DLM-SF: Guideline Overview (2023)
Saturated Fat Evidence-Based Nutrition Practice Guideline (2021-23)
Guideline Narrative Overview
According to the World Health Organization, cardiovascular disease (CVD) is the leading cause of death worldwide.1 In 2019, 17.9 million people died from CVD. Atherosclerosis is the usual cause of CVD, including coronary heart disease (CHD), cerebral vascular accident, and peripheral arterial disease.2 Atherosclerosis is the hardening and narrowing of arteries caused by cholesterol-rich plaques. Most CVD can be prevented by addressing behavioral risks, such as consumption of an unhealthy diet.1
Health organizations have recommended decreased saturated fat intake to reduce the risk of CVD since the 1970s.3 The rationale behind reducing saturated fat intake is to decrease blood levels of low-density lipoprotein cholesterol (LDL-C), 4 which is a causal factor for atherosclerotic CVD.5-7 The 2021 Dietary Guidance to Improve Cardiovascular Health8, the 2019 American College of Cardiology/American Heart Association (ACC/AHA) Guideline on the Primary Prevention of Cardiovascular Disease, 9 the National Lipid Association (NLA) Recommendations for Patient-Centered Management of Dyslipidemia-Part 1 and Part 2, 10, 11 and the 2020-2025 Dietary Guidelines for Americans (DGAs)12 recommend intake of a dietary pattern low in saturated fat. However, within the past decade, a public health debate has emerged on the association between saturated fat intake and CVD.13, 14 The results of some systematic reviews of observational studies showed no association between saturated fat intake and CVD.16, 17 One argument against reduction of saturated fat intake for CVD prevention is that available studies are flawed due to their inability to control for other dietary variables that may change with reductions in saturated fat (e.g., increased intake of unsaturated fats), and that guidelines should focus on whole foods rather than specific nutrients.
Healthcare professionals, particularly registered dietitian nutritionists (RDNs), need clear evidence-based resources to provide quality care. RDNs are food and nutrition experts that utilize the best available evidence to translate it into medical nutrition therapies, dietary recommendations, and public health messaging.18 There is a need for systematic reviews of the evidence that evaluates not only the association between amount of saturated fat intake, but also known sources of saturated fat intake and cardiovascular (CV) outcomes.
The Saturated Fat Evidence-Based Nutrition Practice Guideline (EBNPG) is meant to inform shared decision-making for RDNs and healthcare professionals, along with their patients and clients, in acute, ambulatory, or public health settings on saturated fat intake to prevent or manage CVD. This EBNPG may also help inform public health messaging to improve CV health. The intended population is adults ≥ 18 years of age within the general population. The scope of the systematic review and guideline was not limited by gender or sex, race, ethnicity, anthropometrics, or presence of co-morbidities. This Saturated Fat EBNPG is for individuals living with and without CVD, and the scope was not limited to adults with disorders of dyslipidemia. This EBNPG does not apply to children <18 years of age.
The research question that guided this EBNPG was: In adults, what is the association of saturated fat intake, replacement of saturated fat intake, and sources of saturated fat intake on CVD and CVD risk factors? When feasible, sub-analyses were conducted for populations with or without CVD. In the event there were no differential results between populations, results for the separate populations were merged.
Topics addressed in this EBNPG include:
- Amount of Saturated Fat Intake
- Replacement of Saturated Fat Intake
- Sources of Saturated Fat Intake
The number of supporting documents for these topics is:
Conclusion Statements: 53
Evidence Summaries: 49
Article Worksheets: 37
To learn about the Academy’s systematic review methodology and guideline development process, visit the Policy and Procedures section of the EAL.
Expand the section titled Project Team and Disclosures on the landing page for a list of individuals who developed this guideline.
Academy guidelines are revisited every five years. An expert workgroup will be convened by the Workgroup Selection subcommittee of the Council of Research (COR) to determine the need for new and revised recommendations based on the available science. The process includes:
Conduct a scoping review to identify new research published since the previous searches were completed. Updated inclusion/exclusion criteria and search terms may be warranted.
Review to determine if the update will include modifications to recommendations and compare them to the earlier version of the guidelines, or development of new recommendations.
- World Health Organization. Cardiovascular disease(s). Newsroom Web site. https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)#:~:text=Cardiovascular%20diseases%20(CVDs)%20are%20the,%2D%20and%20middle%2Dincome%20countries. Published 2022. Accessed January 24, 2022.
- Frostegård J. Immunity, atherosclerosis and cardiovascular disease. BMC Med. 2013;11:117-117.
- Mozaffarian D, Rosenberg I, Uauy R. History of modern nutrition science-implications for current research, dietary guidelines, and food policy. BMJ. 2018;361:k2392.
- Mensink R. Effects of saturated fatty acids on serum lipids and lipoproteins: a systematic review and regression analysis. In. Geneva, Switzerland: WHO Press; 2016.
- Mortensen MB, Nordestgaard BG. Elevated LDL cholesterol and increased risk of myocardial infarction and atherosclerotic cardiovascular disease in individuals aged 70-100 years: a contemporary primary prevention cohort. Lancet. 2020;396(10263):1644-1652.
- Abdullah SM, Defina LF, Leonard D, et al. Long-Term Association of Low-Density Lipoprotein Cholesterol With Cardiovascular Mortality in Individuals at Low 10-Year Risk of Atherosclerotic Cardiovascular Disease. Circulation. 2018;138(21):2315-2325.
- Boren J, Chapman MJ, Krauss RM, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2020;41(24):2313-2330.
- Lichtenstein AH, Appel LJ, Vadiveloo M, et al. 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation. 2021;144(23):e472-e487.
- Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;74(10):e177-e232.
- Jacobson TA, Ito MK, Maki KC, et al. National lipid association recommendations for patient-centered management of dyslipidemia: part 1--full report. J Clin Lipidol. 2015;9(2):129-169.
- Jacobson TA, Maki KC, Orringer CE, et al. National Lipid Association Recommendations for Patient-Centered Management of Dyslipidemia: Part 2. J Clin Lipidol. 2015;9(6 Suppl):S1-122.e121.
- U.S. Department of Agriculture and U.S. Department of health and Human Services. Dietary Guidelines for Americans, 2020-2025. https://www.dietaryguidelines.gov. Published 2020. Accessed March 30, 2022.
- Kris-Etherton PM, Krauss RM. Public health guidelines should recommend reducing saturated fat consumption as much as possible: YES. Am J Clin Nutr. 2020;112(1):13-18.
- Krauss RM, Kris-Etherton PM. Public health guidelines should recommend reducing saturated fat consumption as much as possible: Debate Consensus. Am J Clin Nutr. 2020;112(1):25-26.
- Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr. 2010;91(3):535-546.
- Chowdhury R, Warnakula S, Kunutsor S, et al. Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis. Ann Intern Med. 2014;160(6):398-406.
- Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Registered Dietitian Nutritionist. J Acad Nutr Diet. 2018;118(1):141-165.
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