Hetfaillissement van de verzadigd vethypothese van cardiovasculaire ziektes

Abstract

Fat and notably saturated fatty acids (SAFA) have a poor name. The Dutch Health Council recommends: SAFA intake as low as possible [<10 energy% (en%)] and 40-70 en% carbohydrates (CHO). The AHA recommends 5-10 en% polyunsaturated fatty acids (PUFA) of the omega-6 series (i.e. linoleic acid). The general public lived up to these recommendations to a large extent. The SAFA, CHO and linoleic acid recommendations contrast with the dietary composition of our ancestors in the Paleolithic era, with whom we differ little in a genetic sense. It was recently shown that replacing SAFA with CHO is associated with higher cardiovascular disease (CVD) risk, notably because of replacement with CHO with a high glycemic index (GI). Replacing SAFA with PUFA was associated with lower CVD risk. However, reanalysis of the AHA recommendation showed a borderline insignificant higher mortality risk with linoleic acid replacement. Insufficient consumption of fish, vegetables and fruits causes an estimated 10 times higher CVD risk than consumption of too much SAFA. Recent meta-analyses showed that SAFA, milk and milk products are not associated with CVD risk. The current connection between SAFA and CVD risk is based on an association with LDL- and HDL-cholesterol. Atherogenic dyslipidemia is increasingly regarded as secondary to chronic systemic low grade inflammation, reflected by CRP. SAFA cause inflammation by interaction with our immune system. This interaction is facilitated by consumption of CHO and notably its conversion to fat. Promoting factors are a high CHO intake, CHO with high GI, fructose, alcohol and impaired insulin sensitivity. Fish oil fatty acids inhibit de novo fatty acid synthesis and promote fatty acid oxidation, while linoleic acid inhibits the synthesis of these fatty acids and their incorporation. There is no valid evidence for the adverse effects of fat and SAFA per se. Accumulation of SAFA should be prevented. The recommended 40-70 en% CHO should be reconsidered and the consumption of CHO with high GI and fructose should be limited. The recommended 5-10 en% linoleic acid also needs reconsideration. The exaggerated attention for fat and SAFA distracts from more important avoidable risk factors for the many typically Western diseases that are linked with the metabolic syndrome. A lifestyle that causes chronic systemic low grade inflammation should be avoided