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Saturated fat is still a major concern On 22 October, a commentary in the BMJ by Malhotra (2013) described the role of saturated fat in heart disease as a myth. We share Malhotra’s concerns that reformulating food products to reduce saturated fat levels have led to an increase in the sugar content of processed foods. However, the core argument that saturated fat is not a key public health issue may serve to confuse the public. Saturated fat intakes in the UK population remain higher than the recommended 11% of energy limit. This recommendation exists because excess saturated fat consumption is an established risk factor for cardiovascular diseases, and is supported by a large body of evidence and real-life examples from countries such as Finland and Mauritius. The mechanisms through which saturated fats raise the risk of coronary heart disease (CHD) are well established: they raise the levels bad lowdensity lipoprotein serum cholesterol, which leads to atherosclerosis and the narrowing of the coronary arteries (Pederson et al 2011). Malhotra refers to the meta-analysis of cohort studies by Siri-Tano et al, which did not find an association between raised saturated fat intakes and CHD risk. The study has a number of important limitations which have been extensively reviewed elsewhere, including over-adjustment of confounding factors. It was considered as part of recent comprehensive review by the European Heart Network on the links between diet and cardiovascular disease. The review concluded that reducing saturated fat is most beneficial for lowering CHD risk when it is replaced with polyunsaturated fats, but not sugar (European Heart Network 2011). Substituting fats with sugar in processed foods may not have been helpful. However, it is equally unwise to dismiss the evidence on the harmful effects of saturated fats and current dietary advice as a myth. This risks throwing out the baby with the bathwater. The main dietary sources of saturated fat are meat and dairy products. Eating red meat is also linked to a raised risk of cancer. The Mediterranean diet which Malhotra is also in favour of is by definition low in saturated fat because it advocates for less meat and choosing products made from plant oils. It is similar to many traditional diets in that it promotes: eating more bread and pasta (the equivalent of starchy foods) eating more fruit and salad, including tomatoes and vegetables eating more fish eating less meat choosing products made from vegetable and plant oils, such as olive oil (NHS Choices) This debate raises a number of policy implications for solving diet-related public health problems: 1. Protect traditional diets where they are under threat from the processed food industry in developing countries. 2. Address the dominance of highly processed, energy-dense foods in the food supply in countries such as the UK. 3. Food manufacturers should adopt the government’s recommended hybrid front of pack nutrition labelling scheme so consumers easily assess the levels of key nutrients in products. 4. Review the merits and feasibility of technological reformulation versus improving access to minimally processed, whole foods within a wider public health nutrition context. References Department of Health (2013) Final design of consistent nutritional labelling system given green light. https://www.gov.uk/government/news/final-design-of-consistent-nutritional-labelling-systemgiven-green-light European Heart Network (2011) Diet, Physical Activity and Cardiovascular disese prevention in Europe. EHN November 2011. Kromhout D, Geleijnse JM, Menotti A and Jacobs DR. The confusion about dietary fatty acids recommendations for CHD prevention. British Journal of Nutrition (2011) 106, 627-32. Malhotra A. Saturated Fat is not the major issue. BMJ 2013, 347. http://www.bmj.com/content/347/bmj.f6340?thankyou=1 NHS Choices. What is a Mediterranean diet? http://www.nhs.uk/Livewell/Goodfood/Pages/what-isa-Mediterranean-diet.aspx Pederson JI, James PT, Ingeborg AB, Clarke R, Elmadfa E et al. The importance of reducing SFA to limit CHD. British Journal of Nutrition (2011) 106, 961-3.