Some studies suggest that the type of fat has an important
role in determining the risk of coronary heart disease (CHD) of the total
amount of fat in the diet (1). However, because of misleading presentation of
epidemiological data by several authors (1), the reader may be left with the
impression that low-fat, high-carbohydrate diet is the best option for patients
with CHD risk..
In fact, high- carbohydrate diets, in the absence of weight
loss, can lead to both elevated triglyceride and reduced HDL cholesterol,
effects that may be associated with increased risk for CHD.(2) Although these
effects may be lessened with dietary fiber and moderate physical activity, they
appear to be worse among individuals with insulin resistance.(3)
As reviewed by Kris-Etherton(4) adverse metabolic effects of
low fat diet do not occur with substitution of monounsaturated (MUFA) or
polyunsaturated (PUFA) fatty acids for saturated and trans-fatty acids. This is
also the case for individuals with diabetes, with the added benefit of better
glycaemic control.(5)
As predicted by metabolic studies, replacement of saturated
fat, and even more so trans fatty acids with either PUFA or MUFA was associated
with a larger reduction in risk of CHD than simple reduction of total fat
consumption.(6) With respect to weight control, a moderate-fat diet can be as,
or even more, effective that lower-fat diet. (6)
References
1. Hu FB, Manson JE, Willet WC. Types of dietary fat and
risk of coronary heart disease: a critical review. J Am Coll Nutr 2001;20:5-19.
2. Fung MA, Frohlich JJ. Common problems in the management
of hypertriglyceridemia. CMAJ 2002;167:1261-6.
3. Jeppesen J, Schaaf P, Jones G, Zhou MY, Chen YD, Reaven
GM. Effects of low-fat, high-carbohydrate diets on risk factors for ischemic
heart disease in postmenopausal women. Am J Clin Nutr 1997;65:1027-33.
4. Kris-Etherton PM, Kris-Etherton PM, Binkoski AE, Zhao G,
Coval SM, Clemmer KF, et al. Dietary fat: assessing the evidence in support of
a moderate-fat diet; the benchmark based on lipoprotein metabolism. Proc Nutr
Soc 2002;61:287-98.
5. Rivellese AA, De Natale C, Lilli S. Type of dietary fat
and insulin resistance. Ann N Y Acad Sci 2002;967:329-35.
6. Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR,
Deckelbaum RJ et al. AHA Dietary Guidelines: revision 2000: A statement for
healthcare professionals from the Nutrition Committee of the American Heart
Association. Circulation. 2000;102:2284-99.
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