Monounsaturated Fatty Acids and Risk of Cardiovascular Disease

Abstract

for the Nutrition Committee T his report summarizes our current understanding of how monounsaturated fatty acids (MUFAs) affect risk for cardiovascular disease (CVD). This is a topic that has attracted considerable scientific interest, 1-3 in large part because of uncertainty regarding whether MUFA or carbohydrate should be substituted for saturated fatty acids (SFAs) and the desirable quantity of MUFA to include in the diet. MUFAs in the US DietMUFAs are distinguished from the other fatty acid classes on the basis of having only 1 double bond. In contrast, polyunsaturated fatty acids (PUFAs) have 2 or more double bonds, and SFAs have none. The position of the hydrogen atoms around the double bond determines the geometric configuration of the MUFA and hence whether it is a cis or trans isomer. In a cis MUFA, the hydrogen atoms are present on the same side of the double bond, whereas in the trans configuration, they are on opposite sides. The American Heart Association Nutrition Committee recently published a scientific statement regarding the relationship of trans MUFA to CVD risk, 4 and the present statement, therefore, will be limited to a discussion of dietary cis MUFAs, of which oleic acid (cis C18:1) comprises Ϸ92% of cis MUFAs. In the United States, average total MUFA intake is 13% to 14% of total energy intake, an amount that is comparable to (or slightly greater than) SFA intake. In contrast, PUFAs contribute less (ie, 7% of energy).The major emphasis of current dietary guidelines involves replacing SFAs with complex carbohydrates to achieve a total fat intake of Յ30% of calories. There is evidence suggesting that the substitution of MUFA instead of carbohydrate for SFA calories may favorably affect CVD risk. [5][6][7] The American Heart Association dietary guidelines for healthy American adults recommend a diet that provides Ͻ10% of calories from SFA, up to 10% from PUFA, and as much as 15% from MUFA. 8 The recommendation to limit total dietary fat to 30% of calories is intended to facilitate the reduction of SFA and to help control calories to manage weight. At this recommended level of dietary fat, several tablespoons of unsaturated fat can be incorporated in the diet. Depending on SFA and PUFA intake, a high-MUFA diet that provides 15% or more of energy results in a total fat intake Ͼ30% of energy. Nonetheless, a high-MUFA diet can be an alternative to the presently recommended Step 1 diet (Յ30% fat, 8% to 10% SFA, and Ͻ300 mg of cholesterol per day) to favorably affect CVD risk, provided it does not exceed SFA recommendations and energy needs. MUFA Versus Carbohydrate as a Replacement for SFAThe uniqueness of MUFA as a major nutrient in the Mediterranean region's food supply was first identified by Ancel Keys and his colleagues in the landmark Seven Countries Study. 9 Certain Mediterranean populations in that study (Corfu and Crete) had a low prevalence of coronary heart disease (CHD) and low plasma cholesterol levels despite consumption of a diet high in total fat (33% to 40% of calories) and low i...

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Spanish children's diet: compliance with nutrient and food intake guidelines

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