A systematic review of the effect of dietary saturated and polyunsaturated fat on heart disease

Nutr Metab Cardiovasc Dis. 2017 Dec;27(12):1060-1080. doi: 10.1016/j.numecd.2017.10.010. Epub 2017 Oct 18.


Aims: Over the last 7 years there has been intense debate about the advice to reduce saturated fat and increase polyunsaturated fat to reduce CVD risk. The aim of this review was to examine systematic reviews and meta-analyses since 2010 on this topic plus additional cohort studies and interventions not included in these reviews.

Data synthesis: High saturated and trans fat intake (which elevates LDL like saturated fat) in the Nurses and Health Professional Follow-Up Studies combined is associated with an 8-13% higher mortality and replacement of saturated fat with any carbohydrate, PUFA and MUFA is associated with lower mortality with PUFA being more effective than MUFA (19% reduction versus 11%). With CVD mortality only PUFA and fish oil replacement of saturated fat lowers risk with a 28% reduction in CVD mortality per 5% of energy. Replacing saturated fat with PUFA or MUFA is equally effective at reducing CHD events and replacement with whole grains will lower events while replacement with sugar and starch increases events. Replacement of saturated fat with carbohydrate has no effect on CHD events or death. Only PUFA replacement of saturated fat lowers CHD events and CVD and total mortality. Replacing saturated fat with linoleic acid appears to be beneficial based on the Hooper Cochrane meta-analysis of interventions although other analyses with fewer studies have shown no effect.

Conclusions: Reducing saturated fat and replacing it with carbohydrate will not lower CHD events or CVD mortality although it will reduce total mortality. Replacing saturated fat with PUFA, MUFA or high-quality carbohydrate will lower CHD events.

Keywords: Cohort studies; Heart attack; Heart death; Interventions; Meta-analyses; Polyunsaturated fat; Saturated fat; Systematic review.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Diet, Fat-Restricted
  • Diet, Healthy
  • Diet, High-Fat / adverse effects*
  • Dietary Carbohydrates / administration & dosage
  • Evidence-Based Medicine
  • Fatty Acids / administration & dosage
  • Fatty Acids / adverse effects*
  • Fatty Acids, Unsaturated* / administration & dosage
  • Fatty Acids, Unsaturated* / adverse effects
  • Feeding Behavior
  • Heart Diseases / diagnosis
  • Heart Diseases / epidemiology*
  • Heart Diseases / mortality
  • Heart Diseases / prevention & control
  • Humans
  • Meta-Analysis as Topic
  • Protective Factors
  • Risk Assessment
  • Risk Factors
  • Risk Reduction Behavior


  • Dietary Carbohydrates
  • Fatty Acids
  • Fatty Acids, Unsaturated