Intended for healthcare professionals


WHO draft guidelines on dietary saturated and trans fatty acids: time for a new approach?

BMJ 2019; 366 doi: (Published 03 July 2019) Cite this as: BMJ 2019;366:l4137
  1. Arne Astrup, head of department1,
  2. Hanne CS Bertram, professor2,
  3. Jean-Philippe Bonjour, honorary professor of medicine3,
  4. Lisette CP de Groot, professor4,
  5. Marcia C de Oliveira Otto, assistant professor5,
  6. Emma L Feeney, assistant professor6,
  7. Manohar L Garg, director7,
  8. Ian Givens, professor and director8,
  9. Frans J Kok, emeritus professor of nutrition and health4,
  10. Ronald M Krauss, senior scientist and Dolores Jordan endowed chair9,
  11. Benoît Lamarche, chair of nutrition10,
  12. Jean-Michel Lecerf, head of department11,
  13. Philippe Legrand, professor12,
  14. Michelle McKinley, reader13,
  15. Renata Micha, associate professor14,
  16. Marie-Caroline Michalski, research director15,
  17. Dariush Mozaffarian, dean14,
  18. Sabita S Soedamah-Muthu, associate professor16
  1. 1Department of Nutrition, Exercise, and Sport, University of Copenhagen, Nørre Alle 51, DK-2200 Copenhagen N, Denmark
  2. 2Department of Food Science, Aarhus University, Denmark
  3. 3Geneva University Hospitals and Faculty of Medicine, Switzerland
  4. 4Division of Human Nutrition, Department of Agrotechnology and Food Sciences, Wageningen University, Netherlands
  5. 5University of Texas Health Science Center at Houston, TX, USA
  6. 6Institute of Food and Health, University College Dublin, Republic of Ireland
  7. 7Nutraceutricals Research Programme, University of Newcastle, Callaghan, NSW 2308, Australia
  8. 8Institute for Food, Nutrition, and Health, University of Reading, UK
  9. 9Children’s Hospital Oakland Research Institute and UCSF Benioff Children’s Hospital, Oakland, CA, USA
  10. 10Institute of Nutrition and Functional Foods, Université Laval, Québec, Canada
  11. 11Nutrition et Activité Physique, Institut Pasteur de Lille, France
  12. 12Agrocampus-INRA, Rennes, France
  13. 13Institute for Global Food Security, Queen’s University Belfast, UK
  14. 14Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
  15. 15INRA, INSERM, Univ Lyon, Université Claude Bernard Lyon 1, CarMeN laboratory, CRNH Rhône-Alpes, Oullins, France
  16. 16Center of Research on Psychology in Somatic Diseases (CORPS), Department of Medical and Clinical Psychology, Tilburg University, Netherlands
  1. Correspondence to: A Astrup ast{at}

The 2018 WHO draft guidance on fatty acids fails to consider the importance of the food matrix, argue Arne Astrup and colleagues

Key messages

  • The 2018 WHO draft guidelines on dietary saturated fatty acids and trans fatty acids recommend reducing total intake of saturated fat and replacing it with polyunsaturated and monounsaturated fatty acids

  • The recommendations fail to take into account considerable evidence that the health effects of saturated fat varies depending on the specific fatty acid and on the specific food source

  • Maintaining general advice to reduce total saturated fatty acids will work against the intentions of the guidelines and weaken their effect on chronic disease incidence and mortality

  • A food based translation of the recommendations for saturated fat intake would avoid unnecessary reduction or exclusion of foods that are key sources of important nutrients

Non-communicable diseases are the world’s leading cause of death, responsible for 72% of the 54.7 million deaths in 2016.1 Cardiovascular diseases are responsible for approximately 45% of all deaths from non-communicable diseases, with modifiable risk factors such as diet, physical activity, smoking, and alcohol intake being major causes of disease.

Among dietary factors, the World Health Organization considers saturated fatty acids and trans fatty acids to be important. Consensus exists on the health benefits of eliminating industrially produced trans fatty acids—that it will reduce incidence of cardiovascular disease and mortality.2 Foods containing more than 2% total fat as trans fat were banned in Denmark in 2004, and similar legislation is soon to be implemented throughout the European Union. In the United States the Food and Drug Administration no longer considers industrial trans fats to be “generally regarded as safe.”

Many governments consider WHO dietary guidelines to be state of the art scientific evidence, translating them into regional and national dietary recommendations. These guidelines have …

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