1. Dietary Fats and Oils: Relation to Blood Cholesterol
Frank M. Sacks, MD
Professor, Nutrition Department,
Harvard School of Public Health;
Professor of Medicine, Harvard Medical School
Senior Physician, Brigham & Women’s Hospital

2. LDL-cholesterol The “bad” cholesterol Goes into the arterial wall
Causes atherosclerosis
Lowering blood LDL-cholesterol by diet or by most drugs reverses atherosclerosis, prevents heart attacks
In trials of dietary polyunsaturated fats, the decrease in LDL-cholesterol matches the decrease in heart disease.

3. Types of fatty acids w Saturated Monounsaturated (Oleic acid)
Linolenic acid
Linoleic acid
Methyl group w
Acid group
Polyunsaturated (Essential fatty acids)
N-6
N-3

4. Effects of Dietary Fats on LDL-Cholesterol
=0.032*
=-0.009*
=-0.019*
Poly-unsaturated
Mono- unsaturated
Saturated
percentage of calories vs. carbohydrate
Change in
LDL-C
(mmol/L)
Based on Mensink & Katan Figure from Micha & Mozaffarian, Lipids 2010

5. Effects of Individual Saturated Fatty Acids on LDL cholesterol
12:0 (lauric)
=0.052*
LDL cholesterol
=0.048*
14:0 (myristic)
16:0 (palmitic)
=0.039*
Change in
LDL-C
(mmol/L)
=-0.004
18:0 (stearic)
percentage of calories vs. carbohydrate
Figure from Micha & Mozaffarian, Lipids Based on Mensink & Katan 2003.

6. Palm oil and Lard Increase LDL-Cholesterol Compared to Olive Oil: 3 weeks each oil, 17% energy
Tholstrup T. AJCN 2011

7. 18-carbon fatty acids w Oleic acid Stearic acid Linolenic acid
Linoleic acid
Methyl group w
Acid group
Oleic acid trans

8. Meta-analysis of 60 controlled trials on dietary fats and blood lipids: effect of replacing carbohydrate with cis- or trans-fat
Mensink..Katan. Am J Clin Nutr 2003;77:1146

9. Plenary III
Frank Sacks
The OmniHeart Study Diets: Lower Carbohydrate Modifications of DASH Diet
Emphasize:
Fruits, Vegetables; High-protein foods including beans, whole grains, nuts, low-fat dairy, fish and poultry; Unsaturated Cooking Oils
Reduced in:
Carbohydrates, Saturated Fats, Red Meat, Sweets, and Sugar-containing Beverages.
Higher unsaturated fat, higher protein lowered BP and improved lipid risk factors more than the original high-carbohydrate DASH diet. OK
Healthy Kitchens, Healthy Lives

10. Mean Change from Baseline in Each Diet
OmniHeart: LDL-cholesterol (mg/dL) All diets low in saturated fat, healthful DASH-type dietary patterns
Mean Change from Baseline in Each Diet
Baseline
High CARB (DASH)
High PROT
High UNSAT FAT
All
129
-12
-14
-13
LDL-C > 130
157
-20
-24
-22
LDL-C < 130
105 -4 -6 -5
Appel L, Sacks F, et al. JAMA 2007

11. Dietary Fats, Oils to Lower LDL-cholesterol and Prevent Heart Disease
Best Choice:
Polyunsaturated vegetable oils
Peanut, Soybean, Corn, Rapeseed, sesame
Next Best
Monounsaturated vegetable oils
Olive* (more benefits when polyphenols high)
High-oleic sunflower, safflower
Unhealthful Choices:
Trans unsaturated oils
Animal fats, high in saturated fatty acids
Palm oil