Saturated Fatty acids (SFA)

SFA represent the major type of fats in the diet in most countries2.

Specifically, SFA have the strongest impact on blood cholesterol, increasing TC and LDL-cholesterol levels4. There is consistent scientific evidence that replacing saturated with unsaturated fats4,6 is the most beneficial for CHD risk reduction7 (see Table 6).

Replacing 5% energy of saturated fats with unsaturated fats may lead up to a 7% lowering in LDL-cholesterol5
Table 6: Effect of replacing 5% of the dietary energy from SFA on LDL-cholesterol4, 5
SFA replacement with: Approximate LDL-cholesterol reduction
Monounsaturated Fatty Acids (MUFA) -8  mg/dL (-0.21 mmol/L) = -6%
Polyunsaturated fatty acids (PUFA) -10 mg/dL (-0.26 mmol/L) = -7%

According to guidelines, the goal for CVD prevention is reducing SFA consumption to less than 10% of total energy by replacing SFA with unsaturated fat4,6.

The replacement of SFA by both PUFA and MUFA is beneficial for blood lipids6, while the effects of replacing SFA with carbohydrates depends on the quality of the carbohydrates 3,4,7,8.

SOURCES OF SFA:

Fatty meat and dairy products such as full-fat milk, hard cheese, butter and cream, tropical oils such as coconut and palm oil, fully hydrogenated vegetable oils, egg yolk, foods containing 'hidden fat' such as confectionary and cakes or crisps9.

Trans Fatty acids (TFA)

Dietary TFA raise LDL-cholesterol and lower HDL cholesterol10 and contribute consistently and significantly to increase the risk of CHD11. Reducing TFA intake is an important target to lower LDL-cholesterol and consequently, to decrease the risk of CHD3, 4, 10, 11.

As TFA adversely affect multiple CVD risk factors10,11, their intake should be kept as low as possible. No more than 1% of total energy should come from TFA1.

SOURCES OF TFA:

Foods that naturally contain TFA are dairy products such as butter, milk, cheese, and meat

from ruminants such as beef and lamb. Industrial TFA originate from partially hydrogenated vegetable oils, and are commonly found in convenience foods (e.g. pizza with cheese), battered or deep-fried foods (e.g. take-away potatao crisps), commercial baked goods like pies and pastries.

As TFA are harmful for health, the use of partially hydrogenated vegetable oils in food manufacturing (e.g. margarine) has been considerably reduced in Europe over the past years. Nevertheless, TFA intake may still vary between different European countries.

Dietary cholesterol

Dietary cholesterol raises blood cholesterol levels. Yet, the impact of dietary cholesterol on blood cholesterol is weaker if compared with that of SFA and TFA. Nevertheless, it is important to consider the possible consequence of high dietary cholesterol intake on blood lipid levels in those individuals with CVD or who are at increased risk of CVD (see Chapter 1).

When guidelines are followed to lower the intake of SFA, this usually also leads to a reduction in dietary cholesterol intake because they come from the same dietary sources6.

The EAS/ESC guidelines recommend that cholesterol intake should not exceed 300 mg/day4.

SOURCES OF DIETARY CHOLESTEROL:

SFA and cholesterol are typically found in the same foods; dietary cholesterol comes only from foods of animal origin, such as meat, egg yolks, and full-fat dairy products, including butter, cream and cheese. Shrimps and prawns are rich in cholesterol as well9. Occasional consumption of these foods items, rather than habitual, is advised.