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Recommendations Summary

DLM-SF: Sources 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: Sources of Saturated Fat Intake

    Healthcare professionals may prioritize reduction of the amount of saturated fat over reduction of specific sources of saturated fat foods within individualized healthy dietary patterns when providing nutrition education to reduce cardiovascular disease risk. Low certainty of evidence demonstrates that a variety of dairy products are not associated with an increased risk of cardiovascular disease; however, reduction of red meat and processed meat is associated with reduced cardiovascular disease risk. 

    Rating: Level 2(C)
    Imperative

    • Risks/Harms of Implementing This Recommendation

      There are minimal harms associated with the implementation of this recommendation. The review of the scientific evidence for this recommendation focused on studies that included saturated fat in dairy, red meat, and processed meat based on the systematic review inclusion criteria. While healthcare professionals should communicate that inclusion of dairy foods that are high in saturated fat, such as butter and whole fat milk, cheese, and yogurt, can be a part of a healthy dietary pattern, the amount of saturated fat intake must be taken into consideration.  A potential risk associated with this recommendation is disregard for the total amount of saturated fat intake. Such disregard could result in excess saturated fat and calorie intake. Excess intake of saturated fat increases LDL-C levels and may negatively impact other cardiovascular disease risk factors. Excess calorie intake may produce weight gain, which will also negatively impact cardiovascular disease risk factors.

    • Conditions of Application

      Based on the scope of this systematic review and limited evidence, specific amounts, or percentages of overall intake, for evaluated food sources of saturated fat (i.e., milk, yogurt, cheese, butter, red meat, and processed meat) could not be recommended.  This recommendation should be utilized in conjunction with the amount and replacement saturated fat recommendations.  Healthcare professionals should focus on facilitating individualized overall healthy dietary patterns with their patients, rather than strict exclusion of food groups or specific foods high in saturated fat.  For example, meat and full-fat dairy can be part of a healthy diet pattern, especially when the overall quantity of saturated fat is controlled and processed, and red meat is kept to a minimum.  Coupling this guideline with a reasonable daily energy intake, as well as considerations of what dietary changes the individual is willing and able to sustain, also remains crucial.  Overall, the findings of this guideline support the concept that a variety of dietary patterns, including those that include reasonable amounts of saturated fat (even from animal sources), can be included in a heart-healthy lifestyle.

      Some individuals may benefit from lower amounts of saturated fat (i.e., patients with high levels of LDL-C).

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

      Healthcare professionals may also consider using the following resources from the Nutrition Care Manual

      • Nutrition Care Diet Manual: Heart-Healthy (Cardiac) Diet
      • Nutrition Care Cardiovascular Disease
      • Client Education/Diets: Cardiovascular

      Acceptability of the recommendation and potential conflicting messages may be potential barriers to the implementation of this recommendation. Mixed messages about the health impact of foods higher in saturated fat, such as some full-fat dairy products, may result in confusion regarding which foods may be included in a heart-healthy diet. Healthcare professionals can promote acceptability and clarity of this recommendation through communicating the best available evidence on the association between food sources of saturated fat and cardiovascular disease.

    • Potential Costs Associated with Application

      There should be limited costs for healthcare professionals or organizations associated with the implementation of this recommendation. Costs may include development or updating of educational materials for saturated fat, as well as updated training for staff on how these new guidelines differ from prior practice.

    • Recommendation Narrative

      An overview of systematic reviews was conducted for sources of saturated fat and association with cardiovascular disease (CVD) and CVD events. The only systematic reviews that met the inclusion criteria for this systematic review evaluated dairy (butter, milk, cheese, and yogurt) and meat (red meat and processed meat). Four systematic reviews were included that examined the association of dairy intake and mortality, CVD outcomes, and risk factors (O’Sullivan et al. 2013, Pimpin et al. 2016, Guo et al. 2017, Jakobsen et al.2021). Overall, intake of dairy products as a group was not associated with increased CVD risk based on very low to moderate quality evidence that did not control for the amount of saturated fat intake. However, high-fat milk intake was associated with an increased risk of coronary heart disease (CHD). The association of high-fat milk intake with CHD, in contrast to no association with low-fat milk intake, may indicate that the amount of saturated fat intake may have more impact on CHD than the type of food source. Three systematic reviews were included in the red meat and processed meat review. A reduction in red meat and processed meat was associated with a very small decrease in risk of CVD and CVD mortality based on very low to low quality evidence that also did not control for the amount of saturated fat. 

      Systematic reviews were limited to randomized controlled trials that compared the effect of a variety of saturated fat sources on CVD risk factors (inflammation, endothelial function, blood pressure, cholesterol). No significant differences were found between saturated fat food sources for most outcomes. However, dairy compared to non-dairy may increase LDL-C and cheese compared to butter may decrease LDL-C and total cholesterol based on very low certainty evidence.

      The panel took the systematic review evidence and all components of the Evidence-to-Decision framework into consideration when developing the source of saturated fat recommendation. The majority of dairy products were not associated with CVD outcomes. High-fat milk intake compared to low-fat milk intake was associated with CHD, which may indicate that the amount of saturated fat intake has a greater impact on health outcomes.  The red meat and processed meat systematic reviews indicated an association with CVD, and CV and all-cause mortality; however, these results were based on low certainty evidence and did not control for the amount of saturated fat intake.  Available evidence indicates that the source of saturated fat may have an association with CVD. Variations in the amount of saturated fat in these studies are a barrier to drawing clear conclusions about the ideal amount and type of saturated fat. Therefore, the panel recommends careful consideration of the amount of saturated fat in foods when addressing any source of saturated fat with patients and clients.

      Download the summary detail for additional information:

    • Recommendation Strength Rationale

      Red and Processed Meat

      • May be associated with all-cause mortality and cardiovascular mortality (very low certainty).
      • May be associated with stroke and coronary heart disease (low certainty).
      • Little to no impact on myocardial infarction and cardiovascular disease (very low certainty)

      Cheese

      • Little to no effect on all-cause mortality (very low certainty).
      • May be associated with a lower risk for coronary heart disease (moderate certainty).
      • No associated with ischemic stroke (moderate certainty).

      Milk

      • No association with all-cause mortality (low certainty).
      • Total and low-fat milk intake not associated with coronary heart disease (low).
      • High fat milk intake associated with coronary heart disease (low).
      • Association with stroke unclear (low).

      Yogurt

      • No association with all-cause mortality or ischemic stroke (low certainty).
      • No association with coronary heart disease (very low certainty).

      Butter

      • No association with all-cause mortality or cardiovascular-related outcomes (low certainty).

      Dairy compared to Non-Dairy

      • No differing effect on blood pressure, total cholesterol,  HDL cholesterol (moderate certainty) or c-reactive protein (very low certainty).
      • May have a beneficial impact on endothelial function among people with hypertension (very low certainty).
      • May slightly increase LDL-cholesterol (low certainty).

      Dairy Comparisons

      • Cheese likely lowers total and LDL cholesterol compared to butter (very low certainty).
      • Cheese compared butter, no differential effect on HDL cholesterol (very low certainty).
      • Cheese compared to butter, may have minimal effect on decreasing insulin,  glucose,  inflammatory markers, and blood pressure (very low certainty).
      • Cheese compared to yogurt does not have a different effect on cholesterol or blood pressure (very low certainty).

    • Minority Opinions

      None.