British Journal of Nutrition

Horizons in Nutritional Science

The confusion about dietary fatty acids recommendations for CHD prevention

Daan Kromhouta1a2 c1, Johanna M. Geleijnsea1, Alessandro Menottia3 and David R. Jacobs Jra2

a1 Division of Human Nutrition, Wageningen University, PO Box 8129, 6700 EV Wageningen, the Netherlands

a2 Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA

a3 Association for Cardiac Research, Rome, Italy


A recent meta-analysis of prospective cohort studies has not found an association between dietary saturated fat intake and CHD incidence. This funnelled the discussion about the importance of the recommendation to lower the intake of saturated fat for the prevention of CHD. At the same time a document of the European Food Safety Authority has suggested that specific quantitative recommendations are not needed for individual fatty acids but that more general statements can suffice. In this review, we discuss methodological aspects of the absence of association between SFA intake and CHD incidence in prospective cohort studies. We also summarise the results of the controlled dietary experiments on blood lipids and on CHD incidence in which saturated fat was replaced by either cis-unsaturated fat or carbohydrates. Finally, we propose a nutritionally adequate diet with an optimal fatty acid composition for the prevention of CHD in the context of dietary patterns. Such diets are characterised by a low intake of saturated fat, and as low as possible intake of trans-fat and fulfil the requirements for the intake of n-6 and n-3 fatty acids. No recommendation is needed for the intake of cis-MUFA.

(Received November 24 2010)

(Revised March 21 2011)

(Accepted March 22 2011)

(Online publication June 27 2011)


c1 Corresponding author: Professor D. Kromhout, fax +31 317 483342, email


Abbreviations: ALA, α-linolenic acid; EFSA, European Food Safety Authority; P:S, polyunsaturated:saturated