A review of the evidence for the effects of total dietary fat, saturated, monounsaturated and n-6 polyunsaturated fatty acids on vascular function, endothelial progenitor cells and microparticles

Abstract

Vascular dysfunction is recognised as an integrative marker of CVD. While dietary strategies aimed at reducing CVD risk include reductions in the intake of SFA, there are currently no clear guidelines on what should replace SFA. The purpose of this review was to assess the evidence for the effects of total dietary fat and individual fatty acids (SFA, MUFA and n-6 PUFA) on vascular function, cellular microparticles and endothelial progenitor cells. Medline was systematically searched from 1966 until November 2010. A total of fifty-nine peer-reviewed publications (covering fifty-six studies), which included five epidemiological, eighteen dietary intervention and thirty-three test meal studies, were identified. The findings from the epidemiological studies were inconclusive. The limited data available from dietary intervention studies suggested a beneficial effect of low-fat diets on vascular reactivity, which was strongest when the comparator diet was high in SFA, with a modest improvement in measures of vascular reactivity when high-fat, MUFA-rich diets were compared with SFA-rich diets. There was consistent evidence from the test meal studies that high-fat meals have a detrimental effect on postprandial vascular function. However, the evidence for the comparative effects of test meals rich in MUFA or n-6 PUFA with SFA on postprandial vascular function was limited and inconclusive. The lack of studies with comparable within-study dietary fatty acid targets, a variety of different study designs and different methods for determining vascular function all confound any clear conclusions on the impact of dietary fat and individual fatty acids on vascular function. Key words: Dietary fatty acids: CVD: Vascular function: Progenitor cells: MicroparticlesCVD remains the major cause of death in Western societies. Although CVD is a multi-factorial disease, diet has been shown to play an important role in both the development and progression of the disease. Dietary strategies aimed at reducing the incidence of CVD include the recommendation to reduce SFA in the diet. In 1994, the Committee on Medical Aspects of Food Policy (COMA) published a report on Nutritional Aspects of CVD which included a recommendation to reduce the average intake of SFA from 16 % to no more than 11 % of food energy. Although the dietary intake of SFA has fallen, current intakes for 19 -64-year-olds assessed in the first year of the National Diet and Nutrition Survey (NDNS) rolling programme (February 2008 to March 2009) exceed the COMA recommendation, at approximately 12·8 % of food energy (1) ; total fat intake at 35·1 % of dietary energy is at the recommended level of intake for the population. A key question that needs to be addressed is whether the further desired reduction in SFA intake should be achieved through † Joint first authors. replacement of dietary fat with carbohydrate (low-fat diets), or whether substitution of SFA with n-6 PUFA or MUFA is a more desirable population target. There is evidence for potentially detrimental metab...

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