looking at a range of carbohydrate (46-77% of energy) and saturated fat (2.8-13.2% of energy) intake (not a typical range seen in North America or Europe) the authors found that high carbohydrate intake was associated with a higher risk of total mortality, and non-cardiovascular disease mortality (e.g. cancer, respiratory diseases).
For analysis on the study, see: NHS Choices - Behind the Headlines
For further analysis on the study, see The Conversation: New Study Finding Fat Isn't as Bad as Carbs Misses the Point
*For a dietitian's viewpoint, see: That Viral Study Telling You to Eat More Fat? It's Full of Holes
For more information, see PEN Additional Content:
Practice Question: Is a Reduced Saturated Fat Diet Recommended for Primary or Secondary Cardiovascular Disease Prevention?
Evidence Clip: Butter, Margarine, Saturated and Trans Fats - Making Sense of Research Reported in the News
Banning Trans Fat
Australia: See Trans Fat: How Does Australia Shape Up? and Trans Fatty Acids from Food Standards Australia New Zealand for more information.
Canada: Canada's Health Minister Ginette Petitpas Taylor announced the ban of partially hydrogenated oils in all foods sold in Canada. The ban will be enforced starting on September 15, 2018, to give the food industry a year to prepare. This ban will apply to all foods sold in Canada including imported products and foods prepared and served in restaurants and food service establishments. For more information see Health Canada's Backgrounder: Prohibiting the Main Source of Industrially Produced Trans Fat in Food and watch this free podcast: Canada's Trans Fat Ban with Dr. Mary Labbé.
United Kingdom: See U.K. Ban on Trans Fats 'Would save Thousands of Lives' and Trans Fat - Overview of Recent Developments from the European Parliament for more information.
Trans Fats on Their Way Out Again!
Health Canada has published a Notice of Proposal (Information Document) signalling its intent to implement the prohibition on the use of partially hydrogenated oils (PHOs) in all foods by adding PHOs to Part 1 of the List of Contaminants and Other Adulterating Substances in Foods. This prohibition is proposed to take effect in the summer of 2018, which would allow industry stakeholders time to phase-out the use of PHOs. Interested stakeholders are invited to share and provide comments on the proposal by June 21, 2017 and can view further information on the proposals as well as a summary of comments received during the previous public consultation at Notice of Proposal (Prohibiting the Use of PHOs in Foods).
Benefits of Reducing Saturated Fat Intake Criticized
A recent editorial by Malhotra, et al. made headlines claiming that reducing saturated fat intake has no effect on coronary heart disease. The authors do not cite the best or most recent evidence to support this claim. Importantly, they fail to acknowledge the results of a recent Cochrane review, which found moderate quality evidence that reducing saturated fat intake decreased cardiovascular (CV) events (including CV deaths, CV morbidity or unexplained CV interventions) in populations at low, moderate and high risk (1). When talking about reducing saturated fat intake, it is important to consider the replacement calories. Recent evidence identifies that the greater reductions in CV events occurred when saturated fat was replaced with polyunsaturated fat, but not with carbohydrate (1). The editorial does emphasize the benefits of a whole dietary approach, such as the Mediterranean diet, instead of focusing on specific nutrients. There is merit to this approach. The Mediterranean diet pattern is low in saturated fat and includes rich sources of unsaturated fat such as oils, nuts, seeds and oily fish, in addition to plenty of legumes, vegetables, fruit and whole grains. See additional commentary from David Katz published in Linkedin: Sat-Fat Bait & Switch.
Seems we were not alone in our concerns about the opinion piece that garnered media attention last week. Further expert reaction from the U.K. to the editorial on saturated fat and heart disease is available from Science Media Centre.
See Additional Content: Is a reduced saturated fat diet recommended for primary or secondary cardiovascular disease (CVD) prevention?
Hooper L, Martin N, Adbelhamid A, Dave Smith G. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev. 2015 Jun 10;(6):CD011737. doi.10.1002/14651858.CD011737. Abstract available from: http://www.ncbi.nlm.nih.gov/pubmed/26068959
Article Analysis: Cardiovascular Effects of Exchanging Saturated Fat With an Oil High in Linoleic Acid - Not all Vegetable Oils are Created Equally