Reduction In Saturated Fat Intake Research Articles

Effect of reducing saturated fat intake on cardiovascular disease in adults: an umbrella review.

Our objective was to explore the effect of the reduction of saturated fat (SAF) intake on cardiovascular disease, mortality and other health-related outcomes in adults. We conducted an umbrella review, searching Medline, Scopus, EMBASE, Cochrane Library, and LILACS databases for systematic reviews from December 1, 2012, to December 1, 2022. We have included meta-analyses of randomized controlled trials (RCTs) and cohort studies. We extracted effect sizes (95%CI), heterogeneity (I 2), and evidence quality rating based on the population, intervention, comparator, and outcomes. 21 meta-analyses were included (three were from RCTs, and 18 were from cohort studies). Among meta-analyses of RCTs, 15 of the 45 associations were significant. The effect of reduction in SAF intake on combined cardiovascular events (RR 0.79, 95%CI 0.66-0.93) was graded as having moderate certainty of evidence. We found no effect on all-cause mortality, cardiovascular mortality, cancer deaths, and other cardiovascular events. Among meta-analyses of cohort studies, five of the 19 associations were significant. There was an increase in coronary heart disease mortality (HR 1.10, 95% CI 1.01-1.21) and breast cancer mortality (HR 1.51, 95% CI 1.09-2.09) in participants with higher SFA intake compared to reduced SFA. We found no effect on all-cause mortality, cardiovascular mortality, and other cardiovascular events. This umbrella review found the reduction in SAF intake probably reduces cardiovascular events and other health outcomes. However, it has little or no effect on cardiovascular mortality and mortality from other causes. More high-quality clinical trials with long-term follow-up are needed.Systematic review registration: CRD42022380859.

Dietary interventions for dyslipidemia

The prerequisite for any diet is that it is nutritionally adequate, that is, it contains sufficient amounts of macro and micronutrients, in order to meet the recommendations. To do so, it must include a wide variety of foods. Fruits, vegetables and legumes (beans, peas) are good sources of vitamin A, C, folic acid, fiber and minerals. Cereals and derivatives (rice, flours, breads, etc.), especially whole grains, contain B vitamins, complex carbohydrates, fiber, as well as a small amount of protein and iron. Chicken, fish, beef and eggs are good sources of protein, iron and B vitamins. However, these last two food groups are also rich in saturated fats and cholesterol and therefore should be used in small amounts or in a modified form. More specifically, the following modifications should be considered: Total fat - The recommendation that total dietary fat should not exceed 30% of total calories has two goals, to facilitate the reduction in saturated fat intake and to promote weight reduction when necessary. In this article the focus is mainly on diet interventions and lipoprotein metabolism as understood so far.

Evaluation of an intervention to provide brief support and personalized feedback on food shopping to reduce saturated fat intake (PC-SHOP): A randomized controlled trial.

Guidelines recommend reducing saturated fat (SFA) intake to decrease cardiovascular disease (CVD) risk, but there is limited evidence on scalable and effective approaches to change dietary intake, given the large proportion of the population exceeding SFA recommendations. We aimed to develop a system to provide monthly personalized feedback and healthier swaps based on nutritional analysis of loyalty card data from the largest United Kingdom grocery store together with brief advice and support from a healthcare professional (HCP) in the primary care practice. Following a hybrid effectiveness-feasibility design, we tested the effects of the intervention on SFA intake and low-density lipoprotein (LDL) cholesterol as well as the feasibility and acceptability of providing nutritional advice using loyalty card data. The Primary Care Shopping Intervention for Cardiovascular Disease Prevention (PC-SHOP) study is a parallel randomized controlled trial with a 3 month follow-up conducted between 21 March 2018 to 16 January2019. Adults ≥18 years with LDL cholesterol >3 mmol/L (n = 113) were recruited from general practitioner (GP) practices in Oxfordshire and randomly allocated to "Brief Support" (BS, n = 48), "Brief Support + Shopping Feedback" (SF, n = 48) or "Control" (n = 17). BS consisted of a 10-minute consultation with an HCP to motivate participants to reduce their SFA intake. Shopping feedback comprised a personalized report on the SFA content of grocery purchases and suggestions for lower SFA swaps. The primary outcome was the between-group difference in change in SFA intake (% total energy intake) at 3 months adjusted for baseline SFA and GP practice using intention-to-treat analysis. Secondary outcomes included %SFA in purchases, LDL cholesterol, and feasibility outcomes. The trial was powered to detect an absolute reduction in SFA of 3% (SD3). Neither participants nor the study team were blinded to group allocation. A total of 106 (94%) participants completed the study: 68% women, 95% white ethnicity, average age 62.4 years (SD 10.8), body mass index (BMI) 27.1 kg/m2 (SD 4.7). There were small decreases in SFA intake at 3 months: control = -0.1% (95% CI -1.8 to 1.7), BS = -0.7% (95% CI -1.8 to 0.3), SF = -0.9% (95% CI -2.0 to 0.2); but no evidence of a significant effect of either intervention compared with control (difference adjusted for GP practice and baseline: BS versus control = -0.33% [95% CI -2.11 to 1.44], p = 0.709; SF versus control = -0.11% [95% CI -1.92 to 1.69], p = 0.901). There were similar trends in %SFA based on supermarket purchases: control = -0.5% (95% CI -2.3 to 1.2), BS = -1.3% (95% CI -2.3 to -0.3), SF = -1.5% (95% CI -2.5 to -0.5) from baseline to follow-up, but these were not significantly different: BS versus control p = 0.379; SF versus control p = 0.411. There were small reductions in LDL from baseline to follow-up (control = -0.14 mmol/L [95% CI -0.48, 0.19), BS: -0.39 mmol/L [95% CI -0.59, -0.19], SF: -0.14 mmol/L [95% CI -0.34, 0.07]), but these were not significantly different: BS versus control p = 0.338; SF versus control p = 0.790. Limitations of this study include the small sample of participants recruited, which limits the power to detect smaller differences, and the low response rate (3%), which may limit the generalisability of these findings. In this study, we have shown it is feasible to deliver brief advice in primary care to encourage reductions in SFA intake and to provide personalized advice to encourage healthier choices using supermarket loyalty card data. There was no evidence of large reductions in SFA, but we are unable to exclude more modest benefits. The feasibility, acceptability, and scalability of these interventions suggest they have potential to encourage small changes in diet, which could be beneficial at the population level. ISRCTN14279335.

Reduction in saturated fat intake for cardiovascular disease.

Reducing saturated fat reduces serum cholesterol, but effects on other intermediate outcomes may be less clear. Additionally, it is unclear whether the energy from saturated fats eliminated from the diet are more helpfully replaced by polyunsaturated fats, monounsaturated fats, carbohydrate or protein. To assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA), monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity, using all available randomised clinical trials. We updated our searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and Embase (Ovid) on 15 October 2019, and searched Clinicaltrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) on 17 October 2019. Included trials fulfilled the following criteria: 1) randomised; 2) intention to reduce saturated fat intake OR intention to alter dietary fats and achieving a reduction in saturated fat; 3) compared with higher saturated fat intake or usual diet; 4) not multifactorial; 5) in adult humans with or without cardiovascular disease (but not acutely ill, pregnant or breastfeeding); 6) intervention duration at least 24 months; 7) mortality or cardiovascular morbidity data available. Two review authors independently assessed inclusion, extracted study data and assessed risk of bias. We performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity analyses, funnel plots and GRADE assessment. We included 15 randomised controlled trials (RCTs) (16 comparisons, 56,675 participants), that used a variety of interventions from providing all food to advice on reducing saturated fat. The included long-term trials suggested that reducing dietary saturated fat reduced the risk of combined cardiovascular events by 17% (risk ratio (RR) 0.83; 95% confidence interval (CI) 0.70 to 0.98, 12 trials, 53,758 participants of whom 8% had a cardiovascular event, I² = 67%, GRADE moderate-quality evidence). Meta-regression suggested that greater reductions in saturated fat (reflected in greater reductions in serum cholesterol) resulted in greater reductions in risk of CVD events, explaining most heterogeneity between trials. The number needed to treat for an additional beneficial outcome (NNTB) was 56 in primary prevention trials, so 56 people need to reduce their saturated fat intake for ~four years for one person to avoid experiencing a CVD event. In secondary prevention trials, the NNTB was 53. Subgrouping did not suggest significant differences between replacement of saturated fat calories with polyunsaturated fat or carbohydrate, and data on replacement with monounsaturated fat and protein was very limited. We found little or no effect of reducing saturated fat on all-cause mortality (RR 0.96; 95% CI 0.90 to 1.03; 11 trials, 55,858 participants) or cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 10 trials, 53,421 participants), both with GRADE moderate-quality evidence. There was little or no effect of reducing saturated fats on non-fatal myocardial infarction (RR 0.97, 95% CI 0.87 to 1.07) or CHD mortality (RR 0.97, 95% CI 0.82 to 1.16, both low-quality evidence), but effects on total (fatal or non-fatal) myocardial infarction, stroke and CHD events (fatal or non-fatal) were all unclear as the evidence was of very low quality. There was little or no effect on cancer mortality, cancer diagnoses, diabetes diagnosis, HDL cholesterol, serum triglycerides or blood pressure, and small reductions in weight, serum total cholesterol, LDL cholesterol and BMI. There was no evidence of harmful effects of reducing saturated fat intakes. The findings of this updated review suggest that reducing saturated fat intake for at least two years causes a potentially important reduction in combined cardiovascular events. Replacing the energy from saturated fat with polyunsaturated fat or carbohydrate appear to be useful strategies, while effects of replacement with monounsaturated fat are unclear. The reduction in combined cardiovascular events resulting from reducing saturated fat did not alter by study duration, sex or baseline level of cardiovascular risk, but greater reduction in saturated fat caused greater reductions in cardiovascular events.

Reduction in saturated fat intake for cardiovascular disease.

Reducing saturated fat reduces serum cholesterol, but effects on other intermediate outcomes may be less clear. Additionally, it is unclear whether the energy from saturated fats eliminated from the diet are more helpfully replaced by polyunsaturated fats, monounsaturated fats, carbohydrate or protein. To assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA), monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity, using all available randomised clinical trials. We updated our searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and Embase (Ovid) on 15 October 2019, and searched Clinicaltrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) on 17 October 2019. Included trials fulfilled the following criteria: 1) randomised; 2) intention to reduce saturated fat intake OR intention to alter dietary fats and achieving a reduction in saturated fat; 3) compared with higher saturated fat intake or usual diet; 4) not multifactorial; 5) in adult humans with or without cardiovascular disease (but not acutely ill, pregnant or breastfeeding); 6) intervention duration at least 24 months; 7) mortality or cardiovascular morbidity data available. Two review authors independently assessed inclusion, extracted study data and assessed risk of bias. We performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity analyses, funnel plots and GRADE assessment. We included 15 randomised controlled trials (RCTs) (16 comparisons, ~59,000 participants), that used a variety of interventions from providing all food to advice on reducing saturated fat. The included long-term trials suggested that reducing dietary saturated fat reduced the risk of combined cardiovascular events by 21% (risk ratio (RR) 0.79; 95% confidence interval (CI) 0.66 to 0.93, 11 trials, 53,300 participants of whom 8% had a cardiovascular event, I² = 65%, GRADE moderate-quality evidence). Meta-regression suggested that greater reductions in saturated fat (reflected in greater reductions in serum cholesterol) resulted in greater reductions in risk of CVD events, explaining most heterogeneity between trials. The number needed to treat for an additional beneficial outcome (NNTB) was 56 in primary prevention trials, so 56 people need to reduce their saturated fat intake for ~four years for one person to avoid experiencing a CVD event. In secondary prevention trials, the NNTB was 32. Subgrouping did not suggest significant differences between replacement of saturated fat calories with polyunsaturated fat or carbohydrate, and data on replacement with monounsaturated fat and protein was very limited. We found little or no effect of reducing saturated fat on all-cause mortality (RR 0.96; 95% CI 0.90 to 1.03; 11 trials, 55,858 participants) or cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 10 trials, 53,421 participants), both with GRADE moderate-quality evidence. There was little or no effect of reducing saturated fats on non-fatal myocardial infarction (RR 0.97, 95% CI 0.87 to 1.07) or CHD mortality (RR 0.97, 95% CI 0.82 to 1.16, both low-quality evidence), but effects on total (fatal or non-fatal) myocardial infarction, stroke and CHD events (fatal or non-fatal) were all unclear as the evidence was of very low quality. There was little or no effect on cancer mortality, cancer diagnoses, diabetes diagnosis, HDL cholesterol, serum triglycerides or blood pressure, and small reductions in weight, serum total cholesterol, LDL cholesterol and BMI. There was no evidence of harmful effects of reducing saturated fat intakes. The findings of this updated review suggest that reducing saturated fat intake for at least two years causes a potentially important reduction in combined cardiovascular events. Replacing the energy from saturated fat with polyunsaturated fat or carbohydrate appear to be useful strategies, while effects of replacement with monounsaturated fat are unclear. The reduction in combined cardiovascular events resulting from reducing saturated fat did not alter by study duration, sex or baseline level of cardiovascular risk, but greater reduction in saturated fat caused greater reductions in cardiovascular events.

In people with or without cardiovascular disease, what are the effects of reduction in saturated fat intake?

In people with or without cardiovascular disease, what are the effects of reduction in saturated fat intake?

Primary Care SHOPping intervention for cardiovascular disease prevention (PC-SHOP): protocol for a randomised controlled trial to reduce saturated fat intake

IntroductionA diet high in saturated fat (SFA) increases the risk of cardiovascular disease (CVD) and intakes in the UK exceed dietary recommendations. The Primary Care Shopping Intervention for Cardiovascular Disease...

Should we recommend reductions in saturated fat intake or in red/processed meat consumption? The SUN prospective cohort study

While most studies have shown increased mortality associated with excessive red/processed meat consumption, the association of saturated fatty acids (SFA) intake with mortality is less homogeneous. We aimed to prospectively assess the association of both, meat consumption (red, processed, red+processed, and total) and SFA intake, with the risk of all-cause death. We assessed 18,540 participants of the SUN (Seguimiento Universidad de Navarra) cohort, followed-up for a mean of 9.5 years. A validated 136-item FFQ was administered at baseline. We used Cox models adjusted for potential confounders. We observed 255 deaths during 176,916 person-years of follow-up. Age modified the association between meat consumption and all-cause mortality (p for interaction=0.027, 0.075, and 0.013, for red, total, and processed meat, respectively). Among participants aged >45 years the fully-adjusted HRs (95% CIs) for one additional serving/d of red, total, and red+processed meat consumption were 1.47 (1.06, 2.04), 1.23 (1.05, 1.45), and 1.32 (1.05, 1.65), respectively, with significant linear trends (P for trend 0.022, 0.012, and 0.018, respectively). In these participants, SFA intake was non-significantly associated with mortality. However, isocaloric replacement of monounsaturated fat or carbohydrates by SFA resulted in significantly higher mortality risk. Likewise, replacing 100g of vegetables, fruits & nuts or cereals by 100g of red meat resulted in higher mortality risk. No association of meat consumption or SFA with all-cause mortality was observed in participants younger than 46 years. Among highly educated persons, aged >45 years, a high consumption of red, total, and red+processed meat was related to increased all-cause mortality, compared with those with low consumption, whereas no significant associations were found for SFA intake. Dietary guidelines should specifically limit meat consumption and not relying only in limiting SFA intake.

Aceites y grasas: efectos en la salud y regulación mundial

El consumo excesivo de alimentos fuente de grasa, acompañado por estilos de vida sedentarios, afecta el peso corporal y la salud. La ingesta de grasa total se relaciona con el índice de masa corporal (IMC) y el perfil lipídico, por tanto la reducción de su consumo disminuye el peso, el IMC, el colesterol total (CT) y el colesterol LDL. La alteración del perfil lipídico es un factor de riesgo para sufrir enfermedades cardiocerebrovasculares; los ácidos grasos trans (AGT) y ácidos grasos saturados (AGS) se consideran factor de riesgo para algunos tipos de cáncer. La reducción del consumo de grasa saturada puede presentar un efecto protector para eventos cardiovasculares. Además, la disminución del consumo de AGS y el aumento de ácidos grasos monosaturados y poliinsaturados puede reducir el colesterol LDL. La normativa regulatoria del contenido de nutrientes de los alimentos debe ser priorizada con medidas eficaces que protejan la salud del consumidor; es así como varios países cuentan con regulaciones sobre el contenido de grasas. Además, se han realizado acciones exitosas en salud pública como la implementación de diferentes tipos de aceite y acciones educativas con el fin de lograr el consumo de alimentos más saludables.

Dairy food products: good or bad for cardiometabolic disease?

Prevalence of type 2 diabetes mellitus (T2DM) is rapidly increasingly and is a key risk for CVD development, now recognised as the leading cause of death globally. Dietary strategies to reduce CVD development include reduction of saturated fat intake. Milk and dairy products are the largest contributors to dietary saturated fats in the UK and reduced consumption is often recommended as a strategy for risk reduction. However, overall evidence from prospective cohort studies does not confirm a detrimental association between dairy product consumption and CVD risk. The present review critically evaluates the current evidence on the association between milk and dairy products and risk of CVD, T2DM and the metabolic syndrome (collectively, cardiometabolic disease). The effects of total and individual dairy foods on cardiometabolic risk factors and new information on the effects of the food matrix on reducing fat digestion are also reviewed. It is concluded that a policy to lower SFA intake by reducing dairy food consumption to reduce cardiometabolic disease risk is likely to have limited or possibly negative effects. There remain many uncertainties, including differential effects of different dairy products and those of differing fat content. Focused and suitably designed and powered studies are needed to provide clearer evidence not only of the mechanisms involved, but how they may be beneficially influenced during milk production and processing.

Potential benefits of healthy food and lifestyle policies for reducing coronary heart disease mortality in Turkish adults by 2025: a modelling study

ObjectiveThis study uses a modelling approach to compare the potential impact of future risk factor scenarios relating to smoking, physical activity levels, dietary salt, saturated fat intake, mean body mass...

New perspectives on dairy and cardiovascular health.

CVD are the leading cause of mortality and morbidity worldwide. One of the key dietary recommendations for CVD prevention is reduction of saturated fat intake. Yet, despite milk and dairy foods contributing on average 27 % of saturated fat intake in the UK diet, evidence from prospective cohort studies does not support a detrimental effect of milk and dairy foods on risk of CVD. The present paper provides a brief overview of the role of milk and dairy products in the diets of UK adults, and will summarise the evidence in relation to the effects of milk and dairy consumption on CVD risk factors and mortality. The majority of prospective studies and meta-analyses examining the relationship between milk and dairy product consumption and risk of CVD show that milk and dairy products, excluding butter, are not associated with detrimental effects on CVD mortality or risk biomarkers that include serum LDL-cholesterol. In addition, there is increasing evidence that milk and dairy products are associated with lower blood pressure and arterial stiffness. These apparent benefits of milk and dairy foods have been attributed to their unique nutritional composition, and suggest that the elimination of milk and dairy may not be the optimum strategy for CVD risk reduction.

Exploring potential mortality reductions in 9 European countries by improving diet and lifestyle: A modelling approach

BackgroundCoronary heart disease (CHD) death rates have fallen across most of Europe in recent decades. However, substantial risk factor reductions have not been achieved across all Europe. Our aim was to quantify the potential impact of future policy scenarios on diet and lifestyle on CHD mortality in 9 European countries. MethodsWe updated the previously validated IMPACT CHD models in 9 European countries and extended them to 2010–11 (the baseline year) to predict reductions in CHD mortality to 2020(ages 25–74years). We compared three scenarios: conservative, intermediate and optimistic on smoking prevalence (absolute decreases of 5%, 10% and 15%); saturated fat intake (1%, 2% and 3% absolute decreases in % energy intake, replaced by unsaturated fats); salt (relative decreases of 10%, 20% and 30%), and physical inactivity (absolute decreases of 5%, 10% and 15%). Probabilistic sensitivity analyses were conducted. ResultsUnder the conservative, intermediate and optimistic scenarios, we estimated 10.8% (95% CI: 7.3–14.0), 20.7% (95% CI: 15.6–25.2) and 29.1% (95% CI: 22.6–35.0) fewer CHD deaths in 2020. For the optimistic scenario, 15% absolute reductions in smoking could decrease CHD deaths by 8.9%–11.6%, Salt intake relative reductions of 30% by approximately 5.9–8.9%; 3% reductions in saturated fat intake by 6.3–7.5%, and 15% absolute increases in physical activity by 3.7–5.3%. ConclusionsModest and feasible policy-based reductions in cardiovascular risk factors (already been achieved in some other countries) could translate into substantial reductions in future CHD deaths across Europe. However, this would require the European Union to more effectively implement powerful evidence-based prevention policies.

Cardiovascular Disease and the Dietary Consumption of Saturated Fats: A Review of the Strength of the Literature and Evidence

Dietary guidelines suggest the reduction of saturated fat intake due to its perceived association with cardiovascular disease. However ambiguity remains in the literature regarding this association. This review aims to evaluate the strength and level of evidence of the literature regarding the association between cardiovascular disease and the consumption of saturated fats in the diet.

Modelling Future Coronary Heart Disease Mortality to 2030 in the British Isles.

ObjectiveDespite rapid declines over the last two decades, coronary heart disease (CHD) mortality rates in the British Isles are still amongst the highest in Europe. This study uses a modelling approach to compare the potential impact of future risk factor scenarios relating to smoking and physical activity levels, dietary salt and saturated fat intakes on future CHD mortality in three countries: Northern Ireland (NI), Republic of Ireland (RoI) and Scotland.MethodsCHD mortality models previously developed and validated in each country were extended to predict potential reductions in CHD mortality from 2010 (baseline year) to 2030. Risk factor trends data from recent surveys at baseline were used to model alternative future risk factor scenarios: Absolute decreases in (i) smoking prevalence and (ii) physical inactivity rates of up to 15% by 2030; relative decreases in (iii) dietary salt intake of up to 30% by 2030 and (iv) dietary saturated fat of up to 6% by 2030. Probabilistic sensitivity analyses were then conducted.ResultsProjected populations in 2030 were 1.3, 3.4 and 3.9 million in NI, RoI and Scotland respectively (adults aged 25–84). In 2030: assuming recent declining mortality trends continue: 15% absolute reductions in smoking could decrease CHD deaths by 5.8–7.2%. 15% absolute reductions in physical inactivity levels could decrease CHD deaths by 3.1–3.6%. Relative reductions in salt intake of 30% could decrease CHD deaths by 5.2–5.6% and a 6% reduction in saturated fat intake might decrease CHD deaths by some 7.8–9.0%. These projections remained stable under a wide range of sensitivity analyses.ConclusionsFeasible reductions in four cardiovascular risk factors (already achieved elsewhere) could substantially reduce future coronary deaths. More aggressive polices are therefore needed in the British Isles to control tobacco, promote healthy food and increase physical activity.

Reduction in saturated fat intake for cardiovascular disease.

Reducing saturated fat reduces serum cholesterol, but effects on other intermediate outcomes may be less clear. Additionally it is unclear whether the energy from saturated fats that are lost in the diet are more helpfully replaced by polyunsaturated fats, monounsaturated fats, carbohydrate or protein. This review is part of a series split from and updating an overarching review. To assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA) or monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity, using all available randomised clinical trials. We updated our searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and EMBASE (Ovid) on 5 March 2014. We also checked references of included studies and reviews. Trials fulfilled the following criteria: 1) randomised with appropriate control group; 2) intention to reduce saturated fat intake OR intention to alter dietary fats and achieving a reduction in saturated fat; 3) not multifactorial; 4) adult humans with or without cardiovascular disease (but not acutely ill, pregnant or breastfeeding); 5) intervention at least 24 months; 6) mortality or cardiovascular morbidity data available. Two review authors working independently extracted participant numbers experiencing health outcomes in each arm, and we performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity analyses and funnel plots. We include 15 randomised controlled trials (RCTs) (17 comparisons, ˜59,000 participants), which used a variety of interventions from providing all food to advice on how to reduce saturated fat. The included long-term trials suggested that reducing dietary saturated fat reduced the risk of cardiovascular events by 17% (risk ratio (RR) 0.83; 95% confidence interval (CI) 0.72 to 0.96, 13 comparisons, 53,300 participants of whom 8% had a cardiovascular event, I² 65%, GRADE moderate quality of evidence), but effects on all-cause mortality (RR 0.97; 95% CI 0.90 to 1.05; 12 trials, 55,858 participants) and cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 12 trials, 53,421 participants) were less clear (both GRADE moderate quality of evidence). There was some evidence that reducing saturated fats reduced the risk of myocardial infarction (fatal and non-fatal, RR 0.90; 95% CI 0.80 to 1.01; 11 trials, 53,167 participants), but evidence for non-fatal myocardial infarction (RR 0.95; 95% CI 0.80 to 1.13; 9 trials, 52,834 participants) was unclear and there were no clear effects on stroke (any stroke, RR 1.00; 95% CI 0.89 to 1.12; 8 trials, 50,952 participants). These relationships did not alter with sensitivity analysis. Subgrouping suggested that the reduction in cardiovascular events was seen in studies that primarily replaced saturated fat calories with polyunsaturated fat, and no effects were seen in studies replacing saturated fat with carbohydrate or protein, but effects in studies replacing with monounsaturated fats were unclear (as we located only one small trial). Subgrouping and meta-regression suggested that the degree of reduction in cardiovascular events was related to the degree of reduction of serum total cholesterol, and there were suggestions of greater protection with greater saturated fat reduction or greater increase in polyunsaturated and monounsaturated fats. There was no evidence of harmful effects of reducing saturated fat intakes on cancer mortality, cancer diagnoses or blood pressure, while there was some evidence of improvements in weight and BMI. The findings of this updated review are suggestive of a small but potentially important reduction in cardiovascular risk on reduction of saturated fat intake. Replacing the energy from saturated fat with polyunsaturated fat appears to be a useful strategy, and replacement with carbohydrate appears less useful, but effects of replacement with monounsaturated fat were unclear due to inclusion of only one small trial. This effect did not appear to alter by study duration, sex or baseline level of cardiovascular risk. Lifestyle advice to all those at risk of cardiovascular disease and to lower risk population groups should continue to include permanent reduction of dietary saturated fat and partial replacement by unsaturated fats. The ideal type of unsaturated fat is unclear.

Macro and micronutrient differences of AD—libitum palaeolithic vs Australian guide to healthy eating diets

s / Journal of Nutrition & Intermediary Metabolism 1 (2014) 1e55 26 out/in social situations, higher emotional eating, and lower knowledge regarding the effect of diet on health (all p < 0.001; consistent across subgroups). Conclusions: Diet and nutrition education present an important target for primary care of people with SMI. Targeting at-risk populations also presents an opportunity for prevention. Although research has identified the contribution of individual nutrients to mental health, further research needs to elucidate the role of whole diet and nutrition and mental illness. Funding source(s): N/A. MACRO AND MICRONUTRIENT DIFFERENCES OF ADdLIBITUM PALAEOLITHIC VS AUSTRALIAN GUIDE TO HEALTHY EATING DIETS A. Genoni , A. Devine , J. Lo , P. Lyons-Wall . 1 School of Exercise and Health Sciences, Perth, WA, Australia; 2 School of Engineering, Edith Cowan University, Perth, WA, Australia E-mail: agenoni@our.ecu.edu.au (A. Genoni) Background/Aims: To investigate the differences in the macronutrient composition between the palaeolithic and AGHE Diet. Methods: Thirty nine healthy women (mean ± SD age 47 ± 13 years, BMI 27 ± 4 kg/m2) were randomised to either the palaeolithic (n1⁄4 22) or AGHE diet (n 1⁄4 17) for 4-weeks. A 3-day weighed food record (WFR) was collected preand post-intervention. WFR were analysed using FoodWorks (AUSNUT2007, Xyris Software, QLD, 2012). Within group analysis was performed using paired t-tests, between group analysis was conducted using Mann-Whitney and independent t-tests. Results: The palaeolithic group had a lower intake of carbohydrate (28 ± 8% vs 41 ± 9% of energy, p < 0.05), and higher intake of fat (40 ± 10% vs 33 ± 7%, p < 0.05) and protein (27 ± 7% vs 22 ± 6%, p < 0.05) compared to AGHE. Within group analyses showed reductions in saturated fat intake in both groups (p < 0.05) but no change to dietary fibre or total sugars. Within the palaeolithic group, there were significant reductions in energy, thiamin, riboflavin, sodium and calcium and increases in vitamins C, E and bcarotene (all p < 0.05). Conclusions: Despite the reduction in carbohydrates due to the removal of whole grain cereals and dairy, fibre intake was not impacted in the palaeolithic group. However, significant reductions in B vitamins and calcium were seen. Further research to explore the health implications related to long-term palaeolithic dietary patterns are recommended. Funding source(s): N/A. LONG-TERM EFFECTS OF VERY LOWAND HIGH-CARBOHYDRATE WEIGHT LOSS DIETS ON MOOD RESPONSE IN OBESE ADULTS WITH TYPE 2 DIABETES G.D. Brinkworth , N.D. Luscombe-Marsh , C.H. Thompson , M. Noakes , J.D. Buckley , G. Wittert , C.J. Wilson . CSIRO Food and Nutrition, SA, Australia; Department of Medicine, University of South Australia, SA, Australia; Nutritional Physiology Research Centre, University of South Australia, SA, Australia; 4 School of Medicine, Flinders University,

Development and preliminary evaluation of an internet-based healthy eating program: randomized controlled trial.

BackgroundThe HealthValues Healthy Eating Programme is a standalone Internet-based intervention that employs a novel strategy for promoting behavior change (analyzing one’s reasons for endorsing health values) alongside other psychological principles that have been shown to influence behavior. The program consists of phases targeting motivation (dietary feedback and advice, analyzing reasons for health values, thinking about health-related desires, and concerns), volition (implementation intentions with mental contrasting), and maintenance (reviewing tasks, weekly tips).ObjectiveThe aim was to examine the effects of the program on consumption of fruit and vegetables, saturated fat, and added sugar over a 6-month period.MethodsA total of 82 females and 18 males were recruited using both online and print advertisements in the local community. They were allocated to an intervention or control group using a stratified block randomization protocol. The program was designed such that participants logged onto a website every week for 24 weeks and completed health-related measures. Those allocated to the intervention group also completed the intervention tasks at these sessions. Additionally, all participants attended laboratory sessions at baseline, 3 months, and 6 months. During these sessions, participants completed a food frequency questionnaire (FFQ, the Block Fat/Sugar/Fruit/Vegetable Screener, adapted for the UK), and researchers (blind to group allocation) measured their body mass index (BMI), waist-to-hip ratio (WHR), and heart rate variability (HRV).ResultsData were analyzed using a series of ANOVA models. Per protocol analysis (n=92) showed a significant interaction for fruit and vegetable consumption (P=.048); the intervention group increased their intake between baseline and 6 months (3.7 to 4.1 cups) relative to the control group (3.6 to 3.4 cups). Results also showed overall reductions in saturated fat intake (20.2 to 15.6 g, P<.001) and added sugar intake (44.6 to 33.9 g, P<.001) during this period, but there were no interactions with group. Similarly, there were overall reductions in BMI (27.7 to 27.3 kg/m2, P=.001) and WHR (0.82 to 0.81, P=.009), but no interactions with group. The intervention did not affect alcohol consumption, physical activity, smoking, or HRV. Data collected during the online sessions suggested that the changes in fruit and vegetable consumption were driven by the motivational and maintenance phases of the program.ConclusionsResults suggest that the program helped individuals to increase their consumption of fruit and vegetables and to sustain this over a 6-month period. The observed reduction in fat and sugar intake suggests that monitoring behaviors over time is effective, although further research is needed to confirm this conclusion. The Web-based nature of the program makes it a potentially cost-effective way of promoting healthy eating.

Analysis of the dietary habits and nutritional status of patients with spinal cord injury after nutritional intervention

According to the World Health Organization, disability is defined as a restriction of bodily structure or function that is not offset by social measures, with spinal cord injuries (SCI) being a common type of physical disability. Several factors may influence the nutritional status of individuals with SCI, and metabolic complications can lead to a number of acute and chronic changes in the body that are related to the development of chronic diseases and obesity. The evaluation and proper nutritional management of patients with SCI can assist in improving their nutritional status, minimize complications associated with the injury, and facilitate their rehabilitation in the long term. Objective: To evaluate the effect of the nutritional intervention measures used in one nutrition clinic on the eating habits and nutritional status of patients with spinal cord injuries. Method: This was a cross-sectional retrospective exploratory study in which we analyzed the eating habits of all the SCI outpatients in the period from April 2012 to October 2013. Results: 30 patients with mean age of 46 ± 15.29 years were evaluated, 70% of whom were male. After the nutritional intervention there was a reduction in saturated fat intake, a decreased intake of refined grains, and an increased consumption of fruits and vegetables. Conclusion: The study showed the importance of a nutritional intervention in the dietary habits of individuals, and that nutrition education should begin early to prevent complications secondary to the injury.

OP72 EUROHEART II - comparing policies to reduce future coronary heart disease mortality in nine European countries: modelling study

<h3>Background</h3> Coronary heart disease (CHD) death rates have been falling across most of Europe in recent decades. However, CHD remains the leading cause of mortality. Furthermore, substantial risk factor reductions have been achieved in some European countries, but not in others. This partly reflects rather patchy implementation of the most effective prevention policies. Our study therefore aimed to quantify the potential impact of future policy scenarios (reducing smoking, diet and physical inactivity) on future CHD mortality in diverse countries across Europe. <h3>Methods</h3> We updated previously validated IMPACT CHD mortality models in nine countries (Czech Republic, Finland, Iceland, Italy, Ireland, Northern Ireland, Poland, Scotland and Sweden). Using recent risk factor data, these models were extended from 2010 (baseline year) to predict potential reductions in CHD mortality to 2020 (in people aged 25–74 years). We then modelled the mortality reductions in each country expected with future policies to decrease cardiovascular risk factors. We compared three alternative policy scenarios: conservative, intermediate and optimistic improvements for smoking prevalence (absolute decreases of 5%, 10% and 15%), dietary saturated fat intake (1%, 2% and 3% decreases in energy, replaced by unsaturated fats), dietary salt (decreases of 10%, 20% and 30%), and physical activity (absolute increases of 5%, 10% and 15%). Probabilistic sensitivity analyses were then conducted. <h3>Results</h3> Under the conservative, intermediate and optimistic policy scenarios, we estimated approximately 11%, 21% and 29% fewer CHD deaths respectively in 2020 in these countries. Depending on the future mortality trends assumed, this represented between 11,000 and 18,500 fewer CHD deaths for the optimistic scenario. For the conservative scenario, 5% absolute reductions in smoking prevalence could decrease CHD deaths in each country by 2–3% (e.g. approximately 40–80 fewer deaths in Ireland, 460–760 fewer deaths in Poland). Salt intake reductions of 10% could decrease CHD deaths by approximately 1.2–2.5%; and 1% reductions in saturated fat intake might decrease CHD deaths by some 1.5–2.2%. The 5% absolute increases in physical activity levels might decrease CHD deaths by just 0.8–1.4% (approximately 20–40 fewer deaths in Ireland, approximately 220–370 fewer deaths in Poland). These projections remained stable under a wide range of probabilistic sensitivity analyses. <h3>Conclusion</h3> Modest and feasible policy-based reductions in cardiovascular risk factors (already been achieved in some other countries) could translate into substantial reductions in future CHD deaths across Europe. However, this would require the European Union to more effectively implement powerful evidence-based prevention policies.