Disorders of Lipid Metabolism

Disorders of Lipid Metabolism

Welcome to the Disorders of Lipid Metabolism (DLM) Project

Saturated Fat

Heart disease is the leading cause of death for adults living in the United States according to the Centers for Disease Control and Prevention.¹ Dietary advice to prevent and treat heart disease has changed overtime, particularly for saturated fat. The majority of recommendations to reduce saturated fat are primarily based on the impact on serum blood lipids.^2-5 There is available scientific literature on the impact of saturated fat reduction on morbidities and mortality. However, this evidence is less clear. The debate on the need to reduce saturated fat intake to treat or prevent heart disease is ongoing.^6,7 The saturated fat debate is further complicated by the topics of saturated fat replacement, and sources of saturated fat. Multiple systematic reviews were conducted and evaluated to support the development of three evidence-based nutrition practice recommendations.

Saturated Fat 2023 Evidence-Based Nutrition Practice Guideline

The objective of the Saturated Fat guideline is to inform registered dietitian nutritionists or international equivalents, and other healthcare providers to provide adults with nutritional care relating to saturated fat intake to prevent or treat heart disease. This guideline specifically focused on three topics:

• Amount of saturated fat intake
• Replacement of saturated fat with other nutrients
• Source of saturated fat

For tips on implementing the guideline recommendations, download the Saturated Fat Practitioner Guide. This one-page guide is designed with clear and unambiguous language that may help practitioners and their patients/clients to actively participate in shared decision making for their nutrition care.

Saturated Fat 2018-2021 Systematic Review

The goal of the 2018-2021 systematic review supporting the Saturated Fat Evidence-based Practice Guideline was to evaluate available evidence on saturated fat intake and the prevention or treatment of heart disease among adults. The panel evaluated the effect of the amount of saturated fat intake, the effect of replacement nutrients, and the effect that different food containing saturated fat may have on mortality, morbidities (coronary heart disease, stroke, cardiovascular disease), blood lipids, inflammation, and endothelial function.

Key Findings

• Mortality: Observational evidence did not find an association with varying amounts of saturated fat intake regardless of replacement nutrients, or source of saturated fat with mortality.
• CVD and CHD: Observational evidence found that a reduction in saturated fat intake may reduce cardiovascular events. However, the association with coronary heart disease (CHD) events and stroke is unclear. Evidence evaluating replacement of saturated fat with polyunsaturated fat also found a reduction in cardiovascular events. One systematic review did find a reduction in coronary heart disease with higher cheese intake. The same review found an increase in coronary heart disease with high fat milk intake, but not low-fat milk intake. No association was found between yogurt intake or butter intake and CVD or CHD.  
• Blood Lipids: Observational evidence found that a reduction of saturated fat intake will likely reduce total and LDL cholesterol. No significant effect was found on HDL or triglycerides. Evidence evaluating replacement of saturated fat with polyunsaturated found a reduction in total cholesterol and triglycerides, but no clear differential effect on HDL or LDL.
• Endothelial Function and Inflammation: The expert panel identified endothelial function and inflammation as outcomes of interest that have yet to be extensively explored. The available evidence was sparse, and little to no effect was found on most outcomes.  

Use the left navigation to view the results of the Saturated Fat guideline and the supporting systematic review. Expand the section below titled Saturated Fat Project Team and Disclosures for a listing of individuals who contributed to the development of the project, disclosures and project funding information.

References

1. Centers for Disease Control and Prevention. Heart Disease Facts. U.S. Department of Health & Human Services. www.cdc.gov/heartdisease/facts. Published 2022. Accessed January 25, 2023.
2. Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S76-99.
3. 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.
4. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25):e1082-e1143.
5. 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.
6. Krauss RM, Kris-Etherton PM. Public health guidelines should recommend reducing saturated fat consumption as much as possible: NO. Am J Clin Nutr. 2020;112(1):19-24.
7. 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.

2/2/2023

• Saturated Fat Guideline and Systematic Review Project Team and Disclosures (2018-23)

  The following individuals contributed their valuable time and expertise to this project:

  Workgroup Members

  • Carol F. Kirkpatrick, PhD, MPH, RDN, CLS, Chair
    Director and Clinical Associate Professor, Idaho State University, Pocatello, ID, USA 
  • Jo Ann S. Carson, PhD, RDN, LD
    Retired Professor, University of Texas Southwestern Medical Center, Dallas, TX, USA
  • Sarah A. Johnson, PhD, RDN
    Associate Professor and Director of Didactic Program in Dietetics, Colorado State University, Fort Collins, CO, USA
  • Nicole H. Miller, MPH, RD, CDCES
    Clinical Dietitian, James H. Haley Veterans Medical Center, Tampa, FL, USA
  • Ann Fonfa, Patient Advocate
    The Anne Appleseek Project, Delray Beach, FL, USA
     

  Project Leaders

  • Deepa Handu, PhD, RDN, Project Manager
    Senior Scientist, Academy of Nutrition and Dietetics, Chicago, IL, USA
  • Lisa Moloney, MS, RDN, Lead Analyst
    Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, IL, USA
  • Margaret J. Foster, MS, MPH, AHIP, Medical Librarian
    Texas A&M University, TAMU-Libraries, College Station, TX, USA
     

  Evidence Analysts

  • Lisa Davis, MS, RD, Middleton, WI, USA
  • Keiy Murofushi, MS, RD, Los Angeles, CA, USA
  • Maja Redzic, MS, RD, Chicago, IL, USA
  • Heather Valentine, MS, RD, Overland Park, MS, USA
     

  Guideline Reviewers

  • Karen S. Basedow, MS, RDN, CDCES
    Wellness Nutritionist, Newark Beth Israel Medical Center, South Orange, NJ, USA
  • Patricia Davidson, DCN, RDN, LDN, CDCES, FAND, CHSE
    Professor, West Chester University, West Chester, PA, USA
  • Satya Jonnalagadda, PhD, MSc, MS, MBA, RDN
    Vice President Scientific and Clinical Affairs, Medifast, Westerville, OH, USA
  • Penny M. Kris-Etherton, PhD, RDN, FAHA, FASN, FNLA
    Professor, Penn State University, University Park, PA, USA
  • Patricia B. Lane, MPA, RDN, LD/N
    Clinical Dietitian, Cleveland Clinic, Martin North Health, Stuart, FL, USA
  • Kristina S. Petersen, PhD, APD, FAHA
    Assistant Professor of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
  • Geeta Sikand, MA, RDN, FAND, FNLA, CLS, CDE
    Associate Clinical Professor, University of California Irvine, Irvine, CA, USA
  • Nancy T. Smith, MS, RDN, LDN, CDCES, CLS
    Lead Dietitian for Metabolic Health Center, Sodexo at Tallahassee Memorial Hospital, Tallahassee, FL, USA

  
  Financial Contributors

  • Academy of Nutrition and Dietetics
    The views and interests of the funding bodies did not influence the development of the systematic review or guideline.
     

  Practice Guide Focus Group
  The following individuals provided invaluable feedback on the development and use of the Saturated Fat Guideline Practitioner Guide. The Practitioner Guide is a one-page version of the guideline recommendations with tips for implementation.

  • Lisa Cooper, RD, LD
  • Alexandra Kazaks, PhD, RDN, CDCES
  • Robin B. Nwankwo, MPH, RDN, CDCES
     

  Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic. Workgroup members are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have an adverse impact on the content, but they are noted here to fully inform readers.

  • Kirkpatrick C: Received compensation from MB Clinical Research (consultancy), McDonald’s Corporation (presentation), National Lipid Association (presentation honorariums). 
  • Johnson S: Received compensation for serving on the board of Nutrition Research Journal.
• Resources and Articles
  • Disorders of Lipid Metabolism Saturated Fat (2023) Guideline Presentation: this 27-slide MS Powerpoint presentation includes all of the recommendations and ratings of the guideline along with implementation tips and resources. Ideal for meetings, in-service presentations, and classroom lectures (this product is not designed for the consumer). Download for free.
     
  • Johnson SA, Kirkpatrick CF, et al. Saturated Fat Intake and the Prevention and Management of Cardiovascular Disease in Adults: An Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guideline. J Acad Nutr Diet. 2023 123(12):1808-1830.