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Friday, January 8, 2016

A Primer on Dietary Fat Recommendations from the US Dietary Guidelines 2015-2020 Edition

Dietary Fats: The Basics
Dietary fats are found in both plant and animal foods. They supply calories and help with the absorption of the fat-soluble vitamins A, D, E, and K. Some also are good sources of two essential fatty acids—linoleic acid and α-linolenic acid.
All dietary fats are composed of a mix of polyunsaturated, monounsaturated, and saturated fatty acids, in varied proportions. For example, most of the fatty acids in butter are saturated, but it also contains some monounsaturated and polyunsaturated fatty acids. Oils are mostly unsaturated fatty acids, though they have small amounts of saturated fatty acids.

Polyunsaturated fatty acids (polyunsaturated fats are found in greatest amounts in sunflower, corn, soybean, and cottonseed oils; walnuts; pine nuts; and sesame, sunflower, pumpkin, and flax seeds. Only small amounts of polyunsaturated fats are found in most animal fats. Omega-3 (n-3) fatty acids are a type of polyunsaturated fats found in seafood, such as salmon, trout, herring, tuna, and mackerel, and in flax seeds and walnuts. EPA and DHA are long chain n-3 fatty acids found in seafood.
Monounsaturated fatty acids (monounsaturated fats) are found in greatest amounts in olive, canola, peanut, and safflower oils, and in avocados, peanut butter, and most nuts. Monounsaturated fats also are part of most animal fats such as fats from chicken, pork, beef, and wild game.
Saturated fatty acids (saturated fats) are found in the greatest amounts in coconut and palm kernel oils, in butter and beef fats, and in palm oil. They also are found in other animal fats, such as pork and chicken fats and in other plant fats, such as nuts.
Trans fatty acids (trans fats) are unsaturated fats found primarily in partially hydrogenated vegetable oils and foods containing these oils and in ruminant (animal) fats. They are structurally different from the unsaturated fatty acids that occur naturally in plant foods and differ in their health effects.

The proportions of fatty acids in a particular fat determine the physical form of the fat:
  Fats with a higher amount of polyunsaturated and monounsaturated fatty acids are usually liquid at room temperature and are referred to as “oils.”
Fats with a higher amount of saturated fatty acids are usually solid at room temperature and are referred to as “solid fats.” Fats containing trans fatty acids are also classified as solid fats, although they may or may not be solid at room temperature.
A relevant detail in the complexity of making food-based recommendations that consider nutrients is the difference between the terms “saturated fats” and “solid fats.” Although they are closely related terms, saturated fats and solid fats are not synonymous. The term “saturated fats” refers to saturated fatty acids, a nutrient found in foods, while the term “solid fats” describes the physical manifestation of the fats in a food. Some solid fats, such as the strip of fat around a piece of meat, can easily be seen. Other solid fats are not so visible. For example, the solid fats in whole milk are suspended in the fluid milk by the process of homogenization.
Margarines and margarine-like vegetable oil spreads are food products composed of one or more oils or solid fats designed to replace butter, which is high in saturated fats. These products may be sold in sticks, tubs, bottles, or sprays. Margarine and vegetable oil spreads generally contain less saturated fats than butter. However, they vary in their total fat and calorie content and in the fat and oil blends used to make them and, thus, in the proportions of saturated, unsaturated, and trans fats they contain. It is important to read the Nutrition Facts label to identify the calorie and saturated and trans fats content of the spread and choose foods with no trans fats and lower amounts of saturated fats.
The Dietary Guidelines provides recommendations on saturated fats as well as on solid fats because its aim is to improve the health of the U.S. population through food-based guidance. It includes recommendations on saturated fats because of the strong relationship of this nutrient to a health outcome (CVD risk). It includes recommendations on solid fats because they are abundant in the diets of the U.S. population, and reducing solid fats when making food choices is an important way to reduce saturated fats and excess calories.
Saturated Fats, Trans Fats, and Cholesterol
Saturated Fats
Healthy intake: Intake of saturated fats should be limited to less than 10 percent of calories per day by replacing them with unsaturated fats and while keeping total dietary fats within the age-appropriate AMDR. The human body uses some saturated fats for physiological and structural functions, but it makes more than enough to meet those needs. Individuals 2 years and older therefore have no dietary requirement for saturated fats.
Strong and consistent evidence shows that replacing saturated fats with unsaturated fats, especially polyunsaturated fats, is associated with reduced blood levels of total cholesterol and of low-density lipoprotein-cholesterol (LDL-cholesterol). Additionally, strong and consistent evidence shows that replacing saturated fats with polyunsaturated fats is associated with a reduced risk of CVD events (heart attacks) and CVD-related deaths.
Some evidence has shown that replacing saturated fats with plant sources of monounsaturated fats, such as olive oil and nuts, may be associated with a reduced risk of CVD. However, the evidence base for monounsaturated fats is not as strong as the evidence base for replacement with polyunsaturated fats. Evidence has also shown that replacing saturated fats with carbohydrates reduces blood levels of total and LDL-cholesterol, but increases blood levels of triglycerides and reduces high-density lipoprotein-cholesterol (HDL-cholesterol). Replacing total fat or saturated fats with carbohydrates is not associated with reduced risk of CVD. Additional research is needed to determine whether this relationship is consistent across categories of carbohydrates (e.g., whole versus refined grains; intrinsic versus added sugars), as they may have different associations with various health outcomes. Therefore, saturated fats in the diet should be replaced with polyunsaturated and monounsaturated fats.
Considerations: As discussed in Chapter 2, the main sources of saturated fats in the U.S. diet include mixed dishes containing cheese, meat, or both, such as burgers, sandwiches, and tacos; pizza; rice, pasta, and grain dishes; and meat, poultry, and seafood dishes. Although some saturated fats are inherent in foods, others are added. Healthy eating patterns can accommodate nutrient-dense foods with small amounts of saturated fats, as long as calories from saturated fats do not exceed 10 percent per day, intake of total fats remains within the AMDR, and total calorie intake remains within limits. When possible, foods high in saturated fats should be replaced with foods high in unsaturated fats, and other choices to reduce solid fats should be made (see Chapter 2).
Trans Fats
Individuals should limit intake of trans fats to as low as possible by limiting foods that contain synthetic sources of trans fats, such as partially hydrogenated oils in margarines, and by limiting other solid fats. A number of studies have observed an association between increased intake of trans fats and increased risk of CVD. This increased risk is due, in part, to its LDL-cholesterol-raising effect.
Trans fats occur naturally in some foods and also are produced in a process called hydrogenation. Hydrogenation is used by food manufacturers to make products containing unsaturated fatty acids solid at room temperature (i.e., more saturated) and therefore more resistant to becoming spoiled or rancid. Partial hydrogenation means that some, but not all, unsaturated fatty acids are converted to saturated fatty acids; some of the unsaturated fatty acids are changed from a cis to trans configuration. Trans fatty acids produced this way are referred to as “artificial” or “industrially produced” trans fatty acids. Artificial trans fatty acids are found in the partially hydrogenated oils[23] used in some margarines, snack foods, and prepared desserts as a replacement for saturated fatty acids. Although food manufacturers and restaurants have reduced the amounts of artificial trans fats in many foods in recent years, these fats can still be found in some processed foods, such as some desserts, microwave popcorn, frozen pizza, margarines, and coffee creamers.
Naturally occurring trans fats, known as “natural” or “ruminant” trans fats, are produced by ruminant animals. Natural trans fats are present in small quantities in dairy products and meats, and consuming fat-free or low-fat dairy products and lean meats and poultry will reduce the intake of natural trans fats from these foods. Because natural trans fats are present in dairy products and meats in only small quantities and these foods can be important sources of nutrients, these foods do not need to be eliminated from the diet.
Dietary Cholesterol
The body uses cholesterol for physiological and structural functions but makes more than enough for these purposes. Therefore, people do not need to obtain cholesterol through foods.
The Key Recommendation from the 2010 Dietary Guidelines to limit consumption of dietary cholesterol to 300 mg per day is not included in the 2015 edition, but this change does not suggest that dietary cholesterol is no longer important to consider when building healthy eating patterns. As recommended by the IOM,[24] individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern. In general, foods that are higher in dietary cholesterol, such as fatty meats and high-fat dairy products, are also higher in saturated fats. The USDA Food Patterns are limited in saturated fats, and because of the commonality of food sources of saturated fats and dietary cholesterol, the Patterns are also low in dietary cholesterol. For example, the Healthy U.S.-Style Eating Pattern contains approximately 100 to 300 mg of cholesterol across the 12 calorie levels. Current average intake of dietary cholesterol among those 1 year and older in the United States is approximately 270 mg per day.
Strong evidence from mostly prospective cohort studies but also randomized controlled trials has shown that eating patterns that include lower intake of dietary cholesterol are associated with reduced risk of CVD, and moderate evidence indicates that these eating patterns are associated with reduced risk of obesity. As described earlier, eating patterns consist of multiple, interacting food components and the relationships to health exist for the overall eating pattern, not necessarily to an isolated aspect of the diet. More research is needed regarding the dose-response relationship between dietary cholesterol and blood cholesterol levels. Adequate evidence is not available for a quantitative limit for dietary cholesterol specific to the Dietary Guidelines.
Dietary cholesterol is found only in animal foods such as egg yolk, dairy products, shellfish, meats, and poultry. A few foods, notably egg yolks and some shellfish, are higher in dietary cholesterol but not saturated fats. Eggs and shellfish can be consumed along with a variety of other choices within and across the subgroup recommendations of the protein foods group.


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