Intended for healthcare professionals

Letters Saturated fat is not the major issue

What we substitute for saturated fat matters

BMJ 2013; 347 doi: (Published 19 November 2013) Cite this as: BMJ 2013;347:f6844
  1. Alice H Lichtenstein, Gershoff professor of nutrition science and policy1
  1. 1Tufts University, Boston, MA, USA
  1. alice.lichtenstein{at}

Malhotra questions the wisdom of continuing public health recommendations to limit dietary saturated fat for the prevention of cardiovascular disease and went on to suggest that dietary saturated fat may decrease the risk of cardiovascular disease.1 His assessment seems to be missing a crucial point—the displacement source of energy for saturated fat. Data suggest that replacing saturated fat with carbohydrate has no effect on the risk of cardiovascular disease.2 3 However, replacement by polyunsaturated fat protects against the risk of cardiovascular disease.2 3 4 These associations hold regardless of whether the conclusions are drawn from pooled analyses or meta-analyses.2 3

At this time, on the basis of all the data, the best dietary advice that we can give to reduce the risk of cardiovascular disease is to eat a moderate fat diet. We should also advise replacing saturated fat with polyunsaturated fat—that is, replacing animal fats (meat and dairy) with vegetable oils—within the context of an energy intake that is consistent with achieving and maintaining a healthy body weight.


Cite this as: BMJ 2013;347:f6844


  • Competing interests: None declared.


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