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Recommendations Summary

DLM-SF: Amount of Saturated Fat Intake 2023

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

  • Recommendation(s)

    DLM-SF: Amount of Saturated Fat Intake

    In adults living with or without cardiovascular disease, healthcare professionals may suggest reduced saturated fat intake within an individualized healthy dietary pattern. Reduced saturated fat intake was associated with decreased total cholesterol and low density lipoprotein-cholesterol (LDL-C) and cardiovascular disease events; however, no significant associations were found with mortality (all-cause, cardiovascular disease, or coronary heart disease), coronary heart disease events, or cerebral vascular accidents.

    Rating: Level 2(B)

    • Risks/Harms of Implementing This Recommendation

      Recommendations to reduce saturated fat intake may inadvertently have potential risks and harms in some populations as implementation of this recommendation may not be accessible to underserved and vulnerable populations. Underserved and vulnerable populations are populations that face health, financial, educational, and/or housing disparities (Serving Vulnerable and Underserved Populations. Accessed January 17, 2023).  Access to supermarkets and convenience stores that have a variety of foods is known to be limited in neighborhoods with high minority populations and low population density, which could limit access to lower saturated fat food choices (Larson 2009). Underserved and vulnerable populations with limited health literacy may not have access to nutrition education and resources that would facilitate making this change. Food insecurity may also serve as a potential barrier to following this guideline, as provision of adequate food and nutrients may take priority. When overall access to adequate food is a challenge, efforts to reduce saturated fat intake may result in subsequent reduction in other vital nutrients, such as iron, calcium, vitamin, vitamin B12, and protein, which could compromise the overall diet quality. Knowledge deficits regarding how to translate these recommendations into healthy meal choices may further contribute to health inequities. These challenges suggest that the populations who would most benefit from implementation of this guideline may not be able to follow through with the recommendations. 

    • Conditions of Application

      Based on systematic reviews of the currently available evidence, a specific percentage of saturated fat reduction sufficient to impact outcomes could not be determined. However, the panel acknowledges that RDNs may desire some guidance when providing medical nutrition therapy to individuals who may benefit from saturated fat reduction. Hooper et al. 2020 conducted an analysis that compared the effect on the population consuming <10% of total energy from saturated fat compared to >10% of total energy from saturated fat and found greater reductions in CVD events occurred at lower levels of saturated fat. However, these results were not statistically significant. 

      An assessment by RDNs should include evaluation of anthropometrics, biochemical markers, medical history, as well as an individual's present eating habits, socioeconomic status, living conditions, cultural preferences, psychosocial and mental health status, and willingness/ability to make nutrition-related changes. Nutrition Care Process guidelines provide structure to document assessment and medical nutrition therapy recommendations. Nutrition recommendations should be tailored to the individual based on the interpretation of the assessment. This guideline supports the continuation of recommendations to limit total saturated fat intake to reduce the risk of CVD events.

      At the population level, this guideline may also translate into the continued recommendation to limit saturated fat intake for cardiovascular health. Public health messaging and collaboration with the food industry and medical organizations and institutions can serve to promote this message.

      Additional information to promote reduction in saturated fat intake within heart-healthy dietary patterns can be found through the following professional organizations:

      Since recommendations to reduce saturated fat are already adopted by most healthcare organizations and professionals, barriers to implementing the recommendations in this guideline are predicted to be minimal. Many resources already exist to facilitate the promotion of a dietary pattern low in saturated fat, including the resources listed above. Promotion of dietary patterns that are low in saturated fat and include a healthy nutrient profile with regards to other eating behaviors would be an ideal way to align this guideline with practical approaches. The Mediterranean Diet and Dietary Approaches to Stop Hypertension (DASH) dietary patterns are examples of dietary patterns that can be recommended to patients and clients to implement this guideline. 

      A potential barrier to this guideline implementation may be public confusion and frustration about the relationship between dietary-related factors and heart health. Public awareness of the shifting recommendations regarding an optimal dietary pattern for heart health may leave some hesitant to listen to any new recommendations, despite an ever-growing evidence base. Thus, consistent messaging among RDNs, other medical professionals, and public health organizations is crucial to helping build public confidence in using this guideline recommendation to facilitate dietary changes aimed at reducing CVD risk. 

    • Potential Costs Associated with Application

      Potential patient and consumer costs may include consultation with a RDN and cost of grocery items to replace saturated fat intake with unsaturated fat alternatives. Cost may also include the development of educational materials for consumers and patients. 

      Cost for implementation into the healthcare organization should be minimal due to recommendation alignment with current practice. Investment in dissemination of this information within the professional community via further publications in professional journals and seminars at healthcare-related conferences would be beneficial for widespread awareness and implementation of this guideline recommendation.

    • Recommendation Narrative

      This recommendation is based on the results of an Evidence Analysis Center overview of systematic reviews with a total of three systematic reviews (de Souza et al. 2015, Harcombe et al. 2016, Hooper et al. 2020, ). Hooper et al. 2020 (systematic review of RCTs) found a significant reduction in CVD events with reduced saturated fat intake with moderate certainty evidence within the entire study population. However, Hooper et al. 2020 conducted a sub-analysis for populations considered at low-risk, moderate-risk (risk factors for CVD, e.g., hypertension or diabetes), and high-risk (existing CVD) for CVD events and the effect of saturated fat reduction was not significantly associated with CVD events within the sub-analysis. Neither de Souza et al. 2015 (systematic review of observational studies), Harcombe et al. 2016 (systematic review of RCTs published prior to 1983), nor Hooper et al. 2020 found a significant association between saturated fat intake and all-cause mortality, CVD mortality, CHD mortality, CHD events, or cerebral vascular accident with very low to moderate certainty evidence. 

      Two systematic reviews evaluated the effect of reduction of saturated fat on blood lipids. Hooper et al. 2020 and Harcombe et al. 2016 found a significant reduction in total cholesterol and Hooper et al. 2020 found a significant reduction in LDL-C. Harcombe et al. 2016 did not evaluate LDL-C , HDL-C , or triglycerides, and Hooper et al. 2020 found no significant effect on HDL-C or triglycerides. Certainty of evidence for lipid outcomes was not provided in the Hooper or Harcombe systematic reviews. Certainty of evidence was graded as moderate by the authors of this systematic review. 

      The panel took the evidence and all components of the Evidence-to-Decision framework into consideration when developing the amount of saturated fat recommendation. While reduction of saturated fat was not significantly associated with all-cause or CVD mortality, there was a reduction in CVD events based on the Hooper et al. 2020 systematic review. CVD events were a composite measure of CV death, CV morbidity (non-fatal myocardial infarction, angina, cerebral vascular accident, heart failure, peripheral vascular events, atrial fibrillation), and unplanned CV interventions (coronary artery bypass surgery or angioplasty).  Hooper et al 2020 concluded that reduction of saturated fat intake was not found to be associated with individual events due to the short time periods of the included studies and small reductions in saturated fat. Saturated fat reduction was associated with reduced total cholesterol and LDL-C. The panel concluded that the benefits of saturated fat reduction outweigh the harms. While the benefits outweigh the harms of saturated fat reduction, an exact target amount for saturated fat can not be established based on limited available evidence from RCTs. Hooper et al. 2020 conducted a meta-regression to explore the levels of saturated fat reduction and found no statistically significant effect on identified outcomes of interest. The panel acknowledges that health care professionals may desire exact targets for the amount of saturated fat intake; however, because the evidence available is too limited to identify a target amount, the panel encourages individualizing strategies to reduce saturated fat intake as appropriate for each patient.  

      Download the summary tables for details:

    • Recommendation Strength Rationale

      • Endothelial function: no effect based on low certainty evidence.
      • Inflammation: limited/no effect on C-reactive protein, Interleukin 6 (IL-6), Tumor necrosis factor (TNF) based on low-moderate certainty evidence.
      • Blood lipids: reduced total and LDL cholesterol, no effect on HDL or triglycerides based on moderate certainty evidence.
      • Cardiovascular events: reduced cardiovascular events based on moderate certainty evidence.
      • Cardiovascular disease mortality: no effect based on moderate certainty evidence.
      • Coronary heart disease events: unclear effect based on very low evidence.
      • Coronary heart disease mortality: little to no effect based on low certainty evidence.
      • Stroke: unclear effect based on very low certainty evidence.
      • All-cause mortality: little to no effect based on moderate certainty evidence.

    • Minority Opinions