Oktavianus


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Universa Medicina                                                                                                      September-Desember, 2015 - Vol.34 - No.3

Dietary fat and cardiovascular disease?

Lie T Merijanti S
Department of Occupational Medicine, Medical Faculty, Trisakti University

Dietary saturated fat (SF) intake has been
shown to increase low density lipoprotein (LDL)
cholesterol and therefore has been associated
with increased risk of cardiovascular disease
(CVD). This evidence coupled with inferences
from epidemiologic studies and clinical trials,
h a d  l e d  t o  l o n g s t a n d i n g  p u b l i c  h e a l t h
recommendations for limiting SF intake as a
means of preventing CVD. However the
relationship between SF and CVD risk remains
controversial, due at least in part to the intrinsic
limitations of clinical studies that have evaluated
this relationship.(1) A recent meta analysis showed
that current evidence does not clearly support
cardiovascular guidelines that encourage high
consumption of polyunsaturated fatty acids
(PUFA) and low consumption of total SF.(2) They
found weak positive associations between
circulating palmitic and stearic acids (found
largely in palm oil and animal fats, respectively)
and CVD, whereas circulating margaric acid (a
dairy fat) significantly reduced the risk of
CVD.(2,3) Saturated fat are not associated with
all cause mortality, CVD, CHD, ischemic stroke
o r  t y p e  2  d i a b e t e s ,  b u t  t h e  e v i d e n c e  i s
heterogenous with methodological limitations.(4)

Dietary lipids are important regulators of
cardiac function through their role in membrane
phospholipids, as signaling molecules and
ligands for nuclear receptors, and as the
predominant oxidative substrate for cardiac
mitochondria. Moreover, long chain n3 PUFA
decrease very low density lipoprotein assembly
a n d  s e c r e t i o n  r e d u c i n g  t r i a c y l g l y c e r o l

production. Eicosanoids derived from n6 PUFA
have proinflammatory actions, while eicosanoids
from n3 PUFA have anti inflammatory ones.
Previous studies showed that inflammation
contributes to both the onset and progression of
atherosclerosis actually, atherosclerosis is
predominantly a chronic low grade inflammatory
disease of the vessel wall.(5) Studies in rodents
show that in the absence of obesity, replacing
refined carbohydrate with fat can attenuate or
prevent ventricular expansion and contractile
dysfunction in response to hypertension,
infarction or genetic cardiomyopathy. Clinical
studies generally support high intake of n 3 PUFA
from marine sources to prevent and treat heart
failure. This effect is associated with decreased
inflammation and improved resistance to
mitochondrial permeability transition.(6)

Dietary guidelines must carefully consider
the health effect of recommendations for
alternative macronutrient to replace SF.(3)

Saturated fat intake of around 20 g/day
(approximately 10% of total energy) may be
optimal, which corresponds to 200 g of milk a
day and 150 g of meat every other day.(7)

Epidemiologic studies and randomized clinical
trials have provided consistent evidence that
replacing SF with PUFA but not carbohydrates
is beneficial for CHD.(1) In practice, reducing
red meat and dairy products in a food supply
and increasing intakes of nuts, fish, soy products
and non hydrogenated vegetables oils will
improve the mix of FA and have a markedly
beneficial effects on rates of CHD.(4)



160

Univ Med 2015;34:159-60. DOI: http://dx.doi.org/10.18051/UnivMed.2015.v34.159-160

REFERENCES

1. Siri Tarino PW, Sun Q, Hu FB, et al. Saturated
fatty acid and risk of coronary heart disease:
modulation by replacement nutrients. Curr
Atheroscler Rep 2010;12:384-90. DOI: 10.1007/
s11883-010-0131-6.

2. Chowdury 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;160:398-406.

3. Siri Tarino PW, Sun Q, et al. Meta analysis of
prospective cohort studies evaluating the
association of saturated fat with cardiovascular
disease. Am J Clin Nutr 2010;91:535-46. Doi:
10.3945/acjn.2009.27725.

4. De Souza RJ, Mente A, Moroleanu A, et al.
Intake of saturated and trans unsaturated fatty

acids and risk of all cause mortality
cardiovascular disease and type 2 diabetes:
systematic review and metaanalysis of
observational studies. BMJ 2015;351:3978. doi:
10.1136/bmjh3978.

5. Mozaffarian D, Katan MB, Ascherio A, et al.
Trans fatty acids and cardiovascular disease. N
Engl J Med 2006;354:1601-13.

6. Dessi M, Noce A, Bertucci P, et al.
Atherosclerosis, dyslipidemia and inflammation:
The significant role of polyunsaturated fatty
acids. ISRN Inflammation: volume 2013. Article
ID 191823, 13 pages. http://dx.doi.org/10.1155/
2013/191823.

7. Stanley WC, Dabkowski ER, Riberio RF, et al.
Dietary fat and heart failure: moving from
lipotoxicity to lipoprotection. Circ Res 2012;110:
764-76.

Universa Medicina                                                                                                      September-Desember, 2015 - Vol.34 - No.3