Abstract
The role of dietary fat has been long studied as a modifiable variable in the prevention and treatment of noncommunicable cardiometabolic disease. Once heavily promoted to the public, the low-fat diet has been demonstrated to be non-effective in preventing cardiometabolic disease, and an increasing body of literature has focused on the effects of a relatively higher-fat diet. More recent evidence suggests that a diet high in healthy fat, rich in unsaturated fatty acids, such as the Mediterranean dietary pattern, may, in fact, prevent the development of metabolic diseases such as type 2 diabetes mellitus, but also reduce cardiovascular events. This review will specifically focus on clinical trials which collected data on dietary fatty acid intake, and the association of these fatty acids over time with measured cardiometabolic health outcomes, specifically focusing on morbidity and mortality outcomes. We will also describe mechanistic studies investigating the role of dietary fatty acids on cardiovascular risk factors to describe the potential mechanisms of action through which unsaturated fatty acids may exert their beneficial effects. The state of current knowledge on the associations between dietary fatty acids and cardiometabolic morbidity and mortality outcomes will be summarized and directions for future work will be discussed.
Highlights
IntroductionCardiometabolic diseases are estimated to cause over 700,000 deaths per year in the United
Cardiometabolic diseases are estimated to cause over 700,000 deaths per year in the UnitedStates (US) and nearly 50% of these deaths are directly related to diet [1,2], this could be questioned due to so much data being based on potentially flawed food frequency questionnaires (FFQs) [3,4]
To identify the works used in this critical review, the comprehensive electronic literature search using PubMed and Google Scholar included the use of the following key words and their combination: “Low-fat diet”, “high-fat diet”, “Mediterranean diet”, “fatty acids”, “mortality”, “cardiovascular disease”, “weight gain”, “weight loss”, “type II diabetes”, “insulin resistance”, “blood pressure”, “heart failure”, “dyslipidemia”, and “cancer”
Summary
Cardiometabolic diseases are estimated to cause over 700,000 deaths per year in the United. During the same period, controlled-feeding studies demonstrated a link between increasing saturated fatty acids (SFA) in the diet and increased levels of total cholesterol and, more importantly, of low-density lipoprotein cholesterol (LDL-C), which were known to be associated with incidence of coronary heart disease (CHD) [7]. These controlled-feeding studies, in addition to observational evidence, were relied on as sufficient evidence that a higher total fat and SFA intake leads to an increased incidence of CHD by increasing plasma total cholesterol and LDL-C—the “diet-heart hypothesis” [7,8,9]. We will discuss the potential underlying mechanisms through which fatty acids may affect overall cardiometabolic health
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