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Monday, January 30, 2006

If not saturated fat, then eat what?: Epi Inquiry Accolade- RCT 01/2006

[Epidemiologic Inquiry 2006, 1: 11]

Excess dietary intake of saturated fat has long been recognized an a major culprit in contributing to heart disease, and virtually all dietary recommendations urge people to reduce its intake. However, given that people have daily caloric energy requirements below any excesses, the key questions is -- if one reduces saturated fat intake, then one should replace such intake with what for optimal cardiovascular health? Carbohydrate? Protein? Unsaturated fat?

This key question was the impetus behind the recent OMNIHEART randomized crossover trial by Appel et al. Based on the healthy DASH diet, the investigators isocalorically replaced saturated fat with calories from carbohydrates (mix of refined and whole grain), proteins (mix of vegetable and animal), and unsaturated fat (mix of mono- and polyunsaturated). Based on changes in a series cardiovascular risk factors (blood pressure, LDL, HDL, triglycerides), they determined all 3 replacements are indeed better than saturated fat in reducing Framingham risk factors, with particuarly protein and unsaturated fat being better than carbohydrate replacement. While future studies will attempt to further examine protein sources and types of dietary fat in a randomized setting-- this current trial significantly establishes current understanding in nutritional epidemiology of the more optimal macronutrient to substitute for saturated fat.

Therefore, for these important contributions, the editors select as the Epidemiologic Inquiry Accolade: Randomized Trial of the Month ...

Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial.
Appel LJ, Sacks FM, Carey VJ, Obarzanek E, Swain JF, Miller ER 3rd, Conlin PR, Erlinger TP, Rosner BA, Laranjo NM, Charleston J, McCarron P, Bishop LM; OmniHeart Collaborative Research Group.
JAMA. 2005 Nov 16;294(19):2455-64.

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