Purpose of review: Intake of saturated fatty acids (SFAs) increases the low-density lipoprotein cholesterol concentration in plasma and has therefore been suggested to increase the risk of ischemic heart disease (IHD). Focus on limiting SFA intake without specifying the substitutions may be counterproductive because SFAs may be replaced with other equally or more harmful macronutrients. Recent findings on substitution of specified macronutrients for SFAs and risk of IHD are reviewed.
Recent findings: Recent cohort studies suggest that intake of polyunsaturated fatty acids (PUFAs) or carbohydrates with low-glycemic index values in place of SFAs is associated with a lower risk of IHD whereas intake of carbohydrates with high-glycemic index values in place of SFAs is associated with a higher risk of IHD.
Summary: Cohort studies and randomized clinical trials provide convincing evidence of a lower risk of IHD associated with substitution of PUFAs for SFAs. Analyzing substitution of specified macronutrients for SFAs offers a perspective different from the single nutrient focus and may provide further insight into IHD prevention.