How much and which kind of fat? This has remained a surprisingly divisive issue. Surprising because the Australian population has gradually reduced fat consumption from over 40% of energy in the middle of the last century to a little over 30% by the end. This has coincided with a substantial reduction in heart attack prevalence. However, the evidence that the quantity of fat is linked to coronary heart disease (CHD) is weak — it is the quality of the dietary fatty acids that matters.1 After all, CHD prevalence remains low in southern Europe, despite high intakes of lipid, mostly as vegetable oils. Prospective cohort studies and intervention trials, both primary and secondary, point that way. The positive link between dietary saturated fat and CHD is strong, as is the evidence that substituting polyunsaturated fatty acids (PUFAs, linoleic acid) for saturates lowers CHD risk. Whereas PUFAs are part of the eating pattern associated with least CHD in prospective trials, the opposite holds for saturates.2,3
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