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The risk of ischemic heart disease with low-fat, high-
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by: Michal R. Pijak
There is convincing scientific evidence that type of fat have a more important role in
determining the risk of coronary heart disease(CHD) than total amount of fat in the diet.(1)
However, because of misleading presentation of epidemiological data by some authors(1), the
readers might be left with the impression that low-fat, high- carbohydrate diet is the best option
for patients with CHD risk.
In fact, high- carbohydrate diets, in the absence of weight loss, can lead to both elevated
triglyceride and reduced HDL cholesterol, effects that may be associated with increased risk
for CHD.(2) Although these effects may be lessened with dietary fiber and moderate physical
activity, they appear to be worse among individuals with insulin resistance.(3)
As reviewed by Kris-Etherton(4) adverse metabolic effects of low fat diet do not occur with
substitution of monounsaturated (MUFA) or polyunsaturated (PUFA) fatty acids for saturated
and trans-fatty acids. This is also the case for individuals with diabetes, with the added benefit
of better glycaemic control.(5)
As predicted by metabolic studies, replacement of saturated fat, and even more so trans fatty
acids with either PUFA or MUFA was associated with a larger reduction in risk of CHD than
simple reduction of total fat consumption.(6) With respect to weight control, a moderate-fat diet
can be as, or even more, effective that lower-fat diet. (6)
References
1. Hu FB, Manson JE, Willet WC. Types of dietary fat and risk of coronary heart disease: a
critical review. J Am Coll Nutr 2001;20:5-19.
2. Fung MA, Frohlich JJ. Common problems in the management of hypertriglyceridemia.
CMAJ 2002;167:1261-6.
3. Jeppesen J, Schaaf P, Jones G, Zhou MY, Chen YD, Reaven GM. Effects of low-fat, high-
Click Here for more articles carbohydrate diets on risk factors for ischemic heart disease in postmenopausal women. Am J
Clin Nutr 1997;65:1027-33.
4. Kris-Etherton PM, Kris-Etherton PM, Binkoski AE, Zhao G, Coval SM, Clemmer KF, et al.
Dietary fat: assessing the evidence in support of a moderate-fat diet; the benchmark based on
lipoprotein metabolism. Proc Nutr Soc 2002;61:287-98.
5. Rivellese AA, De Natale C, Lilli S. Type of dietary fat and insulin resistance. Ann N Y Acad
Sci 2002;967:329-35.
6. Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ et al. AHA Dietary
Guidelines: revision 2000: A statement for healthcare professionals from the Nutrition
Committee of the American Heart Association. Circulation. 2000;102:2284-99.

About the author:

Dr. Michal R. Pijak is a consultant in rheumatology, allergy and clinical immunology at the
University Hospital in Bratislava, Slovakia

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