[Saturated fatty acids and cardiovascular risk : Is a revision of the recommendations on nutrition indicated?]

The "fat hypothesis of coronary heart disease", according to which saturated fatty acids (SFA) increase the concentration of low-density lipoprotein-cholesterol (LDL-C) and consequently increase the risk for cardiovascular diseases, influenced the nutritional recommendations over the last 60 years, initially in the USA and later also in Europe. Over the years there accumulated a growing body of evidence from epidemiology and controlled clinical studies that the consumption of SFA per se was not associated with an increased cardiovascular risk and the limitation of consumption of SFA did not show a preventive effect. The focus on the SFA content negated the biologically heterogeneous and sometimes biologically favorable effects of various SFAs. In addition, it was neglected that SFAs in foodstuffs are bound in a variety of complex matrices, which are composed of dozens of nutrients with different structures and concomitant substances and therefore each triggers different biological responses and metabolic effects. Accordingly, such nutrient-based recommendations are principally not very productive and also difficult to realize. In addition, LDL‑C is not a suitable marker to assess the effect of lifestyle interventions, such as nutrition or physical activity, on the global cardiovascular risk.