Dietary Fatty acids and cardiovascular health - an ongoing controversy.

In this discussion it is important to realize that it is not recommended to avoid all saturated fatty acids from the diet. That is not the debate. The debate centers around at least two important issues: (1) is the intake of saturated fatty acids causally related to cardiovascular disease and (2) are all saturated fatty acids equal? This discussion is fed by findings from a recent metaanalysis based on prospective cohort studies that did not demonstrate a positive relationship between the intake of saturated fatty acids and cardiovascular disease [5] . Another meta-analysis, however, did show such a relationship, even if the studies used in this meta-analysis were also part of the other meta-analysis [6] . More and more studies are looking for relationships between specific nutrients (for example fatty acids), single food products or food patterns with disease outcome. One important question that needs to be answered is if in these epidemiological studies data on food intake at the individual level has been estimated accurately enough to discern such relationships. May a null relationship not reflect a lack of statistical power, bias or confounding? Are we not making the mistake of relying too heavily on the accurateness of food intake data and on statistical models? These important questions need to be discussed. In this issue of the journal, a summary is given of the dinner debate that was held during the biennial meeting of the International Society for the Study of Fatty Acids and Lipids (ISSFAL), which was held in Maastricht (the Netherlands) from May 29 to June 2, 2010. The subject of the discussion was ‘healthy fats for a healthy heart’. Two important and timely issues related to cardiovascular risk were raised. The first issue was on the importance of saturated fatty acids and the second on the optimal intake of omega-6 polyunsaturated fatty acids. There is no doubt that a mixture of saturated fatty acids in the diet increases serum LDL cholesterol concentrations as compared to iso-energetic amounts of carbohydrates [1] . A wealth of evidence supports the notion that interventions that lower serum LDL cholesterol result in reduced cardiovascular risk. Amongst other findings, this evidence comes from pharmacological and dietary intervention studies [2, 3] , and from genetic studies [4] . Thus, a vast array of evidence from sound science using multidisciplinary approaches underlines the conclusion that LDL cholesterol is a validated biomarker to predict the risk of developing cardiovascular disease. Still, the discussion on the relationship between saturated fatty acids and cardiovascular risk continues. Published online: March 24, 2011