Saturated fats and heart disease link 'unproven'

Behind the Headlines

Tuesday March 18 2014

Fats are an essential part of a balanced diet

Have sat fats had a bad rap?

“No link found between saturated fat and heart disease,” The Daily Telegraph reports. Researchers have looked at large amounts of data and say they have found no significant link between saturated fat and heart disease.

Nutritional guidelines generally encourage low consumption of saturated fats, found in butter, cream, cheese and fatty cuts of meat, as these were thought to be linked to increased cholesterol in the blood and an increased risk of heart disease.

In contrast, unsaturated fats, found in fish and plant sources, have been encouraged (to a certain extent) as these are thought to have a protective effect on the heart and blood vessels.

This latest study finds that the evidence for these guidelines may not be definitive.

Trans fats – the villain

The researchers did find a significant association between the consumption of trans fats and increased risk of heart disease (although no association was seen in studies where levels of trans fats in the blood were measured, rather than assessed through dietary intake).


Trans fats can be formed when oil goes through a process called hydrogenation, which makes the oil more solid (known as hardening). This type of fat, known as hydrogenated fat, can be used for frying or as an ingredient in processed foods.


Trans fats can be found in some processed foods such as biscuits and cakes, to help give products a longer shelf life.


If you are concerned about trans fats, avoid buying goods that list partially hydrogenated fat or oil on the label. Read more about trans fats

Researchers pooled the results of 72 studies that had looked at the link between fatty acids and coronary disease (including heart attackcoronary heart disease and angina).

They found no significant evidence that saturated fats increase the risk of heart disease and no significant evidence that omega-6 and omega-3 polyunsaturated fats protect the heart.

However, some of the pooled studies involved people with cardiovascular risk factors or with cardiovascular disease, so the results may not necessarily apply to the population at large.

Yet the researchers say that despite their results, further research is necessary, especially in people who are initially healthy. Until the picture becomes clearer, it is recommended people stick to the current UK guidelines on fat consumption.

Concentrating on a single food source to protect your health is never a good idea. The most important thing is to eat a healthy and balanced diet, which should include at least five portions of fruit and vegetables.


Where did the story come from?

The study was carried out by researchers from the University of Cambridge and Medical Research Council, University of Oxford, Imperial College London, University of Bristol, Erasmus University Medical Centre and Harvard School of Public Health. It was funded by the British Heart Foundation, Medical Research Council, Cambridge National Institute for Health Research Biomedical Research Centre and Gates Cambridge.

The study was published in the peer-reviewed journal Annals of Internal Medicine.

The results of the research were accurately reported by the UK media, though some of the headlines were a little too black and white. This study hasn’t “proved” that saturated fat isn't bad for the heart, rather that evidence of harm does not appear to be statistically significant.


What kind of research was this?

This was a systematic review and meta-analysis that aimed to summarise the evidence about associations between fatty acids and coronary disease. A systematic review is an overview of primary studies. Systematic reviews use explicit and reproducible methods to search for and assess studies for inclusion in the review. A meta-analysis is a mathematical synthesis of the results of the included studies.

This is an appropriate way of pooling and studying the body of available evidence on a specific topic.


What did the research involve?

The researchers first searched databases of published studies to identify prospective cohort studies related to fatty acid exposure that were at least one year long. They also searched for randomised control trials that had looked at the association between fatty acids exposures and coronary disease.

Fatty acid exposures included:

  • fatty acid intake, estimated by diet questionnaires or diet records
  • levels of fatty acid biomarkers
  • the effect of supplementing diets with fatty acids

Coronary disease was defined as:

  • fatal or nonfatal heart attack
  • coronary heart disease
  • angina
  • coronary insufficiency (also known as angiographic coronary stenosis) – where poor blood flow to the heart causes repeated angina attacks
  • sudden cardiac death (also known as coronary death)

Once the studies had been identified, the researchers assessed if there were any biases and extracted data about the characteristics and results.

The researchers transformed the results of each study, to calculate the relative risk of coronary disease when people in the top third of the fatty acid distribution were compared with people in the bottom third.

The researchers then performed a meta-analysis to combine the results of the included studies.


What were the basic results?

The researchers identified 72 studies: 45 cohort studies and 27 randomised controlled trials. 40 studies had initially healthy populations, 10 recruited people with elevated cardiovascular risk factors and 22 recruited people with cardiovascular disease.

32 cohort studies, including 530,525 people, looked at the association between dietary fatty acid intake and coronary disease. These studies looked at the intake of:

  • total saturated fatty acid
  • total monounsaturated fatty acid
  • total long-chain -3 polyunsaturated fatty acid
  • total -6 polyunsaturated fatty acid
  • total trans fatty acid intake

When comparing people in the top third to those in the bottom third of dietary fatty acid intake, only trans fatty acid intake was significantly associated with a risk of coronary disease.

People in the top third of dietary intake of trans fatty acids had a 16% increased risk of coronary disease compared to people in the bottom third (relative risk [RR] 1.16, 95% confidence interval [CI] 1.06 to 1.27).

17 cohort studies, including 25,721 people, looked at the association between circulating fatty acid biomarkers (i.e. in the blood) and coronary disease. These studies looked at circulating levels of the same fatty acids listed above. Comparing the top third and the bottom third, there were no significant associations between circulating levels of any of these types of fatty acid and the risk of coronary disease.

However, there were significant associations for specific fatty acids. The saturated fatty acid margaric acid was significantly associated with lower risk (RR 0.77, 95% CI 0.63 to 0.93), as were the polyunsaturated fatty acids eicosapentaenoic (RR 0.78, 95% CI 0.65 to 0.94), docosahexaenoic (RR 0.79, 95% CI 0.67 to 0.93) and arachidonic acid (RR 0.83, 95% CI 0.74 to 0.92).

27 randomised controlled trials, including 103,052 people, looked at the effect of fatty acid supplementation on the risk of coronary disease. In these trials, people in the intervention group had been given linolenic acid, long-chain -3 polyunsaturated fatty acid or -6 polyunsaturated fatty acid supplements. No significant difference in the risk of coronary disease was seen for people in the intervention group compared to people in the control group.


How did the researchers interpret the results?

The researchers concluded that “current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats”.



In contrast to current recommendations, this systematic review found no evidence that saturated fat increases the risk of coronary disease, or that polyunsaturated fats have a cardioprotective effect.

Similarly, there was no significant association between the levels of total omega-3 or omega-6 polyunsaturated fatty acids and coronary disease. This lack of association was seen in both cohort studies, which looked at dietary intake or circulating levels the in blood, and in randomised controlled trials that had looked at the effect of supplementation.

There was also no significant association between total saturated fatty acids and coronary risk, both in studies using dietary intake and in those using circulating biomarkers. In addition, there was no significant association between total monounsaturated fatty acids and coronary risk  again, both in studies using dietary intake and those studying fatty acid composition.

Dietary trans fatty acid intake was associated with increased coronary disease risk, although circulating levels were not.

There are some limitations to this study:

  • For the studies based on dietary intake, it is not clear over how long a period of time their diet was assessed. Dietary questionnaires can be inaccurate due to recall bias and may not be representative of diet over a number of years.
  • The level of fat consumption is unclear – that is, how large the difference in fat consumption per day was between people in the top third compared with people in the bottom third.
  • Some of the studies involved people with a pre-existing health condition, so the results may not be applicable to a healthy population.

Despite these limitations, this was an impressively detailed and extensive piece of research, which is likely to prompt further study.

Current UK guidelines remained unchanged:

  • The average man should eat no more than 30g of saturated fat a day.
  • The average woman should eat no more than 20g of saturated fat a day.

Even if saturated fats don’t directly harm your heart, eating too much can lead to obesity, which in turn can damage it.

The key to a healthy diet is “everything in moderation”. The occasional buttered scone or cream cake is not going to hurt you, but you need to be aware of your total calorie intake.

Eating a healthy, balanced diet, being physically active and not smoking are the best ways to keep your heart healthy.

Analysis by Bazian. Edited by NHS Choices.
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Join the Healthy Evidence forum.

Analysis by Bazian

Edited by NHS Choices

Links to the headlines

No link found between saturated fat and heart disease. The Daily Telegraph, March 18 2014

Saturated fat 'ISN'T bad for your heart': Major study questions decades of dietary advice. Daily Mail, March 18 2014

Saturated fat advice 'unclear'. BBC News, March 17 2014

Should I avoid saturated fat? BBC News, March 17 2014

'Butter may be no worse for your heart than using ‘healthy’ low-fat alternative’. Daily Mirror, March 17 2014

Links to the science

Chowdhury R, Warnakula S, Kunutsor S, et al. Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Meta-analysis. Annals of Internal Medicine. Published online March 18 2014


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The 8 comments posted are personal views. Any information they give has not been checked and may not be accurate.

nielsen1 said on 09 August 2015

I really don't understand this article. It's super confusing. You state that the link between saturated fats and heart disease in this study has been unproven, yet you tell us to stick to the current guidance, which has named saturated fat as the main health culprit for the past 20 years? Why is the guidance not being updated? You then go on to say that 'even if saturated fats don’t directly harm your heart, eating too much can lead to obesity'. Where is the evidence for this? And if you mean that too much of any nutrient can cause obesity, then lets also add this line to the article on fruits and vegetables and please - on sugar, which we all know is bad news.

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EBM Paul said on 26 February 2015

No statistically significant evidence is essentially the scientific way of saying no evidence. This comment and that on proof will mislead people unfamiliar with significant in the statistical sense or who may not realise it's almost impossible to prove negatives, like something not causing harm (that is if you don't accept a systematic review that finds no evidence of harm suffiently proof).
To illustrate, if I claim that eating baked beans, bananas or broccoli increases the risk of heart disease (or maybe using feather pillows) can the writer prove me wrong? If there is no statistically significant evidence, I'll say that isn't proof and that more research is needed - because that might find the evidence that a systematic review of years of research couldn't. And in the meantime people shoud follow my guidelines, to be on the safe side...
This is of course the government's face saving position, which this article regrettably sides with. I'm not some Atkins diet zealot, but I do believe we need to be honest and base guidelines on evidence.

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Winch2015 said on 11 February 2015

I was diagnosed with cholesterol levels somewhat higher than the recommended levels and am now avoiding saturated fat and taking statins, which carry a risk of side-effects.

In light of this publication, I am left wondering whether the advice I was given by my GP is to be trusted.

In particular, I wonder whether a correlation between (bad) cholesterol levels and heart disease was inferred from a supposed correlation between saturated fat intake and heart disease (and presumably a provable correlation between saturated fat intake and cholesterol levels) or whether there has been any study of the actual correlation between cholesterol levels and heart disease (which may perhaps have fallen outside the scope of the above meta-analysis).

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Spev said on 06 February 2015

"This study hasn’t “proved” that saturated fat isn't bad for the heart, rather that evidence of harm does not appear to be statistically significant." Indeed, no more than any study has proved that eating too much fish or olive oil isn't bad for you...

What it has proved is that the previous "proof" that saturated fat is bad for the heart cobbled together and then rammed down everyone's throat (notably the highly influential AHA) by Ancel Keys and his merry band of anti-fat & cholesterol crusaders fifty years ago was deeply flawed aka wrong.

As others have noted here, health guidelines should be based on evidence. The "first do no harm" principle means that the onus should be on proving that there is a statistically significant risk of something being bad for you, not that something is NOT bad for you. i.e., innocent until proven guilty, not the other way round!

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viddy9 said on 02 November 2014

I believe this article should be updated to take into account the numerous errors which were found in this meta-analysis by other researchers, which then had to be corrected.

For example, two of the six studies they analysed on N-6 polyunsaturated fatty acids actually showed that they protect against cardiovascular disease: in the original paper, it was claimed that polyunsaturated fats do not protect against it. The same was true for a study on Omega-3 polyunsaturates.

In addition, as Walter Willett of Harvard University points out, much of the monounsaturated fats consumed in the studies analysed came from unhealthier red meat and dairy sources, not plant sources.

Further, results also depend on whether or not refined or unrefined carbohydrates are consumed: eating refined carbohydrates will have no effect, but eating unrefined carbs in place of saturated fat is likely to have a beneficial effect.

In conclusion, the findings of two other systematic reviews in 2009 and 2010, which this meta-analysis failed to mention, seem to be much more sensible given the evidence: saturated fat intake should be limited and monounsaturated and polyunsaturated fats should be used in place of saturated fat. Furthermore, while eating refined carbohydrates has no effect, or may even have a negative effect when used in place of saturated fats, unrefined carbohydrates are better than saturated fats.

One of the co-authors of the meta-analysis mentioned in this article, Dariush Mozaffarian, has even distanced himself from the paper's key conclusion, stating that polyunsaturated fats do offer protection when compared with saturated fats.

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User363614 said on 25 October 2014

No sign of healthy eating guidelines changing. Are they evidence based?

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JamieT76 said on 24 March 2014

"Eating too much saturated fat can lead to obesity..."

While this article appears balanced the last comment seems to share an opinion which is also being challenged under current nutritional thinking. What about eating too much refined / processed carbohydrates or consuming too much sugar - these food groups are the main cause of obesity yet seem curiously missing from the statement made in the conclusion of this article??

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CynicalEng said on 23 March 2014

So the current guidelines are without foundation in evidence, but we should stick to them anyway. Hmm.

The lead author Chowdhury is quoted in the New York Times -

The smaller, more artery-clogging particles are increased not by saturated fat, but by sugary foods and an excess of carbohydrates, Dr. Chowdhury said. “It’s the high carbohydrate or sugary diet that should be the focus of dietary guidelines,” he said. “If anything is driving your low-density lipoproteins in a more adverse way, it’s carbohydrates.”

That'll be the high carbohydrate diet which is the basis of current NHS dietary guidance. Oh dear.

Let's try a balanced diet of 30% protein, 30% carbs and 40% fat and see if it works out any better.

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