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Dietary fats and cardiometabolic disease: mechanisms and effects on risk factors and outcomes

Abstract

The effect of dietary fats on cardiometabolic diseases, including cardiovascular diseases and type 2 diabetes mellitus, has generated tremendous interest. Many earlier investigations focused on total fat and conventional fat classes (such as saturated and unsaturated fats) and their influence on a limited number of risk factors. However, dietary fats comprise heterogeneous molecules with diverse structures, and growing research in the past two decades supports correspondingly complex health effects of individual dietary fats. Moreover, health effects of dietary fats might be modified by additional factors, such as accompanying nutrients and food-processing methods, emphasizing the importance of the food sources. Accordingly, the rapidly increasing scientific findings on dietary fats and cardiometabolic diseases have generated debate among scientists, caused confusion for the general public and present challenges for translation into dietary advice and policies. This Review summarizes the evidence on the effects of different dietary fats and their food sources on cell function and on risk factors and clinical events of cardiometabolic diseases. The aim is not to provide an exhaustive review but rather to focus on the most important evidence from randomized controlled trials and prospective cohort studies and to highlight current areas of controversy and the most relevant future research directions for understanding how to improve the prevention and management of cardiometabolic diseases through optimization of dietary fat intake.

Key points

  • In addition to their role as metabolic fuel, fatty acids modulate diverse cell processes including transcription regulation, cellular and organelle membrane structure and function, ion channel activity and electrophysiology.

  • Dietary fats comprise a wide range of fatty acids, and growing evidence demonstrates heterogeneity in the health effects of specific fatty acids as well as their food sources.

  • Robust evidence from multiple research studies demonstrates no health benefits of lowering total dietary fat in foods or overall diets.

  • For both saturated fatty acids and monounsaturated fatty acids, which have highly diverse dietary sources, considering the food sources and types separately might be most meaningful for understanding their health effects.

  • The overall evidence strongly supports cardiometabolic benefits of total polyunsaturated fatty acid (PUFA), n-6 PUFA and seafood-derived n-3 PUFA consumption.

  • People consume complex foods, not individual fatty acids; therefore, guidance and policies to improve general population diets should place greater emphasis on specific food sources of dietary fats.

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Fig. 1: Effects of dietary fats on cell processes.
Fig. 2: Effects of high-fat versus low-fat diets on cardiometabolic risk factors.
Fig. 3: Effects of replacing dietary saturated fatty acids on cardiometabolic lipid risk factors.
Fig. 4: Effects of replacing dietary saturated fatty acids and carbohydrates on glycaemic markers.
Fig. 5: Effect of replacing dietary saturated fatty acids on the risk of coronary heart disease.
Fig. 6: Effects of specific types of saturated fatty acid on cardiometabolic lipid risk factors.
Fig. 7: Food source of saturated fat and risk of cardiometabolic disease.

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Acknowledgements

J.H.Y.W. received support from a Scientia Fellowship from the University of New South Wales, Australia. R.M. and D.M. received funding from the US National Institutes of Health (NIH) and the US National Heart, Lung and Blood Institute (NHLBI) (R01HL130735 and R01HL115189).

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Nature Reviews Cardiology thanks G. Riccardi and the other anonymous reviewer(s) for their contribution to the peer review of this work.

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J.H.Y.W. and D.M. researched data for the article, and J.H.Y.W. wrote the manuscript. All authors provided substantial contribution to the discussion of content and reviewed and/or edited the manuscript before submission.

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Correspondence to Jason H. Y. Wu.

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J.H.Y.W. and R.M. received research support from Unilever for projects on fatty acid biomarkers not related to the present article. D.M. received research funding from the US National Institutes of Health (NIH) and the Gates Foundation; received personal fees from Acasti Pharma, Amarin, America’s Test Kitchen, Bunge, DSM, GOED, Indigo Agriculture, Nutrition Impact and Pollock Communications; is on the scientific advisory board of DayTwo, Elysium Health and Omada Health; and received chapter royalties from UpToDate; none of these is related to the present article.

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Wu, J.H., Micha, R. & Mozaffarian, D. Dietary fats and cardiometabolic disease: mechanisms and effects on risk factors and outcomes. Nat Rev Cardiol 16, 581–601 (2019). https://doi.org/10.1038/s41569-019-0206-1

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