The dietary fat–heart disease hypothesis: An ongoing debate

Abstract

The belief that the consumption of saturated fat as the primary source of daily energy needs is detrimental to heart health has held a firm grip on public consciousness for decades. It was initially based entirely on tenuous observational (correlation) studies but was later bolstered by a vast array of evidence and more direct observations from long-term randomized controlled trials and dietary intervention studies. Further support also came from the elucidation of the pathophysiology and molecular mechanisms involved in atherogenesis. However, in recent years, the association between dietary saturated fat and heart disease has come under attack based mainly on meta-analyses and large multinational studies most of which relying on questionnaires and diet recall. More recent publications have elevated the debate to a new level, leading some experts to question the evidence behind commonly accepted dietary recommendations, attracting media attention, and generating heated debates. Here, the most relevant studies will be reviewed defining the salient issues and where the proponents and opponents of the hypothesis stand.